Alexandra Foubert-Samier

Trends in dementia incidence: Evolution over a 10-year period in France

Few recent studies have suggested declining trends in dementia frequency. French cohorts with long follow‐up allowed us to explore incidence evolution trends.

New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study

Objectives Orthostatic hypotension (OH) is a key feature of multiple system atrophy (MSA), a fatal progressive neurodegenerative disorder associated with autonomic failure, parkinsonism and ataxia. This study aims (1) to determine the clinical spectrum of OH in a large European cohort of patients with MSA and (2) to investigate whether a prolonged postural challenge increases the sensitivity to detect OH in MSA. Methods Assessment of OH during a 10u2005min orthostatic test in 349 patients with MSA from seven centres of the European MSA-Study Group (age: 63.6±8.8u2005years; disease duration: 4.2±2.6u2005years). Assessment of a possible relationship between OH and MSA subtype (P with predominant parkinsonism or C with predominant cerebellar ataxia), Unified MSA Rating Scale (UMSARS) scores and drug intake. Results 187 patients (54%) had moderate (>20u2005mmu2005Hg (systolic blood pressure (SBP)) and/or >10u2005mmu2005Hg (diastolic blood pressure (DBP)) or severe OH (>30u2005mmu2005Hg (SBP) and/or >15u2005mmu2005Hg (DBP)) within 3u2005min and 250 patients (72%) within 10u2005min. OH magnitude was significantly associated with disease severity (UMSARS I, II and IV), orthostatic symptoms (UMSARS I) and supine hypertension. OH severity was not associated with MSA subtype. Drug intake did not differ according to OH magnitude except for antihypertensive drugs being less frequently, and antihypotensive drugs more frequently, prescribed in severe OH. Conclusions This is the largest study of OH in patients with MSA. Our data suggest that the sensitivity to pick up OH increases substantially by a prolonged 10u2005min orthostatic challenge. These results will help to improve OH management and the design of future clinical trials.

Risk of dementia in an elderly population of Parkinson's disease patients: A 15-year population-based study

The incidence of dementia in Parkinsons disease (PD) is not fully known, and previous studies have provided a wide range of rates owing to variations in diagnostic criteria and methodologies used. We estimated the risk of dementia in newly diagnosed cases of PD in a population‐based cohort of subjects aged >65 years.

Trends in Prevalence of Dementia in French Farmers from Two Epidemiological Cohorts

To determine the prevalence of dementia and cognitive impairment in older people across generations.

Hearing and seeing Unusual early signs of Wernicke encephalopathy

A 31-year-old woman with Crohn disease presented with tinnitus, headache, apathy, blurred vision, and nystagmus after 3 weeks of IV nutrition and partial colectomy. MRI showed abnormalities of the inferior colliculi (figure). Serum thiamine was …

Current Concepts in the Treatment of Multiple System Atrophy

MSA is a progressive neurodegenerative disorder characterized by autonomic failure and a variable combination of poor levodopa‐responsive parkinsonism and cerebellar ataxia (CA). Current therapeutic management is based on symptomatic treatment. Almost one third of MSA patients may benefit from l‐dopa for the symptomatic treatment of parkinsonism, whereas physiotherapy remains the best therapeutic option for CA. Only midodrine and droxidopa were found to be efficient for neurogenic hypotension in double‐blind, controlled studies, whereas other symptoms of autonomic failure may be managed with off‐label treatments. To date, no curative treatment is available for MSA. Recent results of neuroprotective and ‐restorative trials have provided some hope for future advances. Considerations for future clinical trials are also discussed in this review.

Validation of the French version of the MSA health-related Quality of Life scale (MSA-QoL)

INTRODUCTIONnMultiple system atrophy (MSA) has considerable impact on health-related quality of life. The MSA health-related Quality of Life scale (MSA-QoL) is a patient-reported questionnaire, which has been recently designed to evaluate the quality of life in MSA. The objective of the present study was to validate the French version of the MSA-QoL questionnaire.nnnMETHODSnOne hundred and thirty-six consecutive MSA patients were included in the study. Four patients with more than 10% missing responses were excluded from the final analysis. Data quality, scaling assumptions, acceptability, reliability and validity were assessed similar to the original validation of the English version.nnnRESULTSnMissing responses were low, item and subscale scores were evenly distributed and floor and ceiling effects were negligible. Item-total correlations were higher than the recommended greater than 0.30 and internal consistency was high for all subscales. Test-retest reliability was good for all subscales. Validity was supported by moderate interscale correlations between the subscales and the predicted correlations with other scales assessing motor disability, activities of daily living, quality of life and mood.nnnDISCUSSIONnThe French version of the MSA-QoL displays robust psychometric properties similar to the English version.nnnCONCLUSIONnThe French version of MSA-QoL seems suitable for assessing quality of life in French speaking MSA patients.

Feasibility and validity of mobile cognitive testing in the investigation of age-related cognitive decline.

Mobile cognitive testing may be used to help characterize subtle deficits at the earliest stages of cognitive decline. Despite growing interest in this approach, comprehensive information concerning its feasibility and validity has been lacking in elderly samples. Over a one‐week period, this study applied mobile cognitive tests of semantic memory, episodic memory and executive functioning in a cohort of 114 elderly non‐demented community residents. While the study acceptance rate was moderate (66%), the majority of recruited individuals met minimal compliance thresholds and responded to an average of 82% of the repeated daily assessments. Missing data did not increase over the course of the study, but practice effects were observed for several test scores. However, even when controlling for practice effects, traditional neuropsychological tests were significantly associated with mobile cognitive test scores. In particular, the Isaacs Set Test was associated with mobile assessments of semantic memory (γu2009=u20090.084, tu2009=u20095.598, pu2009<u20090.001), the Grober and Buschke with mobile assessments of episodic memory (γu2009=u20090.069, tu2009=u20093.156, pu2009<u20090.01, and the Weschler symbol coding with mobile assessments of executive functioning (γu2009=u20090.168, tu2009=u20094.562, pu2009<u20090.001). Mobile cognitive testing in the elderly may provide complementary and potentially more sensitive data relative to traditional neuropsychological assessment. Copyright

Facial emotion recognition is inversely correlated with tremor severity in essential tremor

AbstractnWe here assess limbic and orbitofrontal control in 20 patients with essential tremor (ET) and 18 age-matched healthy controls using the Ekman Facial Emotion Recognition Task and the IOWA Gambling Task. Our results show an inverse relation between facial emotion recognition and tremor severity. ET patients also showed worse performance in joy and fear recognition, as well as subtle abnormalities in risk detection, but these differences did not reach significance after correction for multiple testing.

Polysomnography in multiple system atrophy: A focus on periodic leg movements analysis

Objectives Sleep disturbances are common features of multiple system atrophy (MSA) and may combine sleep fragmentation, REM-sleep Behavior Disorders (RBD) and sleep-related breathing disorders. Only few studies focused on periodic leg movements (PLM) during sleep in MSA [1] , [3] . Methods Twenty patients with MSA were recruited in Bordeaux University Hospital and were submitted to one-night polysomnography. Sleep stages were identified, apnea/hypopnea index (AHI) was calculated. Detailed analysis of PLM was also performed. Clinical (age, sex, BMI, MSA type cerebellar or parkinsonian, disease duration, UMSARS and COMPASS31 scales, levodopa or dopamine agonist therapy) and biological (haemoglobin) data were collected retrospectively in patients’ database. Results Of these 20 patients, median PLM index during total sleep time (PLM_TST) was 2.9/h. PLM index was higher than 15 in 3 out of 20 patients. When restricted to non-respiratory PLM (nrPLM), the median index was 2.6/h of sleep. Median AHI was 29.4 per hour and 13 out of 20 patients had more than 15 apnea/hypopnea/h of sleep. No correlation was found between disease severity scores (UMSARS and COMPASS), disease duration, MSA type nor with haemoglobin levels and PLM_TST or nrPLM_TST index. We found a trend to an inverse correlation between slow waves sleep PLM index and levodopa equivalent daily dose. Conclusion This preliminary study showed that only few MSA patients (15%) had more than 15 PLM per hour of sleep. Whether this is related to dopaminergic treatment effect remains to be further established. These results have to be confirmed on a larger population of patients with MSA. Further, iron metabolism might be the focus of future studies to assess whether PLM in MSA and idiopathic PLM share a common pathophysiology [2] .