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The aim of the study was to achieve the external validation of the SAGA instrument on the SAFES cohort. This was a prospective longitudinal multicentre cohort study, including patients aged 75 years or over, hospitalized in a short stay medical ward via emergency department. A comprehensive geriatric assessment was implemented. The psychometric validation enabled the study of feasibility, internal consistency, convergent, discriminant, and predictive validity of the instrument. The 1 306 patients of the cohort was 85±6 years, with a majority of women (65%). The completion rate of the SEGA instrument was 94%. Internal consistency was good (Cronbach alpha coefficient=0.7). Convergent validity was poor: Donini instrument (kappa=0.18; IC 95%=0.13-0.23), Rockwood instrument (kappa=0.04; IC 95%=0.02-0.06), and Winograd instrument (kappa=0.04; IC 95%=0.01-0.07). The ability of the instrument to discriminate clinically different groups was good. The SEGA instrument predicted well one-year mortality as well as one-year institution admission. Despite poor convergent validity (which is classic with frailty tools, SEGA instrument has satisfactory metrological properties, allowing its use in emergency departments and immediate post-emergency circumstances.

Le lupus erythemateux systemique (LES) du sujet âge est rare apres 65 ans et reste peu etudie. L’objectif de cette etude etait d’etudier les particularites du LES survenant apres 65 ans par rapport aux sujets jeunes. Methode : Les patients avec un LES debute apres 65 ans ont ete recherches dans 4 centres hospitaliers francais entre 1985 et 2013. Ont ete inclus les cas presentant 4 criteres de l’American college of rheumatology ou plus. Les caracteristiques clinico-biologiques, pronostiques, les traitements et les comorbidites ont ete decrits retrospectivement et compares a la cohorte de 1 000 patients lupiques publiee par Cervera et al. de 1993. Resultats : 18 patients ont ete inclus (14 femmes et 4 hommes) dont 6 reveles apres 75 ans. L’âge moyen etait de 73,0 ± 4,6 ans. Les manifestations revelatrices les plus frequentes etaient les atteintes articulaires (13/18), cutanees (9/18), sereuses (4/18). L’anemie hemolytique et les thromboses etaient plus frequemment revelatrices que chez le sujet jeune (p < 0,05). Au cours de l’evolution, seules les atteintes cutanees (sauf le lupus discoide) etaient moins frequentes que chez les sujets jeunes (p < 0,05). Les atteintes renales, pulmonaires et neurologiques etaient rares apres 75 ans. La corticotherapie, souvent utilisee (16/18), entrainait frequemment des complications (10/16). La survenue d’hemopathie maligne (3 cas) etait plus frequente en cas de LES revele par une thrombopenie ou une anemie hemolytique (p < 0,05). Conclusion : Le lupus du sujet âge est rare mais doit etre evoque dans un contexte clinique evocateur. Son diagnostic et son traitement sont difficiles du fait des complications iatrogenes et de l’intrication avec les comorbidites.

Elderly patients are particularly affected by influenza and pneumococcal infections and consequences of these infections in this population are huge because of the frailty of these patients. Vaccines are nevertheless available to prevent these diseases. The aim of the study was to assess influenza and anti-pneumococcal vaccination coverage among patients admitted in acute geriatric unit and the characteristics of the vaccinated patients. We conducted a prospective observational study involving 149 patients admitted in this kind of unit. Among these patients, influenza coverage was 73.8%. Vaccination rate was significantly higher among institutionalized patients (p=0.01), patients with cognitive disorders (p=0.01) and semi-dependant patients (p=0.02). Anti-pneumococcal vaccination was recommended for 55.7% of the patients because of their comorbidities. Among this specific population, vaccination coverage was very low (10.8%). The best vaccination rate was observed for semi-dependant patients (p

Although the first signs of Alzheimer's disease (AD) mainly affect episodic memory and executive functions, emotional disturbances also have a considerable impact on the mental and relational capacities of AD patients. In AD, the early impairment of amygdala structures, whose central role in the recognition and memorisation of emotions has previously been demonstrated, has led researchers to focus on the possible implications of such impairment in generating cognitive disturbances or behavioural troubles in these subjects. Several studies have shown that emotional processes are altered in AD, and can contribute to varying degrees to deficits in terms of social cognition, and to the generation of behavioural troubles. This review will detail the main avenues of research into the capacity to identify and memorise emotions in AD, and summarise the often conflicting results that have, to date, prevented the emergence of a general consensus concerning the emotional processes. It seems thereby legitimate to question about different elements that can explain these conflicting results, such as the existence of various theories, divergences about the definition of emotions and important methodological differences.

pnv.2012.0323 Auteur(s) : Moustapha Drame1,2 mdrame@chu-reims.fr, Rachid Mahmoudi1,2, Laurie-Anne Bertholon2, Marion Zylberberg2, Jean-Luc Novella1,2 1 Universite de Reims Champagne-Ardenne, Faculte de medecine, EA 3797, Reims, France 2 CHU de Reims, Hopital de la Maison blanche, Servie de medecine interne et de gerontologie clinique, Reims, France La recherche d’un outil d’evaluation est d’abord et avant tout guidee par l’interet que celui-ci peut avoir pour la pratique clinique, [...]

pnv.2012.0324 Auteur(s) : Jean-Luc Novella1,2 jlnovella@chu-reims.fr, Isabella Morrone2, Laurie-Anne Bertholon2, Marion Zylberberg2, Rachid Mahmoudi1,2 1 Universite de Reims Champagne-Ardenne, Faculte de medecine, EA 3797, Reims, France 2 CHU de Reims, Hopital de la Maison blanche, Servie de medecine interne et de gerontologie clinique, Reims, France La maladie d’Alzheimer (MA) etant la plus frequente des demences, elle touche plus de 800 000 personnes en France (Haute autorite [...]