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Background: Alzheimer’s disease (AD) is a neurodegenerative pathology that disrupts processing of facial expressions of emotion. The impairment was demonstrated for negative emotions in tasks of matching, discriminating, and labeling facial expressions but no study has included the expression of pain in its protocol. Objective: The objective was to study the processing of emotional facial expressions in AD with a particular interest in pain expression. Methods: Twenty-seven controls, 15 mild AD patients, and 15 moderate AD patients had to perform four emotional tasks: identification of facial expressions, matching pain expressions, discriminating the intensity of pain expressions, and judging pain intensity. Results: Some emotions were less efficiently recognized by AD patients compared to controls (p

Background Alzheimer disease (AD) is a common complex disorder with a high genetic component. Loss-of-function (LoF) SORL1 variants are one of the strongest AD genetic risk factors. Estimating their age-related penetrance is essential before putative use for genetic counseling or preventive trials. However, relative rarity and co-occurrence with the main AD risk factor, APOE-ε4, make such estimations difficult. Methods We proposed to estimate the age-related penetrance of SORL1-LoF variants through a survival framework by estimating the conditional instantaneous risk combining (i) a baseline for non-carriers of SORL1-LoF variants, stratified by APOE-ε4, derived from the Rotterdam study (N = 12,255), and (ii) an age-dependent proportional hazard effect for SORL1-LoF variants estimated from 27 extended pedigrees (including 307 relatives ≥ 40 years old, 45 of them having genotyping information) recruited from the French reference center for young Alzheimer patients. We embedded this model into an expectation-maximization algorithm to accommodate for missing genotypes. To correct for ascertainment bias, proband phenotypes were omitted. Then, we assessed if our penetrance curves were concordant with age distributions of APOE-ε4-stratified SORL1-LoF variant carriers detected among sequencing data of 13,007 cases and 10,182 controls from European and American case-control study consortia. Results SORL1-LoF variants penetrance curves reached 100% (95% confidence interval [99–100%]) by age 70 among APOE-ε4ε4 carriers only, compared with 56% [40–72%] and 37% [26–51%] in ε4 heterozygous carriers and ε4 non-carriers, respectively. These estimates were fully consistent with observed age distributions of SORL1-LoF variant carriers in case-control study data. Conclusions We conclude that SORL1-LoF variants should be interpreted in light of APOE genotypes for future clinical applications.

International audience; BACKGROUND: People with dementia (PWD) and their caregivers are populations highly vulnerable to COVID-19 pandemic and its consequences. A better knowledge of the living conditions during the first lockdown is necessary to prevent the risk of poor mental health (PMH) in this population. OBJECTIVE: The present study aimed to compare the mental health of caregivers of PWD living at home or in nursing-homes and to identify specific factors influencing their mental health. METHODS: We conducted an anonymous cross-sectional online survey in France from March 17 to May 11, 2020. Three hundred and eighty-nine caregivers accompanying a PWD living at home (HC) and 159 accompanying a PWD living in a nursing home (NHC) participated in the study. Caregivers' mental health including anxiety, depression, stress, and burden was assessed with self-reported standardized scales. RESULTS: Half of the caregivers exhibited PMH, including depression, anxiety, or self-reported stress. Similar PMH rates were provided whatever the PWD place of residence. Regarding HC, our results also highlighted a number of risk factors for PMH, including the fact that caregiver live with PWD, to give increased support to PWD, and to feel more isolated for managing PWD since lockdown. CONCLUSION: PMH was observed for caregivers of PWD during lockdown, whatever PWD living place, suggesting that concern for PWD may explain more of caregiver distress than increased material tasks. In the future, it will be necessary to pay attention to caregivers after the crisis by estimating the longer-term impact on their mental health.

INTRODUCTION Pain is underdiagnosed and undertreated in patients with Alzheimer's disease (AD). Pain management is of major importance in this population to limit behavioural and functional consequences. Our study aimed to assess the capacity of AD patients to represent pain using a questionnaire exploring daily painful situations and to determine the most appropriate pain scale assessment. METHODS Twenty-eight patients with mild AD, 21 with moderate AD and 28 matched controls underwent the Situation Pain Questionnaire (SP-Q) and assessed imaginary pain with four pain scales. Two scores were compared between the three groups: the P(A) discrimination score and the response bias β score. P(A) reflects the degree of discrimination between high-pain and low-pain events, whereas the β score means the degree to which situations are considered as painful. RESULTS Our results showed that AD patients hardly discriminated the high- from low-pain events. Compared to controls, the mean P(A) score was significantly lower for Mild AD (p

Objective: The present report aims to evaluate whether singing intervention can bring an immediate benefit that is greater than the one provided by painting intervention on pain and well-being. Methods: Fifty-nine mild patients with Alzheimer disease were randomized to a 12-week singing (n = 31) or painting group (n = 28). In the present analysis, the immediate evolution of pain and well-being was compared across sessions between the 2 groups using mixed-effects models. Results: We observed a significant improvement in well-being for both singing and painting groups immediately after sessions, compared to the assessment before the sessions. We did not observe this improvement across the sessions for pain intensity measurement. Discussion: Our results revealed that both painting and singing interventions provide an immediate benefit on the patients’ well-being.

Introduction La perte progressive des connaissances semantiques caracterise l’aphasie primaire progressive variant semantique (APPvs) et la maladie d’Alzheimer (MA). Dans la pratique clinique, les connaissances semantiques sont essentiellement evaluees par des epreuves verbales alors qu’il est admis que le deficit doit etre constate dans plusieurs modalites. Objectifs Le but de cette etude etait de proposer un nouvel outil d’evaluation de la memoire semantique et de passation courte : l’ECCS (evaluation courte des connaissances semantiques), offrant au clinicien la possibilite de tester la memoire semantique, en termes d’acces mais aussi d’integrite, selon plusieurs modalites. Methode Quarante huit participants sains ont ete repartis en fonction de 3 niveaux socio-culturels, du sexe (24 hommes et 24 femmes) et de 2 groupes d’âge (50–64 ans et 65 ans et plus) pour realiser la normalisation. Les 10 epreuves constituant l’ECCS, soit les modalites verbale, auditive, tactile, olfactive et gustative leur ont ete administrees. La batterie a egalement ete proposee a 2 patientes presentant une APPvs et 2 souffrant d’une MA. Resultats Les analyses statistiques ont montre, pour les participants sains, un effet du niveau socio-culturel pour la majorite des epreuves et un effet de l’âge pour les epreuves de designation et tactile. Pour les patientes, les resultats se sont montres discriminants pour plusieurs epreuves, allant dans le sens d’une atteinte semantique d’origine centrale. Discussion Cette etude propose des normes pour un nouvel outil, de passation courte : l’ECCS. La normalisation de l’ECCS se poursuit, ainsi que sa validation aupres de patients presentant des troubles lexico-semantiques. Conclusion Cette etude souligne l’interet clinique de la batterie ECCS qui permet de detecter les troubles semantiques multimodaux dans l’APPvs et la MA. Evaluer la memoire semantique a travers toutes les modalites est utile pour le clinicien afin de mieux definir son projet therapeutique.

Background Alzheimer's disease (AD) mainly occurs in elderly individuals. Comorbidities and chronic pain are frequent in this population. Previous studies revealed that personality modulates both chronic pain (CP) andADoccurrence and evolution. Moreover, as pain treatments can induce side-effects, non-drugs treatments, such as art interventions, are interesting alternative therapies for decreasing CP in these patients. Objective Our aim was to assess the potential role of personality traits on art intervention efficacy for reducing CP in a population of patients with mild AD. Methods Design: multicenter randomized controlled trial. Fifty mild AD patients underwent a 12-week art intervention including singing and painting groups. Personality was assessed with the Big Five Inventory before the sessions. CP was measured with Numeric Rating Scale (NRS) [Usual pain (NRS-U) and most Intense pain (NRS-I)], Simple Visual Scale [Usual pain (SVS-U) and most Intense pain (SVS-I)] and Brief Pain Inventory (BPI) before and after the sessions. The influence of personality traits on CP evolution before and after art intervention was assessed with multiple linear regression models. Results A positive association was observed between neuroticism and the evolution of three CP measures including NRS-U (B = 0.34, p = 0.01), SVS-U (B = 0.20, p = 0.04), and BPI-U (B = 0.46, p = 0.02) evolution. No significant relationship was observed between neuroticism and NRS-I, SVS-I and BPI-R evolution. Conclusions Our findings suggest that neuroticism can decrease the efficacy of group art intervention on pain in patients with mild AD. Individual therapies could be more appropriate for these patients. These results emphasize the interest of taking into account patients' personality before proposing them to participate to a group therapy.

Background: The present study examines whether the interaction between emotion and the enactment effect (body involvement) improves memory in people with Alzheimer disease (AD). Methods: Two experiments with drawings of actions were conducted, in which two types of encoding were used: motor and verbal. In experiment 1, with 13 AD patients and 13 older healthy adults, the encoding was incidental. In experiment 2, with 17 mild AD patients and 21 older healthy adults, it was intentional. Results: In experiment 1, no effect of enactment or emotion was observed in the AD patients. In experiment 2, effects of enactment and emotion (better recall for negative actions) were observed in the AD patients. This pattern of results was also observed in the elderly control adults in both experiments. Conclusion: These results confirm effects observed in normal ageing and indicate a more subtle effect on AD.

BACKGROUND Among non-pharmacological therapies, musical intervention is often used for patients with Alzheimer's disease (AD) and patients presenting chronic pain. However, their efficacy is still under debate. OBJECTIVE Our aim was to determine the efficacy of choral singing versus painting sessions on chronic pain, mood, quality of life, and cognition in AD patients. METHODS In this multicenter randomized controlled trial, 59 mild AD patients were randomized to a 12-week singing (SG; n = 31) or painting group (PG; n = 28). Chronic pain, anxiety, depression, and quality of life were assessed before, after, and 1 month after the sessions. Cognitive abilities were assessed before and after interventions. The evolution of these different measures was assessed with mixed linear models. The primary data analysis was by intention-to-treat, and completed by a 'per protocol' approach. RESULTS Both singing and painting interventions led to significant pain reduction (Time effect: F = 4.71; p = 0.01), reduced anxiety (Time effect: F = 10.74; p

Introduction La medecine connectee prend une place importante dans le quotidien de chacun ainsi que l’exercice medical et la prise en charge des patients, notamment dans le domaine de la sclerose en plaques (SEP). Objectifs L’objectif fut d’etudier l’impact du dispositif medical MSdialog® sur l’exercice des professionnels de sante de mesurer son apport au profit des patients suivis en consultation ou en session d’education therapeutique (ETP). Patients et methodes Une etude qualitative observationnelle a ete realisee au travers d’un questionnaire adresse a un groupe de professionnels de sante, utilisateurs de MSdialog®, proposee dans le suivi des patients traites par interferon beta 1a en sous-cutane avec l’injecteur Rebismart2®. Cette population cible de professionnels de sante a ete amenee a reflechir sur cette plateforme connectee depuis son lancement en France et utilisateurs de l’outil au travers de leurs patients. Resultats Dix-sept questionnaires ont ete envoyes a 8 neurologues (hospitaliers et liberaux mixtes) ainsi qu’a 7 infirmiers et 2 cadres de sante, specialises dans le domaine de l’ETP. Un impact positif de MSdialog® est estime a 94 % avec une aide a la consultation (87 %) et une meilleure implication des patients (88 %) sans gain sur le temps de consultation (62 %). L’adherence visualisee sur la plateforme est observee par 70 % des utilisateurs. Les questionnaires les plus utilises sont ceux evaluant la fatigue l’humeur et la qualite de vie. Discussion L’utilisation de la plateforme MSdialog® permet une meilleure observation objective de l’adherence des patients a leur traitement. Elle permet une connaissance approfondie des patients au travers de questionnaires proposes etudiant notamment la fatigue, la douleur et la qualite de vie. Cette plateforme pourrait a terme etre ouverte a l’ensemble des patients SEP et proposer d’autres offres comme des activites de remediation cognitive. Conclusion MSdialog® est une nouvelle approche de medecine connectee. Elle permet de performer la prise en charge des patients SEP, dans le suivi d’adherence et l’evolution des echelles qualitatives proposees.

We studied horizontal saccades by direct-current electro-oculography in 18 patients with internuclear ophthalmoplegia (INO), and in 16 healthy, age-matched subjects. The occurrence of abducting signs, i.e. overshoot and dissociated nystagmus, was related to an increase of interocular dissociation (measured by the ratio of abduction and adduction peak velocities). The amplitude of abduction hypermetria was strongly correlated with the intensity of adduction slowing. These findings support the idea of an adaptive mechanism underlying the overshoot and nystagmus of abduction saccades in INO.