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Biomedical subjects

C Derouesné

Publications and source records attributed to C Derouesné.

At least 19 recordsLinked to original sources
PubMed2001

[Noncognitive symptoms in Alzheimer's disease. A study of 150 community-dwelling patients using a questionnaire completed by the caregiver].

UNLABELLED: We studied the noncognitive symptoms in 150 community-dwelling Alzheimer's patients using a questionnaire completed by the caregiver, the Echelle Psychopathologique de la Démence de Type Alzheimer, EPDTA (Psychopathologic Scale of Dementia of Alzheimer Type). EPDTA is a 44-item questionnaire derived from the BEHAVE-AD and the Depressive Mood Scale, covering many aspects of the behavior, affective and psychiatric disturbances. Each item is rated from 0 (never observed) to 6 (most of the time). Frequency (percentage of symptom present) and severity (mean score when the symptom was present) were assessed for each item. The cognitive status and severity of the disease were assessed by the MMSE and two scales completed by the caregiver assessing the Activities of Daily Living scale (ADL) and the Cognitive Difficulties Scale (CDS). Noncognitive symptoms were present in all patients but remained moderate in severity. A principal component analysis of the 33 items exploring the affective disturbances showed seven clinically relevant factors: apathy, anxiety, anosognosia-irritability, euphoria, dysphoria, emotional incontinence and agitation. The most frequent noncognitive symptoms were the affective disturbances, especially apathy, and the sexual behavioural disturbances. No correlation were found between the overall severity of behavioural disturbances and cognitive status, duration of the disease nor demographic variables. However, a slight negative correlation was found between scores on apathy and on the MMSE. A second evaluation was performed in 59 patients after a mean follow-up of 18,2 months. The patients showed a progression of the disease evidenced by the scores on the MMSE, ADL and CDS scales. However, the frequency and severity of the noncognitive symptoms remained identical except for eating disorders, psychotic symptoms and agitation which were more frequent at the second examination and negatively correlated with the MMSE score. Most patients showed affective disturbances and scored high for apathy and anxiety-emotional incontinence dimensions. Like in a previous study, we found a double dissociation between these two dimensions in some patients, suggesting that they depend from different mechanisms. Agressivity, mostly verbal, was found in three quarters of the patients and was correlated to apathy, anosognosia and psychotic symptoms. CONCLUSION: The relationship between noncognitive manifestations and cognitive deficits in AD is not clear, suggesting that they depend from different biological and psychological mechanisms. Various dimensions may be described in the behavioural disturbances but their relationship with hypothetical biological mechanisms remains difficult. Our study stresses the importance of apathy, which was corelated with various noncognitive psychobehavioral manifestations in AD patients.

Affect↗
PubMed2000

[Diagnosis of Alzheimer's disease in the predementia phase: possibilities and benefits].

THE PREDEMENTIA PHASE: Alzheimer's disease is a progressive condition. The state of dementia defined by international criteria only appears after brain lesions have become important. Dementia is defined by the presence of multiple cognitive deficits and restricted independence. Prior to this, the patient experiences isolated memory impairment, either alone or associated with behavior changes which have little effect on his/her independence (predementia phase). The goal of diagnosis at this time is to reduce psychic suffering for the patient and family as well as the social cost of the disease by retarding the onset of dementia. DIAGNOSIS IN THE PREDEMENTIA PHASE: Diagnosis is based on i) evidence of an alteration of the internal temporal regions leading to memory deficit due to impaired memorization processes. There is an elective impairment of recent memory rapidly leading to difficulties perceived by the family and which diminish performance in complex activities of daily living. Recall processes lose their efficacy. ii) Tomoscintigraphic evidence of a perfusion defect or structural imaging evidence of atrophy of the hippocampal regions. iii) Presence of associated psychoaffective changes (apathy). When these three elements are found, the diagnosis of Alzheimer's disease is highly probable and should be made. If all three are not present, it would be advisable to diagnose what is termed "mild cognitive impairment", defined as a group of subjects with a high risk of progressing to dementia in a few years. PATIENT CARE AT THIS PHASE: Neuroprotective drugs may be prescribed in association with psychological and cognitive support within the framework of regular follow-up.

Aged↗
PubMed2000

Apraxic disturbances in patients with mild to moderate Alzheimer's disease.

Twenty-two patients meeting the NINCDS-ADRDA diagnostic criteria for probable AD were included in the study, along with 10 matched controls. Praxic disturbances were investigated using eight tasks and the results were interpreted according to the neuropsychological model of Roy and Square modified by Rothi et al. (1988) [Aphasiology 21:381-388] which distinguishes a conceptual system concerned with knowledge of the action and function of gestures and a production system that effects gestures in the environment. Disturbance of the production system was found only in 17 patients. Disturbance of the production system was correlated to disturbance of verbal comprehension. The patients scored lower using the left hand than the right. Disturbance of the conceptual system was found in all patients and was not significantly correlated with other cognitive deficits. No significant difference in results was found according to the type of input to the conceptual system (visual or verbal). Deficits in tasks using real objects were correlated to disturbances of both the production and conceptual systems. Most patients performed poorly both in tasks exploring the conceptual system and in those exploring the production system. However, two patients performed badly in production tasks but had performances in the range of controls for conceptual tasks and one patient had the opposite pattern of dissociation. This provides evidence that the production and the conceptual system are independent. Impairment in the ability to perform everyday activities was correlated to disturbances of the conceptual system whereas poor performances in tasks exploring the production system or in using real objects were not.

Activities of Daily Living↗
PubMed2000

[Neurology in Paris hospitals, particularly the Salpêtrière before Charcot: Rostan on brain softening].

In the beginning of the 19th century, many studies were devoted to the diseases of the nervous system in France, long before the work of Charcot. The researches of Léon Rostan on the cerebral softening (1819, 1823) were based on the anatomoclinic method developed by the School of Paris whose most famous representatives were Corvisart and Laennec for the study of heart and lung diseases. The researches of Rostan were performed in the Salpêtrière hospital which was, at this time, an hospice for old women. Rostan was appointed Inspector of the Health service in the Salpêtrière hospital in 1812 then Head of a department in 1818. He was 28 year old when he published his book "Researches on the cerebral softening" in 1819. Rostan was the first to describe the spontaneous cerebral softening as a special anatomoclinic entity distinct from encephalitis and apoplexy. He compared this entity to the senile gangrene and stated that it was related to the ossification of cerebral arteries. He described the pathologic features of the brain softening and also its clinical symptomatology in opposition to that of apoplexy. The concept of brain softening according to Rostan was harshly fought by the followers of the Broussais's physiological medicine (from Lallemand, 1830 to Calmeil, 1859) who claimed that all brain softenings were due to the inflammation process and thus should be described as encephalitis. In opposite, the ideas of Rostan were accepted and developed by others such as Carswell in England (1835), Abercrombie in Scotland (1836) and Andral in France (1827, 1840). These authors agreed that some type of cerebral softening was related to a disease of the arterial system. Nevertheless, the modern concept of brain softening was not definitively accepted before the description of the thromboembolic mechanisms by Virchow in Germany (1856) with the help of the microscope, and the anatomoclinic studies of Proust, Laborde and Prevost and Cottard in France (1866). The book of Rostan was dedicated to the "Conseil Général des Hospices" which was created in 1801 to unify the administration of the hospitals in Paris and became the "Administration Générale de l'Assistance Publique à Paris" in 1849. One hundred and fifty years after its publication, the work of Léon Rostan was outstanding by its modernity of the form as well as the substance.

Cerebrovascular Circulation↗
PubMed2000

[Memory and affect].

In the last decade, numerous studies have been devoted to the cognitive approach of emotions and their relationship with memory. Cognitive neuropsychologists consider affectivity as a contextual factor which can facilitate the processes of encoding or restitution. It is not clear if emotions are memorized by the same processes as the neutral stimuli. In man, a dissociation was found between loss of memory for affective stimuli in subjects with lesions restricted to amygdala and loss of memory for neutral stimuli in subjects with lesions limited to hippocampus. Experimental studies showed that recall of neutral material was better if subjects were in the same mood at the time of recall as during the time of encoding (mood dependency). Other studies showed that subjects had better memory for material with an affective valence corresponding to their mood than for material with a different affective valence (mood congruency). The discrepancy between the results of various experimental studies on mood and memory are related to methodological difficulties and different theoretical approaches. Studies on autobiographical memory showed that some emotional memories can be specially vivid or persistent (flashbulb memories, Post-Stress Traumatic Disorder) but, in the opposite, that strong emotion can result in lacunar amnesia.

Affect↗
PubMed1999

Automatic attentional shifts induced by a noradrenergic drug in Alzheimer's disease: evidence from evoked potentials.

Prior research showed that attentional deficits are observed in Alzheimer's disease (AD). These deficits can further impair other cognitive processes. The present experiment was designed to study the shifts in attention induced by a noradrenergic drug (S 12024-2) through their electrophysiological correlates in 12 outpatients with mild AD, using an auditory oddball paradigm. The P3a component, known to be related to automatic attentional processing, was increased by the drug, whereas no changes occurred either in PN or in P3b, which are considered to reflect conscious processing. These results point to an involvement of the noradrenergic system in the modulation of automatic attentional processing, and provide evidence for weakening of the orienting reflex in AD, due to a possible noradrenergic deficit in patients with mild AD.

Adrenergic Agents↗
PubMed1999

Memory complaints in young and elderly subjects.

OBJECTIVE: To compare the quantitative and qualitative aspects of memory complaints in cognitively normal subjects aged under and above 50 years. SETTING: A memory clinic located in a general hospital in a suburb of Paris offering direct access to subjects. DESIGN: Retrospective review of the files of consecutive patients who attended the clinic during one year. PARTICIPANTS: Subjects were included if (a) they presented with memory complaints, (b) they had normal general cognitive functioning according to age and educational level, (c) they were devoid of present or past history of neurologic or psychiatric disorders. METHODS: Subjects rated the severity of memory complaints as major or minor and filled in a 8-item questionnaire assessing various memory difficulties in everyday life. Relationship between severity of memory complaints and demographic data, memory performance and affective status was compared in 183 non-depressed, non-cognitively impaired healthy adults aged 50 years and over, and in 77 younger adults. RESULTS: Semiologic aspects and correlates of memory complaints were similar in younger and older adults. No close relationship was found between severity of memory complaints and memory performance. In both age groups, memory complaints were strongly related to affective status, mainly to the severity of anxious symptomatology. Memory complaints were related to gender in younger subjects, and to subjective assessment of well-being in older. CONCLUSION: Memory complaints of elderly do not appear basically different from memory complaints of younger subjects. They constitute a complex psychological symptom unlikely to be explained by a few variables and cannot be reduced to the subjective counterpart of memory performance decline associated with age.

Adult↗
PubMed1999

[Cerebral lacunae: still under debate].

During the last fifteen years, a new interest has been shown in cerebral lacunes due to the development of brain imagery using Magnetic Resonance Imaging (MRI). The concept of lacunar infarction as defined par Fisher (lacunar hypothesis) can no longer be accepted. Clinical data showed that the so-called lacunar clinical syndromes were far from being specific and could be observed in corticosubcortical infarcts. Epidemiological data pointed out that hypertensive disease was not found in many cases of lacunar infarction. Pathological studies suggest that there are two types of lacunar infarction. Lacunar infarcts resulting in clinical stroke syndromes (type 1 a lacunae) seem to be mainly due to obstruction of the trunk of a perforating artery by atherosclerosis. Silent lacunar infarcts (type 1 b lacunae) result from obstruction of small ramifications of the perforating arteries by a non specific microangiopathy related to age, atherosclerosis, cardiovascular disease as well as to hypertensive disease. Silent lacunar infarcts and dilatation of perivascular spaces (type 3 lacunae) are associated with the white matter hyperintensities shown by MRI in elderly subjects. Lacunar infarcts and diffuse white matter hyperintensities are related to small vessel changes and ischaemic damages resulting from (a) arteriolar occlusion and or (b) loss of autoregulation associated with variations in systemic blood pressure. Both lesions constitute a high risk to develop Vascular Cognitive Impairment (Hachinski) and are frequently associated with Alzheimer's disease. Cases of giant or expanding type 3 lacunae have been reported in the last ten years but the physiopathology of such lacunes and their relationship with clinical symptoms remain a puzzle.

Aged↗
PubMed1999

Decreased awareness of cognitive deficits in patients with mild dementia of the Alzheimer type.

OBJECTIVE: To study the unawareness of cognitive deficits in patients with mild dementia of Alzheimer type (DAT). DESIGN: Retrospective study. We surveyed the medical records of outpatients meeting the NINCDS-ADRDA criteria for probable DAT who were able to complete the Cognitive Difficulties Scale (CDS) and had a close informant relative (IR) who could complete the family form of the same questionnaire. SETTING: A department of neurology in a general teaching hospital. SUBJECTS: Eighty-eight patients, aged 73.2+/-8.6 years with a mean MMSE score of 22.5+/-3.2. Fifty-two of the 88 patients had a follow-up examination after a mean interval of 21 months. METHODS: Awareness of cognitive deficits was mainly assessed as the difference between the scores on the CDS completed by the IR and the patient (Index of Unawareness, IU). Two secondary assessments of unawareness were performed: (1) an assessment by the clinician on the basis of the patient's answers to questions probing the awareness of memory deficits; (2) an evaluation by the IR of the frequency of behavioural manifestations of unawareness in everyday life. SPECT was performed in 78 patients to study the relationship between unawareness and the topography of perfusion deficits. RESULTS: Awareness of the cognitive deficits varied greatly between patients, according to the assessment method used and the stage of progression of the disease. Most patients with mild DAT were cognitively aware of their cognitive deficits but failed to appraise their severity and their consequences in everyday life. Decreased awareness was positively correlated with age and perfusion deficits in the frontal regions and negatively with the anxious symptomatology. However, the main correlate of unawareness was apathy. CONCLUSION: The nature of unawareness of cognitive deficits appeared to be more dimensional than categorical. In patients with mild dementia, decreased awareness appeared to be more related to affective disturbances, especially to emotional deficit or apathy, than to cognitive deficits.

Affect↗
PubMed1998

[Non-drug management of Alzheimer's disease].

The recent appearance of drugs offering some efficacy has been a major advance in the treatment of Alzheimer's disease. However, non drug therapy of the patients and caring for family members remain the main elements to delay institutionalization. General practitioner has a major role in this approach whose aims are identification and treatment of excess disability, understanding and control of psycho-behavioral manifestations, sustaining and stimulation of cognitive functions and communication, maintaining the patient's autonomy and alleviating of the caregiver's burden. A major point of this approach is to consider the disease manifestations not only as the consequence of brain lesions but also as the impact of the disease on the affective and relational functions of the subject.

Alzheimer Disease↗
PubMed1998

Entropy maps characterize drug effects on brain dynamics in Alzheimer's disease.

Non-linear quantifiers of brain electrical dynamics (entropy maps computed from the degradation of temporal forecasting of EEG signals) were studied in relation to drug treatment of Alzheimer's disease. A placebo condition was compared to three drug doses (50, 100 and 200 mg). A significant general effect of the drug was found when compared to placebo and specific contrasts between placebo and each of the three drug doses only reveal a significant entropy increase for the highest dose. These effects were localized bilaterally in fronto-temporal areas and support changes in the dynamics of the cerebral structures involved in memory processes.

Acoustic Stimulation↗
PubMed1997

[Electrophysiologic study in a patient presenting with expanding cerebral lacunae].

A 42-year-old man was affected with multiple cerebral lesions suggesting expanding lacunae. He had suffered for about 15 years of headaches and blurred vision. Neurological examination showed a Parinaud syndrome and a skew deviation. Magnetic resonance imaging showed an enlargement of the third and lateral ventricles and multiple intraparenchymatous lesions with a signal similar to that of the cerebrospinal fluid. These lesions were located in the mesencephalon and right thalamic region. Important discrepancies between the topography of the lesion and the clinical data were observed. Neurological examination, ocular movements during wake and neuropsychological testing suggested sub-cortical dysfunction. These results suggest functional rather than lesional repercussion of expansive lacunae.

Adult↗
PubMed1996

Utilization of the Draw a Person Test in the elderly.

The purpose of this study was to assess quantitative and qualitative changes that occurred in the drawing of the human figure during depression and dementia in the elderly. A modified scale version of the Draw a Person Test (DAP) is presented. The first study (80 subjects) enabled the reduction of the number of items from 73 to 20 according to interrater reliability and diagnostic sensitivity to differentiate patients with dementia from control subjects. The second study (160 subjects: 51 with dementia, 70 with major depression, 39 elderly controls) used this 20-item DAP for cognitive assessment. The second study also featured an additional qualitative assessment (DAP 50) considering five components based upon a projective examination of the drawings. Combination of the 20-item DAP and the DAP 50 provides a complete approach to patients in accordance with the affective dimension. Results showed the ability of the 20-item DAP to discriminate dementia from depression with a better cutoff score of 7 and the usefulness of the DAP 50 in the investigation of impaired components during depression and dementia in the elderly, with the goal of specifying key aspects of psychopathology in dementia.

Aged↗
PubMed1996

Sexual behavioral changes in Alzheimer disease.

The frequency and correlates of sexual behavioral changes in Alzheimer disease (AD) were assessed in two studies. In the first study, we reviewed the medical records of 135 consecutive community-living patients who fit the criteria of the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer Disease and Related Disorders Association for probable or possible AD, and we asked spouses to complete a questionnaire that included two questions about sexual activity. Indifference to sexual activity was reported by 70% of the spouses, and sexual behavioral modifications were reported by 50%. No correlation was found between sexual changes and the general characteristics of the patients, the severity of the disease, or depressive symptomatology. Sexual changes were correlated to the severity of behavioral and mood disorders, mainly to a reduction of activity and emotional deficit. Seventy-seven of the patients had a second examination after an interval of 18.9 +/- 9.9 months. The links between sexual changes and the other variables were similar to those found by the first examination. In the second study, a questionnaire was sent by mail to the spouses of 100 patients. No relationship was found between sexual changes and the severity of cognitive deficits, previous sexual agreement, age, or gender. Sexual changes were considered a factor of maladjustment for the couple by 46% of the spouses.

Aged↗
PubMed1996

Affective disturbances in Alzheimer's disease.

OBJECTIVE: To evaluate the emotional disturbances in patients with Alzheimer's disease (AD) using both a categorical and a dimensional approach. DESIGN: Prospective study. SETTING: Outpatient clinic in a neurological department from a general University Teaching Hospital. MEASURES: A semi-structured interview was used to fill in the Hamilton Depression Rating Scale, the Retardation Rating Scale for depression, the Tyrer and Covi scales for anxiety, and the Depressive Mood Scale for emotional disturbances. The cognitive status was assessed by the Mini-Mental State Examination and the Mattis Dementia Rating Scale. PATIENTS: One hundred eighteen consecutive AD outpatients fitting the criteria for probable or possible AD, according to the National Institute of Neurological and Communication Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, were compared with 34 community-dwelling healthy older controls and with 20 inpatients meeting the diagnostic criteria for depression according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition-Revised. RESULTS: No AD patient met the criteria for Major Depressive Episode or Generalized Anxiety Disorder, but 10 (8%) met the criteria for Dysthymic Disorder. AD patients scored significantly higher than the control group but lower than the depressed group for depressive and anxious symptomatology. Depressive symptomatology was correlated negatively to the cognitive status and positively to anxious symptomatology. Two main dimensions in emotional disturbances were described using the Depressive Mood Scale: Emotional Deficit (anhedonia, hypoexpressiveness) and Loss of Control (felt irritability, hyperexpressiveness). Emotional Deficit was correlated positively to the depressive symptomatology and correlated negatively to the cognitive status and the Loss of Control dimension. Loss of Control was correlated positively to the severity of the depressive and anxious symptomatology and weakly to cognitive performance. CONCLUSION: Affective changes were found frequently in AD patients, but no major affective disorder was found. The dimensional approach seems to be more appropriate than the categorical approach to describe the emotional disturbances in these patients.

Affect↗
PubMed1996

A special form of cerebral lacunae: expanding lacunae.

The case of a 42 year old man with headache, blurred vision, and diplopia allowed the description of a particular form of cerebral lacunae-that is, expanding lacunae. Brain MRI showed hydrocephalus and multiple lesions in the thalamomesencephalic region. The radiological features of these lesions were similar to the histological brain coronal section of a case reported in 1983 in which expanding lacunae were related to a dilatation of the perivascular spaces and a focal segmental necrotising angiitis. The role of the lymphatic drainage of the brain is discussed to explain the dilatation of the perivascular spaces. The hypothesis of a hydrodynamic factor being responsible for the expanding character of the lacunae was suggested by the location of the lesions and the influence of various clinical events on the symptomatology.

Adult↗