C. Bayle

Executive functions deficit in mild cognitive impairment.

ObjectiveTo investigate whether patients diagnosed with amnestic mild cognitive impairment (MCI) have also impairment in attention/executive functions, and therefore to clarify whether all subcomponents of executive control are equally affected in MCI. BackgroundMCI refers to the transitional state between normal aging and dementia. Amnestic MCI is characterized by impaired episodic memory, although subtle impairment of executive functions has been noted on neuropsychologic tests. MethodsWe investigated 20 MCI patients and 20 normal controls using episodic memory, attention/executive functions, language, and praxis tests. ResultsMCI patients had significantly lower scores on all measures of the Free and Cued Selective Reminding Test (P<0.05 to 0.01) than controls. Furthermore, MCI had a greater number of perseverations (P<0.01) on Modified Card Sorting Test and the lowest performance on the Stroop Test (P<0.02). ConclusionsOur findings showed impairment in episodic memory performance in MCI as compared with that of controls. In addition, MCI patients had problems with response inhibition, switching, and cognitive flexibility, which encompass various aspects of executive functions. 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.

Patients With Alzheimer's Disease Living at Home in France: Costs and Consequences of the Disease

Alzheimers disease (AD) creates a substantial burden on human and financial resources. However, there are few data relating to the cost of AD in France. This retrospective study assesses the total costs of caring for home-based patients with mild to moderate AD. Pattern of care, sociodemographic data, caregiver burden, and estimated net costs of caring for AD patients were assessed in a stratified sample of 50 untreated AD patients. The net costs of caring for all AD patients who completed all study parameters increased with decreasing cognitive ability. Unpaid assistance was the most costly component of the total cost of care. Mini-Mental State Examination scores correlated strongly with functional status, and instrumental activities of daily living scores were a robust indicator of the magnitude of behavioral, cognitive, and dependence problems. This study suggested a significant link between costs of caring for an AD patient at home and disease severity. (J Geriatr Psychiatry Neurol 2003; 16:140-145)

Tratamiento de la demencia

Durante estos ultimos anos, se han realizado ensayos terapeuticos para el tratamiento de la enfermedad de Alzheimer (EA) y de las demencias vasculares. En concreto, el tratamiento sintomatico de la enfermedad de Alzheimer ha experimentado considerables progresos con la comercializacion de los anticolinesterasicos. En el campo de la prevencion, el beneficio de los inhibidores del calcio, de los tratamientos antirradicales, antiinflamatorios e inmunitarios, todavia esta en estudio. Las sustancias que actuan sobre la via beta-amiloide (por ejemplo, inhibidores de las beta y de las gamma-secretasas), los factores de crecimiento neuronal, las terapias genicas y los trasplantes neuronales son otras vias con un futuro prometedor. Por otra parte, se ha subrayado recientemente la relacion entre la enfermedad de Alzheimer y la demencia vascular. Los datos epidemiologicos han demostrado una correlacion entre la presencia de factores de riesgo vascular (hipertension arterial, diabetes, hipercolesterolemia o arritmia completa por fibrilacion auricular) y la posterior aparicion de declive cognitivo, e incluso de demencias, tanto vasculares como degenerativas. La identificacion de estos factores permite plantearse para los proximos anos una posible prevencion de las demencias mediante un tratamiento adecuado que comprenda tratamientos antihipertensores, hipocolesterolemiantes, antidiabeticos o antiagregantes plaquetarios. Los datos recientes de los grandes ensayos terapeuticos convergen en senalar el papel preventivo del tratamiento antihipertensor en la aparicion de la enfermedad de Alzheimer y de las demencias vasculares.