[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to explore perceived difficulties and needs of older adults with mild cognitive impairment (MCI) and their attitudes toward an assistive robot to develop appropriate robot functionalities. Twenty subjects were recruited to participate in either a focus group or an interview. Findings revealed that although participants reported difficulties in managing some of their daily activities, they did not see themselves as needing assistance. Indeed, they considered that they were capable of coping with difficulties with some compensatory strategies. They therefore declared that they did not need or want a robot for the moment but that they considered it potentially useful either for themselves in the future or for other older adults suffering from frailty, loneliness, and disability. Factors underlying unwillingness to adopt an assistive robot were discussed. These issues should be carefully addressed in the design and diffusion processes of an assistive robot.
[Show abstract][Hide abstract] ABSTRACT: Objectives
Evaluation of the influence of single photon emission computed tomography (SPECT) of the dopamine transporter (123I-FP-CIT) on diagnosis and treatment strategies in elderly patients with mild dementia.
Geriatrics memory clinic.
Consecutive ambulatory patients who had 123I-FP-CIT SPECT for a suspicion of DLB.
Clinical diagnoses before SPECT were compared with imaging results.
46 patients were included. Pre imaging clinical hypotheses were probable DLB in 14, possible DLB in 21 and alternate diagnoses in 11. Rates of abnormal imaging in these groups were respectively 71%, 43% and 18%. Overall, diagnoses were revised in 37% of the cases. Four patients with probable DLB had normal imaging. Their number of core criteria did not differ from the remainder (2.75 ± 0.5 vs. 2.1 ± 0.6), but hallucinations in 2 patients were not well formed and detailed as usual in DLB. Among 38 patients free of antipsychotics, rates of abnormal scans were 36% in patients with questionable parkinsonism, 57% in definite parkinsonism, 67% in patients with no parkinsonism. Among 9 patients on Levodopa, 6 had normal scans and Levodopa was stopped.
We show a significant impact of 123I-FP-CIT SPECT on diagnoses, even in cases of definite parkinsonism or probable DLB. In the latter, scarcity of hallucinations, especially if there are not well formed and detailed, should prompt 123I-FP-CIT SPECT.
The Journal of Nutrition Health and Aging 01/2014; DOI:10.1007/s12603-013-0346-7 · 2.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: El aumento de la incidencia de la enfermedad de Alzheimer y de las enfermedades relacionadas así como su impacto sobre la calidad de vida de los pacientes y sus familias debido a su morbilidad y mortalidad hacen que estas enfermedades constituyan actualmente un importante problema de salud pública en las poblaciones envejecidas. Ante la ausencia hasta el momento de un tratamiento farmacológico curativo, la intervención deberá ser integral y multidisciplinaria, con el fin de proporcionar, a pacientes y cuidadores, respuesta a sus necesidades diarias y para tratar de disminuir las repercusiones de la enfermedad relacionadas con la pérdida de autonomía y los síndromes psicoconductuales de la demencia. Este artículo tiene como objetivo precisar las diferentes dimensiones del plan de atención a estas enfermedades. Se presentan, por lo tanto, los tratamientos farmacológicos sintomáticos, la intervención sobre los síndromes psicoconductuales de la demencia y el apoyo social y psicológico, con el fin de proporcionar una síntesis útil en el seguimiento de estos pacientes. Con un afán didáctico, esta presentación sigue el recorrido médico del paciente desde la consulta inicial por síntomas cognitivos hasta las diversas posibilidades de tratamiento. También se abordan los elementos específicos de las enfermedades relacionadas (demencias por cuerpos de Lewy, demencias vasculares y frontotemporales) y el síndrome confusional.
[Show abstract][Hide abstract] ABSTRACT: Despite benefit of secondary prevention of coronary artery disease, evidence-based treatment are underused in very elderly patients. The objective of IRIDIA study is to evaluate feasibility of improving on the use of coronary artery disease evidence-based therapies through a intervention, based on diagnosis and treatment reassessment, in elderly inpatients. Methods: Design: prospective cohort study with one-year follow-up. Setting: six acute care geriatric wards in France. Participants: consecutive inpatients >= 75 years old with a supposed diagnosis of coronary artery disease (CAD). Intervention: First step: reassessment of CAD diagnosis using coronary-oriented investigations. Second step: optimization of CAD treatment in accordance with international guidelines. Primary outcome: change in use of the recommended CAD treatment between admission and discharge. Secondary outcome: diagnosis optimization between admission and discharge. Results: Two hundred and sixty-one participants (mean age 87 years [IQR: 83-92 years]) with a high prevalence of comorbidities, cognitive impairment, and disability. The CAD diagnosis was considered confirmed at inclusion in 138 of the 261 patients (53%) with an evident underuse of beta-blockers and antiplatelet agents. The impact of the intervention on CAD diagnosis was 40%; for 74 patients, the diagnosis remained uncertain. For patients with confirmed CAD (n = 178), the treatment optimization resulted in a increase in use of evidence-based therapy, with rates of 66% for beta-blockers and 79% for antiplatelet agents, without significant complications at 1 year. Conclusion: This multicenter study demonstrated the feasibility of improving on the use of CAD evidence-based therapies through a simple intervention, including CAD diagnosis optimization and treatment reassessment, in a very elderly population with comorbidities in an acute-care setting.
European geriatric medicine 08/2012; 3(4):219–224. DOI:10.1016/j.eurger.2012.04.001 · 0.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Aide dans la Maladie d'Alzheimer (AIDMA) study was conducted to determine whether a psycho-educational programme (PEP) for primary caregivers in addition to standard anti-dementia drugs for patients improves caregivers' psychological condition and patients' activities of daily life.
Multicentre randomised controlled intervention trial. One hundred and sixty-seven dyads 'patient-caregiver' were recruited from 15 French memory clinics and randomised in two parallel groups. The intervention group was offered the PEP in 12 group sessions for 3 months. The control group had usual care. Patients in both groups with mild to moderate Alzheimer's disease (AD) were diagnosed and treated with pharmacotherapy. Patients' primary efficacy variable was functional status assessed with the Disability Assessment Scale for Dementia (DAD) scale. Alzheimer Disease Assessment Scale (ADAS-Cog) and Neuropsychiatric Inventory (NPI) were secondary criteria. Caregivers' first outcome measure was depressive symptoms assessed with the Montgomery and Asberg Depression Rating Scale (MADRS) scale. Zarit scale, Sense of Competence Questionnaire (SCQ) and Visual Analogue Scales (VAS) were secondary criteria. Assessment was done at baseline, 3 months (M3, end of intervention) and 6 months (M6).
Patients' stabilisation was observed in both groups. In caregivers, significant improvement in disease understanding at M3 (p = 0.007) and M6 (p = 0.0001) and in ability to cope with care-recipients' disease at M6 (0.02) was evidenced.
The PEP had no additional impact on patients but carers developed more effective disease understanding and ability of coping. Results support the idea that the PEP although improving caregivers' condition is not sufficient to improve patients' activities in daily life which requires additional individually tailored interventions provided by professionals.
International Journal of Geriatric Psychiatry 08/2011; 26(8):833-42. DOI:10.1002/gps.2611 · 3.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Researchers in robotics have been increasingly focusing on robots as a means of supporting older people with cognitive impairment at home. The aim of this study is to explore the elderly’s needs and preferences towards having an assistive robot in the home. In order to ensure the appropriateness of this technology, 30 subjects aged 60 and older with memory complaints were recruited from the Memory Clinic of the Broca Hospital. We conducted an interview-administered questionnaire that included questions about their needs and preferences concerning robot functions and modes of action. The subjects reported a desire to retain their capacity to manage their daily activities, to maintain good health and to stimulate their memory. Regarding robot functions, the cognitive stimulation programme earned the highest proportion of positive responses, followed by the safeguarding functions, fall detection and the automatic help call.
Health Informatics Journal 03/2011; 17:33-40. DOI:10.1177/1460458210380517 · 0.79 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Multi interventional aids have a major role in the caring of disability in elderly people suffering from Alzheimer's disease. In this article, we report the preliminary data of the TANDEM project who's final aim is to test the technical feasibility and acceptability of a telecare system for patients and their families at home, in order to provide various services in daily life including drug taking, memory aids, family and social contacts, cognitive stimulation and nutritional interventions tailored to the patients’ needs, as well as detection of situations with risks such as falls and wandering using weared sensors. The project encompasses the implementation of the telecare system. The services are being set up and added in a progressive and collaborative way, and are appropriately tailored to patients’ needs by iterative process, including testing by patients, families and professionals. This multi-disciplinary approach, which integrates human, medical, psychological, ethical and social issues, aims at improving patients and families’ daily life as well as alleviating the growing burden of this disease on social and health services.
[Show abstract][Hide abstract] ABSTRACT: Cognitive stimulation is a therapeutic non-pharmacological intervention, which may be provided to both healthy and cognitively impaired people. It encompasses a set of psychoeducational methods including practical applications, gathered in sessions and corresponding to ecological situations in daily life. Cognitive stimulation represents training in cognitive, psychological and social functions. The recent progress in assistant technology has lead to the development of computerized cognitive stimulation programmes that represent a promising means for delivery and dissemination of this non-pharmacological intervention. In the present paper, we describe the principles of cognitive stimulation, the methods of delivery and the advantages of computerized cognitive stimulation, and the necessary conditions for its implementation. We insist on the need to tailor human–machine interfaces to the needs and disabilities of elderly people, in particular those who suffer from cognitive disorders.
[Show abstract][Hide abstract] ABSTRACT: This paper examines and reviews studies on the efficacy of computer-based cognitive intervention programmes in the elderly affected by Mild Cognitive Impairment (MCI). MCI patients are at higher risk to progress to dementia. Recent effort has been made to slow the cognitive decline and delay the onset of dementia in this population.
MEDLINE sources were searched with the following subject headings: computer-based cognitive intervention, cognitive stimulation, cognitive training, aging, elderly, cognitive impairment. Selected studies were quality assessed and data extracted by two reviewers.
Several studies reported encouraging results on cognitive interventions programmes as a means to improve cognitive abilities and emotional states and to decrease subjective memory complaints in MCI patients.
Though both traditional and computer-based cognitive intervention programmes seem to be effective, the computer-based ones present more advantages: 1) they could individualize the programme tailored to the patient's neuropsychological pattern and needs. 2) they permit the user to make an immediate objective comparison with data collected earlier and thus help in setting up a systematic training plan by providing instant value-free feedback. 3) they offer a possibility of a widescale dissemination.
The Journal of Nutrition Health and Aging 01/2010; 14(1):31-5. DOI:10.1007/s12603-010-0006-0 · 2.66 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Caregivers of patients with Alzheimer's disease or related disorders are exposed to many stress factors which increase the risk of developing physical and psychological disturbances. To limit these negative effects, different psychosocial interventions for carers have been proposed. With progress in technologies, telephone or the internet can offer flexible and tailored means to deliver this kind of interventions. In this literature review, we listed and analysed the articles devoted to this topic. Sixteen papers concerning nine intervention programs were selected. The analysis shows that the internet, as a means to deliver an intervention programme, is more interactive, attractive and less intrusive than telephone. Efficacy of the interventions via this kind of technologies can be compared to that observed in face to face ones: despite weak methodology and inconsistent outcomes of the studies, they showed some improvement in burden, anxiety, depression and self-efficacy. Finally, before implementation of this kind of technologies, it is necessary to test learnability, adaptability and acceptability. Usability of a technology is a key factor for its adoption and efficacy.
[Show abstract][Hide abstract] ABSTRACT: Wandering is a behavioural disorder, which occurs in Alzheimer's disease or other dementia. People who wander are at risk of physical harm and untimely death. Moreover, wandering behaviour causes a lot of stress to the caregivers. In the last few years, different geolocation devices have been developed in order to minimise risk and manage unsafe wandering. These detection systems rarely meet patients and caregivers' needs because they are not involved in the devices building process.
The aim is to explore the needs and perceptions of wandering persons and their caregivers towards existing tracking devices as well as their acceptability and usability. This paper reports a dyad case.
The tracking system tested is presented as a mobile Global Positioning System (GPS) receiver-shaped, including function of telephony and data transfer via GSM/GPRS.
Dyad patient/caregiver expressed their needs and perceptions towards tracking devices and gave their impressions about the functioning of the tested device at the end of the test.
The patient focused on the device's shape which he found too voluminous and unaesthetic, and was unable to give an opinion about the device's functioning. The spouse highlighted malfunctions and usage difficulties, which made the device not appropriate to her needs.
Involving end-users in the co-design of new technologies is necessary for building tailored devices. Moreover, in this area of dementia care, the person-centred approach is essential to a tailored wandering management.
Annals of physical and rehabilitation medicine 09/2009; 52(7-8):579-87. DOI:10.1016/j.rehab.2009.07.034
[Show abstract][Hide abstract] ABSTRACT: Older people are an important and growing sector of the population. This demographic change raises the profile of frailty and disability within the world's population. In such conditions, many old people need aides to perform daily activities. Most of the support is given by family members who are now a new target in the therapeutic approach. With advances in technology, robotics becomes increasingly important as a means of supporting older people at home. In order to ensure appropriate technology, 30 caregivers filled out a self-administered questionnaire including questions on needs to support their proxy and requirements concerning the robotic agent's functions and modes of action. This paper points out the functions to be integrated into the robot in order to support caregivers in the care of their proxy. The results also show that caregivers have a positive attitude towards robotic agents.
Technology and health care: official journal of the European Society for Engineering and Medicine 02/2009; 17(1):33-40. DOI:10.3233/THC-2009-0537 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A study was realized on 130 healthy and autonomous volunteers (60-80 years old) who met specific medical and functional inclusion criteria. A comprehensive battery of neuropsychological tests was performed at baseline (M0), 6 and 12 months (M6, M12). At M0 the results indicated that 65% were cognitively normal on each of all the neuropsychological tests, whereas 35% presented a cognitive deficit on one or more tests. At M12, 52% of the subjects who had a cognitive deficit at M0 remained impaired, whereas 48% normalized their scores: they performed as well as the subjects classified normal at M0. The results also indicated that the subjects who remained impaired at M12, had at M0 low scores on three tests or more, whereas the ones who normalized their scores had one or two failed tests. This study focuses on the risk of false positive cases and shows that low scores can be accidental. The authors propose decision rules allowing to reduce the risk of false positive cases. The observation of accidental impairment invites to be cautious and makes this 1-year follow-up study particularly relevant, since a 1-year follow-up is generally needed to diagnose very mild dementia.
European Journal of Neurology 12/2005; 12(11):879-85. DOI:10.1111/j.1468-1331.2005.01100.x · 3.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dehydroepiandrosterone (DHEA; 50 and 25 mg) and placebo tablets were orally administered daily to 24 healthy aging men and women (67.8 +/- 4.3 yr) for 8 days according to a balanced incomplete block design. Nine blood tests on both the first and eighth days allowed the measurement of DHEA, its sulfate DHEAS, and metabolites: testosterone, 5alpha-androstan-3alpha,17beta-diol glucuronide, estradiol, and estrone. Relatively low background levels of DHEA(S) were observed, and with the reestablishment of "young" levels, four important results were obtained. 1) Blood DHEA had an apparent terminal half-life of more than 20 h, the same order of magnitude as that of blood DHEAS, a result explainable by back-hydrolysis of the large amount of DHEAS formed after oral administration of DHEA, a mechanism providing long-lived unconjugated DHEA and metabolites. 2) The metabolic conversion of DHEAS to DHEA was significantly greater in women than in men. 3) No accumulation of steroids was observed. 4) No worrying transformation to androgen and estrogen was recorded; indeed, the limited increased estradiol in aged women could be predicted to be beneficial. These results suggested that daily oral administration of DHEA (25/50 mg) is safe in elderly subjects. The 50-mg dose was chosen for a 1 yr, double blind, placebo-controlled trial of daily oral administration of DHEA in 60- to 80-yr-old individuals (DHEAge).