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Objectives Based on seemingly contradictory results in the existing literature, the objective of our study was to investigate whether older individuals suffering from chronic psychiatric disorders show a more rapid decline in cognitive performances than their non-psychiatric counterparts, or if the pattern of decline through older age is similar in both groups. Method A total of 820 older adults were selected from the Ageing Multidisciplinary Investigation ( AMI) cohort study, which studies health-related issues of people over 65 years old living in rural areas. Among them, 30 suffer from chronic psychiatric disorders. Cognition was assessed with four neuropsychological tests: the Mini-Mental State Examination, the Digit Symbol Substitution Test, the Free and Cued Selective Reminding test and the Isaacs Set Test. Linear mixed models were used to compare the evolution of cognitive performances in the two groups between baseline and the four-year follow-up. Results Despite lower performances at baseline, the pattern of cognitive decline of the psychiatric group is similar to that of the control group. Conclusion As suggested by this study conducted in rural communities, community-dwelling people suffering from chronic psychiatric disorders should not be considered at greater risk of age-related accelerated cognitive decline than the non-psychiatric older population. [ABSTRACT FROM AUTHOR]

Background and purpose The aim of our study was to examine the effect sizes of different cognitive function determinants in middle and early old age. Methods Cognitive functions were assessed in 11 711 volunteers (45 to 75 years old), included in the French CONSTANCES cohort between January 2012 and May 2014, using the free and cued selective reminding test ( FCSRT), verbal fluency tasks , digit-symbol substitution test ( DSST) and trail making test ( TMT) , parts A and B. The effect sizes of socio-demographic (age, sex, education), lifestyle (alcohol, tobacco, physical activity), cardiovascular (diabetes, blood pressure) and psychological (depressive symptomatology) variables were computed as omega-squared coefficients ( ω2; part of the variation of a neuropsychological score that is independently explained by a given variable). Results These sets of variables explained from R2 = 10% (semantic fluency) to R2 = 26% ( DSST) of the total variance. In all tests, socio-demographic variables accounted for the greatest part of the explained variance. Age explained from ω2 = 0.5% (semantic fluency) to ω2 = 7.5% ( DSST) of the total score variance, gender from ω2 = 5.2% ( FCSRT) to a negligible part (semantic fluency or TMT) and education from ω2 = 7.2% ( DSST) to ω2 = 1.4% ( TMT-A). Behavioral, cardiovascular and psychological variables only slightly influenced the cognitive test results (all ω2 < 0.8%, most ω2 < 0.1%). Conclusion Socio-demographic variables (age, gender and education) are the main variables associated with cognitive performance variations between 45 and 75 years of age in the general population. [ABSTRACT FROM AUTHOR]

Arrivé E, Letenneur L, Matharan F, Laporte C, Helmer C, Barberger-Gateau P, Miquel JL, Dartigues JF. Oral health condition of French elderly and risk of dementia: a longitudinal cohort study. Community Dent Oral Epidemiol 2011. © 2011 John Wiley & Sons A/S Abstract - Objectives: Oral condition could be associated with cognitive impairment, but this is not yet well documented. We therefore hypothesized that people with poor oral condition would be more at risk to develop dementia. The objective of this study thus was to describe the oral condition of French community-dwelling elderly persons and to assess its relationship with the occurrence of dementia. Methods: Oral examination was conducted on a sample of individuals aged 66-80 years followed-up prospectively for screening of dementia over 15 years in Gironde, France. Univariate and multivariate analyses of the risk of dementia were performed using a Cox proportional hazard model with delayed entry. Results: Data from 405 individuals were analyzed; 45.4% men; median age at baseline: 70 years [interquartile range (IQR): 68-75]. The median number of decayed, missing, and filled teeth was 18 (IQR: 13-24) and was higher in women (median: 20 versus 17, P = 0.004) and in persons with lower school level (median: 21 versus 17, P = 0.003). Among 348 persons with sextant eligible for periodontal assessment, 2/3 required periodontal care: 5.2% had bleeding observed, 44.8% calculus, 17.8% 4-5 mm pockets, and 2.9%≥6 mm pockets. The incidence of dementia during a median follow-up of 10 years (IQR: 6.5-13.7) was 19 per 1000 person-years. The adjusted hazard ratio for a number of missing teeth≥11 (median) on the risk of dementia was 1.13 (95% confidence interval, CI = [0.60-2.12]) in people with higher education ( n = 312) and 0.30 (CI = 0.11-0.79) in persons with lower school level ( n = 93) ( P for modification effect = 0.0002). Conclusions: Having eleven or more missing teeth seemed to be associated with a lower risk of dementia in people with lower education possibly owing to the suppression of source of chronic inflammation. [ABSTRACT FROM AUTHOR]

Background and purpose: The objective of this study is to estimate the number of dementia cases expected to occur in France and Europe over the next few decades until 2050. Methods: Our estimates are based on a model using the European incidence data for dementia by age and sex, the relative mortality risks related to dementia stratified by age classes, and the projections of mortality coefficients in the French and European general population. Results: In France, in 2010, the number of dementia cases should reach 754000, i.e., 1.2% of the general population or 2.8% of the active population. By 2050 this number should be multiplied by 2.4, i.e., 1813000 cases, which will be 2.6% of the total population and 6.2% of the active population. In Europe this number could reach more than 6 millions in 2010 and 14 millions in 2050. The sensitivity analysis performed on French data showed that our projections were robust to the use of alternative data for incidence and relative mortality risk (variation of 5.5% and 6.5%), but very sensitive to hypotheses of evolution of mortality (variation of −22% to 29%). Conclusions: The approach used in our study, integrating both the dementia incidence and the mortality in the calculations, allowed us to refine the projections and stress the great sensitivity of the demographic hypotheses forecasts on the evolution of life expectancy. The likely increase is particularly important and confirms that French and European health systems must take this into account when making future plans. [ABSTRACT FROM AUTHOR]

Objective – To analyze mortality data from patients with Alzheimer’s disease (AD), Alzheimer’s plus cerebrovascular disease (AD + CVD) or vascular dementia (VaD). Methods – (1) Meta-analysis of mortality data from double-blind, placebo-controlled, randomized trials; and (2) recontact study to collect additional longer term mortality data from previous galantamine trial participants. Results (meta-analysis) – Across 12 trials (≤6 months duration), there was no increased risk of mortality associated with the use of galantamine ( n = 4116) compared with that of placebo ( n = 2386) (OR galantamine/placebo: 0.67, 95% CI 0.41–1.10). Results (recontact study) – Median survival was 79 months for patients with AD ( n = 478) and 59 months for patients with AD + CVD ( n = 180) or VaD ( n = 145). Prolonged galantamine treatment (> vs ≤6 months) was not associated with decreased survival time (75 vs 61 months respectively; P = 0.02). Cox regression analyses were consistent with the Kaplan–Meier analyses. Conclusions – We found no short-term or longer term evidence of increased risk of mortality associated with the use of galantamine in patients with AD, AD + CVD or VaD. [ABSTRACT FROM AUTHOR]

Although highly controversial, the hypothesis of a link between aluminum (Al) in drinking water and Alzheimer's disease (AD) has been supported by several epidemiological studies. Transferrin (Tf) is a major transport protein for both iron and Al. Moreover, it has been demonstrated that defective binding of iron and Al to the Tf variant C2 could be present in AD. Individuals carrying the Tf C2 allele might therefore be at greater risk of developing AD. We investigated whether the Tf C2 allele might be responsible for susceptibility to AD in a sample of 292 subjects (with 55 AD) aged ≥75 years from south-west France, some exposed to high levels of Al in tap water ( n = 181 subjects) and others to low levels of Al ( n = 111 subjects). We also examined the combined genetic effects of Tf C2 and ℇ4 allele of apolipoprotein E gene (ApoE). Logistic regression analysis showed that neither Tf C2 nor its interaction with Al or with the ℇ4 allele of the ApoE were significantly associated with the risk of AD. [ABSTRACT FROM AUTHOR]

To assess the global impact of episodic headaches in patients consulting general practitioners (GPs) using the Headache Impact Test (HIT-6) questionnaire, and to compare this with measures of headache severity and quality of life. A total of 2802 patients consulting 349 GPs participated to this cross-sectional study. Data were collected on headache severity using the Migraine Severity (MIGSEV) scale, headache impact with the HIT-6 and quality of life with the Qualité de Vie et Migraine (QVM) questionnaire. Diagnosis was assigned retrospectively according to the International Headache Society criteria. The association between the HIT-6 scale and the other scales was determined from a Pearson's chi-square test, an analysis of variance and Spearman correlation coefficients. Patients (2537) provided exploitable data. Six percent of the sample had little impact, 14% moderate, 14% substantial and 66% severe impact. The HIT-6 scores were significantly different between diagnostic groups, being highest in the migraine group. The HIT-6 score were well correlated with headache severity and QVM score. The HIT-6 scale correlates, across different diagnostic groups of headache, with both headache severity and with quality of life. [ABSTRACT FROM AUTHOR]

In the last decades in industrialized countries, the increase of life expectancy has resulted in an increase in the population of the elderly. However, little is known about the prevalence of allergies in the elderly population. The aim of the study was to investigate the specific relationship of serum IgE and Phadiatop, with asthma, rhinitis, and smoking in a sample of an elderly population. Subjects from the Paquid cohort living in Gironde Department (age 65 years and over) in France were followed up since 1988 (PAQUID cohort). Among the randomized sample of 352 subjects, there were 158 men (45%) and 194 women (55%). The lowest levels of IgE were in subjects with chronic sputum; and in normal subjects (47.1 ± 56.4 vs 56.2 ± 73.9, NS). Multiple linear regression was performed with log10 IgE values as a dependent variable and age, Phadiatop test, smoking, and respiratory symptoms independently in men and in women. In men, a significant relationship was observed between IgE values and Phadiatop test ( P < 0.001), asthma history ( P = 0.002), and smoking ( P = 0.019). Respiratory allergy is present in persons >65 years of age. There is an association between smoking and IgE level independent of allergic reactivity to common allergens in the elderly. [ABSTRACT FROM AUTHOR]

We report the molecular and phenotypic analysis of a French cluster of three cases of Creutzfeldt–Jakob disease (CJD), two of them occurring in 1998 in the same village and the other in 1995 in a neighboring village. Analyses of the occurrence of these events in a close area with less than 3000 inhabitants over the 1992–1999 notification period confirmed that they are rare. This could be explained either by a common source of contamination or by the coincidental occurrence of either sporadic or genetic CJD. We applied genetic analysis and brain PrPres typing to explore these CJD cases. The three patients did not carry any mutation in their prion protein gene coding sequence. All were homozygous for methionine at the polymorphic codon 129. Brain tissue was available from two cases that died in 1998. The two patients showed different PrP res profiles on Western blot and distinct clinico-pathological features. These findings do not support the conclusion that in these three cases, CJD was acquired from a unique source of contamination and suggest that concurrent occurrence of sporadic CJD accounted for this CJD cluster. [ABSTRACT FROM AUTHOR]

SUMMARY Aims To estimate the incidence and predictors of drug-treated diabetes in elderly subjects. Methods The PAQUID epidemiological survey, a population-based study, has followed up 3777 subjects older than 65 years since 1988. At each visit (baseline, 1, 3, 5 and 8 years), treatment regimen was used to identify new drug-treated diabetic subjects. Potential predictors of drug-treated diabetes were collected during the baseline visit (body mass index (BMI), educational level, cigarette smoking and wine consumption, physical activity, depressive symptomatology, subjective health, treatment, and hypertension) and analysed by using a multivariate backward stepwise regression Cox model with delayed entry. Results The prevalence rate of drug-treated diabetes was 7.5% at baseline and 7.1% after 8 years' follow-up. The incidence rate of drug-treated diabetes was 3.8/1000 person-years, 5.9/1000 person-years in men and 2.4/1000 person-years in women, with no significant variation according to age group. Male sex (relative risk (RR) 2.4, 95% confidence interval (CI) 1.4–4.0, P < 0.001, attributable risk (AR) 0.36), elevated BMI (for one point increase, RR 1.1, 95% CI 1.1–1.1, P < 0.001, ≥ 25 vs. < 25, RR 2.1, 95% CI 1.2–3.5, AR 0.33), thiazide diuretics used alone (RR 5.9, 95% CI 1.8–19.6, P = 0.02), and poorer subjective health (‘the same’ vs. ‘better’ RR 1.8, 95% CI 1.0–3.1, P = 0.04; ‘worse vs. ‘better’ RR 2.3, 95% CI 0.9–5.7, P = 0.06) were independent predictors of drug-treated diabetes in this population. Conclusions In older French individuals, men seem to be particularly exposed to drug-treated diabetes although being overweight was found to be a strong predictor as in younger populations. [ABSTRACT FROM AUTHOR]

A study of glial tumours involving 192 cases is presented. Different issues are addressed: (i) the interrelationships between the histological variables, (ii) the problem of the prediction of the survival time, (iii) the causal role of the variables in the progress of the disease. We propose a three-level grade which can be defined alternatively with perivascular lymphocites or with the signs necrosis and neovascularization. We constructed a predictive model based on the Cox model in which the variables were chosen according to Akaike's criterion. In the explanatory analysis we dropped the variables which could be considered as consequences rather than causes of the disease and we first tested groups of variables (factors): we found that age, the topology and the histology of the tumour were explanatory. [ABSTRACT FROM AUTHOR]

We assessed anterograde conduction electrogram parameters at successful ablation sites according to accessory pathway (APJ location and compared them to the most favorable electrograms at unsuccessful sites. A median of three radiofrequency energy impulses was applied Io ablate 97% of 136 APs versus four impulses to ablate 90% of 65 concealed APs. Electrograms at successful sites showed variable A/V ratio (0.04–7), and a QS pattern of unipolar ventricular wave in 90%. Electrograms were different in right versus left AP: AV time 29 ± 7 versus 38 ± 10; and timing of ventricular deflection: 17 ± 9 versus 2 ± 9 msec, respectively. Analysis in each patient of the mapping parameters at successful versus ‘most favorable’ unsuccessful sites showed an improvement in at least one parameter in 55%, no apparent change in all parameter values in 30%, and even less favorable parameters in 15% of patients. In patients with manifest AP, overall comparison of electrograms at successful versus unsuccessful sites showed no difference in A/V ratio (1.3 ± 1.5 vs 1.2 ± 1.6), unipolar pattern distribution, and AV time (34 ± 10 vs 35 ± 9), but earlier bipolar main ventricular potential ( -4 ± 12 vs -1.5 ± 10 msec) and unipolar intrinsic deflection timings (-5.2 ± 11 vs -1.8 ± 10 msec). In patients with concealed AP, a retrograde continuous electrical activity was recorded in 72% of successful versus 38% of unsuccessful sites (P = 0.03). Conclusions: Electrogram characteristics at successful radiofrequency ablation are different in right and left manifest AP. The timing of the ventricular potential is the only predictive electrogram parameter. Individual analysis of electrograms in each patient shows the better criteria in 55% of successful sites but no improvement in criterion values in 45%. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Social representation and practices related to dementia in Hai District of Tanzania," by D. Mushi and colleagues in the 2014 issue.

The article discusses the Information sur la Maladie d’Alzheimer en Medecine Genérale et Intervention Neurocognitive French study, an epidemiological, randomized comparative survey on identification of cognitive disorders suggestive of Alzheimer's disease (AD). Study subjects are 1, 048 general practitioners (GP) and 510 specialists. Results suggest that additional knowledge about AD and the use of specific neurocognitive tests are useful for improving GP diagnostic abilities.

Background: In the last decades in industrialized countries, the increase of life expectancy has resulted in an increase in the population of the elderly. However, little is known about the prevalence of allergies in the elderly population. The aim of the study was to investigate the specific relationship of serum IgE and Phadiatop, with asthma, rhinitis, and smoking in a sample of an elderly population., Methods: Subjects from the Paquid cohort living in Gironde Department (age 65 years and over) in France were followed up since 1988 (PAQUID cohort)., Results: Among the randomized sample of 352 subjects, there were 158 men (45%) and 194 women (55%). The lowest levels of IgE were in subjects with chronic sputum; and in normal subjects (47.1 +/- 56.4 vs 56.2 +/- 73.9, NS). Multiple linear regression was performed with log(10) IgE values as a dependent variable and age, Phadiatop test, smoking, and respiratory symptoms independently in men and in women. In men, a significant relationship was observed between IgE values and Phadiatop test (P < 0.001), asthma history (P = 0.002), and smoking (P = 0.019)., Conclusions: Respiratory allergy is present in persons >65 years of age. There is an association between smoking and IgE level independent of allergic reactivity to common allergens in the elderly.