Marie-Pierre Hervy

The Prognostic Significance of Isolated Systolic Hypertension in the Elderly. Results of a Ten Year Longitudinal Survey

A ten year longitudinal survey of 191 female elderly subjects (mean age 80--Range 61 to 100 years) was set up to demonstrate that even a moderate isolated systolic hypertension is a powerful contributor to the incidence of cardiovascular complications in the elderly. The incidence of all cardiovascular events was carefully recorded and was correlated with a number of parameters registered at entry into the study. The results show that isolated systolic hypertension as well as diastolic hypertension is significantly correlated to the incidence of strokes and myocardial infarction independently of other parameters (Blood Cholesterol, Blood Sugar) which do not appear in this population as risk factors of cardiovascular morbidity. This underlines the high interest of controlled therapeutic studies run in this field in elderly patients.

Consensus sur la démence de type Alzheimer au stade sévère

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.

Dermatoglyphic patterns in dementia of the Alzheimer type: a case-control study.

STUDY OBJECTIVE--The aim was to compare digital and palmar dermatoglyphics in subjects with dementia of Alzheimer type and in mentally healthy elderly controls. DESIGN--This design was a case-control study. SETTING--The study was carried out in geriatric units and retirement communities in the Paris area. PARTICIPANTS--Cases were women with clinically diagnosed Alzheimer type dementia according to DSM III-R criteria (n = 82), mainly with late onset of the disease. Controls were women aged 85 years or older without cognitive deterioration (n = 76). MEASUREMENTS AND MAIN RESULTS--Finger and palm prints obtained from both hands by the classical ink method were examined. Fingerprints were classified into four types of figures. On palms, palmar flexion creases, palmar axial triradii, true patterns of the hypothenar area, and main line terminations were described. Examinations were performed by two examiners blind to the subjectss diagnostic category. For the different patterns studied, no major differences between dementia patients and elderly controls were found. Nor was there evidence of high frequencies of features commonly observed in Downs syndrome (trisomy 21), which have previously, though sporadically, been reported. CONCLUSIONS--On one of the largest samples of Alzheimer dementia patients studied, and with evaluation blind to diagnosis, no evidence has been found that particular dermatoglyphic patterns occur like those observed in Downs syndrome, a disease which is related to dementia of the Alzheimer type.

Rationale for ACE inhibition in the elderly: treatment of arterial hypertension with enalapril.

A randomized, double-blind, placebo-controlled trial was conducted with 32 elderly patients (aged 75-97 years) with uncomplicated essential hypertension, to evaluate the efficacy and tolerance of enalapril, an angiotensin-converting enzyme inhibitor. It was given over an 8-week period in doses from 20 to 40 mg/day and was compared with an identical placebo. Enalapril caused a significant reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) by the 2nd week, an effect that persisted through to the 8th week (190 +/- 16/102 +/- 7 to 151 +/- 19/85 +/- 11 mm Hg); 67% of patients had their pressures normalized (less than 160/95 mm Hg). BP was also significantly decreased by the 8th week under placebo (183 +/- 16/101 +/- 9 to 165 +/-21/91 +/- 13 mm Hg), but only 35% of patients attained a normal pressure. Heart rate did not change with treatment. Enalapril caused an increase in plasma renin activity (1.22 +/- 0.08 to 3.66 +/- 2.50 ng/ml/h), whereas aldosterone levels remained unchanged. There was a mild, significant elevation of creatinine level with enalapril but other laboratory parameters, including serum potassium, were unaltered. Two deaths occurred in the enalapril group, but were not considered to be treatment-related. The drug was otherwise well tolerated. Serum enalapril concentration was assessed in 10 patients taking 20 mg/day over an 8-day period. At equilibrium, the level was 22.3 +/- 5.0 ng/l and it correlated both with converting enzyme inhibition and with renal function. Enalapril is shown to be an effective and well-tolerated antihypertensive medication in elderly patients.

Two faller risk functions for geriatric assessment unit patients

This study was done in order to construct a simple clinical failer predictor model, which quantifies risk for the individual elderly patient. Fifty patients sequentially admitted to a geriatric assessment unit were assessed systematically at admission for six potential failer risk factors: age, gait, speed, gait quality, gender, symptoms of urinary urgency, and symptoms of dizziness. Falls were systematically recorded during admission. Only age, abnormal gait, and self-selected gait speed were found to be associated with fallers. Multivariate analysis revealed that the two best models for predicting those most likely to be fallers were the factor subgroups: 1) age plus gait quality, and 2) age plus gait speed. The difference between the two models is the choice of gait measure incorporated. Gait speed is a continuous quantitative variable with no known limit of normal. Gait quality is a qualitative variable where abnormal gait is defined by clinical criteria. The predictability of each model was verified in another population (N=78).