Karim Tifratene

Progression of mild cognitive impairment to dementia due to AD in clinical settings

Objectives: To describe the positive predictive value of mild cognitive impairment (MCI) and the factors associated with progression in routine practice. Methods: A retrospective cohort study was conducted from the French National Alzheimer Database. Among 446,439 patients cared for in the participating centers between January 2009 and January 2014, 45,386 (10.2%) were classified as having MCI and 23,676 had at least one follow-up visit. Annual progression rate was used to describe the progression of patients with MCI to dementia due to Alzheimer disease. Hazard ratios of dementia due to Alzheimer disease were estimated using Cox regression model. Results: Annual progression rate (95% confidence interval) was 13.7% person-years (py) (13.5%–13.9%) with higher rate for amnestic MCI (aMCI) (18.2% py [17.9%–18.5%]) than for nonamnestic MCI (naMCI) (9.5% py [9.3%–9.6%]). Separate regression models were performed for each MCI subtype. Higher education, older age, female sex, and lower Mini-Mental State Examination score were associated with an increased risk of progression for both subtypes. Use of anxiolytics (adjusted hazard ratio [95% confidence interval]: 0.77 [0.66–0.91]) was a protective factor for aMCI whereas antidepressant drugs (1.16 [1.04–1.29]) were associated with an increased risk. For naMCI, prescriptions of antidepressants (0.85 [0.74–0.98]) and antipsychotics (0.55 [0.32–0.93]) were protective for progression. Conclusions: Under circumstances emulating routine clinical practice, the positive predictive value of an MCI diagnosis is in line with previous clinical studies and the external validity of the concept is strengthened. Distinguishing between aMCI and naMCI is particularly relevant.

Use of drug treatments for Alzheimer's disease in France: a study on a national level based on the National Alzheimer's Data Bank (Banque Nationale Alzheimer).

To examine the way in which specific drug treatments for Alzheimers disease are used and whether their use complies with clinical practice guidelines issued by the French National Authority for Health in patients with Alzheimers disease.

The mini mental state examination at the time of Alzheimer's disease and related disorders diagnosis, according to age, education, gender and place of residence: a cross-sectional study among the French National Alzheimer database.

The aim of this study was firstly to describe the MMSE (Mini-Mental State Examination) score upon initial diagnosis of Alzheimers disease and related disorders among the French population, according to age. Secondly, education, gender and place of residence were studied as factors potentially associated with delayed Alzheimers disease diagnosis. Design we conducted a cross sectional analysis of the French National Alzheimer database (BNA). Data from 2008 to 2012 were extracted. Patients were selected at the moment of their first diagnosis of AD (n = 39,451). Results The MMSE score at initial diagnosis dropped significantly with increasing age. The test score increased with the degree of educational background regardless of age. Gender and place of residence were significantly related to the MMSE score, women and persons living in medical institutions having lower MMSE scores under the age of 90 years and at all educational levels. Conclusions Health care professionals should be aware of these risk factors in order to maximize chances of earliest possible diagnosis of Alzheimers disease and related disorders.

The French National Alzheimer database: a fast growing database for researchers and clinicians.

Background: Alzheimers disease (AD) is a major public health issue. The French National Alzheimer database (BNA) registers all medical acts performed by memory units and independent specialists throughout France. This article describes the national coverage, the registered patient characteristics and illustrates research possibilities. Methods: All data transmitted up to December 2012 were analyzed. The following patient characteristics were studied: age, sex, educational level, place of living, diagnosis, Mini-Mental State Examination score and existence of pharmacological or psychosocial interventions. Results: At the end of 2012, the BNA included 84% (n = 357) of all French memory units, contained 341,498 patients and more than 800,000 medical acts. AD accounted for 26.4% of all registered diagnoses, related disorders for 21.7% and mild cognitive impairment for 8.7%. Conclusion: The BNA offers a multitude of research possibilities. In the coming years, the BNA will play a major role in monitoring trends and related risk factors in AD.

Outcome after failure of allogeneic hematopoietic stem cell transplantation in children with acute leukemia: a study by the société Francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC)

Allogeneic hematopoietic stem cell transplantation (SCT) contributes to improved outcome in childhood acute leukemia (AL). However, therapeutic options are poorly defined in the case of post-transplantation relapse. We aimed to compare treatment strategies in 334 consecutive children with acute leukemia relapse or progression after SCT in a recent 10-year period. Data could be analyzed in 288 patients (157 ALL, 123 AML and 8 biphenotypic AL) with a median age of 8.16 years at transplantation. The median delay from first SCT to relapse or progression was 182 days. The treatment consisted of chemotherapy alone (n=108), chemotherapy followed by second SCT (n=70), supportive/palliative care (n=67), combination of chemotherapy and donor lymphocyte infusion (DLI; n=30), or isolated reinfusion of donor lymphocytes (DLI; n=13). The median OS duration after relapse was 164 days and differed according to therapy: DLI after chemotherapy=385 days, second allograft=391 days, chemotherapy=174 days, DLI alone=140 days, palliative care=43 days. A second SCT or a combination of chemotherapy and DLI yielded similar outcome (hazard ratio (HR)=0.85, P=0.53) unlike chemotherapy alone (HR=1.43 P=0.04), palliative care (HR=4.24, P<0.0001) or isolated DLI (HR=1,94, P<0.04). Despite limitations in this retrospective setting, strategies including immunointervention appear superior to other approaches, mostly in AML.

Evolution of the Antidepressant Prescribing in Alzheimer's Disease and Related Disorders Between 2010 and 2014: Results from the French National Database on Alzheimer's Disease (BNA).

BACKGROUND Safety warnings from health authorities are currently intended to limit the use of psychotropic agents in dementia-related conditions. Evidence concerning the use of antidepressants in dementia is, however, scarce and contradictory. OBJECTIVE To evaluate antidepressant use among individuals with Alzheimers disease (AD) and related disorders in the French population between 2010 and 2014. METHOD Antidepressant prescriptions in individuals with AD, mixed dementia (MD), and vascular dementia (VaD) in the French National Alzheimer Database between 2010 and 2014 were analyzed (N = 199,544). RESULTS Multivariate analysis showed an annual significant increase (p < 0.001) in the prescription rate of antidepressants from 26% (2010) to 31% (2014), and identified female gender, younger age, higher education, living in long-term facilities, more severe cognitive decline, and presence of vascular signs (VaD and MD) as associated factors for antidepressant prescribing. CONCLUSION The annual increase of antidepressant prescribing among individuals with AD, MD, and VaD in French specialized settings may be partially related to the lack of current valuable medications for dementia-related behavioral symptoms.