A.-S. Rigaud

The apolipoprotein E epsilon4 allele and the response to tacrine therapy in Alzheimer's disease.

The objective of our study was to evaluate the effects of the apolipoprotein E (ApoE) phenotype and gender on the response to tacrine treatment in Alzheimer’s disease (AD). ApoE phenotyping was performed on 76 patients treated with tacrine for AD. This group comprised 33 ApoE ε4 allele carriers (ε4+) and 43 non‐ε4 carriers (ε4–). Patients were treated blindly in relation to the ApoE phenotype, with incremental tacrine dosages ranging from 40 mg/day up to the highest dosage (160 mg) tolerated without side‐effects. At least 6 weeks elapsed between each increase. Changes in the scores for the Alzheimer Disease Assessment Scale‐Cognitive Component (ADAS‐Cog) between baseline and each increment in dosage were assessed in the ε4– and ε4+ groups. The cut‐off point for being considered as responsive to tacrine treatment was a 4‐point decrease in the ADAS‐Cog score.

Le déficit neuropsychologique dans la maladie d’Alzheimer débutante

This analysis is centered on the study of cognitive disorders in Alzheimers disease (AD), mainly for major neuro-psychological functions. We insist on the heterogeneity of the clinical picture peculiarly in the early stages of the illness, even if the deficits of episodic memory and of attentional/executive capacities are the first to deteriorate, preceding impairment in perceptual and language function and potentially having a substantial impact on the patients capacity to cope independently. An episodic memory deficit is the hallmark of AD, but it must be stressed that this deficit may take different forms and its origin may be traced back to different cognitive mechanisms. One of the most striking aspects of episodic memory impairment in AD is the rapidity of forgetfulness on which screening and diagnostic tests of AD are based. There is some evidence that the episodic memory deficit in AD is one of learning (encoding and storage) of information rather than to a deficit of retrieval. Furthermore, episodic memory performance in AD depends on the integrity of semantic memory abilities, so giving support to a hierarchical model of organization of human memory. Finally, recent results show that an impairment of conscious recollection is responsible for the poor performance of AD patients in recognition memory. Executive deficits appear predominantly in tasks requiring cognitive flexibility and self-monitoring. With the progression of the disease, additional deficits are observed in the verbal concept formation abilities. These findings might be also very useful in the differential diagnosis between AD and the other cortical and subcortical dementias, as well as in the differentiation between AD and fronto-temporal dementia. We consider that studying early stages of the illness is necessary to delineate the diagnostic signs, to validate the new therapeutic experiments, to predict stages of decline. Recent research suggested that onset of AD is commonly preceded by an interim phase known as mild cognitive impairment (MCI). MCI refers to the clinical condition in which persons experience memory loss to a greater extent than one would expect for age, yet they do not meet currently accepted criteria for clinically probable AD. Persons who experience this condition are at increased risk for the development of AD. In MCI, despite the comparable global cognitive functioning, the findings show more impaired retrieval from long-term storage than in NC. The cued recall improves slightly the total recall but the recognition is significantly impaired. Moreover, the data indicate that MCI patients had additional problems with response inhibition, switching and cognitive flexibility. This suggests, that MCI may be identified by using a more detailed procedure for the assessment of cognitive decline than the evaluation of memory alone. As preventive strategies are developed and new cognitive enhancing therapies emerge, these results may also help us to define which domains are expected to improve in MCI populations.

Donepezil for the Treatment of Mild to Moderate Alzheimer’s Disease in France: The Economic Implications

In the present study, the socioeconomic impact of the use of the acetylcholinesterase inhibitor donepezil in patients with mild to moderate Alzheimer’s disease (AD) living in France was examined. A model was created to extrapolate over a 3-year period the results from placebo-controlled trials together with epidemiological and prevalence data. Costs considered in the model were net societal costs associated with paid and unpaid assistance, general medical consumption and institutional care. The model suggested that delays in cognitive decline and functional dependence due to treatment reduced the time spent in institutional care and the burden on caregivers. Over a 3-year period, total net costs of caring for untreated patients with an initial Mini-Mental State Examination score ranging from 10 to 26 were EUR 53,206 compared with EUR 42,720 for a patient treated with donepezil – an annual cost saving of approximately EUR 3,500 per patient. Cost savings were mainly due to savings in unpaid caregiver time, which, apart from patient institutionalization, represented the most costly component of total care in this study but had no direct budgetary impact. Overall, these data suggest that donepezil is a cost-effective treatment for mild to moderately impaired AD patients living in France.

Relevance of 10-min delayed recall in dementia screening.

Within the context of early diagnosis of Alzheimers disease (AD), there is a growing interest in neuropsychological screening tests. Amongst these tests, we focused on the largely used Memory Impairment Screen (MIS). The objective of the present work was to show that adding a 10‐min delayed recall to the MIS, improves the test psychometric characteristics in order to detect dementia in the earliest stages. A prospective study was carried out on a cohort of 270 consecutive elderly ambulatory subjects attending the Broca Hospital Memory Clinic: normal controls (n = 67), mild cognitive impairment subjects (n = 98) and mildly demented patients [n = 105, Mini Mental State Examination (MMSE) = 23 ± 4]. This study consisted in testing the advantage of the 10‐min delayed recall entitled MIS‐D compared with the MIS. At a cut‐off score of 6, the MIS‐D revealed satisfying psychometric characteristics with a sensitivity of 81% and a specificity of 91%, whilst the MIS alone indicated a sensitivity of 60% and a specificity of 88% in detecting dementia. In demented patients with MMSE score ≥26, MIS‐D properties still remained satisfying (sensitivity: 75%, specificity: 92%). MIS‐D is a more relevant screening test than MIS alone at very early stages of dementia.

DAD-6: A 6-ltem Version of the Disability Assessment for Dementia Scale Which May Differentiate Alzheimer’s Disease and Mild Cognitive Impairment from Controls

Background: The need to detect early changes in instrumental activities of daily life led us to modify the Disability Assessment for Dementia Scale (DAD) by focusing on executive components of 6 instrumental items (DAD-6). Aim: To evaluate the relevance of the DAD-6 for detecting early impairment in a nondemented population. Methods: The DAD-6 was administered to informants of 84 patients: 31 with mild dementia (MD), 53 with mild cognitive impairment (MCI) and 55 healthy controls. Results: DAD-6 scores gradually decreased with increasing severity of the cognitive status [18 in healthy controls vs. 15.1 ± 3.2 in MCI versus 9.6 ± 3.5 in MD, p < 0.0001). Receiver-operating characteristic curve analyses yielded an optimal cut score of 14 to distinguish MCI from MD with a sensitivity of 0.83 (95% confidence interval 0.74–0.92) and a specificity of 0.84 (0.71–0.94), and a cut score of 15 to distinguish single-domain MCI from multi-domain MCI with a sensitivity of 0.96 (0.90–0.99) and a specificity of 0.54 (0.33–0.75). Conclusion: The DAD-6 reliably detects early loss of autonomy due to cognitive impairment.

Robot services for elderly with cognitive impairment: Testing usability of graphical user interfaces

BACKGROUND Socially assistive robotics for elderly care is a growing field. However, although robotics has the potential to support elderly in daily tasks by offering specific services, the development of usable interfaces is still a challenge. Since several factors such as age or disease-related changes in perceptual or cognitive abilities and familiarity with computer technologies influence technology use they must be considered when designing interfaces for these users. OBJECTIVE This paper presents findings from usability testing of two different services provided by a social assistive robot intended for elderly with cognitive impairment: a grocery shopping list and an agenda application. The main goal of this study is to identify the usability problems of the robot interface for target end-users as well as to isolate the human factors that affect the use of the technology by elderly. METHODS Socio-demographic characteristics and computer experience were examined as factors that could have an influence on task performance. A group of 11 elderly persons with Mild Cognitive Impairment and a group of 11 cognitively healthy elderly individuals took part in this study. Performance measures (task completion time and number of errors) were collected. RESULTS Cognitive profile, age and computer experience were found to impact task performance. Participants with cognitive impairment achieved the tasks committing more errors than cognitively healthy elderly. Instead younger participants and those with previous computer experience were faster at completing the tasks confirming previous findings in the literature. CONCLUSIONS The overall results suggested that interfaces and contents of the services assessed were usable by older adults with cognitive impairment. However, some usability problems were identified and should be addressed to better meet the needs and capacities of target end-users.

Méthode de prise en charge globale non médicamenteuse des patients déments institutionnalisés

Resume Introduction Le present travail decrit un type de prise en charge non pharmacologique de patients atteints de demences neurodegeneratives en institution. L’intervention s’adresse a des patients dements en long sejour presentant des troubles du comportement perturbant les patients eux-memes et les equipes soignantes. Les objectifs du programme de prise en charge sont, d’une part, de stimuler les capacites cognitives, sociales et fonctionnelles des patients et de diminuer leurs troubles du comportement, et d’autre part, de diminuer la charge de travail des equipes soignantes. Methodes Cette prise en charge globale combine plusieurs approches : l’approche psychosociale, l’approche cognitive et l’approche sensorielle et motrice. L’ensemble de ces stimulations est realise par une equipe pluridisciplinaire composee d’un cadre ergotherapeute, de six aides soignantes, d’une ergotherapeute, d’une orthophoniste, d’une psychomotricienne et d’une psychologue. La prise en charge est quotidienne et dure trois mois. Des evaluations sont realisees avant et apres le programme d’intervention afin d’en mesurer le benefice. Resultats Des effets positifs ont ete observes lors de deux etudes sur le plan cognitif pour les patients ainsi que sur leur alimentation, et sur le ressenti des soignants dans la prise en charge des patients dements severes. Cependant, en raison des faibles effectifs de ces etudes, il faut mener des recherches supplementaires sur l’efficacite de ce programme d’intervention global, particulierement concernant les implications nutritionnelles. Conclusion La combinaison d’un traitement pharmacologique et d’une prise en charge non pharmacologique semble donc adaptee a la gestion des troubles psychologiques et comportementaux des patients dements en institution.

CompanionAble- mobile robot companion and smart home system for people with mild cognitive impairment

Introduction: Despite widespread agreement on the importance of positive affect among older adults, debate continues as to the distinctions among various constructs related to positive attitudes towards life among older adults. Constructs such as subjective wellbeing, satisfaction with life, happiness, morale, and positive affect all correlate with one another, leading to questions as to whether they are distinct constructs or not. Here we examine some of these issues with relation to a well-known and widely used measure of affect, the Bradburn Affect Balance Scale (ABS). Methods and Materials: Data were from 187 Canadian community-dwelling older adults (40 males) with a mean age of 69.7 years (SD = 6.24), with about 40% having retired from service occupations. Participants completed the ABS, the 22 item Philadelphia Geriatric Center Morale Scale, the Kutner Morale Scale, and the Social Desirability scale from the Personality Research Form. Results: Principal component analysis of the 10 ABS items with oblique rotation clearly showed two underlying components that correlated positively with one another. This is in contrast to the unidimensional bipolar scoring key for the ABS. Social desirability was positively correlated with all measures of affect and morale. Measures of morale correlated as highly with the ABS as with one another. Conclusions: The traditional scoring key for the ABS does not reflect its actual internal structure, which is of two mildly correlated components that are not positive and negative ends of a single dimension of affect. Both components correlate as highly with the two measures of morale as with one another, suggesting that the measures used are measuring a single underlying construct and that morale and both positive and negative affect reflect a single basic construct. In addition, correlations with a measure of social desirability suggest that all three measures are not free from positive self-presentation styles.

Impact d’un programme psycho-éducatif sur le stress des aidants de patients Alzheimer

En revanche, les donnees manquent sur la maniere dont s’opere cet impact, positif ou negatif, c’est-a-dire, sur la facon dont les participants a ces programmes peuvent ameliorer ou non leur etat. C’est a cet aspect de l’accompagnement des aidants que nous nous interessons, et dans le cadre de ce travail, precisement au stress des aidants familiaux de patients atteints de demence d’Alzheimer vivant a leur domicile.

La stimulation cognitive

Resume La stimulation cognitive est une approche neuropedagogique globale basee sur les resultats de recherche dans le domaine de la neuropedagogie. Cet article met l’accent sur le contexte theorique, les objectifs et les methodes de la stimulation cognitive. Les personnes âgees en bonne sante ayant une plainte de memoire, les patients souffrant de troubles cognitifs legers ou de demence peuvent beneficier de la stimulation cognitive. Dans la maladie d’Alzheimer, la stimulation cognitive est une intervention therapeutique complementaire du traitement pharmacologique.