Valérie Bergua

Influence of education on the pattern of cognitive deterioration in AD patients: The cognitive reserve hypothesis

The cognitive reserve hypothesis proposes that a high educational level could delay the clinical expression of Alzheimers disease (AD) although neuropathologic changes develop in the brain. Therefore, some studies have reported that when the clinical signs of the disease emerge, high-educated patients may decline more rapidly than low-educated patients because the neuropathology is more advanced. However, these studies have only investigated the decline of global cognition or an isolated cognitive process. To study the differential deterioration pattern of several cognitive processes according to education, the performance of 20 AD patients with a high educational level and a low educational level were compared with the performance of 20 control subjects on a neuropsychological battery. The results showed that cognitive deterioration of AD patients is different according to education, although the global performance was similar in AD patients. The high-educated patients exhibited greater impairment of abstract thinking whereas the low-educated patients showed greater impairment of memory and attentional function. This confirms that some cognitive processes, such as abstract thinking, decline more rapidly in high-educated patients whereas others seem to evolve more slowly if compared to low-educated patients. In this latter case, high-educated patients may still benefit from cognitive reserve after the diagnosis of the dementia.

Health and aging in elderly farmers: the AMI cohort.

BackgroundThe health of the agricultural population has been previously explored, particularly in relation to the farming exposures and among professionally active individuals. However, few studies specifically focused on health and aging among elders retired from agriculture. Yet, this population faces the long-term effects of occupational exposures and multiple difficulties related to living and aging in rural area (limited access to shops, services, and practitioners). However, these difficulties may be counter-balanced by advantages related to healthier lifestyle, richer social support and better living environment. The general aim of the AMI cohort was to study health and aging in elderly farmers living in rural area through a multidisciplinary approach, with a main focus on dementia.Methods/designThe study initially included 1 002 participants, randomly selected from the Farmer Health Insurance rolls. Selection criteria were: being 65 years and older; living in rural area in Gironde (South-Western France); being retired from agriculture after at least 20 years of activity and being affiliated to the Health Insurance under own name. The study started in 2007, with two follow-up visits over 5 years. Baseline visits were conducted at home by a neuropsychologist then by a geriatrician for all cases suspected of dementia, Parkinson’s disease and depression (to confirm the diagnosis), and by a nurse for others. A large panel of data were collected through standardised questionnaires: complete neuropsychological assessment, material and social living environment, psychological transition to retirement, lifestyle (smoking, alcohol and diet), medications, disability in daily living, sensory impairments and some clinical measures (blood pressure, depression symptomatology, anxiety, visual test, anthropometry…). A blood sampling was performed with biological measurements and constitution of a biological bank, including DNA. Brain MRI were also performed on 316 of the participants. Finally, the three-year data on health-related reimbursements were extracted from the Health System database (medications, medical and paramedical consultations, biological examinations and medical devices), and the registered Long-Term Diseases (30 chronic diseases 100% covered by the Insurance System).DiscussionAMI is the first French longitudinal study on health and aging set up in a population of elderly farmers living in rural area through a multidisciplinary approach.

Nutritional status of community‐dwelling older people with dementia: associations with individual and family caregivers' characteristics

The objective of this study was to explore the associations of individual characteristics of both older people with dementia and family caregivers with the nutritional status of older people with dementia.

Cognitive Decline After Entering a Nursing Home: A 22-Year Follow-Up Study of Institutionalized and Noninstitutionalized Elderly People

OBJECTIVE The objective of this study is to compare cognitive decline of elderly people after entering an institution with that of elders living in the community with similar clinical conditions. DESIGN The Personnes Agées QUID (PAQUID) cohort is a prospective population-based study which included, at baseline, 3777 community-dwelling people aged 65 years and older. Participants were followed-up for 22 years. Among those who were nondemented and living at home at baseline, 2 groups were compared: participants who entered a nursing home during study follow-up (n = 558) and those who remained living at home (n = 3117). Cognitive decline was assessed with Mini-Mental State Examination (MMSE), Benton visual retention test, and verbal fluency Isaacs Set Test. RESULTS After controlling for numerous potential confounders, including baseline MMSE and instrumental activities of daily living scores, incident dementia, depressive symptoms, and chronic diseases, nursing home placement was significantly associated with a lower score on MMSE between the last visit before and after institutionalization (difference of 2.8 points, P < .0001) and greater further cognitive decline after institutionalization (difference of 0.7 point per year, P < .0001). Similar results were found for the Benton memory test. In a second series of analysis in which the persons who became demented over the study follow-up were excluded, the results remained unchanged. CONCLUSIONS The present study suggests that institutionalized elderly people present a greater cognitive decline than persons remaining in the community. The reasons of that decline remain unclear and may be related to physical and psychological effects of institutionalization in elderly people.

Norms and associated factors of the STAI-Y State anxiety inventory in older adults: results from the PAQUID study.

BACKGROUND The latest version of the State-Trait Anxiety Inventory (STAI-Y) is commonly used in older adults, even though this anxiety scale was developed in and for young adults. Norms and associated factors of the STAI-Y are lacking for older adults in the general population. The objectives of the present study were to produce norms on the STAI-Y State scale for older adults using a large sample of older adults selected from a general population and to examine the sociodemographic and health-related factors associated with the STAI-Y State score. METHODS 993 community-dwelling individuals aged 66 years and over from the PAQUID study were evaluated at home by a psychologist for the following variables: age, education, marital status, proximity of relatives, self-assessment of income sufficiency, occupation during active life, depressive symptomatology, objective and subjective health, objective and subjective cognitive functioning, adverse life events, activities of daily living, drug use, and cigarette consumption. RESULTS Norms were stratified for age, sex, and education and were produced separately for older adults with and without depressive symptomatology. Multivariate analyses revealed that younger age (66-79 years), female sex, lower education, perception of income insufficiency, depressive symptomatology, poor subjective health, subjective cognitive complaints, psychotropic drugs use, and recent adverse life events were independently associated with higher STAI-Y State score. CONCLUSIONS This study provides norms for the STAI-Y State anxiety inventory in a general population of older adults and indicates the specific factors linked with state anxiety. Such factors should be taken into account by clinicians in order to better understand state anxiety in older adults.

Cognitive insight in schizophrenia: the missing link between insight and neurocognitive complaint?

Abstract The aim of this study was to explore the associations between cognitive insight, clinical insight, and neurocognitive complaint in a sample of 54 outpatients with schizophrenia spectrum disorders. Cognitive insight assessed using the Beck Cognitive Insight Scale (BCIS) was not associated with clinical insight assessed using the Scale to Assess Unawareness of Mental Disorder. Associations were found between the BCIS scores and the neurocognitive complaints assessed using the Subjective Scale to Investigate Cognition in Schizophrenia. A high level of neurocognitive complaints was positively associated with self-reflectiveness and negatively associated with self-certainty about beliefs and judgments. These results provide further support for the construct validity of the BCIS. The data also suggest that cognitive insight and neurocognitive complaint are close constructs that should be differentiated from awareness of having a mental illness.

Restriction in instrumental activities of daily living in older persons: association with preferences for routines and psychological vulnerability.

Disabilities in the Instrumental Activities of Daily Living (IADL) are frequently observed in older adults. A restriction in the daily life activities in the elderly may be related to a process of routinization induced by homogenization of activities, in addition to its association with emotional states. The relationship between level of functional disability for IADLs and preferences for routines was explored in 207 non-demented French participants (Mage = 84.2 years, age range: 78–96 years) from the PAQUID cohort study. Multinomial regressions analyses showed that preferences for routines were significantly associated with a higher risk of restriction for at least two functional activities, after adjusting for sociodemographic and psychological variables. However, this association was non significant after controlling for cognitive variables. These findings add new elements for understanding the effect of routinization in the disability process in older persons in that preferences for routines could constitute a risk factor of IADL restriction, similar to cognitive decline.

Vieillesse et routinisation : une revue de la question

The concept of routinization in the elderly is defined as the performance of environmental, behavioral, and social activities, in the same manner over time. First, routines are described from a developmental point of view and a multidisciplinary approach. Second, the development of this concept in recent studies is analyzed. Different functions of routinization are discussed as a general model of disability. Based on the results of the PAQUID epidemiological investigation, routinization of behaviors and activities in older persons appears as a complex phenomenon that cannot only be understood in terms of adaptive functioning. Various relationships were found between preference for routines and vulnerability factors in psychological, functional or cognitive domains. Finally, the theoretical issues and clinical implications are discussed with regard to distinct dimensions of the routinization concept, including its relevance for identifying the vulnerability markers in the elderly, and improving early detection, prevention and management of adaptation difficulties in this population.

Gray matter characteristics associated with trait anxiety in older adults are moderated by depression.

BACKGROUND Structural gray matter characteristics of anxiety remain unclear. The aim of this study was to assess the influence of current depressive symptoms and history of depression on the gray matter characteristics of trait anxiety. METHODS Structural magnetic resonance imaging (MRI) data from 393 individuals aged 65 years or older were used. Regions of interest (ROIs) included the amygdala, anterior cingulate cortex (ACC), insula, orbitofrontal cortex (OFC), and temporal cortex. Trait anxiety was measured by the State-Trait Anxiety Inventory (STAI). Depression and depressive symptoms were measured using DSM-IV criteria and the Center for Epidemiological Studies Depression Scale (CESD). RESULTS After adjustments for sociodemographics and health-related variables, anxiety had a significant influence on the gray matter characteristics in all cortical ROIs. First, in participants without depression antecedents, higher trait anxiety was associated with a larger cortical thickness in all cortical ROIs. Second, in participants with a previous history of depression, higher trait anxiety was associated with a smaller cortical thickness in all cortical ROIs. CONCLUSIONS These results suggest that anxiety is related to cortical thickness differently in healthy older adults and in older adults with psychiatric antecedents. Anxiety associated with thinner cortical areas could reflect symptoms of a specific type of depression or a vulnerability to develop depression.

Short STAI-Y anxiety scales: validation and normative data for elderly subjects

Objectives: The aim of this study was to develop short forms of the STAI-Y trait and state scales and associated norms suitable for the screening of anxiety in elderly populations. Method: This study was based on population-based cohorts of older persons from two epidemiological French studies that each included one subscale of the STAI-Y, i.e. state and trait anxiety scales. For both scales, the most discriminative items were retained and their factorial structure was examined using principal components analysis. Internal consistency (Cronbach’s alpha) was estimated and cut-offs and norms were computed. Results: A 10-item STAI-Y version produced scores similar to those obtained with the full form of the STAI-Y. The factorial structure of the shortened form is comparable to that of the full scales. Results showed good internal consistency (alpha coefficients were 0.92 and 0.85 for short STAI-Y state and trait scales, respectively). Moreover, both short STAI-Y state and trait scales correctly classified 88% of the participants using a cut-off point of 23. Norms for both short trait and state anxiety scales are provided according to age, gender, educational level and depressive symptoms. Conclusion: Both shortened scales have similar factorial structure and internal consistency to the longer scales and classify anxious/non-anxious elderly with acceptable accuracy. The shorter form is likely to be more acceptable to elderly persons through reduction of fatigue effects.