Pascal Menecier

Incidence des évènements de vie dans la maladie d’Alzheimer : étude préliminaire sur le programme Abord

INTRODUCTION Alzheimer disease has been studied according to several approaches: neurological, cognitive, or psychodynamic. Investment in the latter is sparse although it provides an essential clinical overview for global understanding of the disease. OBJECTIVES AND METHODS This study followed the Alzheimer Observation Bank of Research and Data (ABORD) programme, which began in the 1980s. Fifty-nine subjects suffering from Alzheimer disease were compared to 31 control subjects, in order to search for an association between vulnerability factors linked to the life story and future clinical outbreak of Alzheimer disease. The study was carried out with an 11-item questionnaire on difficult life events. They concerned childhood, stress inductive situations, separation or bereavement experiences, family background or psychiatric history. RESULTS Control subjects experienced less difficult events (Chi(2)=5.87; P<0.05). An accumulation of deleterious life events can impact on psychic economy. Pathogenic factors appear, sick people have more often been placed before the age of 10 (Chi(2)=5.06; P<0.01), and recognize more psychiatric family history and/or psychic vulnerability (Chi(2)=5.06; P<0.05). Difficult life events can impact on the subjects ability to grieve, and so the elaboration of losses linked with ageing can become difficult and exceed the psychic ability of the subject, which can be further disrupted by cerebral lesions or pathogenic factors. Hence, the subject could make an unconscious choice of a rescue mental running, which appears in the development of Alzheimer. A protective factor has been found: spiritual practice referring to a form of faith or philosophical adherence (Chi(2)=5.64; P<0.05).

Médicaments et sujets âgés : abus, dépendance ou attirance ?

Psychotropic medicines represent, after alcohol, the second class of substances most susceptible to abuse by elderly people. It can be particularly difficult for caregivers to understand such behaviour as these are prescription-only medicines. This misuse is partly a result of older people tending to trivialise and overrate pharmaceutical drugs, ignoring the potential of non-medicinal methods and psychotherapeutic treatments. The boundaries between prescribed use, overuse, self-medication, excessive use, dependency or addiction to prescription drugs are blurred in older people. Alongside withdrawal methods, prevention must be prioritised by respecting the recommendations of medicine prescriptions in geriatrics and deprescription.

L’ivresse alcoolique dans la vieillesse

Acute alcohol intoxication occurs in elderly subjects. Drunkenness appears in banal clinical forms in geriatrics: falls, dizziness or confusion. Elderly people are more vulnerable to alcohol and need less alcohol to become intoxicated. Age does not exclude the possibility of receiving alcohol addiction treatment. Broaching the subject with an elderly person, the day after a drunken episode, is useful and recommended.Acute alcohol intoxication occurs in elderly subjects. Drunkenness appears in banal clinical forms in geriatrics: falls, dizziness or confusion. Elderly people are more vulnerable to alcohol and need less alcohol to become intoxicated. Age does not exclude the possibility of receiving alcohol addiction treatment. Broaching the subject with an elderly person, the day after a drunken episode, is useful and recommended.

N - 12 Trouble du langage dans la dégénérescence corticobasale : discussion d’une observation

Introduction Les troubles progressifs du langage font habituellement rechercher 3 syndromes que sont l’APP, l’APP fluente et la DS. Nous rapportons l’observation d’un patient ayant un trouble du langage dans le cadre d’une probable DCB. Observation Cas n° 06/2018. Un homme de 73 ans, droitier, consulta au sein d’un centre memoire pour une plainte mnesique, de langage et une gene recente a l’utilisation de sa main droite lorsqu’il jouait au golf. L’interrogatoire revela l’existence d’un trouble du langage, sous forme d’un manque du mot, evoluant progressivement et isolement jusqu’alors depuis environ 2 ans. Le retentissement sur l’autonomie semblait recent. L’examen clinique retrouva un syndrome akineto-rigide et une apraxie de la main droite. Le bilan orthophonique confirma le trouble aphasique, peu fluent avec trouble de l’expression et de denomination avec une atteinte moindre de la comprehension tant orale qu’ecrite. Le bilan neuropsychologique montra des troubles praxiques ideatoire, ideomoteurs et constructifs, une acalculie, des troubles visuo-spatiaux et des troubles executifs predominants sur la flexibilite mentale et la vitesse de traitement de l’information. Il y avait des troubles de memoire de travail alors que la memoire episodique et semantique n’etait pas alteree. Il n’y avait pas de troubles du comportement. L’IRM montra une atrophie parietale et perisylvienne gauches. La TEMP montra une hypoperfusion significative des lobes parietal, temporal et a moindre degre frontal gauches. Discussion Les troubles du langage sont maintenant bien connus dans la DCB. L’atteinte initiale peut faire evoquer retrospectivement le diagnostic syndromique d’une aphasie progressive primaire non fluente. La litterature recente fait etat de l’existence d’« overlap » syndromique entre APP et DCB. Notre observation confirme ces donnees tant par l’evolution clinique que par les donnees de l’imagerie morphologique et fonctionnelle. Conclusion L’existence d’un trouble progressif du langage peut correspondre a une forme de DCB a debut cognitif. La litterature recente semble indiquer qu’il peut s’agir sur le plan histologique des lesions de DCB, de MA ou de Pick.