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S Andrieu

Publications and source records attributed to S Andrieu.

At least 19 recordsLinked to original sources
PubMed2006

The GuidAge study: methodological issues. A 5-year double-blind randomized trial of the efficacy of EGb 761 for prevention of Alzheimer disease in patients over 70 with a memory complaint.

BACKGROUND: 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. METHODS: 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. CONCLUSION: The GuidAge study is the largest study carried out in Europe on the prevention of AD. Final results should be available in 2010.

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PubMed2005

[Consensus statement on severe dementia].

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary group of experts, including geriatricians, neurologists, epidemiologists, psychiatrists, pharmacologists, and public health specialists developed consensus recommendations about care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians, and specialists, based on the knowledge currently available (2005). The aim of care at all stages is to mitigate the quality-of-life of patient, caregiver, and family insofar as possible, combining care and future planning until the end of life. Management, to take into account problems including nutritional status, behavior disorders, and ability (or inability) to perform activities of daily living, must be global, multidisciplinary, and coordinated and must optimize use of local medical and social resources. The group also stressed the importance of clinical research to improve knowledge of disease course and assess management strategies and recommended specific area for research.

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PubMed2005

[Consensus statement on severe dementia].

Under the auspices of the French Society of Gerontology and Geriatrics, a multidisciplinary team including geriatritians, neurologists, epidemiologists, psychiatrists, pharmacologists and public health specialists developed a consensus on care for patients with severe dementia. They defined 21 recommendations for general practitioners, long-term care physicians and specialists based on knowledge available in 2005. At all stages of the disease, the objective of care is to improve as much as possible quality-of-life for the patient and his/her family, including a life project until the end of life. It is always possible to do something for these patients and their family: nutritional status, behavior disorders, and incapacities to deal with basic activities of daily life have to be taken in consideration. Resource allocation and proximity care have to be targeted. Research areas necessary to improve the care of patients with severe dementia has been selected.

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PubMed2005

Improved oral hygiene and Candida species colonization level in geriatric patients.

OBJECTIVES: This work consists in improving oral hygiene (OH) for elderly dependent people in long-term hospital care, in order to decrease the degree of colonization and the associated risk of developing oral candidiasis. As this population frequently suffers from such colonization and because it is difficult to install and practice OH care, a study protocol was designed at the request of geriatricians. The objective of the present study was to set up a programme of OH, applied by the care staff, and to monitor oral colonization of by Candida spp. BASIC RESEARCH DESIGN: We compared the levels of hygiene and Candida spp. colonization for a group of 110 long-term patients in geriatric departments at T1, when clinical data were collected and oral mycological samples taken before the OH protocol was applied, and at T2, during the postprotocol phase after 3 months of application, when the clinical data and sample collection were repeated. RESULTS: During these 3 months 11 patients died. These patients were excluded from the results, which are presented for matched series of the 99 patients still present at T2. Statistical analysis comparing the clinical and biological parameters at T1 and T2 established that there had been an improvement in OH: the 'adequate' level was reached for 72.4% of patients at T2 compared with 41.8% at T1 (P < 0.001) and the 'very inadequate' level was observed for 9.2% at T2 compared with 27.9% at T1 (P < 0.01). A reduction was observed in the number of patients showing the highest degree of C. albicans and C. glabrata colonization (> 50 colony forming units) from 41.9% at T1 to 24.9% at T2 (P < 0.05) and from 56.4% at T1 to 13.0% at T2 (P < 0.05) respectively. The number of patients with candidiasis fell significantly from 43.2% at T1 to 10.2% at T2. CONCLUSIONS: The OH protocol led to an overall decrease in Candida spp. colonization, a significant reduction in the number of candidiasis and an improvement in the level of oral and denture hygiene but vigilance is still necessary concerning OH care and the initial training of staff in specific care of the mouth.

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PubMed2005

Impact of nutritional status on the evolution of Alzheimer's disease and on response to acetylcholinesterase inhibitor treatment.

BACKGROUND: Weight loss is frequently observed in patients with Alzheimer's disease (AD), as observed in clinical practice and reported in the literature. However, information on the evolution of nutritional status and its impact on the prognosis of AD is still scarce. OBJECTIVE: Our aim was to determine the impact of nutritional status on the evolution of AD and on the response to treatment with acetylcholinesterase inhibitors (AChEI) by prospective one-year follow-up of AD patients living at home. METHODS: We studied a cohort of 523 patients with Alzheimer's disease referred from 1994 to 2002 to an Alzheimer centre. After diagnosis, they were followed for one year in a prospective observational study in clinical practice. At entry and every 6 months, patients underwent standardised neurocognitive and geriatric evaluation (MMSE, ADAS-cog, IADL, MNA, caregiver burden). These evaluations were accompanied by complete clinical examination, standard paraclinical investigations and recording of treatment received. RESULTS: Of our patients, 25.8% presented at inclusion a risk of undernutrition with an MNA score of 23.5 or less. During follow-up, the number of patients with rapid loss on the MMSE (3 points or more in one year) was higher in subjects who presented a risk of undernutrition at inclusion (53.6%) than in well-nourished subjects (43.2%) (P = 0.07). Similarly, increased dependence at one year was more frequent in subjects at risk of undernutrition at inclusion (57.7% versus 44.4%, P = 0.0219). The beneficial effect of AChEI treatment on cognitive function was not influenced by initial nutritional status; on the contrary, among the subjects at risk of undernutrition at inclusion, the risk of rapid loss on the MMSE in one year was decreased in subjects treated during follow-up compared with untreated subjects (43.9% versus 73.1% ; OR = 0.29; 95% CI = 0.10-0.83; P = 0.0219). This relationship was not found in subjects whose initial MNA score was greater than 23.5. CONCLUSION: Our work indicates that AD patients living at home with a caregiver are frequently at risk of undernutrition. Undernourished patients seem to present more rapid aggravation of the disease, but paradoxically, these patients appear to be those who best respond to AChEI treatment.

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PubMed2005

Recent data on the natural history of Alzheimer's disease: results from the REAL.FR Study.

OBJECTIVES: This paper aims to present the changes observed in the evolution of Alzheimer's disease (AD) in the cohort REAL.FR after one year by taking account new treatments and improved management. METHODS: Four hundred and ninety-eight patients recruited for the REAL.FR study were followed for one year with a standardized case report filled for each patient every 6 months. Changes in the status of these patients were evaluated on various levels: cognitive, functional, behavioural, global, nutritional, social, medical and caregiver burden. Specific treatments were also recorded. RESULTS: A high proportion of patients received specific treatment for AD throughout the year (86%), mainly acetylcholinesterase inhibitors (AChEI) . As expected we observed statistically significant changes in cognitive function (MMS: -1.93 +/- 3.74, p < 0.0001 and ADAS-cog: +2.40 +/- 3.74, p < 0.0001), an overall loss of autonomy (ADL: -0.56 +/- 1.05, p < 0.0001 and IADL: -1.00 +/- 1.46, p < 0.0001), worsening of behavioral disturbances (NPI: +1.85 +/- 14.83, p=0.0047) and a deterioration of general status (CDRSB: +1.63 +/- 2.55, p< 0.0001). Even if the MNA score decreased not significantly, the loss was close to the threshold of significativity (MNA: -0.31 +/- 3.07, p=0.0531). CONCLUSION: We observed a statistically significant change for the worse in most parameters. However, it appears that this deterioration had been relatively slowed by non-pharmacological management and the specific AD treatments. This resulted in stability or improvement of the condition in 63.4% of patient at 1 year. The management proposed (including prescription of AChEI) seemed to have a real impact on the course of the disease during this first year of follow-up.

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PubMed2005

Changes in informal care over one year for elderly persons with Alzheimer's disease.

BACKGROUND: Informal caregivers play a major role in all types of assistance for elderly persons with Alzheimer's disease but few longitudinal studies reports change in this role over time. OBJECTIVE: The aim of our research was to describe the objective and subjective burden of informal caregivers of elderly persons with dementia of Alzheimer type, and to follow its evolution during one year. METHODS: A multicentre prospective study of 333 principal caregivers of patients with Alzheimer's disease, followed for one year. RESULTS: At inclusion, the majority of caregivers were involved in most tasks of assistance (activities of daily living, handling money, supervision, organisation of support services) but only 13.4% were involved in basic activities of daily living. As expected, during follow-up, the involvement of caregivers increased and extended to all tasks: whereas at inclusion 11.0% regularly assisted in all tasks, after only 12 months follow-up this figure rose to 28.9% (P < 0.001). Whereas 45.9% of caregivers became involved in carrying out new tasks (mainly organisation of support services and help with basic activities of daily living), 8.9% no longer carried out certain tasks (essentially supervision and organisation of support services), 7.3% replaced one task by another, and for 37.8% there was no change. During the same time, the mean burden experienced by the caregiver showed a very slight change (increasing from a mean score of 21.08 +/- 14.65 to 22.68 +/- 16.45, P = 0.044) with great variation between caregivers. Those who increased their involvement also had a significant increase in caregiver burden. CONCLUSION: While home caregiving appeared to follow an even course, the needs of the care recipient changed rapidly over time and caregivers differed in their response to these changes, indicating that regular follow-up is required.

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PubMed2005

Predictive factors for rapid loss on the mini-mental state examination in Alzheimer's disease.

OBJECTIVES: To seek predictors of rapid loss of cognition and to evaluate their frequency in a prospective study of patients suffering from Alzheimer's disease (AD). DESIGN: A one-year prospective study. METHODS: 312 AD patients from the memory clinic at Toulouse University Hospital, participants in the ELSA study, were enrolled. Rapid cognitive decline was defined as a 4-point or greater loss on the Mini-Mental State Examination (MMSE) in 6 months. Comprehensive geriatric and neuropsychological assessment was conducted at baseline, 6 months and one year. RESULTS: Seventy-nine (24.8%) patients presented rapid cognitive loss over 6 months. The majority were stable at one year whereas 15 experienced continued rapid cognitive loss. Multivariate analysis showed that only the Mini Nutritional Assessment score (MNA) was correlated with rate of decline. Patients with rapid cognitive decline were also significantly more dependent at 6 months. CONCLUSIONS: Our findings demonstrate that rapid cognitive loss is frequent in AD patients, probably indicating underlying frailty. Future studies should lead to a practical approach to detecting these frail patients and to increasing preventive interventions.

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PubMed2003

[Association between the A2 allele of the HLA system and age at onset of Alzheimer's disease].

OBJECTIVE: Alzheimer is a multifactor disease occurring in a sensitive genetic territory. The e4 allele of the apolipoprotein E (APO E) is a recognised factor of risk. Some studies have suggested an association between the A2 allele of the HLA system and an earlier onset of the disease notably when it appears before the age of 64 or after the age of 75. The aim of our study was to explore this hypothesis in an independent sample of patients. METHODS: We compared the influence of the A2 allele of the HLA system on the age at onset of the disease in two groups of Caucasian patients presenting with Alzheimer's disease: early onset if the disease appeared before the age of 60 (n= 31) and late onset if it had appeared after the age of 75 (n= 44). The influence of the e4 allele of APO E was also taken into account. RESULTS: The comparison of the patients depending on the presence or not of at least one HLA-A2 allele revealed no significant difference, whatever the group of patients studied, in the age at onset of the disease. CONCLUSION: The age at onset of Alzheimer's disease was not influenced in our study by the presence of the HLA-A2 allele.

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PubMed2003

[The French network multicenter study. Predictive factors of hospitalization and management of Alzheimer's disease patients (REAL.FR)].

We present in this article the REAL.FR research program on Alzheimer disease (AD) and its management. This is a French multicenter prospective study whose objectives are to study the natural history of AD and the modalities of its management. In order to pursue these aims, we set up a cohort of 700 AD patients in France. They entered the study in year 2000 and will be followed for at least four years. The study population consists of AD patients, living in the community at the time of enrollment and looked after by an informal caregiver. On inclusion, each patient underwent a full investigation which included gerontological and social evaluation. Patients will be seen every six months for at least four years. During follow-up, events which have occurred during the previous six months are noted (i.e. admissions to hospital or to an institution, use of new in-home help services...). To date, 577 patients have been reviewed at 6 month, 489 at 12 month, 358 at 18 month, 266 at 24 month, 178 at 30 month and 31 at 36 month. 48 death have been registered, 42 patients have been institutionalised and 124 have been dropped out. Mean age of patients on inclusion was 77.4 +/- 7 years. Nearly one-third of patients were living at home when they were enrolled in the study. Our preliminary results are encouraging regarding the feasibility of patients follow-up. The satisfactory participation of patients and their families in the later evaluations which have already been carried out also seem promising for the continuation of follow-up.

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PubMed2003

[Clinical evaluation of dementia in a cohort of 358 patients with the French version of the Clinical Dementia Rating (CDR) scale].

PURPOSE: A reliable global rating of dementia severity in Alzheimer's disease is critical both in clinical and research practice. In this paper, we present the results of the assessment of a cohort of 358 patients using the French version of the Clinical Dementia Rating Scale (CDR). METHODS: 358 patients from a multicentric cohort were assessed in a comprehensive way: cognitive (Mini Mental Status Examination), functional (Activities of Daily Living), behavioural (Neuro Psychiatric Inventory) and global (Global Dementia Scale). CDR staging was performed after both patient and caregiver interview. RESULTS: 27.6% of the patient had a CDR 0.5 (questionable dementia), 43% CDR 1 (mild dementia), 24.9% CDR 2 (moderate dementia) and 4.5% CDR 3 (severe dementia). All the rating scales were highly correlated with CDR stages (p < 0.0001). The CDR was also correlated with the Global Dementia Scale (p < 0.0001), but a perfect overlap of individual stages was not achieved. CONCLUSIONS: CDR staging takes into account the major domains of dementia assessment: cognition, function and behaviour. Staging Alzheimer's patients as CDR 0.5 arises the issue of the relationship between very mild dementia and Mild Cognitive Impairment. This study represents the first step of the CDR (French version) validation which is underway in this cohort.

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PubMed2003

[Patients with Alzheimer's disease living alone at home in the cohort of REAL.FR].

OBJECTIVE: Despite the French population's growing, we reported an increasing numbers of older adults living alone and an increasing number of older adults with Alzheimer's disease. Social and medical problems may be exacerbated with subjects with both phenomena. The objective is to identify differences in patterns between persons with dementia who live alone versus living with some people at home. METHOD: 700 subjects with mild to moderate Alzheimer's disease from the French Alzheimer network (REAL.FR). We studied social and demographic feature, nutritional and cognitive statute and a comprehensive geriatric assessment. RESULTS: In this study, 28% of subjects with probable or possible Alzheimer's disease live alone. They are more likely to be women (p < 0.001) with few physical impairments (p < 0.02). Subject are more frailty: lower incomes, impairment in the nutritional status and balance, and are more likely to use medical and non medical services (p < 0.0001). They are more likely to be malnourished than the others. On the other hand, there is no association between disability's cognitive levels and living alone. CONCLUSION: We need longitudinal survey to follow up this population to determine predicting factors for keeping them alone at home and to anticipate long-term care placement.

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PubMed2003

[Depressive symptoms in Alzheimer's disease: preliminary results of the REAL.FR study].

UNLABELLED: The Alzheimer's disease (AD) is today regarded as a degenerative pathology with a serious and common complication: occurrence of mental and behavioral disturbances. Among this neuropsychiatrics symptoms, the depressive symptoms occupy a significant place by their frequency and their consequences on the caregiver's burden. The prevalence of such disorders is very variously appreciated in the literature. OBJECTIVE: To assess with precision depressive symptoms in a population with Alzheimer's disease rated on neuropsychiatric inventory NPI. METHOD: Cross-sectional study of patients with AD presenting at the consultation of psycho-geriatic, geriatric or neurologic services in 16 french university hospitals. The frequency of the depression was evaluated with the NPI on a population of 578 subjects with AD. We studied the association existing between these symptoms and the antecedents of depression and we studied the gravity of these disorders according to the cognitive status. RESULTS: Caregivers describe less one depressive symptom for approximately 40% of the subjects included in the study n = 229. The average score of gravity is close to 4 and is thus clinically significant. More the stage of dementia is severe more the number of subjects presenting a clinically significant score is important. Scores of depression evolve parallel to the stage of dementia. The antecedents of depression are a risk factor for depressive symptoms in the AD p < 0.001. DISCUSSION: These results confirm those of primary studies. In our study, more than the prevalence of depressive symptoms it seems that is the severity of the disorder which is associated with the dementia severity. The continuation of this work will allow a prospective evaluation of depressive symptoms in the AD.

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PubMed2003

[Wandering and Alzheimer's type disease. Descriptive study. REAL.FR research program on Alzheimer's disease and management].

PURPOSE: Wandering is a common problem among patients with Alzheimer's disease. Few studies have examined this problematic behaviour in the community. The aim of the present study was to increase our understanding of wandering during Alzheimer's disease in subjects living in the community. METHODS: We studied 571 patients with Alzheimer's disease living in the community. Objective cognitive status was assessed using a series of standardized neuropsychological tests. Nutritional assessment, risk of fall, autonomy were assessed as well as the burden of their family. The behavioural abnormalities of patients were assessed with their caregiver using the Neuro-Psychiatric Inventory. Patients with or without wandering were described. RESULTS: Prevalence of wandering was 12.6%. Patients with wandering appeared to have more severe cognitive impairment, less autonomy and were undernourished. Behavioural and psychological signs significantly associated with wandering were delirium, aggressiveness, irritability, depression, anxiety, euphoria, apathy, desinhibition and eating behaviour disorder. Subtype of Alzheimer's disease patients seemed to have frontal release behaviour. CONCLUSION: Wandering is a common behaviour in Alzheimer's disease patients living in the community. Special care must be organized to help those frail patients and their caregivers.

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PubMed2003

[Factors associated with the moderately severe stage of Alzheimer's disease: first results of the REAL.FR study].

OBJECTIVE: Most studies of Alzheimer's disease deal with the mild to moderate stages of the disease. However the great majority of cases evolve toward a stage of marked severity which can last many years. The few studies of severe dementia that have been carried out have included institutionalized patients. The aim of this study is to describe associated factors with a moderately severe Alzheimer's disease in a French community dwelling patients. METHODS: Initial data from a French cohort Study of Alzheimer's patients (REAL.FR: Réseau sur la maladie d'Alzheimer français) were analysed. These included sociodemographic and medical factors and measures of cognitive and non cognitive performance. We compared two groups according the stage of the disease: moderately severe patients (Mini Mental Status score < 15) and mild to moderate patients (Mini Mental Status score > or = 15). RESULTS: Moderately severe stage of disease was independently related to age (OR: 0.35; 95% CI: 0.16-0.78 for patient aged between 75-80 years compared to patient < or = 75 years), low educational level (non-obtention of french certificate of primary education, OR: 2.43; IC à 95%: 1.28-4.59) and disability to perform activities of daily living (OR: 3.35; 95% CI: 1.62-6.93). After multivariate analysis, there was no difference between the 2 groups for the other factors like behavioral symptoms. CONCLUSIONS: Severe dementia represents major medical and socio-economical problem. Better knowledge of the natural history of the severe stage of the disease is necessary for better clinical practice.

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PubMed2003

[Rapid loss of the Mini Mental State Examination: REAL.FR study].

BACKGROUND: Alzheimer's disease is a chronic pathology requiring regular follow-up. The predictive factors of rapid cognitive decline remain unclear. OBJECTIVES: To analyse the baselines characteristics of patients at increased risk of rapid cognitive decline. METHODS: This study presents transversal data on a community-based sample of 340 patients diagnosed with probable Alzheimer's disease and followed by REAL.FR group. Rapid cognitive decline was defined as a 3-points or greater loss on the Mini Mental State Examination (MMSE) within six months. RESULTS: 54% of patients presented a rapid cognitive decline. Logistic regression analysis showed a positive association between rapid cognitive decline and a MMSE < or = 20 (p < 0.003) or a greater BMI (p < 0.02) and a tendency towards a negative correlation with anxiety (p = 0.06) and negative correlation with the burden severity (p < 0.05). CONCLUSIONS: Patients with a worse cognitive status, a greater BMI and less anxiety or burden were at increased risk of rapid cognitive decline. Future studies should focus on determining etiologies for patients with rapid cognitive loss and help clinicians target these patients for interventions aiming to delay or stabilise the course of this disease.

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PubMed2003

[Burden experienced by informal caregivers assisting Alzheimer's patients in the REAL.FR study].

BACKGROUND: Most AD patients are cared for at home by informal caregivers. The effect of different kind of stressors on caregivers has been referred to as caregiver burden. OBJECTIVE: To determine (1) the level of burden of informal caregivers of Alzheimer's patients in a French national sample; (2) the factors associated with a high level of burden. METHODS: Cross-sectional study of informal caregivers of the demented elderly referred to a psychogeriatric, geriatric or neurological service. The principal caregivers of 531 patients with mild to moderate dementia attending an outpatient cognitive assessment clinic were interviewed via a structured questionnaire that focused upon caregiver-related characteristics such as whether they were living with the patients, their feelings of burden assessed by the Zarit Burden Interview and patients were examined at baseline to evaluate their cognitive, behavioral and functional limitation. RESULTS: Logistic regression analysis showed that patients' characteristics (MMSE, behavioral problems, nutritional problems), caregiver's characteristics (female gender, number of tasks involved in caregiving, cohabitation) and the provision of medical services were independently associated with a high level of burden. In this study increased caregiver burden was related independently to increased levels of patient behaviour disturbance and cognitive impairment. However, neither the illness duration nor the functional disabilities in activities of daily living affected the level of burden. This may have relevance to appropriate interventions for informal caregivers.

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