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Background: Dementia has a negative impact on the quality of life of the person with dementia and their spouse caregivers, as well as on the couple’s relationship, which can lead to high levels of distress for both partners. Hypnosis has been shown to be effective in managing distress and increasing the quality of the relationship. Objective: The aim was to develop a standardized hypnosis intervention for couples confronted with Alzheimer’s disease and evaluate its feasibility, acceptability, and helpfulness in managing the distress of both partners and increasing the quality of the relationship. Methods: In a single-arm study, sixteen couples received the 8-week intervention. Qualitative and quantitative assessments were conducted pre- and post-intervention as well as three months after. Results: 88.9% of couples (n = 16) of the final sample (n = 18) completed the intervention. Despite the negative representations of hypnosis, several factors led couples to accept to participate in this study: positive expectations, professional endorsement, medical application, non-drug approach, home-based, free, flexible, and couple-based intervention. The results showed a significant decrease in distress for both partners. These effects were maintained three months after the intervention. Couples felt more relaxed, had fewer negative emotions, accepted difficulties more easily, were more patient, and reported better communication and more affection in the relationship. Conclusion: Overall, this pilot study shows the feasibility and acceptability of hypnosis with couples confronted with Alzheimer’s disease. Although measures of the preliminary pre- and post-intervention effects are encouraging, confirmatory testing with a randomized controlled trial is needed.

BACKGROUND The institutionalization of a patient with Alzheimer's disease or other dementia (ADOD) is the last resort for the latter's family and/or caregivers. We hypothesized that the degree of kinship between the patient and his/her caregiver would influence the likelihood of institutionalization. OBJECTIVE To assess the association between institutionalization of patients with ADOD and the degree of kinship with the family caregiver. METHODS A cross-sectional study of patients with ADOD aged 75 or over attending a memory center in France for the first time between 2011 and 2014, as recorded in the French National Alzheimer Database. Multivariable logistic regression was used to assess factors associated with institutionalization after adjustment for age, sex, the Mini-Mental State Examination score, educational level, and type of dementia. RESULTS A total of 52,874 patients were included. The primary caregiver was most often a child (54.8%) or the spouse (36.7%). Compared with the "spouse" reference category, all the other caregiver categories were associated with a significantly greater likelihood of institutionalization; the odds ratio [95% confidence interval] was 4.68 [3.67-5.92] when the carer was a grandchild, 5.48 [4.93-6.09] for a child, 4.93 [4.11-5.91] for a daughter-/son-in-law, 8.76 [7.15-10.70] for a sibling, and 8.93 [7.48-10.65] for a niece/nephew. CONCLUSION The likelihood of institutionalization of older patients with ADOD varied with the degree of kinship. Compared with the "spouse" reference category, the likelihood was higher for all other types of caregivers but was especially high when the caregiver was not a direct descendant of the patient.

We investigated serum neutralizing activity against BA.1 and BA.2 Omicron sublineages and T cell response before and 3 months after administration of the booster vaccine in healthcare workers (HCWs).HCWs aged 18-65 years who were vaccinated and received booster doses of the BNT162b2 vaccine were included. Anti-SARS coronavirus 2 IgG levels and cellular response (through interferon γ ELISpot assay) were evaluated in all participants, and neutralizing antibodies against Delta, BA.1, and BA.2 were evaluated in participants with at least one follow-up visit 1 or 3 months after the administration of the booster dose.Among 118 HCWs who received the booster dose, 102 and 84 participants attended the 1-month and 3-month visits, respectively. Before the booster vaccine dose, a low serum neutralizing activity against Delta, BA.1, and BA.2 was detectable in only 39/102 (38.2%), 8/102 (7.8%), and 12/102 (11.8%) participants, respectively. At 3 months, neutralizing antibodies against Delta, BA.1, and BA.2 were detected in 84/84 (100%), 79/84 (94%), and 77/84 (92%) participants, respectively. Geometric mean titres of neutralizing antibodies against BA.1 and BA.2 were 2.2-fold and 2.8-fold reduced compared with those for Delta. From 1 to 3 months after the administration of the booster dose, participants with a recent history of SARS coronavirus 2 infection (n = 21/84) had persistent levels of S1 reactive specific T cells and neutralizing antibodies against Delta and BA.2 and 2.2-fold increase in neutralizing antibodies against BA.1 (p 0.014). Conversely, neutralizing antibody titres against Delta (2.5-fold decrease, p 0.0001), BA.1 (1.5-fold, p 0.02), and BA.2 (2-fold, p 0.0001) declined from 1 to 3 months after the administration of the booster dose in individuals without any recent infection.The booster vaccine dose provided significant and similar response against BA.1 and BA.2 Omicron sublineages; however, the immune response declined in the absence of recent infection.

The COVID-19 epidemic that started in November in China became a national epidemic from March 16, 2020 with the declaration of population containment in order to reduce the spread of the virus in France. From March 17 to March 27, 2020, the monitoring unit of the French society of geriatrics and gerontology decided to conduct a survey to analyze the implementation of the mobilization of geriatric units, given that this epidemic had shown that it resulted in excess mortality mainly among the elderly. The survey was able to bring together the response of 34 services, nine of which were located in a high epidemic cluster zone. Dedicated acute geriatric units for patients infected with COVID-19 were present in eight facilities, only outside the cluster zones. Nine geriatric follow-up and rehabilitation services were dedicated, an additional telemedicine activity concerned 35% of the facilities, and family listening and tablet communication facilities concerned 36% of the facilities. This survey is a snapshot of an initial moment in the epidemic. It provides an opportunity to describe the context in which this epidemic occurred in terms of geriatric policy, and to assess the responsiveness and inventiveness of these services in meeting the needs of the elderly.

The successful design of musical interventions for dementia patients requires knowledge of how rhythmic abilities change with disease severity. In this study, we tested the impact of the severity of the neurocognitive disorders (NCD) on the socioemotional and motor responses to music in three groups of patients with Major NCD, Mild NCD, or No NCD. Patients were asked to tap to a metronomic or musical rhythm while facing a live musician or through a video. We recorded their emotional facial reactions and their sensorimotor synchronization (SMS) abilities. Patients with No NCD or Mild NCD expressed positive socioemotional reactions to music, but patients with Major NCD did not, indicating a decrease in the positive emotional impact of music at this stage of the disease. SMS to a metronome was less regular and less precise in patients with a Major NCD than in patients with No NCD or Mild NCD, which was not the case when tapping with music, particularly in the presence of a live musician, suggesting the relevance of live performance for patients with Major NCD. These findings suggest that the socioemotional and motor reactions to music are negatively affected by the progression of the NCD.

Sensorimotor synchronization (SMS), the coordination of physical actions in time with a rhythmic sequence, is a skill that is necessary not only for keeping the beat when making music, but in a wide variety of interpersonal contexts. Being able to attend to temporal regularities in the environment is a prerequisite for event prediction, which lies at the heart of many cognitive and social operations. It is therefore of value to assess and potentially stimulate SMS abilities, particularly in aging and neurocognitive disorders (NCDs), to understand intra-individual communication in the later stages of life, and to devise effective music-based interventions. While a bulk of research exists about SMS and movement-based interventions in Parkinson’s disease, a lot less is known about other types of neurodegenerative disorders, such as Alzheimer’s disease, vascular dementia, or frontotemporal dementia. In this review, we outline the brain and cognitive mechanisms involved in SMS with auditory stimuli, and how they might be subject to change in healthy and pathological aging. Globally, SMS with isochronous sounds is a relatively well-preserved skill in old adulthood and in patients with NCDs. At the same time, natural tapping speed decreases with age. Furthermore, especially when synchronizing to sequences at slow tempi, regularity and precision might be lower in older adults, and even more so in people with NCDs, presumably due to the fact that this process relies on attention and working memory resources that depend on the prefrontal cortex and parietal areas. Finally, we point out that the effect of the severity and etiology of NCDs on sensorimotor abilities is still unclear: More research is needed with moderate and severe NCD, comparing different etiologies, and using complex auditory signals, such as music.

Long-term care facility (LTCF) older residents display physiological alterations of cellular and humoral immunity that affect vaccine responses. Preliminary reports suggested a low early postvaccination antibody response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this study was to focus on the specific T-cell response. We quantified S1-specific IgG, neutralizing antibody titers, total specific IFNγ-secreting T cells by ELISpot, and functionality of CD4+- and CD8+-specific T cells by flow cytometry, after two doses of the BNT162b2 vaccine in younger and older people, with and without previous COVID-19 infection (hereafter referred to as COVID-19-recovered and COVID-19-naive subjects, respectively). Frailty, nutritional, and immunosenescence parameters were collected at baseline in COVID-19-naive older people. We analyzed the immune response in 129 young adults (median age 44.0 years) and 105 older residents living in a LCTF (median age 86.5 years), 3 months after the first injection. Humoral and cellular memory responses were dramatically impaired in the COVID-19-naive older (n = 54) compared with the COVID-19-naive younger adults (n = 121). Notably, older participants’ neutralizing antibodies were 10 times lower than the younger’s antibody titers (p + and IFNγ+IL-2+TNFα+ cells among specific CD4+ T cells, and the frequency of specific CD8+ T cells were lower in COVID-19-naive older participants than in COVID-19-naive young adults (p p = 0.0018, respectively). However, COVID-19-recovered older participants (n = 51) had greater antibody and T-cell responses, including IFNγ+ and IFNγ+IL-2+TNFα+-specific CD4+ T cells (p +-specific CD8+ T cells (p + and CD8+ T cells, in addition to impaired antibody response, and that specific studies are warranted to assess the efficiency of SARS-CoV-2 mRNA-based vaccines, as in other immunocompromised subjects. Our study also shows that, despite their physiological alterations of immunity, vaccination is highly efficient in boosting the prior natural memory response in COVID-19-recovered older people.

We quantified S1-specific IgG, neutralizing antibody titers, specific IFNγ secreting T cells and functionality of specific CD4+ and CD8+ T cells in 130 young adults (median age 44.0 years) and 106 older residents living in a long-term care facility (86.5 years) after 2 doses of BNT162b2. Three months after the first injection, humoral and cellular memory responses were dramatically impaired in the 54 COVID-19-naive older compared to the 121 COVID-19-naive younger adults. Notably, older participants’ neutralizing antibodies, detected in 76.5% (versus 100% in young adults,P< 0.0001), were ten times lower than the younger’s antibody titers (P< 0.0001). Antibody and T cell responses were greater among the 52 COVID-19-recovered than among the 54 COVID-19-naive older adults (P< 0.0001). Our study shows that 2 doses of BNT162b2 does not guarantee long-term protection against SARS-CoV-2 in the older. An additional dose should be considered to boost their specific memory response.

The present study aimed to evaluate the persistent immunogenicity offered by a third dose of BNT162b2 against Delta and Omicron variants, in nursing home (NH) residents.In this monocenter prospective observational study, anti-spike IgG levels, S1 domain reactive T cell counts, serum neutralizing antibody titers against Delta and Omicron variants were compared before and up to three months after the BNT162b2 booster dose, in NH residents without COVID-19 (COVID-19 naive) or with COVID-19 prior to initial vaccination (COVID-19 recovered).106 NH residents (median [interquartile range] age: 86·5 [81;91] years) were included. The booster dose induced a high increase of anti-spike antibody levels in all subjects (The booster dose restores high neutralization titers against Delta in all NH residents, and at a lower level against Omicron in a large majority of participants. Future studies are warranted to assess if repeated BNT162b2 booster doses or new specific vaccines might be considered for protecting such fragile patients against Omicron and/or future SARS-CoV-2 variants.French government through the Programme Investissement d'Avenir (I-SITE ULNE/ANR-16-IDEX-0004 ULNE) and the Label of COVID-19 National Research Priority (National Steering Committee on Therapeutic Trials and Other COVID-19 Research, CAPNET).

International audience; Background Music-based interventions appear to be efficient non-pharmacological approaches to improve emotional, social, and cognitive functioning of patients with neurodegenerative diseases such as Alzheimer's Disease (AD). Objectives Because the benefits seem to increase with patients motor involvement, we studied the ability to move in synchrony with musical rhythms and more specifically the impact of live performance compared to video recording of a musician on sensorimotor abilities in patients with cognitive impairments (AD, vascular and mixed dementia) and in patients with no evidence of cognitive impairments. Methods Sensorimotor synchronization (SMS) to a metronomic or a musical stimulus was assessed in patients when they were viewing a live musician or his pre-recorded video. Results Participants were better at synchronizing to a metronome than to music but this effect was modulated by the social context. While SMS to a metronome was better when facing a video than a live performance, there was no impact of the social context on SMS to music. Lastly, we found no group differences on SMS. Conclusion The decrease in synchronization ability to metronome in the live performance may be due to the social pressure associated with the presence of the musician. Such a pressure might be removed in pleasant and ecological social activities, like moving with music, explaining the lack of the social context effect on SMS to music. Remarkably, the group with cognitive impairments performed no worse than the group without cognitive impairments, which suggests relatively spared SMS abilities in these patients. By showing that it is possible to encourage a patient to synchronize with others, even in front of a video, the results of our study indicate that SMS can be used as a relevant predictor in clinical trials and open up promising therapeutic options for patients living in remote areas.

Introduction Memory clinics (MCs) are the main model for dementia diagnosis and care. Following the development of a MC network in Northern France, our objectives were to assess its impact on patient characteristics over 20 years. Methods The characteristics of new consultants were studied from 1997 to 2016. Results New consultants increased from 774 per year in 1997 to 26258 per year in 2016, as the number of MCs increased from 12 to 29. Over time, patients were progressively older and less educated, and more were living alone. A greater proportion of patients were referred by specialists. Referral delay and home‐to‐MC distance kept decreasing. The oldest patients were referred at a progressively less‐severe stage. The proportion of young patients kept increasing in the tertiary referral center. Discussions The development of a region‐wide MC network led to increased referral of vulnerable patients and differentiation of the tertiary referral center over time.

Introduction Memory clinics (MCs) are the main model for dementia diagnosis and care. Following the development of a MC network in Northern France, our objectives were to assess its impact on patient characteristics over 20 years. Methods The characteristics of new consultants were studied from 1997 to 2016. Results New consultants increased from 774 per year in 1997 to 26258 per year in 2016, as the number of MCs increased from 12 to 29. Over time, patients were progressively older and less educated, and more were living alone. A greater proportion of patients were referred by specialists. Referral delay and home‐to‐MC distance kept decreasing. The oldest patients were referred at a progressively less‐severe stage. The proportion of young patients kept increasing in the tertiary referral center. Discussions The development of a region‐wide MC network led to increased referral of vulnerable patients and differentiation of the tertiary referral center over time.

Objective: Anosognosia heterogeneously affects cognitive functioning and indeed, at the very onset of dementia symptoms. This raises the question of accountable predictors of each cognitive impairment. The objective of this study was to identify the cognitive and non-cognitive predictors of so-called cognitive anosognosia. Method: A paradigm based on the discrepancies between performance predictions and actual performance in the light of the Dementia Rating Scale (DRS) helped distinguish cognitive anosognosia in relation to four major functions: Attention Initiation-perseveration, Conceptualisation and Memory. Patients achieved a complete set of neuropsychological tests and assessments of the level of anxiety, apathy and functional independence. Results: Significant correlations existed between all cognitive anosognosia scores (AS) and neuropsychological performance scores of the participants. Similarly, significant correlations were found between the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) scores and the Initiation and Conceptualisation AS and between anxiety score and Conceptualisation and Memory AS. However, the regression models were exclusively cognitive for Attention Initiation-perseveration and Memory AS. Only the Conceptualisation AS was predicted by a non-strictly cognitive regression model including the ADL score. Conclusions: If the different specific cognitive anosognosias are predicted by separate sets of variables, our results emphasise that dysexecutive impairment plays a major role regardless of the deficiencies considered.

Background It is well known that informal care giving for Alzheimer patients can be a burden and may result in caregivers’ distress and stress. Caring for a person with Alzheimer's disease (AD) is a difficult task, which can become overwhelming. Their caregivers need attention as well. Objectives The present study examines the socio-demographic characteristics and the quality of health and life of the sandwich grandparent generation (SGP) caregivers defined as providing care to both old demented parents and young grandchildren. Study design Multicentric, prospective and observational study over a one-year period. Setting Eleven voluntary Memory Clinics across the North of France. Participants Voluntary SGP caregivers recruited in Memory Clinics who completed an oral questionnaire, during an interview one to one with a physician. Results A vast majority of our SGP caregivers were women, mean age 59 years, married, retired, described in the literature as “women in the middle”, felling stressed and not sleeping well in more than half of the cases. They had three grandchildren, mean age 7 years. The AD patient, mean age 86-years-old, was most frequently the caregiver's mother. Many SGPs had been providing their help for 5 years or even longer. Nevertheless, the SGPs considered themselves satisfied about their health, and said they had a good quality of life. Conclusion Although SGP women caregivers reported high levels of perceived burden, they considered that their health and quality of life were good.

Resume Contexte Bien que les personnes âgees soient particulierement vulnerables aux effets nocifs de l’alcool, tres peu de travaux ont ete consacres a la consommation d’alcool en etablissement d’hebergement pour personnes âgees dependantes (EHPAD). Objectifs Determiner les niveaux de consommation des residents de 8 EHPAD du Nord Pas-de-Calais et les caracteristiques des consommateurs excessifs (≥ 3 verres de vin ou equivalent par jour). Methodes Tous les residents etaient invites a participer a l’etude a la condition de satisfaire aux criteres d’inclusion (âge ≥ 60 ans, Mini Mental State de Folstein (MMSE) > 15, consentement) et d’exclusion (communication orale impossible, fin de vie). Deux questionnaires ont ete utilises, l’un destine aux residents et l’autre aux soignants. Resultats Trois cent soixante-huit residents ont ete inclus dans l’etude [242 femmes (65,8 %) et 126 hommes (34,2 %), d’âge moyen 80,5 ± 8,9 ans]. Parmi eux, 98 (26,6 %) disaient ne jamais boire de boissons alcoolisees et 21 (5,7 %) ne boire qu’occasionnellement. Les 249 (67,7 %) autres declaraient une consommation quotidienne, principalement dans la salle de restaurant au moment des repas. Soixante-sept (18,2 %) etaient des consommateurs excessifs. Compares aux autres residents inclus dans l’etude, les consommateurs excessifs etaient plus souvent des hommes et etaient plus jeunes. Conclusion L’etude confirme que la prevalence de la consommation a risque chronique est elevee dans les EHPAD. Des progres doivent etre faits pour une meilleure reconnaissance et un meilleur traitement des problemes lies a l’alcool sur ce terrain particulier.

Resume Objectif Nous avons elabore un guide local de prescription contenant des recommandations pour l’antibiotherapie initiale empirique des pneumonies communautaires ou nosocomiales. Le but de notre etude etait d’evaluer l’impact de cette mesure. Methode Le guide a ete ecrit et diffuse en mai 1999. Nous avons revu retrospectivement tous les dossiers des patients âges de plus de 65 ans, hospitalises dans le service de medecine aigue geriatrique du CHRU de Lille (59) entre mai 1999 et novembre 2000, et ayant eu une pneumonie communautaire, institutionnelle ou nosocomiale. Les criteres etudies ont ete le respect des recommandations, l’efficacite clinique a 72 heures, l’adequation aux germes isoles et la mortalite intra-hospitaliere. Resultats Les donnees concernent 112 patients (63 femmes et 49 hommes, d’âge moyen 80 ± 8 ans). L’infection etait communautaire dans 52 cas (46 %), institutionnelle dans 25 cas (22 %) et nosocomiale dans 35 cas (31 %). L’antibiotherapie etait conforme a notre guide de prescription dans 64 cas (57 %). Lorsque le traitement antibiotique etait conforme, les patients etaient plus souvent ameliores apres 72 heures (45/64 versus 23/48 ; p = 0,01). Malgre une tendance, l’adequation aux germes n’etait pas significativement meilleure lorsque l’antibiotherapie etait conforme (22/36 antibiotherapies adequates versus 10/20). La mortalite intra-hospitaliere (25 %) a ete la meme dans les groupes conforme et non-conforme. Le staphylocoque dore meti-R a ete la bacterie multiresistante la plus souvent isolee. Conclusion L’utilisation d’un guide de prescription doit permettre d’accroitre l’efficacite des traitements antibiotiques probabilistes. L’impact de cette mesure sur le cout global des antibiotiques et la flore microbienne reste a evaluer.

Although frail elderly people are particularly vulnerable to the adverse effects of alcohol, very little work on alcohol consumption patterns in older people living in nursing homes has been undertaken.To determine alcohol consumption patterns among the residents of 8 nursing homes of the Nord Pas-de-Calais in France, and the characteristics associated with heavy drinking (≥ 3 glasses of wine or equivalent/day).All residents were invited to participate in the study on condition that they satisfied the inclusion criteria (age ≥ 60 years, Mini Mental State of Folstein (MMSE)15, agreement) and the exclusion criteria (no oral communication, end of life). Two questionnaires were used, one for the residents and the other for the personnel nursing.Three hundred and sixty-eight residents [242 females (65.8%) and 126 males (34.2%); mean age, 80.5 ± 8.9 years] participated in the study. Among them, 98 (26.6%) reported no consumption of alcohol and 21 (5.7%) reported occasional consumption. The 249 (67.7%) others reported every-day consumption, principally in the restaurant at the time of the meals. Sixty-seven (18.2%), were heavy drinkers with an early-onset alcoholism for two out of three. Compared with the other residents participating in the study, the at-risk alcohol drinkers were younger and more likely to be a man.The study confirms that the prevalence of chronic at risk consumption is high in nursing homes. More efforts are needed to identify and improve management of alcohol disorders in this particular setting.

We developed a prescribing guideline containing recommendations for the initial empirical antibiotic therapy in community or nosocomial pneumonia. The aim of the present study was to examine the impact of this measure.The prescribing guideline was implemented in May 1999. We retrospectively reviewed the charts of all patients65 years with community-, or nursing home- or hospital-acquired pneumonia hospitalised in our department of acute geriatric care between May 1999 and November 2000. The criteria assessed were: consistence with the guideline, clinical effectiveness within 72 hours, adequation with the isolated germs and intra-hospital mortality.Data were collected on 112 patients (63 women et 49 men; mean age=80 +/- 8 Years). The pneumonia was community-acquired in 52 cases (46%), nursing home acquired in 25 cases (22%) and hospital-acquired in 35 cases (31%). Antibiotic prescription was consistent with the guideline in 64 cases (57%). When the antibiotic therapy was consistent, the patients were more likely to improve within 72 hours (45/64 versus 23/48; p=0.01). Despite a tendency, the number of antimicrobial treatments adapted to the isolated microorganisms was not significantly higher in the consistent group (22/36 adapted treatments versus 10/20). The intra-hospital mortality (25%) was similar in the two groups consistent and not consistent with the guideline. SARM was the most frequent multiresistant bacteria that was isolated.The use of a prescribing guideline might improve the efficiency of empirical probabilistic antibiotic therapies. The impact of the guideline use on overall antibiotic costs and microbiological flora remains to be determined.