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Introduction: Parkinson's disease (PD) is a prevalent neurodegenerative disorder with significant nonmotor symptom (NMS) burden, including impulse control disorders. This study aimed to comprehensively evaluate NMS and impulse control disorders in PD patients under primary care., Materials and Methods: A descriptive cross-sectional study was conducted on 32 PD patients and evaluated using standardized assessment tools. Demographics, comorbidities, and symptom burdens were recorded. Evaluation tools included the Hoehn and Yahr Scale, REM Sleep Behavior Disorder assessment, Geriatric Depression Scale, Montreal Cognitive Assessment scale for cognitive impairment, NMS scale, and identification of impulse control disorders., Results: In PD, comorbidities were prevalent (84%), and most were at Hoehn and Yahr Stages 2 and 3. REM Sleep Behavior Disorder was present in 28.12%, with 5 receiving clonazepam treatment. Depression affected 28.12%, with 5 receiving pharmacological treatment. Cognitive impairment was notable in 9 patients. NMS burden was high, with varying severity. Impulse control disorders were limited, whereas one case of dopamine dysregulation syndrome was identified., Discussion: This primary care-based study in India assessed NMS and impulse control disorders in PD patients, highlighting comorbidities and management opportunities. The study's strength lies in evaluating an unselected primary care population, whereas limitations include small sample size., Conclusion: This study emphasizes the importance of primary care physicians in monitoring and managing NMS in PD patients. Impulse control disorders and cognitive impairment are critical aspects that need attention. The findings support an integrated approach involving health-care professionals across various disciplines to provide holistic care for PD patients., (Copyright © 2024 Copyright: © 2024 Annals of African Medicine.)

Delirium is a commonly encountered syndrome in clinical practice. Older people with cognitive disorders are most at risk of developing delirium during the hospital stay. However, the risk of underdiagnosis is significant, particularly because of the overlap of behavioral symptoms and cognitive impairment between delirium and dementia. With an aging population and an ever-increasing prevalence of cognitive disorders, this article exposes the bilateral relationship maintained between dementia and delirium and bring certain diagnostic tools and clinical management clues to support the clinician. Finally, the perspectives of ongoing clinical research that could respond to current challenges are discussed., Competing Interests: les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Cerebral amyloid angiopathy (CAA) is a common and well-defined small vessel disease characterized by the deposition of amyloid β in the vascular wall. CAA causes devastating outcomes related to intracerebral hemorrhage and cognitive decline in older adults. The shared pathogenic pathway between CAA and Alzheimer's disease, co-occuring frequently in the same subject, has important implications for cognitive outcomes and novel anti-amyloid-β immunotherapies. In this review, we present the epidemiology, pathophysiology, current diagnostic criteria of CAA, and future developments in the field., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

A growing number of studies in animal models have highlighted the link between sleep disorders and Alzheimer's disease (AD). In the absence of curative treatment, it is therefore important to consider any comorbidities that may influence the course of AD such as Obstructive sleep apnea-hyponea (OSAH) and its syndrome (OSAHS), which appear to be potentially interesting because it is frequent, treatable and often associated with cognitive impairment. The association between OSAH/OSAHS and cognition is variable across studies, but OSAH/OSAHS is more common in older patients with AD than in cognitively normal individuals. OSAH/OSAHS is often associated with the subsequent development of mild cognitive impairment and AD. Although there is no evidence that treatment of OSAH/OSAHS in AD would have a major impact on the course of the disease, treatment would appear to improve cognition in AD patients with OSAH/OSAHS. Finally, the literature suggests a link between OSAH/OSAHS and AD biomarkers. Together, these data highlight the importance of detecting and treating OSAHS in this population.

The objective of this study was to compare in general practice, patients aged 65 years and over: the MMSE, screening tools for cognitive disorder recommended by the HAS and the Codex., Method: 53 patients were included between June and October 2017 at La Charmille general practice in Limpiville in rural areas during an observational study. Patients over 65 years of age were included following a consultation with their general practitioner. The MMSE and the Codex were compared on their results, intrinsic variables, the time of handover. Geriatric comorbidity factors are compared between groups of patients "with" and "without" cognitive disorders detected., Results: Of the 53 patients, 94% CI 95% [4.10; 20.25] had cognitive impairment, at an average age of 74.15 years. The predominance is female with 30 patients (57%). The passage time of the Codex is on average 1min 43s, significantly faster (p = 4,29*10 -26 ) than the time of passing the MMSE 4min 51s on average. There is a better satisfaction of the Codex compared to the MMSE (p = 1.675*10 -6 ) with an average digital scale score of 7.3 against 6.3 respectively. There is no significant difference between population with cognitive and non-cognitive impairment and geriatric comorbidity factor due to selection bias., Conclusion: Codex appears to be a rapid, reliable, reproducible cognitive impairment screening tool adapted to the general practice consultation format. An important axis to work, awareness, education of doctors at the university and continuing education on the screening and management of dementia syndromes and fragility.

Objective: Benzodiazepines are a source of well-known adverse reactions related to their pharmacological properties: memory disorders, falls in the elderly, confusion and sedation, drug addiction. The impact of their chronic use on cognitive decline and dementia has been the subject of many studies for two decades., Methods: From 25 studies identified in the international literature from 1997 to 2017, the Bradford-Hill causality criteria were systematically applied., Results: Fifteen studies found a statistically significant association with a deleterious effect, two a protective effect and eight did not find any association. The most recent studies using a longer delay to take into account a protopathic bias did not find any association or any dose-effect relationship. The majority of studies suggest impaired cognitive functions for contemporary consumption or those closest to the event being studied. Finally, the biological plausibility remains discussed., Conclusion: The question of the role of benzodiazepines in the onset of dementia remains open, and other studies attempting to limit previous methodological drawbacks should be carried out., (Copyright © 2018 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: Charles-Bonnet syndrome (CBS) is conventionally defined by the presence of visual hallucinations in patients suffering from lowered visual acuity without having psychosis or dementia. Actually, it is a syndrome that interests many specialties, especially ophthalmology, geriatrics, neurology and psychiatry. "Atypical CBS" or "CBS plus" was introduced to designate any kind of visual hallucinations that could be considered as a CBS but accompanied by a low level of insight, a possible cognitive decline, other hallucinatory modalities etc. Since all patients suffering from CBS have to be psychiatrically evaluated, psychological and psychiatric implications of their syndrome have to be well understood in order to better manage them. These psychiatric and psychological implications are: the relationship between the CBS and dementia, the psychological reaction of the patients towards their hallucinations and psychiatric comorbidities that could be developed during the course of the syndrome., Methods: A research via MEDLINE for all the articles published in French or in English between January 1999 and December 2009 was done using the following keywords Charles-Bonnet, psychiatric comorbidities and Charles-Bonnet syndrome, Charles-Bonnet syndrome and dementia, psychological reaction and Charles-Bonnet syndrome., Results: Although some studies report an association between the CBS and dementia, the majority of these studies do not confirm this association and point towards an atypical initial presentation of the syndrome. The psychological reaction accompanying the visual hallucinations of the typical CBS is variable (mild distress, indifference, pleasure). Patients suffering from a typical CBS conserve a full insight during the course of the syndrome. A positive personal psychiatric history or a concomitant psychiatric disorder changes the clinical presentation of the syndrome., Discussion: Our research allowed us to define the following diagnostic criteria for the atypical CBS: 1) diminished level or absence of insight towards the visual hallucinations; 2) presence of a mild cognitive decline; 3) presence of an atypical psychological reaction towards the visual hallucinations as in the case of a severe and prolonged stressful reaction; 4) presence of other hallucinatory modalities; 5) presence of a positive personal psychiatric history or a concomitant psychiatric disorder. Each patient suffering from CBS should be initially evaluated psychiatrically and neurologically in order to confirm or to eliminate the presence of the most common causes of visual hallucinations. In the presence of a lowered visual acuity and a conserved cognitive functioning, the typical CBS is diagnosed after eliminating more common disorders. Once this diagnosis is established, patients should be evaluated in order to rule out the presence of an atypical clinical presentation., Conclusion: Atypical CBS is a syndrome that could be eventually associated with dementia, accompanied with a major depressive disorder or another psychiatric disorder, or with vulnerability towards psychiatric disorders. Patients suffering from atypical CBS should be closely followed psychiatrically and neurologically. Patients suffering from the typical CBS should also benefit from a psychiatric follow-up, due to their multiple psychiatric vulnerability factors and their possible management with psychotropic drugs., (Copyright © 2011 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)