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International audience; Objectives : The co-occurrence of multiple medical or psychosocial conditions (geriatric syndromes (GS) and age-related diseases) is a growing concern in older people. Given the diversity of these conditions and their complex interactions, our aim was to determine whether they could be structured into synthetic dimensions in order to facilitate the management of multimorbidity.Design : The underlying structure of 10 GSs and 8 age-related diseases was identified using a multiple correspondence analysis (MCA), and confronted to subjective and objective health outcomes.Setting : Community residents from Bordeaux City (France) older than 75 years in 2010Participants : 630 adults aged 75+ years who lived in Bordeaux and participated in the 10-year follow-up of the Three-City study.Measurements : GSs included physical frailty, cognitive impairment and dementia, dependency, depressive symptoms, polymedication, thinness, falls, sensory deficit, social isolation, incontinence. Age-related diseases were cancer, cardiac diseases, peripheral vascular diseases, diabetes, hypertension, pulmonary diseases, osteoporosis, other chronic diseases. Association of the MCA-derived independent dimensions was assessed with 10-year visit subjective health and well-being, and with incident death and entry into institution during the remaining cohort follow-up.Results : Most of the participants (82%) had at least two age-related syndromes or diseases. The MCA structured the 18 conditions into three major dimensions: Degradation (D) driven by GS, Vascular (V), and Psychosocial (P) representing 68.7%, 7.4%, and 5.7% of the total variance, respectively. Dimension D was a strong predictor of future death and institutionalization. Dimensions D and P were strongly associated with current well-being.Conclusions : This work confirmed that multimorbidity is very common among older adults, and demonstrated the essential role of GS as manifestations of aging, even more than age-related diseases.

All definitions of frailty converge in two aspects: the notion of loss or decline and the ability to predict negative health outcomes. Numerous factors were reported to be associated with frailty among which biological, psychological, economic and social factors. Whether the latter contribute at the same level is a relevant question, as social vulnerability does not refer to an ongoing process of decline leading a person to become frail but rather to a relativity stable state making the person fragile. Thus, social vulnerability should increase the risk of frailty.This study aims at assessing whether social vulnerability increases the risk of incident frailty.1531 participants aged 65 or older from the PAQUID cohort study were included. Cox regression models tested the association between social vulnerability index (SVI, based on 28 social items) and frailty index (FI, based on 25 health-related items) over the 27 years of follow-up.Adjusted for age and sex, higher SVI was associated with increased risk of incident frailty (HR=3.85, 95% CI=1.87-7.94, p.001). After additional control for IADL disability and comorbidities, higher SVI was associated with increased risk of frailty (HR=3.40, 95% CI=1.63-7.07, p.05). The association remained significant after controlling for MMSE (HR=2.34, 95% CI=1.08-5.07, p.05).Poor social status is a risk factor of frailty. From a conceptual point of view, our results claim for a distinction between the concepts of frailty and fragility, the first one being the consequence of an ongoing decline, the other one related to a relatively stable condition of fragility, mainly explained by unfavorable social conditions.

The population of older adults over 60 years is growing faster than any other age group and will more than double between 2020 and 2050. This increase has led to clinical, public health, and policy interest in how to age "successfully". Before the Rowe and Kahn's model proposed thirty years ago, aging was seen as a process of losses associated with diseases and disability. However, since the emergence of this model, there has been a shift towards a more positive view, serving for promoting diverse medical or psychosocial models, and personal perspectives. Several technical terms of "success" (e.g. "successful aging", "healthy aging", "active aging", "aging well"…) coexist and compete for the meaning of the concept in the absence of a consensual definition. Our literature review article aims to study discrepancies and similarities between the main technical terms through quantitative or qualitative studies. A literature review using PubMed, SCOPUS, PsycINFO, Psycarticles, Psychology, and Behavioral Sciences Collection, Cochrane database, and clinicaltrials.gov databases was conducted. A total of 1057 articles were found and finally, 43 papers were selected for full extraction. We identified several components in these definitions, which reveal considerable inconsistency. The results particularly suggest that lay personals perspectives could bridge the gap between biomedical and psychosocial models in successful aging. In conclusion, an optimal definition would be a multidimensional one that could combine functional capacities, psychosocial abilities, environmental factors and subjective assessments of one's own criteria to discriminate older adults at potential risk of "unsuccessful" aging to healthy aging trajectories.

BackgroundEmerging epidemiological evidence suggests a relationship between exposure to various air pollutants (AP) (fine particles (PM2.5), ozone (O3), nitrogen dioxide (NO2)) and dementia. Howeve...

The SORL1 protein plays a protective role against the secretion of the amyloid β peptide, a key event in the pathogeny of Alzheimer's disease. We assessed the impact of SORL1 rare variants in early-onset Alzheimer's disease (EOAD) in a case-control setting. We conducted a whole exome analysis among 484 French EOAD patients and 498 ethnically matched controls. After collapsing rare variants (minor allele frequency ≤1%), we detected an enrichment of disruptive and predicted damaging missense SORL1 variants in cases (odds radio (OR)=5.03, 95% confidence interval (CI)=(2.02-14.99), P=7.49.10(-5)). This enrichment was even stronger when restricting the analysis to the 205 cases with a positive family history (OR=8.86, 95% CI=(3.35-27.31), P=3.82.10(-7)). We conclude that predicted damaging rare SORL1 variants are a strong risk factor for EOAD and that the association signal is mainly driven by cases with positive family history.

Amyloid beta (Aβ) peptides are the major components of senile plaques, one of the main pathological hallmarks of Alzheimer disease (AD). However, Aβ peptides' functions are not fully understood and seem to be highly pleiotropic. We hypothesized that plasma Aβ peptides concentrations could be a suitable endophenotype for a genome-wide association study (GWAS) designed to (i) identify novel genetic factors involved in amyloid precursor protein metabolism and (ii) highlight relevant Aβ-related physiological and pathophysiological processes. Hence, we performed a genome-wide association meta-analysis of four studies totaling 3 528 healthy individuals of European descent and for whom plasma Aβ 1-40 and Aβ 1 -42 peptides levels had been quantified. Although we did not observe any genome-wide significant locus, we identified 18 suggestive loci (P

To investigate the association of the change in practice of leisure and social activities with dementia risk taking into account the evolution of cognitive performances. From the PAQUID prospective cohort re-examined every 2 years until the 20-year follow-up since 1988, 1461 subjects were seen at 10th year of follow-up. Engagement in 10 leisure and social activities was collected at baseline and at the 10-year follow-up visit for 805 subjects. Four categories of change in activity engagement were considered: subjects who remained active; remained inactive; became inactive and became active. Adjustment on confounders (age, gender, educational level, diabetes, stroke and depression) and rate of evolution of cognitive performances was made with the multivariate Cox proportional hazards model. Time to incident cases of dementia occurring between the 10th and the 20th year of follow-up. A total of 258 incident dementia cases were documented. The risk of dementia was lower for subjects remaining or becoming active (cumulative risk of dementia: 30%) compared to those remaining or becoming inactive (52% and 42%, respectively) (p

Objective: The Multidomain Alzheimer Preventive Trial (MAPT study) was designed to assess the efficacy of isolated supplementation with omega-3 fatty acid, an isolated multidomain intervention (consisting of nutritional counseling, physical exercise, cognitive stimulation) or a combination of the two interventions on the change of cognitive functions in frail subjects aged 70 years and older for a period of 3 years. Ancillary neuroimaging studies were additionally implemented to evaluate the impact of interventions on cerebral metabolism (FDG PET scans) and atrophy rate (MRIs), as well as brain amyloïd deposit (AV45 PET scans). Design, patients: 1680 subjects (mean age: 75.3 years; female: 64.8 %), enrolled by 13 memory clinics, were randomized into one of the following four groups: omega-3 supplementation alone, multidomain intervention alone, omega-3 plus multidomain intervention, or placebo. Participants underwent cognitive, functional and biological assessments at M6, M12, M24 and M36 visits. The primary endpoint is a change of memory function at 3 years, as assessed by the Free and Cued Selective Reminding test. All participants will be followed for 2 additional years after the 3-years intervention (MAPT PLUS extension study). Interventions: 1/ Omega-3 supplementation: two soft capsules daily as a single dose, containing a total of 400 mg docosahexaenoic acid (DHA), i.e., 800 mg docosahexaenoic acid per day, for 3 years. 2/ Multidomain intervention: collective training sessions conducted in small groups (6–8 participants) in twelve 120-minute sessions over the first 2 months (two sessions a week for the first month, and one session a week the second month) then a 60-minute session per month in the following three areas: nutrition, physical activity, and cognition until the end of the 3 years. In addition to the collective sessions, individualized preventive outpatient visits exploring possible risk factors for cognitive decline are performed at baseline, M12 and M24. Baseline population: For cognition, the mean MMSE at baseline was 28.1 (± 1.6). About 58% and 42% of participants had a CDR score equal to 0 and 0.5, respectively. Regarding mobility status, 200 (11.9%) had a 4-m gait speed lower or equal to 0.8 m/s. According to the Fried criteria, 673 (42.1%) participants were considered pre frail, and 51 (3.2%) frail. The red blood cell DHA content was 26.1 ± 8.1 µg/g. Five hundred and three participants underwent baseline MRI. AV45 PET scans were performed in 271 individuals and preliminary results showed that 38.0% had a cortical SUVR > 1.17, which gave an indication of significant brain amyloïd deposit. Discussion: The MAPT trial is presently the first largest and longest multidomain preventive trial relevant to cognitive decline in older adults with subjective memory complaints. The multidomain intervention designed for the MAPT trial is likely to be easily implemented within the general population.

Item does not contain fulltext Mutations in leucine-rich repeat kinase 2 (LRRK2) cause inherited Parkinson disease (PD), and common variants around LRRK2 are a risk factor for sporadic PD. Using protein-protein interaction arrays, we identified BCL2-associated athanogene 5, Rab7L1 (RAB7, member RAS oncogene family-like 1), and Cyclin-G-associated kinase as binding partners of LRRK2. The latter two genes are candidate genes for risk for sporadic PD identified by genome-wide association studies. These proteins form a complex that promotes clearance of Golgi-derived vesicles through the autophagy-lysosome system both in vitro and in vivo. We propose that three different genes for PD have a common biological function. More generally, data integration from multiple unbiased screens can provide insight into human disease mechanisms.

Resume Introduction Les outils actuels explorant les capacites de memoire visuospatiale sont peu adaptes au sujet âge ; soit ils ne rendent pas compte des capacites d’apprentissage et de rappel differe, soit ils necessitent le traitement d’une quantite importante d’informations. Le test des gobelets permet une evaluation rapide des processus de memoire visuospatiale et explore les capacites d’apprentissage et de stockage. L’objectif de cette etude est d’etablir des scores normatifs du test des gobelets et d’etudier sa validite dans la detection de la demence et de la maladie d’Alzheimer (MA). Methode Cette etude a ete realisee a partir des donnees de la cohorte AMI. Le sous-echantillon analyse pour les normes inclut 795 sujets âges non dements ; celui de l’etude de validite inclut 912 sujets dont 76 MA et 802 normaux. Resultats Les normes ont ete etablies en fonction de l’âge (65–74 ans et 75 ans et plus) et du niveau d’etudes (certificat d’etude primaire [CEP] non valide versus CEP valide versus niveau superieur au CEP). Concernant la validite, le test des gobelets semble etre plus specifique que sensible et presente des valeurs predictives negatives elevees. Conclusion Le test des gobelets est un outil simple et rapide qui peut etre propose en clinique dans une demarche de detection de la MA.

Despite the popularity of cognitive-oriented therapies in dementia, very few data gathered from scientific literature provide a clear demonstration of the genuine efficacy of these techniques. Most of the results published have issued from studies suffering from important methodological limitations such as: absence of control group to compare clinical courses, very small size of study samples, absence of group randomization, absence of blind assessment of efficacy criteria or absence of long-term efficacy assessment. Randomized clinical trials are rare or even absent for some techniques and generally report more modest benefits. In this context, the ETNA3 study has been implemented. The ETNA3 study is a French nationwide prospective simple-blinded randomized clinical trial conducted to evaluate the impact of cognitive training, reminiscence therapy and an individualized cognitive rehabilitation program on the progression rate of dementia. The study was conducted in 653 outpatients with mild to moderate Alzheimer's disease followed up for 2 years (MMSE score 16 and 26). The main objective was to determine whether any or several of these non-pharmacological treatments could delay the severe stage of dementia during a 2-year follow-up compared to a usual care group without non-pharmacological treatment. The secondary outcomes assessed cognitive abilities, functional abilities in activities of daily living, behavioral disturbance, apathy, quality of life, depression, caregiver's burden and resource utilization. This article presents the rationale and methodology of the study.

To determine the association between dyspnea at entry into the PAQUID cohort and 13-year mortality, taking into consideration BMI and other mortality-related factors. Longitudinal study. In Dordogne and Gironde, South Western France. A total of 3646 French community dwellers aged 65 years old and over from the PAQUID study were included. Main outcome measures: dyspnea measured on 5-grades scale, mortality measured over 13 years of follow-up. Adjustment variables: age, gender, BMI (kg/m2), antecedent of ischemic heart disease, antecedent of stroke, hypertension, smoking history and diabetes. The study sample included 3646 subjects out of whom 54.11% died at 13 years of follow-up, 57.3% of participants were women and mean age was 75.3 (SD 6.8) years. Univariate analysis showed that dyspnea was associated with 13-year mortality. Death occurred in 45.6% of non-dyspneic subjects, 51.8% in those with level 1 of dyspnea, 65.6% in level 2 and 80.6% in level 3 and 4 (P

International audience; There is agreement that elderly people complain about word finding difficulties, particularly proper names. However, few studies have focused on the prevalence of this complaint in the general population, nor is it clearly known whether it is predictive of dementia. The aim of this study was to fill this gap using the PAQUID cohort. 1,838 people aged 65 or more completed questionnaires and neuropsychological evaluation regularly during 13 years. Results show that the complaint about proper name retrieval concerns 64% of people aged above 65 years, and the complaint about common names 30%. The complaint was not associated with enhanced risk of dementia, whereas short naming tests were. Only a marginal relation was found between these naming tests and word retrieval complaint. This study emphasizes the importance of proper name retrieval complaint in the general population and suggests that elderly subjects can be reassured in the absence of other symptoms.

Background/Aims: This study was designed to develop a practical risk score for predicting 5-year survival after the diagnosis of dementia. Methods: Using the Paquid Study (prospective, population-based, long-term cohort study), we created a prognosis score with incident cases of dementia and validated it in another prospective, population-based, long-term cohort study, the Three City Study. -Results: Among the 3,777 subjects enrolled in the Paquid Study, 454 incident cases of dementia were included in this study. After a 5-year follow-up period, 319 (70.3%) were deceased. The score was constructed from three independent prognostic variables (gender, age at diagnosis and number of ADL restricted). The discriminant ability of the score was good with a c index of 0.754. Sensitivity was 64.7% and specificity 76.3%. In the validation cohort, the discriminant ability of the prognostic score with c statistics was 0.700. Sensitivity was 26.3% and specificity 95.4%. Conclusions: The prognostic factors selected in the predictive model are easily assessable, so this simple score could provide helpful information for the management of dementia, particularly to identify patients with duration of the disease greater than 5 years.

Une etude transversale, de type porte-a-porte dans le troisieme arrondissement de Bangui, menee en population generale, a ete realisee, entre octobre 2008 et mars 2009, afin d’aider a une meilleure connaissance des demences chez les personnes âgees de plus de 65 ans vivant dans la capitale centrafricaine. Sur 496 personnes âgees interrogees, 188 sujets presentaient des troubles cognitifs. Apres examen neuropsychologique, 40 de ces sujets ont ete diagnostiques dements. La prevalence des demences dans cette population etait de 8,1 % (IC 95 % = [5,7–10,5]). L’âge moyen des sujets dements, allant de 65 a 90 ans, etait de 76,0 ± 7,1 ans. Il existait un risque important de developper la demence pour une augmentation d’âge de dix ans (OR = 2,6; IC 95 %: [1,5–4,5]). Le rapport de masculinite etait de 6/34. Nous avons constate que 82,5 % des dements n’avaient jamais ete scolarises. Soixante-dix pour cent presentaient un etat de denutrition (indice de masse corporelle [IMC] ≤ 18,5 kg/m2), significativement associe aux demences (OR = 3,3; IC 95%: [1,5–7,3]). Pour 67,5 % des dements, leur tension arterielle etait elevee et significativement associee aux demences (OR = 2,4; IC 95 %: [1,1–5,4]). Un changement recent du statut financier etait un facteur significativement associe aux demences (OR = 6,4; IC 95 %: [1,8–22,5]). Ces resultats confortent l’existence des demences en milieu urbain africain. La prevalence observee est proche de celles retrouvees dans les pays a revenu eleve. Il convient de mener d’autres etudes plus elargies, aussi bien en zone rurale qu’en zone urbaine, afin de mieux cerner le probleme et d’envisager des solutions de prise en charge globale et des axes de prevention adaptes a notre contexte.

Objective:Several studies indicate a potential link between orthostatic hypotension (OH) and incident dementia, but without substantial evidence to date. Objective: to study the association between OH and dementia in a cohort of elderly individuals.Design and method:Baseline lying and standing blood

Arrive 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.

Alzheimer's disease is the most common form of dementia. As the aging population increases, Alzheimer's disease is becoming a major concern of Public Health. Many molecular lesions have been detected in Alzheimer's disease, but physiopathology is still poorly understood. If the neurotoxicity of anaesthetics in human remains debatable, perioperative period is certainly a high-risk factor for cognitive impairment, especially in elderly population. Large clinical studies are required to develop new strategies for perioperative management in such patients, including the adjustment of anaesthesia techniques. Before that, information of patient and its relatives and a particular attention for elderly during anaesthesia and perioperative period should be considered.

International audience; Background: Worldwide, degenerative eye diseases (age-related maculopathy (ARM), cataract, glaucoma) are the main causes of visual impairment and blindness, which contribute to disability in the elderly. Mainly three types of nutritional factors are investigated for their potential protection against eye ageing: antioxidants; lutein and zeaxanthin (carotenoids which accumulate specifically in the eye); omega 3 polyunsaturated fatty acids. Few epidemiological studies have been conducted in this field, particularly in Europe. Objective: The Alienor (Antioxydants, Lipides Essentiels, Nutrition et maladies OculaiRes) Study aims at assessing the associations of eye diseases with nutritional factors, determined from plasma measurements and estimation of dietary intakes. Design, setting and participants: Subjects were recruited in Bordeaux (France) from the ongoing population-based 3C study. In 2006-2008, 963 subjects from the 3C Study, aged 73 years or more, had an eye examination and will have follow-up eye examinations every 2 years. Measurements: Vascular, genetic and nutritional factors were assessed at baseline (1999-2001) and follow-up examinations of the 3C Study. Eye diseases were classified according to international classifications. Results: Nutritional status and vascular disease and risk factors were similar between participants and non participants, except for a slight difference in plasma triglycerides and HDL-cholesterol. As expected, the prevalence of eye diseases was high: early and late ARM (28.4 % and 5.6 %, respectively), open-angle glaucoma and treated ocular hypertension (4.8 % and 10.0 %, respectively), cataract extraction (45.2 %), retinopathy (8.4 %), retinal vein occlusion (1.1 %), epiretinal membrane (3.9 %), current use of artificial tears (17.3 %). Conclusions: This study confirms the high prevalence of eye diseases in the elderly. Its main strength is the combination of nutritional, vascular and genetic information, collected over a 7 year period of time before the first eye examination. It may help design future interventional studies, which might be common with other age-related disorders, because of common nutritional factors.

Resume Introduction L’objectif de cette etude est de proposer des normes en population generale pour les fluences verbales categorielles (couleurs, animaux, fruits, villes) et litterales (lettres « L » et « P »). Methodes Cette etude a ete realisee a partir des donnees de la cohorte PAQUID, une cohorte prospective en population generale conduite dans les departements de la Gironde et de la Dordogne. Resultats Le sous-echantillon analyse a porte sur 1730 personnes, non institutionnalisees et non dementes, vues au suivi a cinq ans de la cohorte. Les normes ont ete calculees en fonction de l’âge (70–74 ans, 75–79 ans, ≥ 80 ans), du niveau d’etudes (pas de scolarite, niveau primaire ou secondaire court et au moins secondaire court valide) et du sexe. Pour chaque epreuve, le nombre de bons mots produits ainsi que le nombre de repetitions ont ete calcules. Conclusion Les epreuves de fluence verbale etant classiquement utilisees dans l’examen des fonctions cognitives de sujets presentant une atteinte cerebrale focale ou une pathologie neurodegenerative, les normes presentees dans cette etude pourront interesser les cliniciens pour situer les performances de leurs patients âges de 70 ans et plus par rapport a ceux de sujets âges normaux.

Objectif Notre objectif est d’identifier les facteurs de risque bases sur la puissance de l’EEG et les caracteristiques des fuseaux de sommeil associees a l’apparition de plaintes isolees de memoire ou de troubles cognitifs legers lies au vieillissement. Methodes Des patients ayant des plaintes isolees de memoire ou des troubles cognitifs legers ont ete recrutes au sein de la cohorte MEMENTO. Ces derniers ont ete apparies en âge et sexe avec des temoins n’ayant aucune plainte mnesique. Les participants ont effectue 2 nuits consecutives d’enregistrement polysomnographique. Les caracteristiques des fuseaux et la puissance spectrale absolue de l’activite delta, theta et sigma ont ete calculees a partir de la derivation EEG CzOz purifiee au cours du sommeil non-R (ASEEGA solution) de la deuxieme nuit. Resultats Vingt-neuf patients (21 femmes, âge = 71 ± 7) et 29 temoins ont ete enregistres. Les regressions logistiques demontrent qu’une reduction de l’amplitude des fuseaux (p Conclusion La reduction de l’amplitude des fuseaux de sommeil ainsi qu’une diminution de l’activite delta, theta et sigma au cours du sommeil non-R contribueraient a l’apparition de plaintes isolees de memoire ou de troubles cognitifs legers lies au vieillissement.

Summary. Background: Hemostatic biomarkers have been associated with coronary heart disease (CHD) and stroke. However, few studies have investigated these associations in the elderly. Moreover, vascular factors may be involved in dementia. Data on the relationship between hemostatic biomarkers and dementia remain scarce. Objectives: Our study aimed to investigate the relationship between hemostatic biomarkers and the risk of CHD, stroke and dementia in an elderly population. Patients/Methods: In the Three-City cohort study including men and women aged ≥ 65, we investigated the association of fibrinogen, D-dimer and von Willebrand factor with the 4-year incidence of arterial disease (CHD, n = 199; and stroke, n = 111) and dementia (n = 218). Measurements were performed for all cases and for a random sample of the entire cohort (n = 1254). Hazards ratios (HR) compared the last quintile with the first of each parameter’s distribution and P-values refer to the test for linear trend across quintiles. Results: Elevated fibrinogen was associated with the risk of CHD and myocardial infarction (HR = 2.20, P

Several lines of evidence indicate that a decrease in the CSF concentration of amyloid beta(42) (Abeta(42)) is a potential biomarker for incident Alzheimer disease. In contrast, studies on plasma Abeta(1-40) and Abeta(1-42) peptide levels have yielded contradictory results. Here, we explored the links between incident dementia and plasma Abeta(1-40) and Abeta(1-42) peptide concentrations in the prospective, population-based Three-City (3C) Study. We also assessed the association between plasma concentrations of truncated Abeta (Abeta(n-40) and Abeta(n-42)) and the risk of dementia.During a subsequent 4-year follow-up period, 257 individuals presented incident dementia from 8,414 participants, and a subcohort of 1,185 individuals without dementia was drawn as a control cohort. Plasma levels of Abeta(1-40), Abeta(1-42), Abeta(n-40), and Abeta(n-42) were measured using an xMAP-based assay technology. The association between plasma Abeta peptide levels and the risk of dementia was assessed using Cox proportional hazard models.Of the various Abeta variables analyzed, the Abeta(1-42)/Abeta(1-40) and Abeta(n-42)/Abeta(n-40) ratios presented the strongest association with the risk of dementia: people with a high Abeta(1-42)/Abeta(1-40) or Abeta(n-42)/Abeta(n-40) ratio had a lower risk of developing dementia. These associations were restricted to individuals diagnosed at 2 years of follow-up and the Abeta(n-42)/Abeta(n-40) ratio was mainly associated with the risk of mixed/vascular dementia.Plasma Abeta peptide concentrations and Abeta(1-42)/Abeta(1-40) and Abeta(n-42)/Abeta(n-40) ratios may be useful markers to indicate individuals susceptible to short-term risk of dementia.

Resume Cette revue presente divers aspects des demences vasculaires (DV), dont la definition a bien evolue depuis la demence par infarctus multiple de Hachinski. Nous avons aborde plus particulierement les criteres diagnostiques actuels des demences vasculaires, leur histoire naturelle encore mal connue, leurs aspects neuroradiologiques morphologiques et fonctionnels, les difficultes de l’epidemiologie de ces affections, la notion recente de liens avec la maladie d’Alzheimer et le probleme des demences dites mixtes. L’evolution du concept de demences vasculaires vers une notion plus large de « desordres cognitifs d’origine vasculaire », incluant un stade de trouble cognitif vasculaire dans lequel le sujet n’est pas dement, est evoquee. Enfin, une breve revue des traitements actuels est presentee.

Resume Introduction Le test de rappel libre/rappel indice a 16 items adapte du test de Grober et Buschke constitue aujourd’hui l’une des epreuves-cles de l’examen de la memoire en particulier chez des personnes venant en consultation pour une suspicion de Maladie d’Alzheimer. Ce test de memoire episodique a l’avantage de controler les conditions d’encodage et de recuperation. Le but de cette etude est donc d’etablir des scores normatifs en population generale pour le test de Grober et Buschke. Methodes Cette etude a ete realisee a partir des donnees de l’etude des Trois Cites, une etude en population generale. Resultats Le sous-echantillon analyse inclue 1 458 personnes âgees de 65 ans et plus, non institutionnalisees et non dementes. Les normes ont ete calculees en fonction de l’âge (65-70 ans, 70-74 ans, 74-78 ans, 78-90 ans), du sexe et du niveau d’etudes des sujets (enseignement primaire ou technique court versus enseignement technique ou professionnel long et superieur). Conclusion Les normes presentees dans cette etude pourront servir aux cliniciens de balises permettant de situer le score d’un patient ayant une plainte mnesique par rapport a ceux de sujets âges normaux.

Elderly people commonly suffer from dyspnoea, which may stem from expiratory flow limitation (EFL). The relationship between EFL, as assessed by the negative expiratory pressure method and spirometric indices, was investigated in an elderly French population. Subjects, aged 66-88 yrs, filled in socio-demographic and standardised questionnaires, which dealt with: medical history, smoking status and respiratory symptoms. EFL measurements and forced expiratory manoeuvres were performed. Validated measurements were obtained in 750 out of 1,318 subjects: 47% were EFL+ (EFL >0), with a higher prevalence in females than in males. EFL and forced expiratory volume in one second (FEV1) were correlated with age. A total of 116, from the 750 subjects, with no medical history and no symptoms, served as a healthy group. The prevalence of EFL+ subjects increased with the grade of dyspnoea and was highest in respiratory and cardiac patients when compared with the healthy subjects. EFL did not correlate with FEV1/forced vital capacity (FVC), the usual index of obstruction. Some elderly subjects (15%) with dyspnoea but with no medical history, mainly females with small FVC and normal FEV1/FVC, had a greater EFL than the healthy subjects. In elderly people, expiratory flow limitation measurements, along with the usual forced expiratory volume in one second/ forced vital capacity ratio, may be of value for the interpretation of dyspnoea.

Resume Introduction L’objectif de cette analyse etait d’etablir des normes pour le Mini-Mental State Examination, le test de retention visuelle de Benton en reconnaissance, le set test d’Isaacs, le sous-test des codes de la WAIS et le test de barrage de Zazzo (barrage simple, version en 8 lignes) dans une population de sujets âges. Materiel et methode Ces normes ont ete etablies a partir d’un echantillon de 1 780 sujets normaux, âges de 70 ans et plus, vus au suivi a cinq ans de la cohorte PAQUID. Seuls les sujets ne presentant pas de caracteristiques pouvant influencer leurs performances aux tests (notamment une demence) ont ete consideres dans cette analyse. Resultats Les indicateurs presentes sont la mediane, le dixieme percentile, le premier et le troisieme quartile. Ils sont donnes en fonction de l’âge, du sexe et du niveau d’etudes. Conclusions Dans un contexte clinique, ces normes permettent de situer les performances d’un sujet par rapport a la distribution observee dans un echantillon representatif de sujets du meme sexe, du meme âge et du meme niveau d’etudes.

Resume On dispose aujourd’hui de donnees scientifiques solides indiquant que l’hypertension arterielle et a un moindre degre d’autres facteurs de risque vasculaire pourraient etre la cible d’interventions visant a diminuer l’incidence de la demence. Deux essais ont demontre l’effet des antihypertenseurs sur le risque de demence, maladie d’Alzheimer pour l’un et demence post accident vasculaire cerebral pour l’autre. Par ailleurs, plusieurs grandes etudes epidemiologiques ont mis en evidence une association entre facteurs vasculaires et demence. Ces resultats permettent d’envisager des strategies de prevention de la demence. Il reste, par des etudes epidemiologiques appropriees, a estimer quel impact pourraient avoir ces interventions sur l’incidence et la prevalence de la demence. Si l’impact espere est important, les etudes permettant de demontrer l’efficacite de la prevention de la demence devraient etre mises en place.

We present an illness-death model for studying the incidence and the prevalence of Alzheimer's disease or dementia. We argue that the illness-death model is better than a survival model for this purpose. In this model the best choice for the basic time-scale is age. Then we present extensions of this model for incorporating covariates and taking account of a possible effect of calendar time. Calendar time is introduced via a proportional intensity model. We give the likelihood for a mixed discrete-continuous observation pattern from this model: clinical status is observed at discrete visit-times while the date of death is observed exactly or right-censored. The penalized likelihood approach allows to non-parametrically estimate the transition intensities. Application on the data of the Paquid study allows to produce estimates of the age-specific incidence of dementia together with mortality rates of both demented and non-demented subjects. Then the effect of calendar time and educational level are studied. Low educational level increases the risk of dementia. The risk of dementia increases with calendar time while the mortality of demented subjects decreases. The most likely explanation of this result seems to be in a shift in the diagnosis of dementia towards earlier stages of the disease prompted by a change in the perception of dementia and the arrival of new drugs. Copyright © 2004 John Wiley & Sons, Ltd.

We investigated the prevalence of multiple system atrophy (MSA) in Gironde, France, through a network of 120 public and private specialists and assessed the relationship between some environmental factors and MSA in a case-control study involving 50 MSA patients, 50 Parkinson’s disease (PD) patients and 50 healthy controls. The occupational exposure to pesticides was evaluated through a job-exposure matrix. On prevalence day (November 1, 1998), the crude prevalence of MSA in Gironde was 1.94/100,000 inhabitants. We found no significant relationship between occupational exposure to pesticides and MSA. PD patients were significantly less frequently ever-smokers than controls and the same tendency was observed for MSA patients. We also described the clinical features that heralded the disease among this nonselected population.

Introduction et but de l’etude Quelques etudes epidemiologiques rapportent qu’une plus forte adherence au regime mediterraneen serait associee a un declin cognitif plus lent chez les personnes âgees. Les etudes s’interessant specifiquement au risque de demence ou de maladie d’Alzheimer sont plus rares et encore controversees. Dans un travail precedent, nous avions emis l’hypothese selon laquelle l’effet potentiellement protecteur d’une plus forte adherence au regime mediterraneen sur le risque de demence ne serait observable qu’apres au moins 5 ans de suivi. L’objectif de la presente etude etait d’eprouver cette hypothese en analysant une population de sujets âges francais vivant au domicile et suivie pendant 12 ans. Materiel et methodes La population d’etude (74,0 ans en moyenne, 61 % de femmes) etait constituee de 1307 participants de la cohorte Trois-Cites-Bordeaux, initialement non dements et revus (environ tous les 2 ans) au moins une fois entre 1999–2000 et 2011–2012. Un score refletant l’adherence des participants au regime mediterraneen (de 0, bas a 9, haut) a ete construit selon les medianes de consommation des neuf groupes d’aliments caracteristiques de ce regime : fruits, legumes, legumineuses, poisson, cereales, rapport acides gras monoinsatures/satures, viande, produits laitiers et vin. Apres une batterie de tests neuropsychologiques et un entretien avec un neurologue, les cas incidents de demence ont ete valides a chaque suivi par un comite de neurologues independants. Resultats et analyse statistique Au cours d’un suivi moyen de 9,4 ans, 176 cas de demence incidente ont ete diagnostiques, dont 97 cas apres 5 ans de suivi. En ce qui concerne l’etiologie de la demence, 120 cas de maladie d’Alzheimer ont ete diagnostiques au cours des 12 ans de suivi, dont 64 apres 5 ans de suivi. Apres ajustement sur les facteurs de confusion sociodemographiques et cliniques, dont la presence d’une symptomatologie depressive, et les performances cognitives globales a l’inclusion, les participants avec une adherence plus forte au regime mediterraneen (scores 6 a 9) avaient un risque significativement diminue de 42 % (intervalle de confiance a 95 % [IC 95 %] 12–62 %, p = 0,01) de demence toute cause apres 12 ans de suivi par rapport aux participants avec la plus faible adherence (scores 0 a 3). En se limitant aux cas incidents diagnostiques apres 5 ans de suivi, les associations etaient encore plus fortes : une plus forte adherence au regime mediterraneen etait associee significativement a une baisse de 49 % (IC 95 % 11–70 %, p = 0,02) du risque de demence. Concernant le risque de maladie d’Alzheimer, une plus forte adherence au regime mediterraneen etait significativement associee a un moindre risque de maladie d’Alzheimer, de 55 % (IC 95 % 24–73 %, p = 0,003) sur la totalite de la duree de suivi, a 66 % (IC 95 % 31–84 % p = 0,003) pour les cas survenus apres 5 ans de suivi dans le modele multivarie complet. Conclusion Cette etude a mis en evidence une diminution significative du risque de demence et de maladie d’Alzheimer a long terme quand l’adherence au regime mediterraneen est la plus forte a l’inclusion, en tenant compte de nombreux facteurs de confusion potentiels dont les performances cognitives globales initiales. Ces donnees suggerent qu’adopter une alimentation de type mediterraneenne au plus tot pourrait retarder la survenue d’une demence en fin de vie.

To describe the sequence of basic activities of daily living (ADL) loss to determine whether there is a hierarchical structure of ADL in dementia in two epidemiological prospective studies: the Paquid study and the Three City Study (3C).Two prospective population-based cohort studies: Paquid (over 22 years of follow-up) and 3C (over 10 years of follow-up).Paquid Study, Gironde, Dordogne, France; The Three Cities Study, Bordeaux, Montpellier, Dijon, France.We analyzed four ADL of the Katz scale: bathing, dressing, transferring and feeding. The a priori hierarchical relationship of the 4 activities tested was 1) no ADL-disability at all four activities; 2) moderate ADL-disability, or disability at bathing and/or dressing (and no disability in transferring nor feeding); and 3) severe ADL-disability, or disability in bathing and/or dressing and transferring and/or feeding. We performed a Guttman scale analysis to establish the hierarchical properties scale.In total, 845 incident cases of dementia were included, among which 838 cases (99.2%) were without any missing data for ADL. Upon diagnosis of dementia, 564 subjects (67.3%) had no ADL-disability, 236 (26.2%) had moderate ADL-disability, and 38 subjects (4.5%) had severe disability. The a priori hierarchy was respected with non-discordance.We defined 3 simple relevant stages of ADL functional decline in dementia that would be easy to collect in clinical practice: stage 1, subjects with no major ADL disabilities; stage 2, subjects with complete disability in bathing and/or dressing; and stage 3, subjects with complete disability in all 4 tasks.

Background: The global prevalence of dementia has been estimated at 44.35 million in 2013 and is expected to rise to 135.46 million by 2050. Southeast Asia will not be spared by this epidemic as the proportionate increase of affected people will be one of the highest, reaching 340% (Prince et al., 2013). Aim: The aim of this study was to estimate the prevalence of dementia among older people in Lao PDR and investigate the factors associated with dementia in those communities. Methods: A cross sectional 2-stage study among people aged 65 years old and over living in Vangvieng (province of Vientiane) was carried out. Socio-demographic data and medical history were collected. Participants were screened using the Community Screening Instrument for Dementia (CSI-D), those who obtained a poor performance where assessed by a neurologist and performed further psychometrical tests. Diagnosis of dementia followed the DSM-IV criteria. This study was approved by the Ethics Committee of the Ministry of Health of Lao PDR. Results: In total, 471 elderly were included in this study, with a mean age of 74.1 ± 6.9 years. After neurological assessment, the prevalence of dementia was estimated at 9.1% (95% CI [6.7–12.1]) in this rural area of Laos, and wasn't different between Hmong (9.2%, 95% CI [5.8–13.7]) and non-Hmong (9.1%, 95% CI [5.8–13.4]; p = 0.976) ethnic groups. Conclusion: This first population-based study in Lao PDR showed a high crude prevalence of dementia, close to the estimates for other Asian or LMIC countries.

We report the results of a 5-year prospective cohort study of risk factors for fractures, including drinking fluoridated water, in a cohort of 3,216 men and women aged 65 years and older. We studied risk factors for hip fracture and fractures at other locations separately. We found a higher risk of hip fractures for subjects exposed to fluorine concentrations over 0.11 mg per liter but without a dose-effect relation (odds ratio (OR) = 3.25 for a concentration of 0.11-0.25 mg per liter; OR = 2.43 foror = 0.25 mg per liter]. For higher thresholds (0.7 and 1 mg per liter), however, the OR was less than 1. We found no association between fluorine and non-hip fractures. Non-hip fractures were associated with polymedication rather than with specific drug use, whereas fracture was associated with polymedication and use of anxiolytic and antidepressive drugs. Subjects drinking spirits every day were more likely to have hip fractures. Tobacco consumption increased the risk for non-hip fractures.

Genome-wide association studies (GWAS) have identified a region upstream the BIN1 gene as the most important genetic susceptibility locus in Alzheimer's disease (AD) after APOE. We report that BIN1 transcript levels were increased in AD brains and identified a novel 3 bp insertion allele ∼28 kb upstream of BIN1, which increased (i) transcriptional activity in vitro, (ii) BIN1 expression levels in human brain and (iii) AD risk in three independent case-control cohorts (Meta-analysed Odds ratio of 1.20 (1.14-1.26) (P=3.8 × 10(-11))). Interestingly, decreased expression of the Drosophila BIN1 ortholog Amph suppressed Tau-mediated neurotoxicity in three different assays. Accordingly, Tau and BIN1 colocalized and interacted in human neuroblastoma cells and in mouse brain. Finally, the 3 bp insertion was associated with Tau but not Amyloid loads in AD brains. We propose that BIN1 mediates AD risk by modulating Tau pathology. ispartof: Molecular Psychiatry vol:18 issue:11 pages:1225-1234 ispartof: location:England status: published

International audience; Alzheimer disease (AD) and other related dementia represent a major challenge for health care systems within the aging population. It is therefore important to develop better instruments for assessing disease severity and disease progression to optimize patient's care and support to care provide rs, and also provide better tools for clinical research. In this area, Information and Communication Technologies (ICT) are of particular interest. Such techniques enable accurate and standardized assessments of patients' performance and actions in real time and real life situations. The aim of this article is to provide basic recommendation concerning the development and the use of ICT for Alzheimer's disease and related disorders. During he ICT and Mental Health workshop (CTAD meeting held in Monaco on the 30th October 2012) an expert panel was set up to prepare the first recommendations for the use of ICT in dementia research. The expert panel included geriatrician, epidemiologist, neurologist, psychiatrist, psychologist, ICT engineers, representatives from the industry and patient association. The recommendations are divided into three sections corresponding to 1/ the clinical targets of interest for the use of ICT, 2/ the cond itions, the type of sensors and the outputs (scores) that could be used and obtained, 3/ finally the last section concerns specifically the use of ICT within clinical trials.

BACKGROUND: Accidents are the major cause of morbidity and mortality in children. The aim of this population-based study was to describe characteristics of head injuries leading to hospitalization in children less than 15 years old, in a defined geographic population (Aquitaine: 2.7 millions inhabitants) and the longterm outcome (5-year follow up) of a sample of these patients. PATIENTS AND METHODS: Hospitalized patients, residents of the region, were included in a prospective study during 13 weeks spread over the whole year in 1986 in all emergency services of the region. The follow-up study concerned patients hospitalized in 3 hospitals (a trauma I level center, a pediatric hospital and a general hospital), with a sampling frame taking into account the overall injury severity. Impairments, disabilities and handicaps were assessed with a structured questionnaire five years later and results in children compared with those of adults. RESULT: Annual incidence of hospitalized head injuries in children was 294/100,000 inhabitants. The lethality was 0.3% in hospitalized patients. Ninety-two percent of head injuries were minor. In the youngest patients, the most frequent circumstances were a fall at home. The traffic accidents rate increased with age from 14% to 53% in the 10-14 years old children. Five years later, 104 children were reviewed (83 minor and 21 moderate or severe head injuries). Children complained less often of somatic symptoms than adults. Two children had disabilities in daily life activities, including one whose minor head injury eventually worsened and one after a very severe brain injury. According to the Glasgow Outcome Scale three patients had a poor recovery (2 severe and 1 moderate disability). CONCLUSIONS: Origin and mechanisms of head injuries in childhood were similar than in previous studies. Incidence was higher because of a higher proportion of minor head injuries. Disabilities and poor recovery happened in children with brain lesions or in one children with a minor head injury complicated by a severe anoxia. Anxiety and depression should be better studied in these children. Language: fr

International audience; IntroductionLe vieillissement de la population pose un problème majeur de santé publique en Afrique sub-saharienne. Les règles traditionnelles de parenté fragilisent la personne âgée démente (PAD) conduisant à la stigmatisation de celle-ci dans le cercle familial. L’objectif de notre étude est d’analyser la situation des PAD en fonction des liens d’alliance, de filiation et de germanité.Matériel et méthodesÉtude qualitative de type ethno-anthropologique, conduite au Congo, en zones urbaine et rurale, lors d’un séjour de trois mois d’immersion sur le terrain. Cette recherche a été réalisée par entretiens non directifs, observation participante, recueil d’histoires de vie des enquêtés, PAD (issues d’une enquête antérieure porte-à-porte) et leurs aidants familiaux (AF), suivi d’une analyse du contenu verbatim avec choix des catégories thématiques. Les entretiens ont été menés en français et en langues locales : Kituba, Lingala, Téké et Lari.RésultatsTrente-six récits de vie ont été recueillis (19 en zone urbaine et 17 en zone rurale). Deux critères favorisent l’irruption de la maltraitance envers les PAD : le système de parenté, selon les ethnies, matrilinéaire ou patrilinéaire, peut être protecteur ou défavorable, et les conditions matérielles des AF. Plus elles sont précaires, plus la PAD est maltraitée : privation de soins, de nourriture, isolement, accusation de sorcellerie, menaces, escroqueries. Ce sont surtout les AF qui sont à l’origine de la maltraitance.DiscussionLa qualité de la cohabitation familiale entre PAD et AF est fragile. Les PAD n’ayant pas de revenus ne sont pas les bienvenues dans les ménages des AF. L’individualisme prédomine en zone urbaine entraînant les ruptures des liens sociaux avec les PAD au profit d’une cohésion sociale plus forte en zone rurale.ConclusionLes difficultés économiques des AF et la non-participation des PAD aux charges sont sources majeures de stigmatisation des PAD.

The aim of this study was to assess the prevalence of increased thyroid-stimulating hormone (TSH) levels (subclinical or undiagnosed hypothyroidism) in a representative sample of a community-living elderly population and to examine the relationships with cognitive functions and depressive symptoms. An epidemiological study was made of a cohort of 2792 subjects over 65 years of age. A blood sample was obtained from 425 volunteers of this cohort and assayed for TSH. Every subject participating in the study was interviewed and given a battery of neuropsychological tests by a psychologist. Three hundred and eighty-one subjects (89.7%) had normal TSH levels; 18 subjects (4.2%) had TSH lower than 0.4 microU/ml, associated in two of them with hyperthyroxinaemia. Twenty-six subjects (6.1%) had increased TSH levels, associated in 18 of them with a normal free thyroxine level and in eight with a low free thyroxine level. Increased TSH levels were significantly linked with female sex and with the presence of symptoms of depression on the CES-D scale but not with impairment of cognitive function.

Most current tools exploring visuospatial memory abilities are poorly adapted to the elderly population. The Goblets test allows a brief evaluation of visuospatial memory abilities through an encoding phase in which the participant has to learn a particular sequence and a further delayed recall phase. The aim of the present work was to produce normative scores for this test and to study its properties in the detection of dementia.Data were collected in a sample of 1002 agricultural retirees aged 65 years and over included in the AMI study, a population-based cohort study conducted in Gironde (southwestern France). The sample analyzed to establish normative data included 795 non-institutionalized and non-demented participants. Regarding the validity study, the sample analyzed included 912 participants of whom 76 subjects with a diagnosis of Alzheimer's disease.Normative scores were calculated according to age (65-74 years and 75 years and over) and educational level (primary school level not validated by a diploma, primary school level validated by a diploma and more than a primary school level). The normative scores of the learning phase were described using the percentiles while rates of success were reported for the delayed recall. Regarding the properties of the test, the Goblets test seemed to be more specific than sensitive and presented high negative predictive values. The Youden index showed that the better cut-off score was two trials (with 75.0% sensitivity and 83.0% specificity).The Goblets test can be a helpful tool in screening for dementia. Nevertheless, like many other simple and quick cognitive tests, it cannot be used alone to establish the diagnosis of dementia. This test has the advantage to be easy to administer in clinical situations; the normative scores presented in this study could be used as an aid to interpret a patient's performance.

The efficacy and safety of catheter ablation of accessory pathways (AP) was studied in 79 children (age, 4–16 years), using DC shocks (n=25) or radiofrequency energy (n=54). All patients had docwnented arrhythimias including ventricular fibrillation in four. Organic heart disease was present in four patients. AP locations were left lateral (n=36), posteroseptal (n=36), right lateral (n=8), Mahaim fibres (n=2) and right anteroseptal (n=6). Seven patients had multiple AP. One patient had a preexcitation which appeared secondary to an atrio-infundibular connection (Fontan procedure). The ablation site of concealed or overt AP was identified by retrograde or anterograde conduction mapping, respectively. A mean of 2·6 ± 1 cathodal shocks (80–160 J) was delivered to 25 patients over 29 sessions, resulting in initial AP ablation in all. Fulguration was uncomplicated in all except in one patient (4%) who developed a secondary complete AV block post-ablation. During a follow-up period of 30–69 months, intermittent preexcitation recurred in two asymptomatic patients, but no significantly tachycardia was inducible at late electrophysiological study, including under isoproterenol infusion. Radiofrequency energy was applied to 54 patients during 62 sessions, using 20–40 watts for 30–60 s. AP ablation was initially achieved in all patients using a median of three impulses, without significantly immediate side-effects. Two patients (4%) developed a short episode of blurred vision possibly due to a microembolism. After discharge, the follow-up period was 10 ± 5 months (range 1 to 24). All patients but one (98%) were asymptomatic without any drug therapy. AP conduction and tachycardias recurred in one child, within one month after radiofrequency catheter ablation. Asymptomatic intermittent preexcitation recurred in another patient who had had three AP; a late study showed no inducible reciprocating tachycardia even wider isoproterenol infusion and a minimal preexcited RR interval of 350 ms during induced atrial fibrillation. It is concluded that catheter ablation is an effective and relatively safe method for ablation of AP in children.

To evaluate the longitudinal relationship between moderate chronic kidney disease (CKD), decline in kidney function, and microalbuminuria with subsequent cognitive decline and incident dementia.This study is based on a population-based cohort of 7,839 subjects over 65 years with 7 years of follow-up. Glomerular filtration rate was estimated (eGFR) using the CKD-EPI equation. Global cognitive function was assessed using the Mini-Mental State Examination (MMSE) and dementia was actively screened and diagnosed.At baseline, 12% of the participants had an eGFR60 mL/min/1.73 m(2). A total of 564 incident dementia cases were diagnosed during the follow-up. Low baseline eGFR values were not associated with an increased risk of incident dementia or cognitive decline over the 7-year follow-up, except a borderline significant association with dementia with vascular component. However, eGFR decline over the first 4-year period was associated with higher risk of dementia with vascular component (relative risk = 5.35 [1.76-16.3] in those with eGFR decline4 mL/min/1.73 m(2)/y compared with those4) and with higher cognitive decline on the MMSE (-0.12 points, p0.01 in those with eGFR4 mL/min/1.73 m(2)/y compared with those4) in the 3 subsequent years. Proteinuria tended to be associated with an increased risk of subsequent dementia with vascular component.Despite a large sample and a long follow-up, we found no increased risk of cognitive decline or dementia associated with low eGFR level. However, faster eGFR decline was associated with global cognitive decline and incident dementia with vascular component, suggesting that this association may be mediated by vascular mechanisms.

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.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.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).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.