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Sandrine Andrieu

Publications and source records attributed to Sandrine Andrieu.

At least 19 recordsLinked to original sources
PubMed2007

Predictive value of 6-month decline in ADAS-cog for survival without severe Alzheimer's disease.

BACKGROUND/AIMS: To determine the predictive value of the 6-month evolution of the ADAS-cog score in initially mild to moderate Alzheimer's disease (AD) patients on the risk of death or severe dementia (MMSE <10) within 2 years. METHODS: Cognition was assessed every 6 months using the ADAS-cog scale in the Real.fr study, a cohort of AD patients. Six classes of ADAS-cog evolution were distinguished, from the severest deterioration (decline >or=7 points) to the greatest cognitive improvement (gain >or=4 points). RESULTS: Among 536 AD patients, 53 (9.9%) had a 6-month decline of 7 points or more. This group with the severest deterioration was significantly associated with the risk of severe dementia or death at 2 years (relative risk, RR = 3.8, 95% confidence interval, CI = 2.1-6.8), even after adjustment for baseline MMSE, disability and ADAS-cog score (RR = 2.6, 95% CI = 1.4-5.0). In addition, subjects with a decline by at least 4 points were also at greater risk of severe dementia. CONCLUSION: These results confirm the value of the ADAS-cog scale as a judgement criterion in clinical trials since it is a good surrogate marker of long-term prognosis. The proportion of fast decliners on the ADAS-cog could be a helpful judgement criterion for future trials in AD.

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PubMed2007

Disease-modifying trials in Alzheimer's disease: a European task force consensus.

After symptomatic treatments, the new target for therapeutic approaches in Alzheimer's disease is the development of disease-modifying drugs. The concept of disease modification in Alzheimer's disease is controversial and the design of these trials raises many questions. Which populations should be studied? For how long? With which principal and secondary endpoints? Are surrogate markers available? Here, we present a European consensus on disease-modifying trials in Alzheimer's disease, agreed under the auspices of the European Alzheimer's Disease Consortium and based on the European perspective of the concept of disease modification, study designs, the role for biomarkers, risk benefit, and pharmacoeconomic issues.

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PubMed2006

Outcome of Alzheimer's disease: potential impact of cholinesterase inhibitors.

BACKGROUND: Alzheimer's disease is fast becoming a major public health concern with serious economic consequences. The cholinesterase inhibitors (CEIs) offer some benefit in the symptomatic treatment of the disease. This study aims to investigate the effect of CEIs on three clinically relevant domains (rapid cognitive decline, institutionalization, and weight loss) in patients with Alzheimer's disease. METHODS: A prospective observational study was performed in which a population of 455 Alzheimer's disease patients were recruited and followed up for at least 1 year between 1994 and 2002. Patients were reevaluated at 6 monthly intervals using standardized neurocognitive and geriatric evaluations in addition to complete clinical examination, standard paraclinical investigations, and recording of treatment received. RESULTS: The risk of rapid cognitive deterioration was significantly decreased in patients taking CEIs for at least 1 year compared to untreated patients (odds ratio [OR]=0.56, 95% confidence interval [CI], 0.34-0.93; p=.025). The potential benefit of CEI use was also found on institutionalization (OR=0.2, 95% CI, 0.08-0.48; p<.001) and weight loss (OR=0.56, 95% CI, 0.32-0.97; p=.039) after 1 year of follow-up. CONCLUSION: The special interest of this study is that all patients were recruited and followed in the same center with the same management care plan and the same medical team. This follow-up offers us a unique opportunity to compare the 1-year evolution of the disease in clinical practice before and after the marketing of CEIs and allows us to demonstrate a clinically significant improvement in patient outcome over time.

Age Factors↗
PubMed2005

[Managing Alzheimer's disease: global care and support program].

Alzheimer's disease (AD) is the main cause of progressive decline during which there is progressive dependence on family members and the health care system. The first step in the treatment is to make a diagnosis and communicate it to patients and families. The many things that should be done for optimal management must be started early. In the majority of patients enhancement of cholinergic function can produce a plateau for a period of time or at least can reduce the speed of decline. Comprehensive and appropriate treatment plans that meet all patients' needs can only be developed as a result of thorough assessment of the patient, the family, and the home environment. The assessment should address the patient's medical condition, including functional status, cognitive status, other medical conditions and non cognitive symptoms of AD. The assessment should also address the caregiver's needs and risks. Physicians should solicit and consider their input in post-diagnostic treatment planning. Comprehensive reassessment should occur every 6 months or more frequently with any sudden decline or be havioral change. The primary care practitioner should provide information and education about current level of disease and should talk with the patient and family to establish treatment goals.

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PubMed2005

Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians.

OBJECTIVES: The purpose of this study was to explore the structure of the Zarit Burden Interview (ZBI) for informal caregivers of patients suffering from AD or related disorders, and to examine the relations of the dimensions found with functional disabilities and other patient health indicators. DESIGN: 152 dyads of community-dwelling older adults with dementia and their primary caregivers were analysed. METHODS: Caregiver burden was measured by the 22-item ZBI. Caregivers' and care recipients' characteristics were collected with the MDS (Minimum Data Set) of the RAI (Resident Assessment Instrument) Home Care instrument. Data on dementia (diagnosis, severity, MMSE) were also obtained. Burden data were analysed by principal component analysis (PCA) with varimax rotation. Relationships between scores on PCA factors and care recipients' health indicators were studied with inferential statistical tests. RESULTS: Three dimensions of burden were found: effect on the social and personal life of caregivers, psychological burden and feelings of guilt. Some health variables were linked to these dimensions. Spouses and children perceived burden differently. Spouse caregivers emphasized the deterioration of their personal and social life. Children, less involved in daily care, were more prone to feel guilt that they were not doing enough for their parent.

Activities of Daily Living↗
PubMed2005

Different modes of weight loss in Alzheimer disease: a prospective study of 395 patients.

BACKGROUND: Alzheimer disease is often accompanied and worsened by malnutrition. Patterns of weight loss can differ by the patients concerned and by the outcome and interventions required. OBJECTIVE: Our aim was to describe and analyze 2 modes of weight loss (progressive and severe) in the course of Alzheimer disease. DESIGN: This was a prospective study of 395 patients with Alzheimer disease, who had a mean age of 75.4 y. A standardized gerontologic evaluation was conducted at 6 mo and 1 y, including assessments of nutrition, neuropsychology, function, and caregiver burden. RESULTS: We investigated 2 modes of weight loss. The first, progressive loss (4% in 1 y), affected 33.4% of subjects. Disease severity was a risk factor [odds ratio (OR): 7.2; 95% CI: 1.4, 38.2 for a Reisberg score > or = 5], whereas treatment with cholinesterase inhibitors at baseline decreased this risk (OR: 0.33; 95% CI: 0.14, 0.79). The second mode of weight loss, a severe loss of > or =5 kg in 6 mo, affected 10.2% of subjects. The existence of an acute phase reaction was a risk factor (OR: 2.4; 95% CI: 1.2, 4.8), as was an intercurrent event, such as hospitalization, acute disease, institutionalization, and change of living arrangements (OR: 6.8; 95% CI: 1.2, 39.9). CONCLUSION: During the follow-up of patients with Alzheimer disease, risk factors for these 2 modes of weight loss should be sought to identify patients who would benefit from a nutritional intervention. Our findings lead us to advocate follow-up, which involves an assessment of functional, nutritional, and neuropsychologic status every 6 mo.

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PubMed2005

Cognitive impairment and composition of drinking water in women: findings of the EPIDOS Study.

BACKGROUND: The concentration of aluminum or silica in drinking water may be a potential environmental risk factor for Alzheimer disease (AD). OBJECTIVES: The objective was to investigate at baseline the potential association between the composition of drinking water and the level of cognitive function in women taking part in the Epidemiology of Osteoporosis (EPIDOS) Study and to determine during follow-up the effects of the composition of drinking water on the risk of AD. DESIGN: Women aged >/=75 y (n = 7598) were recruited between 1992 and 1994 in 5 geographic areas of France. The participants from one center (n = 1462) were followed for </=7 y; during this time, an active search for incident cases of AD was conducted. The initial questionnaire comprised a food consumption survey with specific questions about the daily consumption of tap and mineral water. The evaluation of cognitive function was based on the Short Portable Mental Status Questionnaire. During follow-up, the diagnosis of dementia was made by a geriatrician and a neurologist. RESULTS: A low silica concentration was associated with low cognitive performance at baseline. Compared with the nondemented subjects, the women with a diagnosis of AD during follow-up were older at inclusion, had a lower financial status and educational level, had a poorer perception of their own health, and had a more difficult time performing activities of daily living. A multivariate analysis including potential confounding factors showed that women with AD appeared to have been exposed to lower amounts of silica at baseline. CONCLUSIONS: Silica in drinking water may reduce the risk of developing AD in elderly women. The results corroborate those of another epidemiologic study carried out in France. The potential effect of silica needs to be confirmed in additional investigations.

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PubMed2004

[Physical restraint in old people's homes. Evaluation of skills following specific training].

AIM: The use of physical restraint in elderly patients is sometimes necessary but not without risk. We studied the prevalence and modalities of physical restraint in elderly patients in 6 old people's homes in the urban area of Toulouse, and emphasized the need for better use by the nursing staff of physical restraint in such patients with a specific training course. METHODS: Other than the prevalence of restraint, we also examined the modalities of its use in elderly patients. We studied the respect of the Anaes (Agence nationale d'accréditation et d'évaluation en santé) guidelines regarding the use of restraint in such patients, before and after an intervention that associated first a collective training course of all the staff in the old people's homes, and then specific individual training by a visiting practitioner. The information concerning the number of patients in whom restraint was used was obtained from the manager of the home or from the head nurse and was then checked by the investigator. RESULTS: The prevalence of restraint was of 22.2% (n=110 patients) at the start of the study, 15.9% following training sessions (at 6 months) and 15.5% at the end of the study (at 9 months). Skills improved regarding the benefit/risk assessment, the installation of the person restrained and the regular removal of the restraint during the day. CONCLUSION: Our strategy helped to underline this problem for the staff. The Anaes guidelines are too strict to be applied in old people's homes. One of the key points in improved management would be the presence of a coordinating physician and nurse in all the institutions caring for the elderly.

Accreditation↗
PubMed2004

Minimum data set for nutritional intervention studies in elderly people.

Malnutrition, considered for the purpose of the present data set as undernutrition, is a major risk factor of mortality in elderly people. Such protein-energy malnutrition should be detected as soon as possible. Once established, this malnutrition state must be corrected by appropriate diet, supplementation, artificial nutrition, or therapeutic treatment. If carried out well, these interventions should reduce the risk of mortality and, for some diseases such as degenerative diseases, may postpone morbidity and dependence. The efficiency of nutritional interventions has already been evaluated by different means including the measurement of anthropometric and laboratory parameters. However, in the absence of a consensus on the use of these parameters, comparison between studies and even effectiveness of the proposed treatment are frequently unconvincing. The relevance of the most common markers used in epidemiologic studies on malnutrition and nutritional interventions in elderly persons was studied for establishing a minimum data set. The aim of this task force was to provide investigators and operators in the field of clinical nutrition with clear and expert validated clinical outcomes allowing them to design and set up conclusive trials.

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PubMed2004

Improvement of weight and fat-free mass with oral nutritional supplementation in patients with Alzheimer's disease at risk of malnutrition: a prospective randomized study.

OBJECTIVES: To study the effects of oral nutritional supplements (OS) on body weight, body composition, nutritional status, and cognition in elderly patients with Alzheimer's disease (AD). DESIGN: Prospective, randomized, controlled study. SETTING: Geriatric wards and day care centers in the Toulouse area, France. PARTICIPANTS: Ninety-one subjects with AD aged 65 and older at risk of undernutrition as evaluated using the Mini Nutritional Assessment. INTERVENTION: After randomization, 46 patients (intervention group) received 3-month OS. The other 45 patients (control group) received usual care. MEASUREMENTS: Weight, body composition (evaluated using dual-energy x-ray absorptiometry), cognitive function, activities of daily living, eating behavior, and dietary intakes were evaluated at the beginning of the study and at 3 months and 6 months. Supplement compliance was recorded each day. RESULTS: Between baseline and 3 months, energy and protein intakes significantly improved in the intervention group, resulting in a significant increase in weight and fat-free mass, but no significant changes were found for dependence, cognitive function, or biological markers. The nutritional benefit was maintained in the intervention group after discontinuation of OS at 3 months. CONCLUSION: Three-month daily OS significantly improves body weight. It is practicable and effective, and the patients accepted it well. The improvement that was observed even in the control group showed that caregiver education is an important factor in maintaining the nutritional status of patients with AD. Moreover, regular courses of OS may help to maintain the increase in fat-free mass and improve the nutritional status of these patients.

Adipose Tissue↗
PubMed2003

Body composition in French women 75+ years of age: the EPIDOS study.

BACKGROUND: There are presently no published data on age-related changes in body composition in French individuals older than 65 or 80 years. This paper presents a cross-sectional study of 7518 community-residing French women older than 75 years. METHODS: We examined age differences changes in body composition and anthropometry between age groups (76-80, 81-85, and 86-95 years of age). Whole body composition was estimated using a dual energy X-ray absorptiometry (DXA) scanner. Measurements of appendicular skeletal muscle (ASM) mass and sarcopenia were performed for a subsample of 1321 women. RESULTS: Significant age differences exist in total fat mass and total bone mineral content in elderly women between 76 and 95 years of age. There was also a significant decreased in fat free soft tissue mass from 76 to 85. The decline in fat free mass may be reduced over 85 years of age. The prevalence of low muscle mass, or sarcopenia, increased with age from 8.9 in 76-80 to 10.9% in 86-95 age group, but the difference was not statistically significant. CONCLUSIONS: Interventional programs developed to prevent or reduce sarcopenia would have a better influence on population under 85 years, i.e. when the decline in ASM mass is the most severe. Others longitudinal studies could be performed to confirm our results.

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PubMed2003

Comparison of bone mineral density and body composition measurements in women obtained from two DXA instruments.

Information is lacking regarding the comparison of bone mineral and body composition measurements obtained from the different dual energy X-ray absorptiometry (DXA) systems. The purpose of this study is to compare body composition and whole body bone mineral density (BMD) measurements from the hologic QDR-4500 W (DXA H) and the lunar (DXA L) systems. Seven women older than 40 years of age, were scanned on the same day by using DXA H and DXA L by the same observer. Measured total fat mass, percentage fat, whole body fat free soft tissue mass and BMD were similar between machines, but body mass was significantly higher with DXA L than with DXA H (P=0.0156). This was due to a higher bone mineral content obtained with DXA L. Agreement between the two DXA systems was quantified by using the Bland and Altman method. For each variable, all pairs of measurements were within the 95% confidence limits. These results suggested that we could use the two measurement methods interchangeably. However, due to the bone mineral inter-machine differences, comparisons of DXA measurements from different machines should be interpreted with caution.

Absorptiometry, Photon↗
PubMed2003

Music perception in adult cochlear implant recipients.

OBJECTIVE: To evaluate musical perception in adult cochlear implant (CI) recipients, i.e. perceptual accuracy for pitch, timbre, rhythmic patterns and song identification. MATERIAL AND METHODS: Twenty-nine adult patients were included in this transverse single-center study. Evaluative measures included tests assessing ability to discriminate pitch, rhythm and timbre and to identify nursery songs with and without verbal cues. Performance scores were correlated with duration of deafness, duration of implantation, speech discrimination and musical perception skills. RESULTS: A total of 38% of patients reported that they did not enjoy listening to music with their device and 86% presented lower scores of listening habits after implantation. We found positive correlations between musical background and pitch identification and identification of nursery songs played by piano. We also found positive correlations between speech discrimination and rhythm, timbre and identification of nursery songs with verbal cues. CONCLUSION: Trends in the patterns of correlation between speech and music perception suggest that music patterns are differentially accessible to CI users. New processing strategies may improve this.

Acoustic Stimulation↗
PubMed2003

Association of Alzheimer's disease onset with ginkgo biloba and other symptomatic cognitive treatments in a population of women aged 75 years and older from the EPIDOS study.

BACKGROUND: Peripheral C4A treatment (cerebral and peripheral vasotherapeutics) and especially Ginkgo biloba extracts are prescribed for a number of symptoms, particularly memory impairment, in elderly patients. It is postulated that because of its pharmacological actions, this treatment could prevent the decline of cognitive function, but no studies have been published to date to test its efficacy in prevention of Alzheimer's disease. The potential association between use of C4A treatments, in particular EGb 761 (standardized Ginkgo biloba extracts), and dementia of the Alzheimer type was investigated. METHODS: A case-control study was nested in a cohort of 1462 community-dwelling elderly women aged over 75 years. Sixty-nine women with Alzheimer-type dementia were compared with 345 paired women whose cognitive function remained normal. This study involved women whose cognitive function was evaluated at baseline by use of Pfeiffer's test and whose medication history was taken. The onset of cognitive impairment was investigated over a 7-year follow-up period. In order to study the factors associated with the onset of dementia, the data concerning women with a score of > or = 8 on Pfeiffer's test at inclusion, indicating normal cognitive function, were analyzed. RESULTS: A multivariate analysis including potential confounding factors showed that fewer women who developed Alzheimer's dementia had been prescribed C4A treatment (including EGb 761) for at least 2 years (odds ratio = 0.31, 95% confidence interval = 0.12-0.82, p =.018). Figures for EGb 761 alone were similar but did not reach statistical significance (odds ratio = 0.38, 95% confidence interval = 0.08-1.76, p =.22). CONCLUSION: These results suggest that C4A treatment may reduce the risk of developing Alzheimer's dementia in elderly women. The potential preventive effect of C4A treatments, including EGb 761, requires further examination. To establish a causal relationship, these findings have to be confirmed with prospective studies.

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PubMed2003

Colonization of the oral cavity by Candida species: risk factors in long-term geriatric care.

The population of elderly people in hospitals for long-term geriatric care presents many risk factors for nosocomial infection by Candida species. The aim of this work was to reduce the risk of C. albicans nosocomial infections starting from colonization of the oral cavity. The population of concern was the patients in long-stay geriatrics units; a sample of 110 people was selected by drawing lots. The clinical and biological parameters of each patient included in the study were recorded. The oral cavity was colonized by Candida spp in 67% of cases. The distribution of the strains showed that C. albicans was the most frequently identified strain, followed by C. glabrata; of the 73 patients with at least one strain of Candida spp., 47 had a clinically diagnosed candidiasis (64.4%). The wearing of dentures was not statistically linked with the development of oral candidiasis. Detecting which patients have been colonized, identifying the risk factors and applying preventive measures should reduce the probability of elderly people falling into the vicious circle of infection-malnutrition-immune-depression.

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PubMed2002

Predictive factors of acute hospitalization in 134 patients with Alzheimer's disease: a one year prospective study.

OBJECTIVE: To evaluate the frequency of and determine predictive factors for acute hospitalization in a prospective study of patients with Alzheimer's disease (AD). DESIGN: A one year prospective study. PARTICIPANTS: 134 patients recruited from the memory clinic in Toulouse University Hospital, with AD diagnosed using the NINCDS-ADRDA criteria. MEASURES: A comprehensive geriatric and neuropsychological assessment was conducted 6 monthly. RESULTS: Among the 134 patients included in this study, at one year follow up, 32 patients had at least one acute hospitalization. Patient-related variables predictive of acute hospitalization in the univariate analysis were: level of education, ADL-bathing, ADL-toileting, ADL-feeding, total ADL score, IADL A scale (daily upkeep), history of falls, and level of behavioural disorder as measured by the Cohen scale. In the multivariate regression model, two variables were associated with acute hospitalization: dependency for ADL-bathing [Odds Ratio (OR) = 5.65, 95% Confidence Intervals (CI): 2.3-14.4] and low level of education. CONCLUSION: The results of this study demonstrate that acute hospitalization is frequent in AD patients resulting in considerable cost implications. Interventions that support patients and their cares to manage their loss of ADL may be a practical approach to reducing the need for acute hospital admissions.

Activities of Daily Living↗
PubMed2002

Cognitive function and caregiver burden: predictive factors for eating behaviour disorders in Alzheimer's disease.

BACKGROUND: Patients with Alzheimer's disease (AD) commonly develop aversive feeding behaviours. These behaviours lead to weight loss and frequently to physicians using tube feeding. Little is known about factors correlated with feeding difficulties during AD. OBJECTIVE: To investigate predictors of aversive feeding behaviours (AFBs) which occurred during a one-year interval among AD patients living at home with a caregiver. METHOD: One-year study initiated in January 1998 with 224 AD patients and their caregivers. MAIN OUTCOME MEASURES: all patients underwent a nutritional, psychologic and functional evaluation at baseline and one year later. Feeding difficulties were assessed using the Feeding Dependency Scale and the Aversive Feeding Behaviour Inventory. The Burden Interview was also done to assess the material and emotional burden. RESULTS: Initial feeding difficulties were significantly associated with the age of the caregiver, the severity of the disease and the initial patient's autonomy and psychological functioning (mood and behaviour disorders). AD patients, who lived with a more affected caregiver at baseline, developed feeding difficulties and AFBs during the follow-up. Logistic regression analysis showed a positive association between AFBs worsening and the initial caregiver's burden after controlling for confounding factors. On the other hand, memory impairment was inversely associated with AFBs. CONCLUSIONS: Both cognitive impairment and family stress can help in predicting which AD patients living at home will develop AFBs. Nutritional information and support to families are probably the best strategies to prevent AFBs during AD and to improve consequently the patient's and caregiver's quality of life.

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