Alain Grand

Dementia Prevention: Methodological Explanations for Inconsistent Results

The prevention of neurodegenerative dementias, such as Alzheimer disease, is a growing public health concern, because of a lack of effective curative treatment options and a rising global prevalence. Various potential risk or preventive factors have been suggested by epidemiologic research, including modifiable lifestyle factors, such as social contacts, leisure activities, physical exercise, and diet, as well as some preventive pharmacologic strategies, such as hormone replacement therapy, nonsteroidal antiinflammatory drugs, and Ginkgo biloba. Some factors have been targeted by interventions tested in randomized controlled trials, but many of the results are in conflict with observational evidence. The aim of this paper is to review the epidemiologic data linking potential protective factors to dementia or cognitive decline and to discuss the methodological limitations that could explain conflicting results. A thorough review of the literature suggests that, even if there are consistent findings from large observational studies regarding preventive or risk factors for dementia, few randomized controlled trials have been designed specifically to prove the protective effects of interventions based on such factors on dementia incidence. Because of the multifactorial origin of dementia, it appears that multidomain interventions could be a suitable candidate for preventive interventions, but designing such trials remains very challenging for researchers.

Comparison of Informal Care Time and Costs in Different Age-Related Dementias: A Review

Objectives. Age-related dementia is a progressive degenerative brain syndrome whose prevalence increases with age. Dementias cause a substantial burden on society and on families who provide informal care. This study aims to review the relevant papers to compare informal care time and costs in different dementias. Methods. A bibliographic search was performed on an international medical literature database (MEDLINE). All studies which assessed the social economic burden of different dementias were selected. Informal care time and costs were analyzed in three care settings by disease stages. Results. 21 studies met our criteria. Mean informal care time was 55.73 h per week for Alzheimer disease and 15.8 h per week for Parkinson disease (P = 0.0076), and the associated mean annual informal costs were

Contrasting legal conceptions of family obligation and financial reciprocity in the support of older people: France and England

17,492 versus

Consensus sur la démence de type Alzheimer au stade sévère

3,284, respectively (P = 0.0393). Conclusion. There is a lack of data about informal care time and costs among other dementias than AD or PD. Globally, AD is the most costly in terms of informal care costs than PD,

Coxibs: evolution of prescription's behaviour in France

17,492 versus

Consensus sur la démence de type alzheimer au stade sévère

3,284, respectively.

« Il n’y aura plus personne pour s’occuper des vieux »

This paper explores the way family obligation and reciprocity are defined in law in France and England. Focusing on the areas of inheritance and financial support in relation to older people, it explores how these are contrasted and linked in the two societies. In France, families are legally obliged to support their kin through obligation alimentaire, but inheritance is secured by law within the family. In England by contrast there is no such legal obligation to support older relatives; nor is there any constraint on inheritance: testamentary freedom is the legal principle. The paper discusses the significance of these differences and assesses how far they are modified by the operation of the welfare state and by embedded assumptions about family relations. It sets the differences within the context of different discourses of law and social policy in the two countries.

L'État face aux solidarités familiales à l'égard des parents âgés fragilisés : substitution, soutien ou responsabilisation

Resume Sous l’egide de la Societe Francaise de Geriatrie et Gerontologie, un groupe pluridisciplinaire de specialistes en geriatrie, neurologie, epidemiologie, psychiatrie, neuroradiologie, pharmacologie, sante publique a entrepris une demarche de consensus sur les modalites d’evaluation, de suivi et de prise en charge globale de la demence de type Alzheimer au stade severe. Cette reflexion, fondee sur l’etat des connaissances en 2005, a permis de formuler 21 recommandations a destination des praticiens hospitaliers, medecins traitants, medecins coordonnateurs et specialistes. Quel que soit le stade evolutif de la maladie, l’objectif de la prise en charge est d’ameliorer la qualite de vie de la personne malade et de sa famille, en associant projet de soins et projet de vie et ce jusqu’en fin de vie. La prise en charge, pour etre globale, doit etre necessairement pluridisciplinaire et coordonnee, en mobilisant les ressources sanitaires et medico-sociales de proximite pour optimiser leur utilisation. Le groupe a souligne egalement l’importance d’une recherche dynamique : recherche clinique visant a mieux connaitre l’evolution des troubles, evaluation des strategies de prise en soins.

Les dispositifs d'action sur l'aide de l'entourage en France et au Québec

The aim of the present study was, first to characterize profiles of coxibs’ prescribers [general practitioners (GPs) and rheumatologists] in 2002 in France and, secondly, to identify factors associated with modification of this profile 1 year later. All GPs and rheumatologists from Midi‐Pyrenees, Aquitaine, Languedoc‐Roussillon and Pays de Loire areas (South of France: 11 050 000 inhabitants) were included in the study. For each practitioner, we used data concerning all non‐steroidal anti‐inflammatory drugs (NSAIDs) including coxibs reimbursed during period 1 (P1; January–March 2002) and period 2 (P2; January–March 2003). The ratio between the number of coxibs’ prescriptions and the total number of NSAIDs’ prescriptions (including coxibs) was used to define the two profiles of prescribers, one with a low level of coxibs’ prescriptions and another one with a high level of coxibs’ prescriptions. Characteristics of practitioners and characteristics of their practices were compared according to this profile. In the second step, we investigated the characteristics (of practitioners and practices) associated with an increase in the level of coxibs’ prescriptions in P2 for practitioners with a low level of coxibs’ prescriptions in P1. Results are expressed as odds ratio with their 95% confidence intervals. A positive statistical link was found between a high level of coxibs’ prescriptions, the speciality of rheumatologist or extra costs for consultation. In contrast, a negative association was observed with female gender or age below 44 years. No relationship was found with the status of referent. Concerning practices’ characteristics of practitioners, there was a positive statistical link between a high ratio of coxibs’ prescriptions and high co‐prescriptions of gastroprotective agents and a negative association with a high number of acts, a high proportion of patients with chronic disabling diseases (CDD) or a high number of patients between 15 and 64 years. There was no statistical link with proportion of patients covered by Universal Medical Coverage (UMC) or aged more than 65 years. Among the factors involved in the increase in the ratio (between P1 and P2), no relationship was found with practitioners’ characteristics. In contrast, some factors related to practices (level of gastroprotective co‐prescriptions, number of acts, number of CDD patients) were related to a change in coxibs’ prescriptions between P1 and P2. This study allowed to discuss some relationships between coxibs’ prescription and practitioners’ (age, gender, medical speciality or extra costs for consultation) or practices’ (level of medical practice, patients’ age, number of CDD patients or level of gastroprotective prescriptions) characteristics. In contrast, some other factors like the referent status or the number of patients with UMC are not related. Physicians, initially low prescribers of coxibs and increasing their coxibs’ prescriptions during the period of our study, were those with a high level of gastroprotective prescriptions, a low number of acts or a small proportion of CDD patients.