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Biomedical subjects

L Letenneur

Publications and source records attributed to L Letenneur.

At least 19 recordsLinked to original sources
PubMed2005

Correlates of regular fish consumption in French elderly community dwellers: data from the Three-City study.

OBJECTIVE: Several studies have found an inverse association between fish consumption and risk of dementia. The objective of this study was to describe the characteristics of older fish consumers, in order to identify potential confounders in this relationship. DESIGN: Cross-sectional analysis of the baseline data of a prospective cohort study. SETTING: Bordeaux, Dijon, and Montpellier (France) in 1999-2000. SUBJECTS: A total of 9280 community dwellers aged 65 y and above participating in the baseline examination of the Three-City Study. INTERVENTIONS: All participants answered a face-to-face interview and underwent a physical examination. Cross-sectional analyses were performed by logistic regressions. RESULTS: Regular fish consumers (at least weekly) had a higher education (OR from 1.19 to 1.65, P = 0.0003) and income (OR from 1.37 to 1.89, P < 0.0001). Controlling for age, sex, education, and city, they had a higher consumption of pulses, fruit, and vegetables (P < 0.001). They were more often alcohol drinkers (P < 0.0001). They felt in better health (P < 0.05), exhibited less depressive symptoms (P < 0.001), and scored higher on the Mini Mental Status Examination (P < 0.05). However, their objective physical health status was not better, except that they were leaner. They suffered more often from hypertension and past stroke. CONCLUSIONS: Socioeconomic status, dietary habits, depression, and vascular risk factors could act as confounders in the relationship between fish consumption and risk of dementia.

Aged↗
PubMed2005

Aging affects the retinoic acid and the triiodothyronine nuclear receptor mRNA expression in human peripheral blood mononuclear cells.

BACKGROUND: Inadequate retinoid status has often been described as occurring with aging. Moreover, subclinical hypothyroid status has also been evoked in the elderly. Several studies performed in animals have described the crucial incidence of age-related hypo-functioning of retinoid and thyroid signalling pathways, particularly in the brain. OBJECTIVE: The aim of the present study was to clarify whether aging modifies retinoid and thyroid signalling in humans. METHODS: Using real-time RT-PCR the relative amount of mRNA of the retinoid (RARalpha, RARgamma and RXRalpha) and thyroid (TRalpha and TRbeta) nuclear receptors in peripheral blood mononuclear cells (PBMC) of young (24-57 years old, n = 22) compared with elderly (69-90 years old, n = 24) healthy subjects was quantitated. Classical plasma parameters used to characterize the retinoid and thyroid status - retinol (ROH), retinol-binding protein (RBP), free triiodothyronine (FT3) and thyroxine (FT4), thyroid-stimulating hormone (TSH) and transthyretin (TTR) - were also assessed. RESULTS: RARgamma expression was significantly decreased in elderly versus young subjects while no modification of the retinoid-related plasma parameters ROH and RBP were emphasized by aging. Concerning thyroid criteria, the elderly exhibited an increase in TSH concentration (+39%) without significant modifications of FT3 and FT4, which indicated an age-related sub-clinical hypothyroidism. Concurrently, the amount of TR mRNA (alpha as well as beta subtypes) was significantly decreased in the elderly. CONCLUSION: These data constitute the first evidence of an age-related hypo-activation of the retinoid and thyroid nuclear pathways in PBMC. Further study of the possible association between the expression of the retinoid and thyroid nuclear receptors and age-related cognitive alterations in humans would be interesting.

Adult↗
PubMed2004

Effect of smoking on global cognitive function in nondemented elderly.

BACKGROUND: Contrary to early case-control studies that suggested smoking protects against Alzheimer disease (AD), recent prospective studies have shown that elderly who smoke may be at increased risk for dementia. OBJECTIVE: To examine prospectively the effect of smoking on cognition in nondemented elderly. METHOD: In a multicenter cohort, the European Community Concerted Action Epidemiology of Dementia (EURODEM), including the Odense, Personnes Agées Quid (Paquid), Rotterdam, and Medical Research Council: Ageing in Liverpool Project-Health Aspects (MRC ALPHA) Studies, 17,610 persons aged 65 and over were screened and examined for dementia. After an average 2.3 years of follow-up, 11,003 nondemented participants were retested. Excluding incident dementia cases and those without baseline information on smoking gave an analytical sample of 9,209 persons. Average yearly decline in Mini-Mental State Examination (MMSE) score was compared among groups, adjusting for age, sex, baseline MMSE, education, type of residence, and history of myocardial infarction or stroke. RESULTS: MMSE score of persons who never smoked on average declined 0.03 point/year. The adjusted decline of former smokers was 0.03 point greater and of current smokers 0.13 point greater than never smokers (p < 0.001). Higher rates of decline by smoking were found in men and women, persons with and without family history of dementia, and in three of four participating studies. Higher cigarette pack-year exposure was correlated with a significantly higher rate of decline. CONCLUSION: Smoking may accelerate cognitive decline in nondemented elderly.

Age Distribution↗
PubMed2004

Incidence and mortality of Alzheimer's disease or dementia using an illness-death model.

We present an illness-death model for studying the incidence and the prevalence of Alzheimer's disease or dementia. We argue that the illness-death model is better than a survival model for this purpose. In this model the best choice for the basic time-scale is age. Then we present extensions of this model for incorporating covariates and taking account of a possible effect of calendar time. Calendar time is introduced via a proportional intensity model. We give the likelihood for a mixed discrete-continuous observation pattern from this model: clinical status is observed at discrete visit-times while the date of death is observed exactly or right-censored. The penalized likelihood approach allows to non-parametrically estimate the transition intensities. Application on the data of the Paquid study allows to produce estimates of the age-specific incidence of dementia together with mortality rates of both demented and non-demented subjects. Then the effect of calendar time and educational level are studied. Low educational level increases the risk of dementia. The risk of dementia increases with calendar time while the mortality of demented subjects decreases. The most likely explanation of this result seems to be in a shift in the diagnosis of dementia towards earlier stages of the disease prompted by a change in the perception of dementia and the arrival of new drugs.

Alzheimer Disease↗
PubMed2004

[Normative data for the MMSE, the Benton visual retention test, the Isaacs's set test, the digit symbol substitution test and the Zazzo's cancellation task in subjects over the age 70: results from the PAQUID Study].

UNLABELLED: Introduction. The aim of this study was to produce norms for the Mini-Mental State Examination, the Benton visual retention test, Isaacs's set test, the digit symbol substitution test and Zazzo's cancellation task (short 8-line version), in elderly people. METHODS: Data was collected in a representative sample of 1780 subjects aged 70 years and older, followed-up for five years after inclusion in the PAQUID study. Only individuals who did not have characteristics likely to alter their cognitive performance were considered. RESULTS: Descriptive statistics (median, tenth percentile, first and third quartile) were used to define gender-, age- and education-specific norms. CONCLUSIONS: These norms can be used by clinicians to interpret a patient's performance on several widely used cognitive tests according to the scores obtained by individuals of the same age, gender and educational level.

Aged↗
PubMed2004

Relationship between body mass index and different domains of disability in older persons: the 3C study.

OBJECTIVE: To study the relationships between body mass index (BMI) and different domains of disability in elderly subjects from the French 3C study. SETTING: Three cities in France: Bordeaux (South-West), Dijon (North-East) and Montpellier (South-East). DESIGN: Cross-sectional study. SUBJECTS: A sample of 8966 elderly community dwellers (age: 65-101 y). MEASUREMENTS MAIN OUTCOME MEASURES: BMI, continence, basic and Instrumental Activities of Daily Living (ADL and IADL) and mobility. Adjustment variables: age, educational level, lifestyle, cognitive functioning, smoking and drinking history, depression, dyspnea, diabetes and indicator of cardiovascular disease. RESULTS: Obesity (BMI> or =30 kg/m2) was significantly associated with disability in each domain for women. The relationship tended to be linear for ADL and for continence; whereas for IADL, underweight women (BMI <21 kg/m2) were also at higher risk of disability. In men, relationships were weaker since BMI was only associated with mobility restriction, with a higher risk for both underweight and obese subjects. CONCLUSION: These results are in favor of a strong association between obesity and the three domains of disability and incontinence. Weaker relationships between underweight and disability were observed. Results suggest that maintaining a BMI in the healthy range could contribute to independence in activities of daily living.

Activities of Daily Living↗
PubMed2004

Nutritional factors and risk of incident dementia in the PAQUID longitudinal cohort.

PURPOSE: The aim of this study was to present a summary of the results obtained in the PAQUID study regarding wine consumption, fish and seafood consumption and vitamin A and E plasma concentrations. METHODS: This study was carried out from the PAQUID (Personnes Agees QUID) cohort, an epidemiological study on cognitive and functional aging after 65 years in Southwestern France. The relationship between nutritional factors and risk of incident dementia was measured using logistic regression or Cox proportional hazards models on different subsamples of the cohort. RESULTS: Among 2950 initially non-demented subjects, moderate drinkers had a decreased relative risk of developing a dementia in the subsequent 8 years (RR=0.56) compared to non-drinkers. In a sub-sample of 1416 subjects, those who ate fish or seafood at least once a week had a significant reduced risk of incident dementia adjusted for age and sex (RR=0.66). Lastly, a nested casecontrol study was performed among 182 subjects. Adjusted for confounders, the risk of dementia was significantly increased for the lowest vitamin E concentration compared to the highest one (OR=2.54). DISCUSSION: These results are in agreement with a possible protective role of a diet rich in poly-unsaturated fats and antioxidant components. However, confounding factors such as education and lifestyle may be involved and should be further explored.

Aged↗
PubMed2004

Sociodemographic differences in dietary habits in a population-based sample of elderly subjects: the 3C study.

PURPOSE: Diet plays an important role in maintaining quality of life in ageing and can be influenced by sociodemographic factors. We aimed to describe dietary habits in a large population-based sample of elderly people and to explore how they may vary according to sex, age, educational level and lifestyle. METHODS: 9250 community dwellers aged 65 years and over recruited in three French cities were interviewed about their food habits with a brief frequency questionnaire. For each food considered, the subjects were classified as occasional or regular consumers. Quantities of alcoholic beverages consumed daily were also assessed. Dietary habits were compared for men and women separately according each sociodemographic factor. RESULTS: Women were characterized by a more regular consumption of fruit and vegetables and drunk fewer alcoholic beverages. Older subjects ate meat, fish, cereals, raw vegetables and pulses less regularly. The proportion of regular consumers of fish, raw fruit, raw vegetables and cooked fruit or vegetables and the quantity of alcohol consumed increased with educational level. Subjects living alone were less regular consumers of almost all foods. DISCUSSION: The results show that even in a sub-population of elderly people, dietary patterns can vary greatly according to several factors. Identifying such factors is of value for future analytic studies on nutrition and health in the elderly. In view of dietary recommendations advising a high consumption of fruit and vegetables, subjects living alone and people with a low educational level are particularly at risk and should be encouraged to eat more balanced meals.

Aged↗
PubMed2003

Body mass index and incidence of dementia: the PAQUID study.

To study the relationship between body mass index (BMI) and risk of dementia, a cohort of 3,646 individuals aged > or =65 years living at home and without cognitive disorders at baseline were followed up for 8 years (the PAQUID [Personnes Agées Quid] Study). Subjects with a BMI < 21 had an increased risk of developing dementia as compared with subjects whose BMI was between 23 and 26 (odds ratio = 1.48, 95% CI = 1.08 to 2.04). However, when individuals who developed dementia early during the follow-up were excluded from the analysis, this relationship was no longer significant. A low BMI does not in itself seem to be a risk factor for dementia.

Aged↗
PubMed2003

[Necrotizing enterocolitis and apnoeas-bradycardias of the preterm newborn].

UNLABELLED: We conducted a case control study during six and a half years with the objective to analyse the risk factors for NEC. POPULATION AND METHODS: All cases of confirmed NEC matched to controls for identical gestational age and period of hospitalization; apnoeas-bradycardias prospectively counted. RESULTS: Forty-five cases were compared to 89 controls. The isolated risk factors were: an intra-uterine growth retardation (OR = 3,65, 95% confidence interval [CI] 95%: 1,54-8,63); a birth weight < 1000 g (OR = 8,16, CI 95%: 1,17-56,62), compared to a weight >/= 1500 g; a triple antibiotherapy (OR = 6,15, CI 95%: 1,16-32,45); an umbilical venous catheterization (OR = 2,64, CI 95%: 1,09-6,44); a number of simple apnoeas-bradycardias >/= 3rd tercile (n = 27) (OR = 4,54, CI 95%: 1,29-15,93), or severe (stimulated or with hypoxia) apnoeas-bradycardias >/= 3rd tercile (n = 8) (OR = 6,15, CI 95%: 1,59-23,75); an haemoglobin level lower than the 1(st) tercile (95 g/L) (OR = 5,90, CI 95%: 1,20-20,13); and milk thickening by Gumilk (OR = 2,78, CI 95%: 1,11-6,90). CONCLUSION: In the present practices, anoxo-ischemic factors during the first week of life do not represent an important risk of NEC; a great vigilance must be exercised for indications of the triple antibiotherapy and the treatment of apnoeas-bradycardias.

Apnea↗
PubMed2003

Association between antioxidant nutritional indicators and the incidence of dementia: results from the PAQUID prospective cohort study.

OBJECTIVE: To analyse the relation between antioxidant vitamins A, E, and malondialdehyde (MDA) lipoperoxidation product plasma concentrations with incident dementia. DESIGN: : A nested case-control within the PAQUID (Personnes Agées QUID) cohort. SETTING: The PAQUID population-based prospective cohort in southwestern France. SUBJECTS: Among 626 subjects with blood collection at baseline, 46 developed a dementia during the follow-up and were considered to be cases. Each case was matched (on age and sex) to three controls. RESULTS: Plasma vitamin E concentrations were lower among cases (mean value at 22.62 micromol/l (s.d.: 7.38) vs 24.99 (s.d.: 6.73 among controls). The same trend was observed for vitamin A concentrations, but the difference was not significant. On the contrary, MDA concentrations tended to be higher (mean value 1.35 micromol/l (s.d.: 0.53) vs 1.23 (s.d.: 0.44)) among cases. In logistic regression models, plasma values were split into tertiles. Adjusted for confounders, the risk of dementia was significantly increased in the lowest vitamin E tertile (< or =21.0 micromol/l) (OR=3.12, P=0.033) compared to the highest one (> or =25.5 micromol/l). The risk of Alzheimer's disease was also increased, with borderline significance (OR=3.06, P=0.053). Risks associated with vitamin A were nonsignificant. Similarly, there was a trend to an increased risk of dementia in the highest tertile of MDA (OR=1.67, P=0.31). CONCLUSIONS: These results suggest that subjects with low plasma vitamin E concentrations are at a higher risk of developing a dementia in subsequent years.

Aged↗
PubMed2003

[Prevalence of dementia and Alzheimer's disease among subjects aged 75 years or over: updated results of the PAQUID cohort].

The progression of the prevalence of dementia in developed countries will increase the difficulties of medical and psycho-social management of demented patients and their family. The aim of this study was to estimate the prevalence of dementia among subjects aged 75 years and over. These subjects have been followed-up ten years after the baseline examination of the PAQUID study, a prospective population-based cohort study on normal and pathological aging after 65 years. A total of 1,461 subjects, aged 75 years and over, have been visited. The prevalence of dementia was estimated to be at 17.8 p.cent. About 38.5 p.cent of these demented subjects ware living in an institution, which leads to the fact that more than the two thirds of the subjects living in an institution were demented persons. Alzheimer's disease was the main etiology of dementia (79.6 p.cent). Based on the French population census, currently there would be about 769,000 demented people aged 75 years or over in France. Dementia accounts for 72 p.cent of the potential need for the French subvention for dependent persons, called Allocation Personnalisee d'Autonomie P. These results point out the importance of regarding dementia as a Public Health priority and of developing necessary measures for caring for these subjects, whether residing in their home or an institution.

Activities of Daily Living↗
PubMed2002

Incidence and outcome of mild cognitive impairment in a population-based prospective cohort.

OBJECTIVE: To estimate the age-specific incidence rate of mild cognitive impairment (MCI) according to sex and educational level and to explore the course of MCI, particularly its progression to AD, in a population-based cohort. METHODS: A community-based cohort of nondemented elderly people (Personnes Agées QUID [PAQUID]) was followed longitudinally for 5 years. MCI was defined as memory complaints with objective memory impairment, without dementia, impairment of general cognitive functioning, or disability in activities of daily living. Incidence rates were calculated using the person-years method. A descriptive analysis at the different follow-up times was performed to study the course of MCI. RESULTS: At baseline, there were 58 prevalent cases of MCI (2.8% of the sample). During a 5-year follow-up, 40 incident cases of MCI occurred in 1,265 subjects at risk. The global incidence rate of MCI was 9.9/1,000 person-years. MCI was a good predictor of AD with an annual conversion rate of 8.3% and a good specificity, but it was very unstable over time: Within 2 to 3 years, only 6% of the subjects continued to have MCI, whereas >40% reverted to normal. CONCLUSIONS: Conventionally defined MCI has reasonable predictive value and specificity for AD. However, MCI was very unstable across time in this study. Furthermore, the definition of MCI seems to be too restrictive and should probably be extended to other categories of individuals also at high risk of developing AD.

Activities of Daily Living↗
PubMed2002

Longitudinal analysis of the effect of apolipoprotein E epsilon4 and education on cognitive performance in elderly subjects: the PAQUID study.

BACKGROUND: The apolipoprotein E (apoE) epsilon4 allele has been shown to be a risk factor for dementia, but it is not clear to what extent apoE affects overall cognitive function in non-demented elderly subjects, or how this risk may be modified by gene-environment interactions. OBJECTIVE: To examine changes in cognitive function in elderly people as a function of the apoE epsilon4 phenotype. METHODS: A community based prospective cohort study of 600 non-demented subjects aged over 65 years living in Gironde (France) was analysed to evaluate change over time (seven years) in scores on the mini-mental state examination (MMSE). RESULTS: Age at cohort inception was negatively associated with cognitive performance for both epsilon4 carriers and non-carriers (p < 0.001). The evolution of MMSE scores differed as a function of age: scores remained stable among younger subjects but decreased over time in older subjects. The epsilon4 allele was shown to be significantly associated with lower cognitive performance at baseline (p = 0.02). The course of cognitive performance during the follow up was the same for both epsilon4 carriers and non-carriers. Lower educational level was associated with lower cognitive performance at baseline (p < 0.001) and the effect of an epsilon4 allele on cognitive performance disappeared after adjustment for education. When incident cases of dementia were excluded, the results were unchanged except for the course of the MMSE scores, which now remained stable over time in the older subjects. CONCLUSIONS: apoE epsilon4 carriers show decreased MMSE scores compared with epsilon4 non-carriers, but the effect of apoE on cognition disappears after adjustment for education. Non-demented elderly people maintain a stable cognitive performance regardless of their apoE phenotype.

Aged↗
PubMed2001

Mortality with dementia: results from a French prospective community-based cohort.

Despite the magnitude of the problem, little is known about the duration of dementia. Survival and risk factors of mortality with dementia and the impact of dementia on the risk of death were investigated using the Personnes Agées Quid (PAQUID) prospective population-based cohort study between 1988 and 1998. Statistical models dealing with interval censoring were performed. Among 3,675 participants aged 65 years or older and initially nondemented, 2,923 have been followed up for 8 years. Of these, 281 persons with incident dementia were actively diagnosed. The mean age of onset of dementia was 82.3 years. In the total population, the relative risk of dying after developing dementia was estimated to be 1.82 (95% confidence interval (CI): 1.77, 2.68) when adjusted for sociodemographic variables and comorbidity. Deaths from cerebrovascular diseases and respiratory diseases were particularly increased among persons with dementia, compared with those without. The median survival time of the persons with dementia was estimated to be 4.5 years. Women with dementia had a longer survival than did men with dementia, particularly for Alzheimer-type dementia (relative risk = 0.47, 95% CI: 0.27, 0.83). Educational level was not significantly associated with survival in persons with dementia. These results provide further evidence of the malignancy of dementia, which will be a challenge for the 21st century.

Age of Onset↗
PubMed2001

Benzodiazepine use in an elderly community-dwelling population. Characteristics of users and factors associated with subsequent use.

OBJECTIVES: The objective of this study was to describe determinants of current and subsequent benzodiazepine use in an elderly population, the Paquid cohort. METHODS: The study was conducted on a cohort of 2,792 community-dwelling subjects 65 years of age or more living in the Gironde department, southwestern France. Benzodiazepine use and its correlates were studied with data collected at inclusion in the cohort. Longitudinal analysis over a 5-year period of follow-up was done to identify baseline predictors of subsequent use. RESULTS: At baseline, prevalence rate of benzodiazepine use was 31.9%. It was associated with female gender [odds ratio (OR) = 2.0; 95% confidence interval (CI): 1.66, 2.46], previous psychiatric disease (OR = 2.87; 95% CI: 2.31, 3.56), concomitant antidepressant use (OR = 2.45; 95% CI: 1.59, 3.78), depressive symptomatology (OR = 1.70; 95% CI: 1.28, 2.26), multiple drug use (OR = 1.82; 95% CI: 1.50, 2.21), multiple chronic diseases (OR = 1.37; 95% CI: 1.12, 1.67) and poor self-perceived health (OR = 1.63; 95% CI: 1.33, 2.0). For the 1926 benzodiazepine non-users at inclusion and followed during 5 years, incidence rate of subsequent use was 5.37 per 100 person-years (95% CI: 4.76, 5.98). In multivariate Cox proportional hazards regression analysis, previous psychiatric diseases, poor self-perceived life satisfaction and polymorbidity were significantly associated with subsequent benzodiazepine use. CONCLUSIONS: Elderly people are heavy users of benzodiazepines. Independently from mental health status, those in poor health were most at risk of benzodiazepine use.

Aged↗
PubMed2001

Dyspnea and 8-year mortality among elderly men and women: the PAQUID cohort study.

PAQUID is an epidemiological cohort which aims to study cerebral and functional factors of ageing. We have examined the relationship between dyspnea level at entrance into this cohort and mortality occurring during the subsequent 8 years. Dyspnea was evaluated by a questionnaire derived from a Fletcher's five-degree scale. Mortality was recorded during follow-up according to its date and cause. Of 2762 subjects (98.9%) initially giving their dyspnea level, 935 (33.5%) had died 8 years later including 444 (40%) men and 491 (29.4%) women. Mortality was closely related to dyspnea level (p < 0.0001) both in men and women, especially for grade 3 and over, even after adjusting on age, sex, smoking history and former occupation. These results show that dyspnea grade 3 or higher is an important predictive symptom of mortality, thus suggesting that this is a threshold defining the dyspneic subject.

Aged↗