[Show abstract][Hide abstract] ABSTRACT: There is an obvious lack of validated norms for elderly persons aged 85 and older for the large majority of the neuropsychological tests used in clinical practice. Yet this range of "oldest-old" individuals drastically increases worldwide and is the more likely to develop dementia. Providing clinicians validated and updated norms to accurately evaluate cognitive functioning in this population is an important issue in geriatrics. This study provides normative scores for 7 neuropsychological tests commonly used in clinical practice. Data were collected in a sample of 283 subjects aged 85 and older, included in the PAQUID study, a population-based cohort conducted in France. Normative scores were calculated according to 2 age ranges and 2 educational levels, and are presented in percentiles. The norms provided in the present study involve 7 tests that are widely used in the neuropsychological assessment of geriatrics populations and should be of help for clinicians.
Archives of Clinical Neuropsychology 09/2015; DOI:10.1093/arclin/acv055 · 1.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Joint models are used in ageing studies to investigate the association
between longitudinal markers and a time-to-event, and have been extended to
multiple markers and/or competing risks. The competing risk of death must be
considered in the elderly because death and dementia have common risk factors.
Moreover, in cohort studies, time-to-dementia is interval-censored because
dementia is only assessed intermittently. So subjects can become demented and
die between two follow-up visits without being diagnosed. To study pre-dementia
cognitive decline, we propose a joint latent class model combining a (possibly
multivariate) mixed model and an illness-death model handling both interval
censoring (by accounting for a possible unobserved transition to dementia) and
semi-competing risks. Parameters are estimated by maximum likelihood handling
interval censoring. The correlation between the marker and the times-to-events
is captured by latent classes, homogeneous groups with specific risks of death
and dementia and profiles of cognitive decline. We propose markovian and
semi-markovian versions. Both approaches are compared to a joint latent class
model for standard competing risks through a simulation study, and then applied
in a prospective cohort study of cerebral and functional ageing to distinguish
different profiles of cognitive decline associated with risks of dementia and
death. The comparison highlights that among demented subjects, mortality
depends more on age than duration of dementia. This model distinguishes the
so-called terminal pre-death decline (among non-demented subjects) from the
[Show abstract][Hide abstract] ABSTRACT: Several studies in Western countries have shown an association between cognitive disorders and low BMI or weight loss in elderly people. However, few data are available in Africa. We analysed the association between cognitive disorders and undernutrition among elderly people in Central Africa. A cross-sectional, multicentre, population-based study using a two-phase design was carried out in subjects aged 65 years and above in the Central African Republic (CAR) and the Republic of Congo (ROC). All subjects were interviewed using the Community Screening Interview for Dementia, and those with low performance were clinically assessed by a neurologist and underwent further psychometrical tests. Diagnostic and Statistical Manual-IV and Petersen's criteria were required for the diagnoses of dementia and mild cognitive impairment (MCI), respectively. Undernutrition was evaluated using mid-upper arm circumference (MUAC) < 24 cm, BMI < 18·5 kg/m
and arm muscular circumference (AMC) < 5th percentile. Multivariate binary logistic regression models were used to estimate the associations. In CAR, MCI was associated with MUAC < 24 cm (OR 0·7, 95 % CI 0·4, 1·0) and dementia with BMI < 18·5 kg/m
(OR 2·3, 95 % CI 1·6, 3·1), AMC < 5th percentile (OR 2·3, 95 % CI 1·1, 4·6) and MUAC < 24 cm (OR 1·8, 95 % CI 1·4, 2·4). In ROC, both MCI and dementia were associated with all markers of undernutrition, but only AMC < 5th percentile was significantly associated with MCI (OR 3·1, 95 % CI 1·9, 4·8). In conclusion, cognitive disorders were associated with undernutrition. However, further studies are needed to elucidate the relationship between MCI and undernutrition in CAR.
The British journal of nutrition 06/2015; -1:1-10. DOI:10.1017/S0007114515001749 · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Structural gray matter characteristics of anxiety remain unclear. The aim of this study was to assess the influence of current depressive symptoms and history of depression on the gray matter characteristics of trait anxiety.
Structural magnetic resonance imaging (MRI) data from 393 individuals aged 65 years or older were used. Regions of interest (ROIs) included the amygdala, anterior cingulate cortex (ACC), insula, orbitofrontal cortex (OFC), and temporal cortex. Trait anxiety was measured by the State-Trait Anxiety Inventory (STAI). Depression and depressive symptoms were measured using DSM-IV criteria and the Center for Epidemiological Studies Depression Scale (CESD).
After adjustments for sociodemographics and health-related variables, anxiety had a significant influence on the gray matter characteristics in all cortical ROIs. First, in participants without depression antecedents, higher trait anxiety was associated with a larger cortical thickness in all cortical ROIs. Second, in participants with a previous history of depression, higher trait anxiety was associated with a smaller cortical thickness in all cortical ROIs.
These results suggest that anxiety is related to cortical thickness differently in healthy older adults and in older adults with psychiatric antecedents. Anxiety associated with thinner cortical areas could reflect symptoms of a specific type of depression or a vulnerability to develop depression.
International Psychogeriatrics 06/2015; DOI:10.1017/S1041610215000836 · 1.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to develop short forms of the STAI-Y trait and state scales and associated norms suitable for the screening of anxiety in elderly populations.
This study was based on population-based cohorts of older persons from two epidemiological French studies that each included one subscale of the STAI-Y, i.e. state and trait anxiety scales. For both scales, the most discriminative items were retained and their factorial structure was examined using principal components analysis. Internal consistency (Cronbach's alpha) was estimated and cut-offs and norms were computed.
A 10-item STAI-Y version produced scores similar to those obtained with the full form of the STAI-Y. The factorial structure of the shortened form is comparable to that of the full scales. Results showed good internal consistency (alpha coefficients were 0.92 and 0.85 for short STAI-Y state and trait scales, respectively). Moreover, both short STAI-Y state and trait scales correctly classified 88% of the participants using a cut-off point of 23. Norms for both short trait and state anxiety scales are provided according to age, gender, educational level and depressive symptoms.
Both shortened scales have similar factorial structure and internal consistency to the longer scales and classify anxious/non-anxious elderly with acceptable accuracy. The shorter form is likely to be more acceptable to elderly persons through reduction of fatigue effects.
Aging and Mental Health 06/2015; DOI:10.1080/13607863.2015.1051511 · 1.75 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aβ-related cerebral amyloid angiopathy (CAA) is a major cause of primary non-traumatic brain hemorrhage. In families with an early onset of the disease, CAA can be due to amyloid precursor protein (APP) pathogenic variants or duplications. APP duplications lead to a ~1.5-fold increased APP expression, resulting in Aβ overproduction and deposition in the walls of leptomeningeal vessels. We hypothesized that rare variants in the 3'untranslated region (UTR) of APP might lead to APP overexpression in patients with CAA and no APP pathogenic variant or duplication. We performed direct sequencing of the whole APP 3'UTR in 90 patients with CAA and explored the functional consequences of one previously unreported variant. We identified three sequence variants in four patients, of which a two-base pair deletion (c.*331_*332del) was previously unannotated and absent from 175 controls of same ethnicity. This latter variant was associated with increased APP expression in vivo and in vitro. Bioinformatics and functional assays showed that the APP c.*331_*332del variant affected APP messenger RNA (mRNA) structure and binding of two microRNAs (miR-582-3p and miR-892b), providing a mechanism for the observed effects on APP expression. These results identify APP 3'UTR sequence variants as genetic determinants of Aβ-CAA.European Journal of Human Genetics advance online publication, 1 April 2015; doi:10.1038/ejhg.2015.61.
European journal of human genetics: EJHG 04/2015; DOI:10.1038/ejhg.2015.61 · 4.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To estimate the prevalence of refractive error in adults across Europe. Refractive data (mean spherical equivalent) collected between 1990 and 2013 from fifteen population-based cohort and cross-sectional studies of the European Eye Epidemiology (E(3)) Consortium were combined in a random effects meta-analysis stratified by 5-year age intervals and gender. Participants were excluded if they were identified as having had cataract surgery, retinal detachment, refractive surgery or other factors that might influence refraction. Estimates of refractive error prevalence were obtained including the following classifications: myopia ≤-0.75 diopters (D), high myopia ≤-6D, hyperopia ≥1D and astigmatism ≥1D. Meta-analysis of refractive error was performed for 61,946 individuals from fifteen studies with median age ranging from 44 to 81 and minimal ethnic variation (98 % European ancestry). The age-standardised prevalences (using the 2010 European Standard Population, limited to those ≥25 and <90 years old) were: myopia 30.6 % [95 % confidence interval (CI) 30.4-30.9], high myopia 2.7 % (95 % CI 2.69-2.73), hyperopia 25.2 % (95 % CI 25.0-25.4) and astigmatism 23.9 % (95 % CI 23.7-24.1). Age-specific estimates revealed a high prevalence of myopia in younger participants [47.2 % (CI 41.8-52.5) in 25-29 years-olds]. Refractive error affects just over a half of European adults. The greatest burden of refractive error is due to myopia, with high prevalence rates in young adults. Using the 2010 European population estimates, we estimate there are 227.2 million people with myopia across Europe.
European Journal of Epidemiology 03/2015; 30(4). DOI:10.1007/s10654-015-0010-0 · 5.34 Impact Factor