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Biomedical subjects

L Letenneur

Publications and source records attributed to L Letenneur.

At least 91 records · Page 5Linked to original sources
PubMed1994

[Factors associated with a 1-year development in the functional autonomy of elderly persons living at home].

The purpose of the study was to examine the incidence and reversibility of disability among elderly people over one year follow-up and to determine the predictors of functional changes. The population used in this analysis consisted in 1850 subjects aged 65 and over included in the PAQUID cohort and visited again at one year follow-up. Disability was measured by Katz's scale (Activities of Daily Living or ADLs), Lawton's scale (Instrumental Activities of Daily Living or IADLs) and a mobility scale. The one year incidence of the dependency was 5.6% for ADLs, 10.8% for IADLs, and 3.3% for mobility. Being dependent at baseline was associated with an increased risk of one year mortality comprised between 3.3 and 5.3 according to the measurement scale. Recovery back to independence was frequent however, especially for ADLs (44.7%) and mobility (28.9%). Predictors of disability were: age in all scales, vision impairment and Mini Mental State Examination score for IADL and mobility scales, depressive symptomatology for ADLs, female sex and breathlessness for IADLs. Absence of cognitive impairment at baseline was associated with recovery to independence in all scales.

Activities of Daily Living↗
PubMed1993

Four Instrumental Activities of Daily Living Score as a predictor of one-year incident dementia.

The purpose of the study was to estimate the risk of one-year incident dementia in elderly community dwellers, according to their performance on a four Instrumental Activities of Daily Living (IADL) score. From a random sample of 2792 French elderly community dwellers included in the PAQUID study, 1804 non-demented subjects were interviewed by specifically trained psychologists about their performance on telephone use, use of transport, responsibility for medication intake, and budget management, and then followed up. One year later 21 of these subjects had a diagnosis of incident dementia, according to DSM-IIIR criteria and confirmed by a neurologist. The odds ratio for incident dementia, adjusted for age, increased from 10.6 for subjects dependent in one IADL to 318.4 for those dependent in the four IADLs (p < 0.0001), compared with independent subjects. These four IADLs could be useful for screening subjects at high risk of incident dementia.

Activities of Daily Living↗
PubMed1993

The relationship between dyspnoea and main lifetime occupation in the elderly.

PAQUID is a prospective epidemiological study of mental and functional ageing. Based on the data collected during the baseline screening of this cohort, the present paper will examine the relationship between main lifetime occupation and the presence of dyspnoea in a representative sample of 3777 subjects aged > or = 65 years; living at home in the south-west of France. Subjects were considered dyspnoeic if they had a dyspnoea level 3, 4 or 5 according to the Fletcher classification. Occupational categories were determined according to the classification of the French 'Institut National de la Statistique et des Etudes Economiques,' and to the type of occupation for blue-collar workers. The proportion of dyspnoeic subjects varied significantly according to the occupational categories (from 13% for teachers to 37% for farm workers) and to the type of work (from 18% for printing workers to 41% for building workers). When age, sex, weight, smoking history, place of residence, educational level and some concurrent diseases were adjusted for, former farm workers (odds ratio [OR] = 3.3, 95% confidence interval [CI]: 2.0-5.6), farm managers (OR = 2.1, 95% CI: 1.3-3.5), domestic service employees (OR = 1.9, 95% CI: 1.2-3.6) and blue-collar workers (OR = 1.9, 95% CI: 1.3-3.0), had a higher risk of dyspnoea than subjects who used to have an intellectual occupation. The risk was not significant for other professional categories. These results demonstrate the important long-term effect of previous professional activities on respiratory health in the elderly.

Age Factors↗
PubMed1993

Diagnostic screen for assessment of the IHS criteria for migraine by general practitioners.

This study examines the sensitivity and specificity of a self-report screen for the diagnosis of migraine according to the IHS criteria in a sample of 1049 employees of the French National Railways. The diagnosis of migraine derived from the self-report instrument was compared to an unstructured diagnostic interview conducted by a neurologist specialized in the diagnosis and treatment of headache. The sensitivity of the diagnostic screen was poor, but the specificity was excellent. Optimal cut-off points for the questionnaire were determined by the Receiver Operator Characteristics (ROC) method. Assessment of the specific IHS criteria for migraine revealed that the following criteria failed to discriminate subjects with migraine from non-cases: "aggravation by physical activity" and "photophobia and phonophobia". Implications of the findings for modification of the IHS criteria were discussed.

Adult↗
PubMed1993

Cerebral and functional aging: first results on prevalence and incidence of the Paquid cohort.

Paquid is an interdisciplinary study designed to investigate cerebral and functional aging. A cohort of 3,777 community residents living in two administrative areas of South-Western France was selected. A standardized questionnaire was administered at home by trained psychologists. The same procedure was applied one and three years after the baseline data collection. The identification of demented subjects was made with a two-step procedure. The first step is a systematic screening by the psychologists using the DSM-III criteria for dementia. Subjects who fulfilled the DSM-III criteria were examined by a neurologist. Diagnosis of dementia is confirmed according to the NINCDS-ADRDA criteria. The Paquid cohort is complemented by a random sample of 357 institutionalized subjects. First results of prevalence and incidence rates show an exponential increase of dementia with age.

Aged↗
PubMed1993

[Prevalence of dementia in Gironde (France)].

The objective of the study is to estimate the prevalence of dementia using the data of the Paquid cohort. A sample of 3,149 subjects aged 65 years and older living at home or in institution was randomly chosen in Gironde (France). A questionnaire and psychometric tests were used to evaluate cognitive functioning and the presence of dementia was assessed through DSM III Diagnostic and Statistical Manual of mental disorders (ed. III) criteria. Hachinski scale and work group NINCDS-ADRDA criteria were applied to confirm the presence of dementia and identify Alzheimer's disease. Overall prevalence was estimated to 4.3%. No difference was found between men and women. The prevalence increased with age with nearly a doubling every 5 years of age. In institution, dementia frequency remained stable. The relative risk of a demented subject to be institutionalized with regard to a non demented subject decreased with age.

Aged↗
PubMed1992

Comparison of the proportions of affected relatives of cases and controls: analysis and minimum sample size formula.

The problem of familial aggregation has frequently been approached by comparing the proportion of affected relatives of index cases with the proportion of affected relatives of index controls. This type of study has an analogy with the case-control design and is frequently analysed as if it was one. It is however an essentially different design which may involve dependent observations. We show that conventional tests for comparing proportions of affected subjects are still valid with this design; we give a formula for computing the minimum sample size required to detect a given degree of aggregation measured by the intracluster correlation coefficient, which can be estimated very simply by the difference in proportions of affected relatives in the two groups.

Case-Control Studies↗
PubMed1992

Principal lifetime occupation and cognitive impairment in a French elderly cohort (Paquid).

The purpose of the present study was to examine the relation between principal lifetime occupation and cognitive performance with the initial data collected (1988-1989) in a cohort of 3,777 community residents of the area of Bordeaux, France, aged 65 years and older. Subjects were considered as cognitively impaired if they scored under 24 on the French version of the mini-mental state examination. Cognitive impairment was found to vary significantly across the different occupational categories. Results of the logistic regression show that age, sex, and educational level are significantly related to cognitive impairment. Moreover, after controlling for these and other covariates, farmworkers (odds ratio (OR) = 6.1, 95% confidence interval (CI) 3.3-11.4), farm managers (OR = 2.9, 95% CI 1.6-5.1), domestic service employees (OR = 2.8, 95% CI 1.5-5.1), and blue-collar workers (OR = 2.5, 95% CI 1.4-4.4) had a higher risk of cognitive impairment than did subjects who had an intellectual occupation. Follow-up of the cohort will permit precise determination of the role of principal lifetime occupation in subsequent cognitive deterioration. Occupational status should be taken into consideration when studying brain aging.

Age Factors↗
PubMed1992

Improving screening for dementia in the elderly using, Mini-Mental State Examination subscores, Benton's Visual Retention Test, and Isaacs' Set Test.

The Mini-Mental State Examination score is often used as a screening test for dementia. We studied its properties for a population of French community residents, using a sample of 2,792 randomly selected subjects in Gironde, France. When the traditional cutoff point 23-24 was used, we observed a sensitivity of 1.0 and a specificity of 0.77. We sought to increase the specificity of the test, while keeping sensitivity at 1.0, with the use of logistic regression analysis. We found (1) a specificity of 0.81 when "recall three objects" and "orientation to time" were added to the Mini-Mental State Examination score; (2) a specificity of 0.90 when Benton's Visual Retention Tests and Isaacs' Set Test of Verbal Fluency were added to the Mini-Mental State Examination score and subscores; and (3) no improvement in specificity when age and educational level were included in the analyses.

Age Factors↗
PubMed1992

Statistical description of the Mini-Mental State Examination for French elderly community residents. Paquid Study Group.

The distribution of total Mini-Mental State Examination (MMSE) scores, individual items, and groups of items were studied in French elderly community residents from a random sample of 2727 subjects. Serial seven, recall three objects, and copy pentagons had the lowest percentage of correct responses, while orientation to place, naming two objects, and three objects registration had the highest percentage of correct responses. The structure of correlation of the items was studied using Principal Components Analysis. The projection of the items on the first axis reflects the tendency of the items to vary in the same direction and is compatible with the fact that the MMSE items are all indicators of the same concept: cognitive performance. The second and third axes identify clusters of highly correlated variables and provide support for the internal validity of the MMSE score for a French population. The full MMSE score seems to be a valid instrument for the evaluation of cognitive performance in community-based elderly residents.

Aged↗
PubMed1992

Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers.

OBJECTIVE: To identify which Instrumental Activities of Daily Living (IADL) are related to cognitive impairment, independent of age, sex, and education; to assess the performance of an IADL score using these items in screening for cognitive impairment and dementia in elderly community dwellers. DESIGN: Survey based on the baseline interview of the PAQUID study on functional and cerebral aging. SETTING: Community survey in 37 randomly selected parishes in Gironde, France. SUBJECTS: Random sample of 2,792 community dwellers aged 65 and over (participation rate: 69%). MEASUREMENTS: Two-phase screening: (1) functional assessment, Mini-Mental State Examination (MMSE) and DSM-III criteria for dementia; (2) in DSM-III-positive patients, NINCDS-ADRDA criteria applied by a neurologist. Functional assessment: IADL scale of Lawton and Brody. Criterion standards: cognitive impairment: MMSE score lower than 24; dementia: DSM-III and NINCDS-ADRDA criteria. RESULTS: Four IADL items are correlated with cognitive impairment independent of age, sex, and education: telephone use, use of means of transportation, responsibility for medication intake, and handling finances. A score adding the number of IADL dependencies has a sensitivity of 0.62 and a specificity of 0.80 at the lowest cut-off point (score > 0) for the diagnosis of cognitive impairment. The same score at the same cut-off has a sensitivity of 0.94 and a specificity of 0.71 for the diagnosis of dementia. The prevalence of dementia (2.4%) is reduced by a factor of 12 in subjects independent for the four IADL. CONCLUSION: The four IADL score could be incorporated into the screening procedure for dementia in elderly community dwellers.

Activities of Daily Living↗
PubMed1992

The Paquid epidemiological program on brain ageing.

Paquid is an epidemiological study designed to gather and follow-up a cohort of 3,777 elderly subjects (65 years and older) living at home. In order to study normal and pathological brain ageing, these subjects were randomly chosen in the general population of 75 communities of Gironde and Dordogne, two administrative areas of South-Western France. The subjects were interviewed at home by trained psychologists and followed-up with the same procedure at 1, 3 and 5 years after the initial data collection. The identification of the demented cases is made with a two-stage design: the first stage is a systematic screening by the psychologists with application of the DSM-IIIR criteria and the second stage consists in a confirmation of the diagnosis by a neurologist according to the NINCDS-ADRDA criteria. Paquid is complemented by the study of a random sample of 357 subjects living in institutions in Gironde.

Activities of Daily Living↗
PubMed1992

Occupation during life and memory performance in nondemented French elderly community residents.

Using data obtained during the baseline screening of the PAQUID cohort, an epidemiologic study on brain aging conducted in the Bordeaux area of France, we studied the relationship between lifetime occupation and memory performance in visual recognition (Benton Visual Retention Test; BVRT) and verbal induced recall (Wechsler Paired Associates Test; WPAT) in 2,720 elderly community residents. Occupational category was strongly correlated with poor memory performance for both the BVRT and the WPAT. Independent of the educational level, the risk of having poor memory performance was two to three times greater for farmers, domestic service employees, and blue-collar workers than for professionals/managerials. Occupational category should be taken into account in future cross-national studies on brain aging.

Aged↗
PubMed1992

[Perceptions of consequences of chronic respiratory insufficiency in subjects over 65 years with home respiratory assistance. Apropos of 85 patients].

Chronic respiratory diseases (C.R.D.) induce changes in daily activities and mood for the patients who require respiratory assistance (oxygen delivery or ventilation). The aim of this study was to compare physical and social consequences of this disease. A self administered questionnaire was sent to one hundred patients, over sixty five years of age, who were affiliated with the "Association Limousine d'Aide aux Insuffisants Respiratories" (A.L.A.I.R.). The mean age was 72.4 +/- 0.66 (65-92), the mean PaO2 was 54 mm Hg +/- 0.2 (39-76). C.R.D. was stable during the study and treatments did not change. The questionnaire was composed of four scales and twenty-eight subjects; each item was weighed for importance. Subjects included: symptoms, mood, sleep, relationships with their wife or family, home activities. Eighty-five questionnaires were analysed. Reproductibility was good (92%) and non-responses to some questions was less than 10%. Coherence between the scales and the twenty-eight items was poor. Regression linear analysis found that only dyspnea was correlated with PaO2 (p < 0.007). For patients, the most important items were: abnormalities of home activities (37%), dyspnea (38%), relationships with their wife (39%) or family (45%), dependence (52%) and perception of A.L.A.I.R. (77%). Quality of life is an important concept for these patients with C.R.D. versus clinical symptoms. Perception of respiratory assistance is very good.

Activities of Daily Living↗
PubMed1991

[The Paquid research program on the epidemiology of dementia. Methods and initial results].

Paquid is an epidemiological study designed to gather and follow up a cohort of 4,000 elderly subjects (65 years and older) living at home in order to study normal and pathological brain aging. These subjects were randomly chosen in the general population of 75 communities of South-Western France. We present the results of the data collected from 2,792 subjects on the prevalence and the correlates of clinically diagnosed dementia. The DSM III criteria for dementia were met by 101 subjects (3.62 p. 100). These cases were reviewed by a neurologist to confirm the diagnosis and to determine the cause of dementia using the NINCDS-ADRDA criteria. Forty-three subjects were classified as probable Alzheimer's disease; 8 as possible Alzheimer's disease; 5 as vascular dementia; 5 as Parkinson's disease with dementia; 2 as alcoholic dementia; 2 as "dementified psychosis"; and 1 unclassified. Fifteen patients refused to be examined by the neurologist, 18 were false-positives, and 2 died before the neurologists visit. Using the NINCDS-ADRDA criteria, the prevalence of dementia was as low as 1.6 p. 100. The prevalence of probable Alzheimer's disease decreased dramatically as educational level increased, lung 5.4 p. 100 for subjects with no education, 1.7 p. 100 for subjects with grade school level, 0.4 p. 100 for subjects with high school level and 0.4 p. 100 for subjects with university degrees. The relationship between dementia and educational level is still controversial in the literature. In this study the sample was large and randomly selected; all the demented cases fulfilled the NINCDS-ADRDA criteria. This suggests that educational level is indeed an important correlate of dementia in the French elderly community.

Aged↗
PubMed1990

Validity of the Mini-Mental State examination as a screening instrument for cognitive impairment and dementia in French elderly community residents.

A survey was made of 2,792 subjects aged 65 and older living in the community of Gironde (South-Western France). The predictive value of the Mini-Mental state examination (MMS) as a screening instrument for the detection of cognitive impairment was tested against DSM-III criteria for dementing syndromes. Of the 2,792 subjects who consented to participate in the study, 101 met the DSM-III criteria for dementia, giving a 3.62% prevalence rate. With an MMS threshold of 24, the sensitivity was 100%, the specificity was 78%, and the positive predictive value was equal to 15%. Using the same MMS threshold, 572 subjects (85%) were false-positive for the diagnosis of dementia. A multiple logistic regression analysis revealed that age, sex, depressive symptomatology and educational level were independently correlated with false-positive cases of the MMS. Several issues are raised for using the MMS as the only screening instrument for cognitive impairment in elderly community residents.

Aged↗