Reinhild Mulligan

Estimation de l’intelligence prémorbide chez les francophones

Resume Il est important de connaitre l’intelligence premorbide lors de l’evaluation de la demence en clinique et en recherche. Ceci permet de determiner si la performance cognitive actuelle est stable (pendant toute la vie) ou s’il s’agit d’un declin recent. Chez les personnes anglophones, l’evaluation du quotient d’intelligence (QI) premorbide est effectuee couramment par le National Adult Reading Test (NART). Il a ete demontre que ce test est un indicateur robuste vis-a-vis de la demence. La presente etude a cherche a confirmer la validite et les proprietes psychomotrices d’une version francaise du NART. Le test est base sur la capacite de prononcer 40 mots dont l’orthographe est irreguliere. Le test a ete administre dans le cadre d’une etude epidemiologique chez des personnes âgees de 65 a 94 ans, vivant dans le canton de Geneve en Suisse. Les donnees completes de 368 personnes (dont 50 % d’hommes) sur un echantillon total de 456 personnes ont ete suffisantes pour effectuer une analyse statistique. Le coefficient alpha de Cronbach etait eleve pour l’echelle de 40 items (0,89). La theorie de reponse aux items (TRI) a montre que le test etait essentiellement unidimensionnel et que deviner la prononciation des mots n’influencait pas sa performance. La plupart des items etaient performants, montrant une saturation factorielle moyenne de 0,53. La validite du test comme mesure d’intelligence a ete demontree statistiquement par des etudes de correlations entre les mesures de l’intelligence cristalline, de la memoire et de la vitesse de traitement (Multiple R = 0,62). La comparaison avec les resultats obtenus par les etudes precedentes effectuees a Montpellier (France) montre qu’un bon nombre d’items fonctionnent dans chaque groupe de maniere identique. Des etudes supplementaires sont necessaires pour valider le fNART par rapport a des tests d’intelligence courants comme le WAIS et pour l’appliquer dans les differentes regions de langue francaise. Le test developpe dans le cadre de cette etude offre aux cliniciens et chercheurs une methode facile d’estimation de l’intelligence premorbide en utilisant un test robuste face au declin cognitif. Il est disponible gratuitement sur le site Internet : http://www.mhri.edu.au/biostats/fNART .

Detecting anxiety and depression in hospitalised elderly patients using a brief inventory

This study validated a French language version of an inventory designed to detect symptoms of depression and anxiety [Goldberg et al, 1987] in a sample of elderly French-speaking inpatients at risk for one of these disorders. Latent trait analysis was used to replicate the structure of the symptoms in the inventory, and receiver operating characteristic analysis was used to assess the performance of the inventory as a screening measure for Major Depressive Episode and Generalised Anxiety Disorder according to DSM-IV criteria. Reflecting the ascertainment of individuals in the sample as being at risk for a disorder, prevalence of individual symptoms was high although the general structure of the inventory was found to be comparable to that found in samples of both community elderly and younger medical patients. ROC analyses showed that the subscales of inventory performed satisfactorily as screening measures for anxiety or depression but lacked specificity for each disorder. In addition to providing further evidence for the utility of this inventory to detect general psychiatric distress in elderly persons, this study provides a valid means of detecting symptoms of depression and anxiety in French speaking groups.

Specific BACE1 genotypes provide additional risk for late‐onset alzheimer disease in APOE ε4 carriers

Alzheimer disease (AD) is characterized neuropathologically by neurofibrillary tangles and senile plaques. A key component of plaques is Aβ, a polypeptide derived from Aβ‐precursor protein (APP) through proteolytic cleavage catalyzed by β and γ‐secretase. We hypothesized that sequence variation in genes BACE1 (on chromosome 11q23.3) and BACE2 (on chromosome 21q22.3), which encode two closely related proteases that seem to act as the APP β‐secretase, may represent a genetic risk factor for AD. We analyzed the frequencies of single nucleotide polymorphisms (SNPs) in BACE1 and BACE2 genes in a community‐based sample of 96 individuals with late‐onset AD and 170 controls selected randomly among residents of the same community. The genotype data in both study groups did not demonstrate any association between AD and BACE1 or BACE2. After stratification for APOE status, however, an association between a BACE1 polymorphism located within codon V262 and AD in APOE ε4 carriers was observed (P = 0.03). We conclude that sequence variation in the BACE1 or BACE 2 gene is not a significant risk factor for AD; however, a combination of a specific BACE1 allele and APOE ε4 may increase the risk for Alzheimer disease over and above that attributed to APOE ε4 alone.

Economic considerations of Alzheimer's disease and related disorders.

Economic analyses of geriatric syndromes are seldom performed. However, demographic and epidemiological imperatives have led to significant interest in the evaluation of AD-related costs. Over 300 papers devoted to economic considerations of Alzheimer’s disease have been published in peer-reviewed journals, within the last five years. In these papers, the chosen perspective (costs to society or to specific payers) is important. Analytical methods are still evolving and remain complex. Unresolved methodological issues will need to be addressed to further our understanding of long-term economic consequences. At present, it is clear that diagnostic and drug costs are low compared to the major cost of institutionalization. Thus, directing efforts at early diagnosis and delaying nursing home placement are two key cost-containment interventions. In this respect, the need to support informal care should not be underestimated.