Denis Federico

One-Year Evolution of Behavioral and Psychological Symptoms of Dementia in Patients Initially Hospitalized in Cognitive Behavioral Units: The EVITAL Prospective Cohort

BACKGROUND The 2008-2012 French Alzheimers Plan has provided hospital Cognitive and Behavioral Units (CBU) to improve the management of patients with productive behavioral and psychological symptoms of dementia (BPSD). Little is known concerning the behavioral outcome of these patients after discharge. OBJECTIVE The present study investigated the long-term evolution of BPSD over one year after CBU discharge. METHODS The EVITAL cohort included 221 participants admitted to the CBUs of 3 French hospitals. BPSD were collected using the Neuropsychiatric Inventory (NPI) at admission and 3, 6, and 12 months after hospitalization. The global NPI score evolution was assessed using a linear mixed-effect model. A four-factor model of the NPI including behavioral dyscontrol, psychosis, mood, and agitation subscores was also analyzed. RESULTS Our analysis focused on 148 patients followed up during 12 months and evaluated at each visit. The global NPI score was 48.5 (SD 21.7) at baseline, 28.8 (SD 18.7) at 3-month, 23.2 (SD 16.4) at 6-month and 20.9 (SD 15.9) at 12-month follow-up. The score significantly decreased from baseline to follow-up (F = 109.3 p < 0.0001). Moreover, the decrease was observed for each NPI subscores. The Clinical Dementia Rating (CDR) scale score was significantly linked to the baseline NPI score (t = 2.76, p = 0.009). Conversely, the NPI decline was observed whatever the CDR level. CONCLUSION The present study showed a decrease in the global NPI score and all its subscores during the year following the CBU hospitalization, regardless of the initial CDR score.

Initial and long-term evaluation of patients with Alzheimer’s after hospitalization in cognitive and behavioural units: the EVITAL study design

BackgroundAlzheimer’s disease and related disorders are characterized by cognitive impairment associated with behavioral and psychological symptoms of dementia. These symptoms have significant consequences for both the patient and his family environment. While risk factors for behavioral disorders have been identified in several studies, few studies have focused on the evolution of these disorders. Moreover, it is important to identify factors linked to the long-term evolution of behavioral disorders, as well as patients’ and caregivers’ quality of life. Our purpose is to present the methodology of the EVITAL study, which primary objective is to determine the factors associated with the evolution of behavioral disorders among patients with Alzheimer’s disease and related disorders during the year following their hospitalization in cognitive and behavioral units. Secondary objectives were 1) to assess the factors related to the evolution of behavioral disorders during hospitalization in cognitive and behavioral units; 2) to identify the factors linked to patients’ and caregivers’ quality of life, as well as caregivers’ burden; 3) to assess the factors associated with rehospitalization of the patients for behavioral disorders in the year following their hospitalization in cognitive and behavioral units.Method/DesignA multicenter, prospective cohort of patients with Alzheimer’s disease and related disorders as well as behavioral disorders who are hospitalized in cognitive and behavioral units.The patients will be included in the study for a period of 24 months and followed-up for 12 months. Socio-demographic and environmental data, behavioral disorders, medications, patients’ and caregivers’ quality of life as well as caregivers’ burden will be assessed throughout hospitalization in cognitive and behavioral units. Follow-up will be performed at months 3, 6 and 12 after hospitalization. Socio-demographic and environmental data, behavioral disorders, medications, patients’ and caregivers’ quality of life, unplanned rehospitalization as well as caregivers’ burden will also be assessed at each follow-up interview.DiscussionThe present study should help better identify the factors associated with reduction or stabilization of the behavioral and psychological symptoms of dementia in patients with Alzheimer’s disease. It could therefore help clinicians to better manage these symptoms.Trial registrationClinical Trials NCT01901263. Registered July 9, 2013.

Apport de l'épreuve des dix images au diagnostic des troubles de mémoire dans la maladie d'Alzheimer, le déficit cognitif léger et le syndrome anxiodépressif

INTRODUCTION Episodic memory is often considered to be essential in the neuropsychological examination of elderly people consulting in the memory clinics. Therefore, the performance of three different episodic memory tests were compared in Alzheimers disease (AD), mild cognitive impairment (MCI) and anxiety/depression. METHODS Seventy-six patients with AD, 46 with MCI, and 36 with anxiety/depression performed three memory tests: (1) three-words immediate and delayed recall of the MMSE test; (2) 10-pictures reminding test; (3) 16-items free and cued reminding test. RESULTS Patients with AD and MCI differed from the depressed/anxious participants on all subcomponents of the memory tests. Only the three-words immediate and delayed recall in the MMSE test as well as the immediate recall (encoding) of the free and cued reminding test (16-items) did not differ between AD and MCI. Significant correlations were also evidenced between the free and cued recall of the 10 pictures and the score of the 16-items for all patients. Scores of total and free recalls distinguished the three group of patients; also, a trend was observed for the free recall between the patients with AD and MCI. CONCLUSION The three-words immediate and delayed recall of the MMSE test is linked with hippocampic dysfunction. Also, the present study suggests that the 10-pictures reminding test, is a simple and reliable test for investigating memory, in addition to other evaluation tests. Finally, further studies would be necessary to assess the sensitivity and specificity of the tests.

REGIONAL FRONTAL CORTEX VOLUME PREDICTS APATHY IN ALZHEIMER’S DISEASE

CDR 0.024 0 265(71.0%) 158(62.5%) 0.5 108(29.0%) 95(37.5%) CDR SOB 0.19460.33 0.2560.35 0.033 B-ADL 19.9060.61 19.8660.61 0.468 BNT 0.3560.68 0.2960.66 0.277 Digit_BD 0.2761.13 0.0760.97 0.022 SVLT delayed 0.63 60.64 -0.1860.50 0.000 SVLT recognition 0.3660.81 -0.0060.77 0.000 RCFT delayed 0.3860.78 0.1960.75 0.004 RCFT recognition 0.0660.96 -0.01 60.84 0.337 COWAT total 0.2360.99 0.0361.01 0.102 Stroop 0.2060.98 0.1460.89 0.031 MMSE 0.1960.87 0.0960.92 0.178

BRAIN VOLUME PREDICTS BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS IN ALZHEIMER’S DISEASE

(FTD), rather than the purely memory and cognitive deficit presentation of typical AD. Methods:Case study methods included analysis of seven patients’ cases with a confirmed mutation on the PSEN-2 gene. The history of illness and disease progression of each patient was reviewed and examined to further identify common symptoms associated with PSEN-2 mutations such as behavioral changes, psychiatric symptoms and memory loss. Results: The participants consisted of six females and one male. Six out of seven patients had a clinical diagnosis of AD between the ages of 51-57 years old, while they presented the first symptom in an age range between 48-56 years. In six out of seven patients, initial symptoms included changes in behavior and personality followed by memory deficits as the disease progressed. Four out of seven patients were diagnosed with depressive/affective disorder and three patients had visual hallucinations. Three patients had previous brain imaging studies in which two of them presented frontal lobe atrophy. All patients had a rapid progression leading to early incapacity on most cases. Conclusions: For the first time, we describe the clinical presentation of a PSEN-2 mutation in seven Puerto Rican patients. Coupled with recent literature, this report suggests that PSEN-2 mutations can present with a mixed AD and FTD clinical criteria, with behavioral changes and psychiatric symptoms being the earliest prominent signs. These findings can guide physicians to recognize that patients with the aforementioned symptoms may have an underlying PSEN-2mutation and may need further evaluation of their families. We believe these results can raise awareness for future studies on PSEN-2 mutation prevalence in the Puerto Rican population.