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[show abstract]
[hide abstract]
ABSTRACT: Introduction: The National Institute for Health and Clinical Excellence (NICE) in the United Kingdom, the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWIG) in Germany and the Haute Autorité de Santé (HAS) in France have recently set out guidelines on prescription of anti-dementia medication. The HAS proposes in particular that continuation of these drugs for longer than one year should be decided in multidisciplinary team meetings (MDTM). Objective: To assess the feasibility of MDTM and the satisfaction of coordinating physicians from institutions for the dependent elderly (nursing home, NH) and expert physicians from memory clinics who have participated in the meetings. Methods: Survey carried out among physicians who had participated in the MDTM held as part of the IDEM study (Interest of systematic tracking of dementia cases in NH: analysing the contribution of MDTM in Alzheimer's disease and related diseases; PHRC National 2009, Code 0910701). The survey evaluated the organization of MDTM and the physicians' opinion of these meetings. Results: The cases of 574 patients were discussed in MDTM involving 133 healthcare professionals (32 coordinating physicians, 48 expert physicians, 4 general practitioners and 49 other health professionals). The mean number of participants was 4.2±1.6. About 16 minutes were spent discussing the case of each resident. About 90% of physicians considered that the meetings were useful. Overall assessment of their efficacy was 11.5/20 for the coordinating physicians and 14.1/20 for the expert physicians. The benefits of MDTM in relation to the work entailed were considered important by 60% of expert physicians and 33% of coordinating physicians. Conclusions: Our survey confirmed the feasibility of MDTM in the field of Alzheimer's disease. The overall benefit/workload ratio of the meetings was considered to be favorable for the expert physicians. The benefits of MDTM were turned out to be less appreciated by the coordinating physicians according to high workload involved.
The Journal of Nutrition Health and Aging 01/2013; 17(2):137-41. · 2.69 Impact Factor
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B Vellas,
L Hausner,
L Frolich,
C Cantet,
V Gardette,
E Reynish,
S Gillette,
E Aguera-Morales,
S Auriacombe,
M Boada, [......],
E Salmon,
A Salva,
P Scheltens,
A Schneider,
A Sinclair,
L Spiru,
J Touchon,
D Zekry,
B Winblad,
S Andrieu
[show abstract]
[hide abstract]
ABSTRACT: The clinical progression of Alzheimer disease (AD) was studied in European subjects under treatment with AChE inhibitors (AChE-I) in relation to geographical location over a 2-years period. One thousand three hundred and six subjects from 11 European countries were clustered into 3 regions (North, South, West) and investigated with biannual follow-up over 2 years. Primary outcomes were cognitive, functional and behavioral measures. Caregiver burden, hospital admission and admission to nursing home were also recorded. Participant cognitive function declined non-linearly over time (MMSE: -1.5 pts/first year, -2.5 pts/second year; ADAScog: + 3.5 pts/first year, + 4.8 pts/second year), while the progression of behavioral disturbances (NPI scale) was linear. Neither scale showed regional differences, and progression of the disease was similar across Europe despite different health care systems. Functional decline (ADL, IADL) tended to progress more rapidly in Southern Europe (p=0.09), while progression of caregiver burden (Zarit Burden Interview) was most rapid in Northern Europe (5.6 pts/y, p=0.04). Incidences of hospital admission (10.44, 95%CI: 8.13-12.75, p < 0.001) and admission to nursing home (2.97, 95%CI: 1.83-4.11, p < 0.001) were lowest in Southern Europe. In general cognitive and functional decline was slower than in former cohorts. European geographical location reflecting differences in culture and in health care system does not impact on the progression of AD but does influence the management of AD subjects and caregiver burden.
Current Alzheimer research 06/2012; 9(8):902-12. · 4.97 Impact Factor
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M. E. Soto,
S. Andrieu,
C. Arbus,
M. Ceccaldi,
P. Couratier,
T. Dantoine,
J. -F. Dartigues,
S. Gillette-guyonette,
F. Nourhashemi, P. -J. Ousset,
M. Poncet,
F. Portet,
J. Touchon,
B. Vellas
[show abstract]
[hide abstract]
ABSTRACT: The rate of cognitive decline in Alzheimer’s disease (AD) varies considerably between individuals, with some subjects showing
substantial deterioration and others showing little or no change over the course of the disease. These wide variations support
the relatively new concept of Rapid Cognitive Decline (RCD). Patients with an accelerated rate of cognitive decline have showed
to present a worse evolution in terms of mortality, loss of autonomy and institutionalisation. The conclusions from RCD studies
conducted in the past years remain very heterogeneous and sometimes contradictory. This is possibly due to methodological
differences, mainly the different “a priori” definitions of RCD used to identify rapid decliners. Consequently of this, there
is considerable variation in reported frequency of patients with RCD which may vary from 9.5% to 54%. The lack of both consensus
definition and consensual clinical assessment tools is one of the major barriers for establishing an appropriated management
of rapid decliners in clinical practice. Presently, management of rapid decliners in AD remains to be a challenge waiting
to better know predictive factors of a RCD. To date no specific guidelines exist to follow-up or to treat patients with this
condition. This consensus paper proposes the loss of 3 points or greater in Mini-Mental State Examination (MMSE) during six
months as an empirical definition of rapid cognitive decline to be used in routine medical practice and to be relevant for
clinical-decision making in patients with mild to moderately-severe AD.
The Journal of Nutrition Health and Aging 04/2012; 12(10):703-713. · 2.69 Impact Factor
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J. Delrieu,
T. Voisin,
S. Andrieu,
S. Belliard,
J. Belmin,
F. Blanchard,
M. Ceccaldi,
J. F. Dartigues,
B. Defontaines,
S. Lehericy, [......],
L. Naccache,
F. Nourhashemi, P. J. Ousset,
F. Pasquier,
P. Payoux,
F. Puisieux,
P. Robert,
J. Touchon,
B. Vellas,
B. Dubois
[show abstract]
[hide abstract]
ABSTRACT: Under the auspices of the Société Française de Gériatrie et Gérontologie, a multi-disciplinary group of specialists in geriatrics,
neurology, epidemiology, psychiatry, neuroradiology and nuclear medicine met with the aim of drawing up references on the
methods for diagnosing and treating mild Alzheimer’s disease. The critical analysis of international literature, conducted
by Professor Bruno Vellas for the scientific committee, has served to support study of the latest knowledge in 2008. The multi-disciplinary
group met on 14 and 15 May 2008 in order to set out the questions that this study must answer and to allocate draft studies.
Thus, it has been possible to conduct a study focused on mild Alzheimer’s disease, giving particular attention to diagnostic
procedure, specific methods of treatment and the benefits of making a diagnosis.
The Journal of Nutrition Health and Aging 04/2012; 13(6):503-519. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Objectives: To describe the design and baseline patient characteristics of a multicomponent specific care and assistance plan (PLASA)
study in Alzheimer’s Disease (AD). The study is designed to evaluate the effect of PLASA in AD primarily looking at change
in functional capacity.Design: Two-years prospective cluster randomized controlled trial comparing PLASA and usual care. Setting: Forty-nine hospitals
in France.Participants: 1120 community-dwelling AD.Intervention: Patients in the intervention group are evaluated bi-annually using a standardized comprehensive global assessment. In the
case of decline in any one domain a standardized study protocol recommends specific physician directed intervention in addition
to information and training for the caregiver.Measurements: Alzheimer Disease Cooperative Study-Activities of Daily Living scale, Resource Utilization in Dementia scale, Clinical Global
Impression of Change.Results: At baseline, the two groups were similar regarding patient and caregiver characteristics. The mean patient age was 79.61
+ 5.72 years and the mean MMSE 19.73 + 4.01 for the whole cohort. Time since dementia diagnosis was about 1.37 + 1.65 years
in the whole cohort. Almost a third of the patients lived alone at baseline. Mean monthly time spent in caregiving in the
whole cohort was 52.70 + 71.83 hours for instrumental activities and 17.73 + 51.38 hours for basic activities.Conclusion: Persons with dementia suffer different losses at different stages of the disease and therefore accurate assessment of abilities
and losses is critical to assist the person in planning for their future and for care needs. The PLASA intervention study
is ongoing with 2 year follow-up to be completed in 2007.
The Journal of Nutrition Health and Aging 04/2012; 12(4):263-271. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: ObjectivesThis study aimed to estimate the costs of formal and informal care of patients with Alzheimer's disease, to compare care costs
across European countries and identify potential differences in cost patterns between countries and regions.
SettingThe ICTUS study is a prospective, naturalistic observational study conducted in specialised memory clinics in 12 European
countries. In total, 1385 patients diagnosed with Alzheimer's disease were enrolled at baseline. All subjects had a reliable
informant (primary caregiver) and informed consent was obtained from patients or their primary caregiver.
Main outcome measuresResource utilization data was captured with the RUD Lite (Resource Utilization in Dementia) instrument and caregiver burden
with the Zarit Burden Interview (ZBI). Patient disease severity was measured with the Mini-Mental State Examination (MMSE),
Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-cog), Katz’ index (PADL), Instrumental activities of daily living
(IADL) scale and Neuropsychiatric inventory (NPI).
ResultsThe mean annual cost of care per patient was estimated to €7,820 (95% CI: €7,194–€8,446), whereof 54% were costs of informal
care, 16% direct medical costs and 30% community care costs. There were substantial differences in total resource utilization
and also in the balance between formal and informal care between Northern, Western and Southern Europe. PADL scores were strongly
associated with formal care costs while IADL scores correlated strongly with informal care costs.
ConclusionsCosts of Alzheimer's Disease are high across European countries. Activities of daily living is an important determinant of
care costs. Formal care service use is lower and informal care higher in Southern Europe compared to Western and Northern
Europe. Differences in resource utilization patterns are important to consider in international studies of dementia care costs
as well as in economic evaluations of new treatments for dementia.
Key wordsAlzheimer-economics-cost of illness
The Journal of Nutrition Health and Aging 04/2012; 14(8):648-654. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Recent advances in the understanding of Alzheimer's disease pathogenesis have led to the development of numerous compounds that might modify the disease process. Amyloid β (Aβ) peptide represents an important molecular target for intervention in Alzheimer's disease. Several types of Aβ peptide immunotherapy for Alzheimer's disease are under investigation, direct immunization with synthetic intact Aβ(42) , active immunization involving the administration of synthetic fragments of Aβ peptide conjugated to a carrier protein and passive administration with monoclonal antibodies directed against Aβ peptide. Pre-clinical studies showed that immunization against Aβ peptide can provide protection and reversal of the pathology of Alzheimer's disease in animal models. Indeed, several adverse events have been described like meningoencephalitis with AN1792, vasogenic edema and microhemorrhages with bapineuzumab. Although immunotherapy approaches resulted in clearance of amyloid plaques in patients with Alzheimer's disease, this clearance did not show significant cognitive effect for the moment. Currently, several Aβ peptide immunotherapy approaches are under investigation but also against tau pathology.
Journal of Neurochemistry 08/2011; 120 Suppl 1:186-93. · 4.06 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: EHT0202 (etazolate hydrochloride) is a new compound exhibiting both potential disease-modifying and symptomatic treatment properties in Alzheimer's Disease increasing alpha-secretase activity and sAPP alpha secretion, as well as acting as a GABA-A receptor modulator and as a PDE-4 inhibitor.
This pilot, randomized, double-blind, placebo-controlled, parallel group, multicentre, Phase IIA study was conducted in 159 randomized patients suffering from mild to moderate Alzheimer's Disease. EHT0202 (40 or 80 mg bid) or placebo was administered as adjunctive therapy to one acetylcholinesterase inhibitor over a 3-month period. This study was designed to assess the clinical safety and tolerability of EHT0202 as a primary objective, with secondary endpoints (cognitive function, daily living activities, behaviour, caregiver burden and global functioning) included to explore clinical efficacy of EHT0202 versus placebo.
EHT0202 was shown to be safe and generally well tolerated. Dose-dependent numbers of early withdrawal and central nervous system related adverse events were observed. As expected, since the study was not powered and not designed to show drug efficacy, and except for ratings on the ADCS-ADL scale, no significant differences were seen between treatment groups.
These first encouraging safety results do support further development of EHT0202 in order to assess its clinical efficacy and to confirm its tolerability in a larger cohort of Alzheimer patients and for a longer period.
Current Alzheimer research 01/2011; 8(2):203-12. · 4.97 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: This study aimed to estimate the costs of formal and informal care of patients with Alzheimer's disease, to compare care costs across European countries and identify potential differences in cost patterns between countries and regions.
The ICTUS study is a prospective, naturalistic observational study conducted in specialised memory clinics in 12 European countries. In total, 1385 patients diagnosed with Alzheimer's disease were enrolled at baseline. All subjects had a reliable informant (primary caregiver) and informed consent was obtained from patients or their primary caregiver.
Resource utilization data was captured with the RUD Lite (Resource Utilization in Dementia) instrument and caregiver burden with the Zarit Burden Interview (ZBI). Patient disease severity was measured with the Mini-Mental State Examination (MMSE), Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-cog), Katz´ index (PADL), Instrumental activities of daily living (IADL) scale and Neuropsychiatric inventory (NPI).
The mean annual cost of care per patient was estimated to €7,820 (95% CI: €7,194-€8,446), whereof 54% were costs of informal care, 16% direct medical costs and 30% community care costs. There were substantial differences in total resource utilization and also in the balance between formal and informal care between Northern, Western and Southern Europe. PADL scores were strongly associated with formal care costs while IADL scores correlated strongly with informal care costs.
Costs of Alzheimer's disease are high across European countries. Activities of daily living is an important determinant of care costs. Formal care service use is lower and informal care higher in Southern Europe compared to Western and Northern Europe. Differences in resource utilization patterns are important to consider in international studies of dementia care costs as well as in economic evaluations of new treatments for dementia.
The Journal of Nutrition Health and Aging 01/2010; 14(8):648-54. · 2.69 Impact Factor
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J Delrieu,
T Voisin,
S Andrieu,
S Belliard,
J Belmin,
F Blanchard,
M Ceccaldi,
J F Dartigues,
B Defontaines,
S Lehericy, [......],
L Naccache,
F Nourhashemi, P J Ousset,
F Pasquier,
P Payoux,
F Puisieux,
P Robert,
J Touchon,
B Vellas,
B Dubois
[show abstract]
[hide abstract]
ABSTRACT: Under the auspices of the Societe Francaise de Geriatrie et Gerontologie, a multi-disciplinary group of specialists in geriatrics, neurology, epidemiology, psychiatry, neuroradiology and nuclear medicine met with the aim of drawing up references on the methods for diagnosing and treating mild Alzheimer's disease. The critical analysis of international literature, conducted by Professor Bruno Vellas for the scientific committee, has served to support study of the latest knowledge in 2008. The multi-disciplinary group met on 14 and 15 May 2008 in order to set out the questions that this study must answer and to allocate draft studies. Thus, it has been possible to conduct a study focused on mild Alzheimer's disease, giving particular attention to diagnostic procedure, specific methods of treatment and the benefits of making a diagnosis.
The Journal of Nutrition Health and Aging 08/2009; 13(6):503-19. · 2.69 Impact Factor
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M E Soto,
S Andrieu,
C Arbus,
M Ceccaldi,
P Couratier,
T Dantoine,
J-F Dartigues,
S Gillette-Guyonnet,
F Nourhashemi, P-J Ousset,
M Poncet,
F Portet,
J Touchon,
B Vellas
[show abstract]
[hide abstract]
ABSTRACT: The rate of cognitive decline in Alzheimer's disease (AD) varies considerably between individuals, with some subjects showing substantial deterioration and others showing little or no change over the course of the disease. These wide variations support the relatively new concept of Rapid Cognitive Decline (RCD). Patients with an accelerated rate of cognitive decline have showed to present a worse evolution in terms of mortality, loss of autonomy and institutionalisation. The conclusions from RCD studies conducted in the past years remain very heterogeneous and sometimes contradictory. This is possibly due to methodological differences, mainly the different "a priori" definitions of RCD used to identify rapid decliners. Consequently of this, there is considerable variation in reported frequency of patients with RCD which may vary from 9.5% to 54%. The lack of both consensus definition and consensual clinical assessment tools is one of the major barriers for establishing an appropriated management of rapid decliners in clinical practice. Presently, management of rapid decliners in AD remains to be a challenge waiting to better know predictive factors of a RCD. To date no specific guidelines exist to follow-up or to treat patients with this condition. This consensus paper proposes the loss of 3 points or greater in Mini-Mental State Examination (MMSE) during six months as an empirical definition of rapid cognitive decline to be used in routine medical practice and to be relevant for clinical-decision making in patients with mild to moderately-severe AD.
The Journal of Nutrition Health and Aging 01/2009; 12(10):703-13. · 2.69 Impact Factor
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S Gillette Guyonnet,
G Abellan Van Kan,
S Andrieu,
J P Aquino,
C Arbus,
J P Becq,
C Berr,
S Bismuth,
B Chamontin,
T Dantoine, [......],
F Nourhashemi, P J Ousset,
F Portet,
P Ritz,
P Robert,
Y Rolland,
C Sanz,
M Soto,
J Touchon,
B Vellas
[show abstract]
[hide abstract]
ABSTRACT: Alzheimer's disease (AD) is the most frequent form of dementia and according to the most recent estimation it affects nearly 27 million people in the world. The onset of the disease is generally insidious. It is becoming increasingly evident that the underlying pathophysiological mechanisms are active long before the appearance of the clinical symptoms of the disease. In the current context, it is important to develop strategies to delay the onset of cognitive decline. Delaying the onset by 5 years would reduce the prevalence by half at term, and a delay of 10 years would reduce it by three-quarters. The effectiveness of currently suggested preventive approaches remains to be confirmed, but certain strategies could be applied straight away to at-risk subjects. We propose that a health-promoting memory consultation should be set up for elderly persons who have attended a specialized memory consultation and in whom the diagnosis of dementia and of AD in particular, has not been established by standardized tools. Through this consultation, they would be offered full multidimensional investigation of all aspects of their health status, follow-up could be organized, general practitioners in private practice could be made more conscious of this population and the elderly could be made more aware of the risk factors to which they are exposed. The development of an information policy for the elderly would meet a present need. In our reflection, we must take into account the question of how to give this preventive consultation its due place in the healthcare pathway of the elderly person in order to ensure coordinated follow-up with all the other health professionals involved. The principle of the health-promoting memory consultation is undergoing validation in a large French multicentre preventive trial in 1200 frail elderly persons aged 70 years followed for three years, the Multidomain Alzheimer Preventive Trial (MAPT).
The Journal of Nutrition Health and Aging 11/2008; 12(8):520-9. · 2.69 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: To describe the design anf baseline patient characteristics of a multicomponent specific care and assistance plan (PLASA) study in Alzheimer's Disease (AD). The study is designed to evaluate the effect of PLASA in AD primarily looking at change in functional capacity.
Two-years prospective cluster randomized controlled trial comparing PLASA and usual care.
Forty-nine hospitals in France.
1120 community-dwelling AD.
Patients in the intervention group are evaluated biannually using a standardized comprehensive global assessment. In the case of decline in any one domain a standardized study protocol recommends specific physician directed intervention in addition to information and training for the caregiver.
Alzheimer Disease Cooperative Study-Activities of Daily Living scale, Resource Utilization in Dementia scale, Clinical Global Impression of Change.
At baseline, the two groups were similar regarding patient and caregiver characteristics. The mean patient age was 79.61+5.72 years and the mean MMSE 19.73+4.01 for the whole cohort. Time since dementia diagnosis was about 1.37+1.65 years in the whole cohort. Almost a third of the patients lived alone at baseline. Mean monthly time spent in caregiving in the whole cohort was 52.70+71.83 hours for instrumental activities and 17.73+51.38 hours for basic activities.
Persons with dementia suffer different losses at different stages of the disease and therefore accurate assessment of abilities and losses is critical to assist the person in planning for their future and for care needs. The PLASA intervention study is ongoing with 2 year follow-up to be completed in 2007.
The Journal of Nutrition Health and Aging 05/2008; 12(4):263-71. · 2.69 Impact Factor
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Revue Neurologique 05/2008; 164 Spec No 2:F98-106. · 0.49 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Memory complaints are relatively common in elderly people, although they are not always reported to the general practitioner (GP). These subjective complaints do not necessarily correlate with objective measures of memory impairment or cognitive performance, but they may be an early indication of impairment at a state that is undetectable by standard testing instruments. Memory complaints may also predict future cognitive decline. The GuidAge study is a secondary prevention trial for Alzheimer's disease involving non-demented individuals aged 70 years or older having spontaneously complained of memory problems to their GP. More than half of participants had a Clinical Dementia Rating score of 0.5 at baseline. The percentage of participants reporting problems on the McNair and Kahn scale varied from 6.2% to 78.6% per item. Certain specific memory complaints may be more related than others to the beginning of the neurodegenerative process, and could predict future cognitive decline. The importance of memory complaints should not be underestimated in clinical practice.
The Journal of Nutrition Health and Aging 02/2008; 12(1):66S-72S. · 2.69 Impact Factor
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P J Visser,
F R J Verhey,
M Boada,
R Bullock,
P P De Deyn,
G B Frisoni,
L Frolich,
H Hampel,
J Jolles,
R Jones, [......],
A-S Rigaud,
P Scheltens,
H Soininen,
L Spiru,
J Touchon,
M Tsolaki,
B Vellas,
L-O Wahlund,
G Wilcock,
B Winblad
[show abstract]
[hide abstract]
ABSTRACT: There is an urgent need to identify subjects with Alzheimer's disease (AD) in the predementia phase, but validated diagnostic approaches are currently lacking. In this paper, we present the background, design and methods of a study, which aims to develop clinical criteria for predementia AD. We also present baseline characteristics of the subjects included. The study was part of the multicentre DESCRIPA project, which is being conducted within the network of the European Alzheimer's Disease Consortium.
Clinical criteria will be based on a prospective cohort study of non-demented subjects older than 55 years and referred to a memory clinic. At baseline, a number of markers and risk factors for AD were collected, including demographic variables, measures of performance in activities of daily living, cognitive, neuroimaging and genetic markers, and serum and cerebrospinal fluid markers. Subjects will be reassessed annually for 2-3 years, and we will evaluate which combination of variables best predicts AD-type dementia at follow-up.
Between 2003 and 2005, 881 subjects were included from 20 memory clinics. Subjects were on average 70.3 years old, and had 10.4 years of education. The average score on the Mini-Mental State Examination was 27.4.
Neuroepidemiology 02/2008; 30(4):254-65. · 2.31 Impact Factor
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P. Aalten,
F. R. Verhey,
M. Boziki,
A. Brugnolo,
R. Bullock,
E. J. Byrne,
V. Camus,
M. Caputo,
D. Collins,
P. P. De Deyn, [......],
C. Hurt,
A. Marriott,
P. Mecocci,
F. Nobili, P. J. Ousset,
E. Reynish,
E. Salmon,
M. Tsolaki,
B. Vellas,
P. H. Robert
[show abstract]
[hide abstract]
ABSTRACT: Background/Aims: The aim of this study was to determine the consistency of neuropsychiatric subsyndromes of the Neuropsychiatric Inventory across several clinical and demographic subgroups (e.g. dementia subtypes, dementia severity, medication use, age and gender) in a large sample of outpatients with dementia. Methods: Cross-sectional data of 2,808 patients with dementia from 12 centres from the European Alzheimer's Disease Consortium were collected. Principal component analysis was used for factor analysis. Subanalyses were performed for dementia subtypes, dementia severity, medication use, age and gender. Results: The results showed the relatively consistent presence of the 4 neuropsychiatric subsyndromes 'hyperactivity', 'psychosis', 'affective symptoms' and 'apathy' across the subanalyses. The factor structure was not dependent on dementia subtypes, age and gender but was dependent on dementia severity and cholinesterase use. The factors hyperactivity and affective symptoms were present in all subanalyses, but the presence of the factors apathy and psychosis was dependent on use of cholinesterase inhibitors and dementia severity, respectively. Conclusion: The present study provided evidence of the relative consistency of neuropsychiatric subsyndromes across dementia subtypes, age and gender, thereby stressing the importance of thinking about neuropsychiatric subsyndromes instead of separate symptoms. However, the subsyndromes apathy and psychosis were dependent on use of cholinesterase inhibitors and dementia severity. Copyright (c) 2007 S. Karger AG, Basel.
Dement Geriatr Cogn Disord. 01/2008; 25(1):1-8.
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E Reynish,
F Cortes,
S Andrieu,
C Cantet,
M Olde Rikkert,
R Melis,
L Froelich,
G B Frisoni,
L Jönsson,
P J Visser, P J Ousset,
B Vellas
[show abstract]
[hide abstract]
ABSTRACT: The long-term objective of the ICTUS study is to identify milestones in Alzheimer's disease (AD) progression and to develop a model to predict disease course in individual AD patients in Europe. The secondary objectives are to describe the patterns of prescribing, and the socioeconomic impact of AD in Europe. Between 2003 and 2005 1,380 patients with probable AD were recruited in specialised (secondary care) clinics in 12 European countries. Their mean age was 76 years and they had a mean of 8.0 +/- (SD) 4.6 years of education. Thirty-five percent were male. The mean MMSE score was 20.4 +/- (SD) 4.0. Forty-three percent had very mild dementia (CDR 0.5) and 44% had mild dementia (CDR 1). All patients completed baseline evaluation and biannual follow-up is ongoing. The goals of the current study are to describe the specific methods for recruitment in this crosscultural setting and the characteristics of the inception ICTUS cohort, including clinical features, co-morbidity, neuropsychological performance, neuropsychiatric symptoms, functional impairment and social burden.
Neuroepidemiology 02/2007; 29(1-2):29-38. · 2.31 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Preventive approaches in the field of Alzheimer disease (AD) is important but these trials raise many questions. Which protective factor should be studied? What population should be studied? With which principal and secondary criteria? We present here the design of the ongoing GuidAge Study. In the past, several studies suggest that Ginkgo biloba could have a potential benefit effect on cognitive function. The aim of the GuidAge Study is to evaluate the efficacy of 240 mg/d of EGb 761 in the prevention of AD.
GuidAge is a 5-year double-blind randomized trial conducted in France by a private practice/hospital network of general practitioners and hospital practitioners specializing in memory disorders. This study enrolled elderly subjects with spontaneous memory complaint and the primary outcome is the incidence of AD during a 5 years follow-up period. A total of 2854 subjects were enrolled between March 2002 and September 2004. The age of the study population was 76.8 +/- 4.4 with mean MMSE at entry 27.8 +/- 1.7.
The GuidAge study is the largest study carried out in Europe on the prevention of AD. Final results should be available in 2010.
Neurology 12/2006; 67(9 Suppl 3):S6-11. · 8.31 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Mild cognitive impairment (MCI) was proposed as a nosological entity referring to elderly people with mild cognitive deficit but no dementia. MCI is a heterogeneous clinical entity with multiple sources of heterogeneity. The concept of MCI was reviewed and a diagnostic procedure with three different stages was proposed by the European Consortium on Alzheimer's Disease Working Group on MCI. Firstly, MCI should correspond to cognitive complaints coming from the patients or their families; the reporting of a relative decline in cognitive functioning during the past year by a patient or informant; cognitive disorders as evidenced by clinical evaluation; absence of major repercussions on daily life; and absence of dementia. These criteria, similar to those defined during an international workshop in Stockholm, make it possible to identify an MCI syndrome, which is the first stage of the diagnostic procedure. Secondly, subtypes of MCI had to be recognised. Finally, the aetiopathogenic subtype could be identified. Identifying patients at a high risk for progression to dementia and establishing more specific and adapted therapeutic strategies at an early stage, together with more structured overall management, is made possible by the diagnostic procedure proposed.
Journal of neurology, neurosurgery, and psychiatry 07/2006; 77(6):714-8. · 4.87 Impact Factor
