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Antipsychotic (AP) dosing is well established in nonelderly patients with acute exacerbations of schizophrenia, but not in special populations.This review describes the AP dosing procedures that have been used in clinical studies for acute psychotic agitation, a first episode of psychosis (FEP), and elderly patients. AP dosing data was extracted from the databases of drug regulatory authorities, and from clinical studies available in the medical literature. In acute psychotic agitation, intramuscular and oral APs are frequently prescribed in higher doses than those that saturate D2 receptors. Supersaturating doses of APs should be avoided due to an increased risk of adverse effects. In FEP, many studies showed efficacy of low doses of APs. Studies with risperidone and haloperidol suggested a dose reduction of approximately one third. Titration with a lower starting dose is recommended in elderly patients, due to possible decreases in pharmacokinetic clearance, and due to the risk of concomitant diseases and drug interactions. Exposure to some APs has been associated with QTc prolongation and arrhythmias, and a small but significant increase in the risk of stroke and mortality with APs has been seen, particularly in older people with dementia-related psychosis.

Numerous factors are known to influence quality of life of adults with schizophrenia. However, little is known regarding the potential predictors of quality of life in the increasing population of older adults with schizophrenia. The main objective of the present study was to propose a comprehensive model of quality of life in this specific population. Data were derived from the Cohort of individuals with Schizophrenia Aged 55 years or more (CSA) study, a large (N = 353) multicenter sample of older adults with schizophrenia or schizoaffective disorder recruited from French community mental-health teams. We used structural equation modeling to simultaneously examine the effects of six broad groups of clinical factors previously identified as potential predictors of quality of life in this population, including (1) severity of general psychopathology, (2) severity of depression, (3) severity of cognitive impairment, (4) psychotropic medications, (5) general medical conditions and (6) sociodemographic characteristics. General psychopathology symptoms, and in particular negative and depressive symptoms, cognitive impairment, reduced overall functioning and low education were significantly and independently associated with diminished quality of life (all p

Cognitive disorders are frequently found during late-life depression (LLD). Many cognitive functions may be concerned and can be explained by frontostriatal brain circuits and hippocampus dysfunctions partly through abnormalities related to cerebrovascular diseases. It seems important to distinguish between early and late onset depression, the cognitive characterisation and aetiopathogenesis of which differ in some respects. Cognitive impairment may represent markers of depression, but it is still unclear whether potential biomarkers of disease should be considered as markers of condition, trait or risk factors. These disorders may precede depression and persist despite symptomatic remission. Moreover, the interest of specifying these disorders is multiple because they can have pejorative consequences, such as by modifying emotional content, encouraging suicidal acts, limiting the effectiveness of psychotherapy, being a risk factor for a poor response to antidepressants, or being a potential risk factor for progression to a minor or major neurocognitive disorder, especially Alzheimer disease.

Prior research suggests that certain psychiatric symptoms could be associated with increased risk of death. However, it remains unclear whether this association could rely on all or specific symptoms. In this report, we used data from a multicenter 5-year prospective study (N = 641) of older adults with an ICD-10 diagnosis of schizophrenia, bipolar disorder or major depressive disorder, recruited from French community psychiatric departments. We used a latent variable approach to disentangle the effects shared by all psychiatric symptoms (i.e., general psychopathology factor) and those specific to individual psychiatric symptoms, while adjusting for sociodemographic and clinical factors. Psychiatric symptoms were assessed face-to-face by psychiatrists trained to semi-structured interviews using the Brief Psychiatric Rating Scale (BPRS). Among older adults with major psychiatric disorders, we found that all psychiatric symptoms were associated with increased mortality, and that their effect on the 5-year mortality were exerted mostly through a general psychopathology dimension (β = 0.13, SE = 0.05, p 0.05). No BPRS item or lower order factor had a significant effect on mortality beyond and above the effect of the general psychopathology factor. Greater number of medical conditions, older age, male sex, and being hospitalized or institutionalized at baseline were significantly associated with this risk beyond the effect of the general psychopathology factor. Since psychiatric symptoms may affect mortality mainly through a general psychopathology dimension, biological and psychological mechanisms underlying this dimension should be considered as promising targets for interventions to decrease excess mortality of older individuals with psychiatric disorders.

Cognitive disorders are frequently found during late-life depression. Many cognitive functions may be concerned and can be explained by fronto-striatal brain circuits and hippocampus dysfunctions partly through abnormalities related to cerebrovascular diseases. It seems important to distinguish between early and late onset depression whose cognitive characterisation and etiopathogenia differ in some aspects. Cognitive impairment may represent markers of depression but it is still unclear whether one should consider potential biomarkers of disease state or trait or risk factor. These disorders may precede depression and persist despite symptomatic remission. Moreover, the interest of specifying these disorders is multiple because they can have pejorative consequences such as the modification of emotional content, promote suicidal act, limit the effectiveness of psychotherapy, be a risk factor for poor response to antidepressants. or be a potential risk factor for progression to a minor or major neurocognitive disorder, especially Alzheimer's disease.

(1) Background: Internet gaming disorder (IGD) shares many similarities with substance use disorder (SUD), contributing to its recognition as an addictive disorder. Nevertheless, no study has compared IGD to other addictive disorders in terms of personality traits established as highly co-occurring with SUDs. (2) Methods: We recruited a sample of gamers (massively multiplayer online role-playing games) (MMORPGs) via online in-game forums. We compared 83 individuals with IGD (MMORPG-IGD group) to 47 former heroin addicts under methadone maintenance treatment (MMT; MMT group) with regard to alexithymia, impulsivity, sensation seeking and aggressiveness assessed through self-administered scales, being TAS-20, BIS-10, Z-SSS and BDHI, respectively. (3) Results: Our results draw a relatively similar personality profile between groups but indicate that the subject traits are generally more pronounced in the MMT cohort. The overall lesser intensity of these traits in the MMORPG-IGD group might reflect the greater variability in the severity of the IGD. (4) Conclusions: IGD shares personality traits with MMT, and intensity may be influenced by the severity of the addiction or by certain direct environmental factors, and might also influence the propensity towards one behavior rather than another.

Late-life depression is a heterogeneous mood disorder frequently associated with many adverse conditions, including decreased cognitive function and an elevated risk for comorbid medical disorders, as well as with an elevated mortality rate. Late-life depression encompasses both late-onset as well as early-onset depression that occurs or continues into later years of life. Conventional treatment often required several trials of antidepressants before an effective regimen can be found for an individual. This is associated with persistent depressive symptoms, a disability in activities of daily living and an increased risk of suicide and worsening of medical comorbidities. Thus, in the elderly, it is particularly important to identify predictors of treatment remission to reduce these risks. The purpose of this paper was to review the current status of knowledge regarding predictors of remission to antidepressants among older depressed patients. Patients with high number of cardiovascular risk factors, poor performance in working memory, verbal fluency tests and executive functioning, reduced volumes of cerebral structures (hippocampus, anterior cingular cortex, orbitofrontal cortex) were more likely to reach remission. Reduction of depression score during the first weeks of treatment was correlated with remission. However, more studies are needed to confirm these results.

One of the most basic and person-specific affective responses to music is liking. The present investigation sought to determine whether liking was preserved during spontaneous auditory imagery. To this purpose, we inserted two-second silent intervals into liked and disliked songs, a method known to automatically recreate a mental image of these songs. Neural correlates of musical preference were measured by high-density electroencephalography in twenty subjects who had to listen to a set of five pre-selected unknown songs the same number of times for two weeks. Time frequency analysis of the two most liked and the two most disliked songs confirmed the presence of neural responses related to liking. At the beginning of silent intervals (400–900 ms and 1000–1300 ms), significant differences in theta activity were originating from the inferior frontal and superior temporal gyrus. These two brain structures are known to work together to process various aspects of music and are also activated when measuring liking while listening to music. At the end of silent intervals (1400–1900 ms), significant alpha activity differences originating from the insula were observed, whose exact role remains to be explored. Although exposure was controlled for liked and disliked songs, liked songs were rated as more familiar, underlying the strong relationship that exists between liking, exposure, and familiarity.

Background Longitudinal studies of dementia with Lewy bodies (DLB) are rare. Clinically, DLB is usually considered to worsen into Alzheimer’s disease (AD). The aim of our study was to compare the rate of the cognitive decline in DLB, AD, and the association of the two diseases (AD + DLB). Methods Using the Regional Network for Diagnostic Aid and Management of Patients with Cognitive Impairment database, which includes all the patients seen at all memory clinics (medical consultation and day hospitals) in four French regions, and beta regression, we compared the longitudinal the Mini-Mental State Examination scores of 1159 patients with AD (n = 1000), DLB (n = 131) and AD + DLB (association of the two) (n = 28) during follow-up of at least 4 years. Results The mean follow-up of the patients was 5.88 years. Using beta regression without propensity scores, the comparison of the decline of patients with AD and patients with DLB did not show a significant difference, but the decline of patients with AD + DLB was worse than that of either patients with DLB (P = 0.006) or patients with AD (P

Impulsivity is a multidimensional phenomenon that remains hard to define. It compounds the core pathological construct of many neuropsychiatric illnesses, and despite its close relation to suicide risk, it currently has no specific treatment. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique whose application results in cognitive function improvement, both in healthy and psychiatric populations. Following PRISMA recommendations, a systematic review of the literature concerning tDCS's effects on impulsive behaviour was performed using the PubMed database. The research was based on the combination of the keyword 'tDCS' with 'impulsivity', 'response inhibition', 'risk-taking', 'planning', 'delay discounting' or 'craving'. The initial search yielded 309 articles, 92 of which were included. Seventy-four papers demonstrated improvement in task performance related to impulsivity in both healthy and clinical adult populations. However, results were often inconsistent. The conditions associated with improvement, such as tDCS parameters and other aspects that may influence tDCS's outcomes, are discussed. The overall effects of tDCS on impulsivity are promising. Yet further research is required to develop a more comprehensive understanding of impulsivity, allowing for a more accurate assessment of its behavioural outcomes as well as a definition of tDCS therapeutic protocols for impulsive disorders.

Elderly people, especially those with depression, represent the population most at risk for suicide. In addition to commonly used neuropsychological, psychiatric and biological tests, ocular saccadic analysis can be an interesting tool for identifying suicidal behaviors (SB). These SBs could be associated with an alteration of the cortical structures involved in the executive functions. This alteration is particularly manifested by a decrease in the ability to control eye movements (EM). Thus, depressed elderly people with SB may have a greater impairment of oculomotor performance than those without SB. The purpose of this article is to summarize the literature allowing us to support this hypothesis.

Resume Depuis les annees 1950, la pharmacogenetique s’est developpee avec l’objectif d’ameliorer les strategies therapeutiques en particulier dans la prise en charge des pathologies psychiatriques. Si les prescriptions reposent sur des strategies adaptees au plus grand nombre, dans un certain nombre de cas, elles connaissent des limites en termes de delai d’action, voire des risques d’inefficacite. Ces risques sont en partie dus a des modifications pharmacocinetiques et pharmacodynamiques. Pour maitriser ces donnees et personnaliser les therapeutiques, il serait souhaitable de pouvoir prendre en compte les caracteristiques individuelles de chaque patient. La pharmacogenetique, qui vise a utiliser l’analyse du genome pour evaluer son implication dans la reponse au traitement, est un des outils de cette adaptation therapeutique. Les resultats sont encourageants, mais d’autres recherches sont necessaires avant de pouvoir integrer l’analyse pharmacogenetique dans la pratique clinique courante.

International audience; INTRODUCTION:Diagnostic relevance of plasma amyloid β (Aβ) for Alzheimer's disease (AD) process yields conflicting results. The objective of the study was to assess plasma levels of Aβ42 and Aβ40 in amnestic mild cognitive impairment (MCI), nonamnestic MCI, and AD patients and to investigate relationships between peripheral and central biomarkers.METHODS:One thousand forty participants (417 amnestic MCI, 122 nonamnestic MCI, and 501 AD) from the Biomarker of AmyLoïd pepTide and AlZheimer's diseAse Risk multicenter prospective study with cognition, plasma, cerebrospinal fluid (CSF), and magnetic resonance imaging assessments were included.RESULTS:Plasma Aβ1-42 and Aβ1-40 were lower in AD (36.9 [11.7] and 263 [80] pg/mL) than in amnestic MCI (38.2 [11.9] and 269 [68] pg/mL) than in nonamnestic MCI (39.7 [10.5] and 272 [52] pg/mL), respectively (P = .01 for overall difference between groups for Aβ1-42 and P = .04 for Aβ1-40). Globally, plasma Aβ1-42 correlated with age, Mini-Mental State Examination, and APOE ε4 allele. Plasma Aβ1-42 correlated with all CSF biomarkers in MCI but only with CSF Aβ42 in AD.DISCUSSION:Plasma Aβ was associated with cognitive status and CSF biomarkers, suggesting the interest of plasma amyloid biomarkers for diagnosis purpose.Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Depression is associated with higher risk of death and major adverse cardiac events among patients undergoing coronary artery bypass grafting (CABG). This study aimed to investigate the impact of preoperative depression on health-related quality of life (HRQoL) changes over the first 12 postoperative months. Patients were the participants in the MOTIV-CABG study that was a single-center, non-stratified, randomized, double-blind, parallel-group, phase 4 trial, conducted between January 2006 and February 2012 at University Hospital, Besancon, France. The effect of preoperative depression (measured using the Beck Depression Inventory, BDI) on changes in SF-36 component summary scores [mental (MCS) and physical (PCS)] over time was tested using a generalized linear model for repeated measures. The presence of depression was defined as a BDI score >3. There were 359 patients in this study: 217 (60.4 %) had no preoperative depression, and 142 (39.6 %) had preoperative depression. During follow-up, the MCS and PCS scores increased in both groups. The improvement was of smaller magnitude in the group of patients depressed baseline as compared to those with no depression (difference in LSM = −7.45, p

Background: A single cutoff is widely used to screen amnestic mild cognitive impairment (aMCI). However, results of screening test performance are never adjusted for spectrum effect and spectrum bias. Objectives: To assess the potential impact of spectrum effect and spectrum bias on screening test performance and clinical decision. Methods: The ability of the combination of Memory Impairment Screen (MIS), the Isaacs Set Test (IST), and the Mini-Mental State Examination (MMSE) to distinguish aMCI (n = 3,330) from patients with subjective cognitive complaints (SCC) (n = 1,522) was investigated across a wide range of age and educational backgrounds. The spectrum effect was defined as the variation of the sensitivity and/or the specificity across different subgroups. A spectrum bias was highlighted if the likelihood ratio (LR) observed in a subgroup of subjects statistically differed from the LR observed in the overall sample. Results: For the MIS-IST pairing, the overall sensitivity and specificity were equal to 72.5% and 75.2%, the positive LR (LR+) and the negative LR (LR–) were equal to 2.91 and 0.37, respectively. Across the different age-education subgroups, the sensitivities ranged from 43.7% to 92.5% and specificities from 39.3% to 95.2%. LR+ and LR– ranged from 1.51 to 9.10 and 0.13 to 0.59, respectively. A statistically significant spectrum bias was found in some subgroups and may result in differences between the post-test probabilities. Similar results were also found for the MMSE. Conclusion: These findings could potentially affect the clinician’s decision with a possible greater impact in elderly patients with a lower educational level.

The aim of this study was to evaluate the impact, on a regional scale (Franche-Comte), of 3 National Alzheimer care plans, particularly concerning the development of the offer of care management by clinicians as well as the panel of diagnoses concerned. Data on sociodemographic, neuropsychological and diagnostic characteristics were retrieved from the RAPID regional database between 1st January 2003 and 31st December 2012. These analyses focused exclusively on patients who had an initial consultation (n=12,017) during the same period. The existence of a previously established health network capable of carrying out governmental health plans has produced an effective interface between regional administrative structures responsible for the implementation of these plans and health professionals responsible for carrying out them out. This network study, the use of a battery of tests and a common software database have enabled the development of patient care management throughout the Franche-Comte region. It also showed the diversification of diagnoses mentioned over the past years as well as changes in clinical practices on how to address the issue of cognitive impairment.

Objective This double-blind, sham-controlled trial investigated the effects of two daily tDCS sessions over a 5-day period in treatment-resistant depression. Method Twenty-four treatment-resistant depressed patients received two daily sessions of active or sham anodal tDCS to the left prefrontal cortex (2 mA, 10 sessions over 1 week). Depression severity, psychomotor retardation and cognitive function were assessed. Results Active tDCS was not significantly superior to sham tDCS on the HDRS at week 4, as well as on the MADRS and SRRS scales, and on neuropsychological tests. Response rates were not significantly higher with active tDCS. tDCS was well tolerated, with mild adverse events limited to transient scalp discomfort. Conclusion tDCS did not induce clinically relevant antidepressant effect in active and sham stimulation groups. There was no impact on psychomotor and neuropsychological functioning. Significance tDCS efficacy on specific symptom profiles in pharmacotherapy-resistant depression is limited. The use of optimized stimulation protocol and longer period of follow up may valuably contribute to specify the place of tDCS in treatment-resistant depression.

The logopenic variant of primary progressive aphasia is a syndrome with neuropsychological and linguistic specificities, including phonological loop impairment for which diagnosis is currently mainly based on the exclusion of the two other variants, semantic and nonfluent/agrammatic primary progressive aphasia. The syndrome may be underdiagnosed due (1) to mild language difficulties during the early stages of the disease or (2) to being mistaken for mild cognitive impairment or Alzheimer's disease when the evaluation of episodic memory is based on verbal material and (3) finally, it is not uncommon that the disorders are attributed to psychiatric co-morbidities such as, for example, anxiety. Moreover, compared to other variants of primary progressive aphasia, brain abnormalities are different. The left temporoparietal junction is initially affected. Neuropathology and biomarkers (cerebrospinal fluid, molecular amyloid nuclear imaging) frequently reveal Alzheimer's disease. Consequently this variant of primary progressive aphasia does not fall under the traditional concept of frontotemporal lobar degeneration. These distinctive features highlight the utility of correct diagnosis, classification, and use of biomarkers to show the neuropathological processes underlying logopenic primary progressive aphasia. The logopenic variant of primary progressive aphasia is a specific form of Alzheimer's disease frequently presenting a rapid decline; specific linguistic therapies are needed. Further investigation of this syndrome is needed to refine screening, improve diagnostic criteria and better understand the epidemiology and the biological mechanisms involved.

Neurocognitive disorders leading to progressive cognitive, functional and behavioural impairment are often undiagnosed or diagnosed lately. But tailored care and therapeutics help in implementing secondary and tertiary prevention dynamics aiming at preserving quality of life and delaying, anticipating or preventing behavioural crisis and severe stages of dementia. Moreover, the diagnosis of numerous diseases induces specific care and therapeutics, as well access to research and clinical trials. For the first time, the representatives of the National College of General Practitioners, the French Federation of Memory Centres, the French Federation of Gerontology and Geriatrics, the French Federation of Neurology, the French Society of Psychogeriatrics and the national plan on neurodegenerative diseases propose a graduated and tailored diagnosis strategy involving primary care and specialists of neurocognitive disorders. This strategy has been built in the context of the national plan on neurodegenerative diseases, the European Joint Action "Act on dementia", and has been consensually agreed after a seminar animated by the National College of General Practitioners in March 2017.

Background/Aims: It is well established that healthy adults obtain low performances when simultaneously interpreting the results of multiple tests. The aim of this study was to estimate the proportion of French-speaking healthy older adults with low scores for the RAPID (Réseau d’Aide au diagnostic et à la PrIse en charge des Détériorations cognitives et de maladies neurologiques chroniques en Franche-Comté et au niveau national) battery test and consider different combinations of test scores within a specific domain and across different domains. Methods: The prevalence of low scores (i.e., ≤5th percentile) on the 14 RAPID primary measures was calculated from the RAPID normative sample (n = 476), based on 4 ages (50–89 years) and 3 levels of education. Results: A high percentage (40.1%) of the normative sample obtained at least one or more low scores (i.e., false positives). In contrast, the risk of having low scores was much less important (Conclusion: Low scores are very common in healthy older subjects and are thus not necessarily pathological or indicative of truly impaired functioning. The information derived from a cognitive profile may provide a greater clinical relevance in an individual, since very few of the healthy older adults obtained low scores on combinations of 2 test-scores.

A psychotherapeutic approach for schizophrenia is now recommended as an adjuvant for psychopharmacology, since antipsychotic medications only have a partial impact especially as regards positive symptoms and insight. In addition, cognitive distortions and the lack of metacognitive skills might increase positive symptoms leading to poor social functioning. This underlines the need for specific approaches which target cognitive processes relevant for insight, and abilities in metacognition. Metacognitive training (MCT) is a structured group intervention, which enhances a patient's reflection on cognitive biases and improves problem-solving. The aim of our study was to assess MCTs' short term impact on insight, symptoms and quality of life. Fifty patients with schizophrenia or schizoaffective disorders and persistent positive symptoms (delusions or hallucinations) were enrolled in the study. After baseline assessment participants were randomised either to supportive therapy or MCT. Both groups used the same design (1h-session twice a week during 8weeks) although the basic knowledge given to participants was different between interventions. Participants were assessed at eight weeks based on the Scale to Assess Unawareness of Mental Disorder, Positive and Negative Syndrome Scale (PANSS), Psychotic Symptom Rating Scales, the Calgary Depression Scale for Schizophrenia and the Quality of Life Scale. Between-group differences were significant in favour of MCT on the PANSS positive scale. Between-group differences in post- and pre-test values showed a trend in favour of MCT for insight on hallucinations. Results of our study indicate that the MCT has an effect on reducing positive symptomatology, and a trend impact on insight and social functioning.

Objectives: Although several reported studies have suggested that younger adults with depression display depressionrelated biases during the processing of emotional faces, there remains a lack of data concerning these biases in older adults. The aim of our study was to assess scanning behavior during the processing of emotional faces in depressed older adults. Method: Older adults with and without depression viewed happy, neutral or sad portraits during an eye movement recording. Results: Depressed older adults spent less time with fewer fixations on emotional features than healthy older adults, but only for sad and neutral portraits, with no significant difference for happy portraits. Conclusion: These results suggest disengagement from sad and neutral faces in depressed older adults, which is not consistent with standard theoretical proposals on congruence biases in depression. Also, aging and associated emotional regulation change may explain the expression of depression-related biases. Our preliminary results suggest that information processing in depression consists of a more complex phenomenon than merely a general searching for moodcongruent stimuli or general disengagement from all kinds of stimuli. These findings underline that care must be used when evaluating potential variables, such as aging, which interact with depression and selectively influence the choice of relevant stimulus dimensions.

Resume La presente etude se propose de determiner la validite de la version francaise d’une echelle anglo-saxonne validee en 2000 par McGahuey et al. [9] , l’Arizona Sexual Experience Scale (ASEX). L’ASEX est un auto-questionnaire simple et rapide permettant de reperer l’existence de troubles sexuels dans une population de patients deprimes. La validite de l’echelle a ete testee par comparaison entre un groupe de 37 patients deprimes (criteres DSM-IV-TR), et un groupe de 64 sujets temoins. Cette etude montre que la version francaise de l’echelle ASEX est un outil de mesure des troubles sexuels specifique, sensible et qui possede une bonne consistance interne. L’ASEX est egalement un outil bien accepte par le patient. Sa brievete (seulement cinq minutes de passation) et son faible degre d’intrusion permettent des mesures frequentes et repetees de la dysfonction sexuelle, provoquant un minimum de gene et d’embarras pour le patient. En pratique courante, cette echelle permet au clinicien d’identifier rapidement quel element de la sexualite est affecte d’un trouble et ainsi traiter specifiquement celui-ci.

Objective Several studies have demonstrated saccadic eye movement (SEM) abnormalities in Alzheimer's disease (AD) when patients performed prosaccade (PS) and antisaccade (AS) tasks. Some studies have also showed that SEM abnormalities were correlated with dementia rating tests such as the Mini Mental State Evaluation (MMSE). Therefore, it has been suggested that SEMs could provide useful information for diagnosis. However, little is known about predictive saccades (PreS)-saccades triggered before or very quickly after stimuli appearance-and their relationships with cognition in AD. Here, we aimed to examine the relationships between our usual dementia screening tests and SEM parameters in PS, AS, and also PreS task. Method We compared SEMs in 20 patients suffering from AD and in 35 healthy older adults (OA) in PS, AS, and PreS task. All participants also completed a neuropsychological evaluation. Results We showed that AD patients had higher latency and latency variability regardless the tasks, and also higher AS cost, in comparison with OA. Moreover, AD patients made more uncorrected AS and took more time-to-correct incorrect AS. In PreS task, AD patients showed higher gain and gain variability than OA when they made anticipated saccades. Close relationships were found between the majority of SEM variables in PS, AS, and PreS tasks and dementia screening tests, especially the MMSE and episodic memory measures. Conclusion Our findings, in agreement with previous studies, demonstrated that AD affects several SEM parameters. SEM abnormalities may reflect selective and executive-attention impairments in AD.

Background Frailty is highly prevalent in elderly people. While significant progress has been made to understand its pathogenesis process, few validated questionnaire exist to assess the multidimensional concept of frailty and to detect people frail or at risk to become frail. The objectives of this study were to construct and validate a new frailty-screening instrument named Frailty Groupe Iso-Ressource Evaluation (FRAGIRE) that accurately predicts the risk for frailty in older adults. Methods A prospective multicenter recruitment of the elderly patients was undertaken in France. The subjects were classified into financially-helped group (FH, with financial assistance) and non-financially helped group (NFH, without any financial assistance), considering FH subjects are more frail than the NFH group and thus representing an acceptable surrogate population for frailty. Psychometric properties of the FRAGIRE grid were assessed including discrimination between the FH and NFH groups. Items reduction was made according to statistical analyses and experts’ point of view. The association between items response and tests with “help requested status” was assessed in univariate and multivariate unconditional logistic regression analyses and a prognostic score to become frail was finally proposed for each subject. Results Between May 2013 and July 2013, 385 subjects were included: 338 (88%) in the FH group and 47 (12%) in the NFH group. The initial FRAGIRE grid included 65 items. After conducting the item selection, the final grid of the FRAGIRE was reduced to 19 items. The final grid showed fair discrimination ability to predict frailty (area under the curve (AUC) = 0.85) and good calibration (Hosmer-Lemeshow P-value = 0.580), reflecting a good agreement between the prediction by the final model and actual observation. The Cronbach's alpha for the developed tool scored as high as 0.69 (95% Confidence Interval: 0.64 to 0.74). The final prognostic score was excellent, with an AUC of 0.756. Moreover, it facilitated significant separation of patients into individuals requesting for help from others (P-value

The aim of the present study was to investigate the relationship between trait impulsivity, risk-taking, and decision-making performance. We recruited 20 healthy participants who performed the Iowa Gambling Task (IGT) and the Balloon Analog Risk Task (BART) to measure decision-making and risk-taking. The impulsivity was measured by the Barratt Impulsiveness Scale. Resting-state neural activity was recorded to explore whether brain oscillatory rhythms provide important information about the dispositional trait of impulsivity. We found a significant correlation between the ability to develop a successful strategy and the propensity to take more risks in the first trials of the BART. Risk-taking was negatively correlated with cognitive impulsivity in participants who were unable to develop a successful strategy. Neither risk-taking nor decision-making was correlated with cortical asymmetry. In a more exploratory approach, the group was sub-divided in function of participants’ performances at the IGT. We found that the group who developed a successful strategy at the IGT was more prone to risk, whereas the group who failed showed a greater cognitive impulsivity. These results emphasize the need for individuals to explore their environment to develop a successful strategy in uncertain situations, which may not be possible without taking risks.

Background The efficacy of antidepressant therapy in patients undergoing coronary artery bypass grafting (CABG) is not clearly established. Methods This double-blind trial was conducted at University Hospital, Besancon, France. Adult CABG patients were randomized (1:1) to receive escitalopram (10 mg daily) or placebo from 2 to 3 weeks before to 6 months after surgery, including 12 months post-surgery follow-up. The primary composite endpoint was the occurrence of mortality or predefined morbidity events. Secondary endpoints included measures of depression, mental and physical health using Beck Depression Inventory Short Form (BDI), and quality of life 36-Item Short Form (SF-36) self assessments. Results The treated cohort contained 361 patients with mean age 67 years. At 12 months, the proportions of patients with the composite morbidity and mortality endpoint were not different between escitalopram and placebo (110 of 182 [60.4%] vs 108 of 179 [60.3%], p = 0.984). However, over the 6 months postoperative period, the BDI and SF-36 Mental Component Summary scores were better overall in the escitalopram group than in the placebo group for all patients ( p = 0.015 and p = 0.014, respectively) and preoperatively depressed (BDI > 3) patients ( p = 0.002 and p = 0.005, respectively). Moreover, the SF-36 Pain score was better overall in the escitalopram group than in the placebo group in the preoperatively-depressed subset ( p = 0.026). Conclusions Antidepressant therapy had no effect on morbidity and mortality events up to 1 year after CABG. However, antidepressant therapy may provide faster improvements to mental health aspects of quality of life and reduce postoperative pain in patients with preoperative depression. Subject to contra-indications, we recommend antidepressant therapy in coronary revascularization patients who are preoperatively depressed.

Psychomotor retardation is a central feature of depression which includes motor and cognitive impairments. Effective management may be useful to improve the classification of depressive subtypes and treatment selection, as well as prediction of outcome in patients with depression. The aim of this paper was to review the current status of knowledge regarding psychomotor retardation in depression, in order to clarify its role in the diagnostic management of mood disorders. Retardation modifies all the actions of the individual, including motility, mental activity, and speech. Objective assessments can highlight the diagnostic importance of psychomotor retardation, especially in melancholic and bipolar depression. Psychomotor retardation is also related to depression severity and therapeutic change and could be considered a good criterion for the prediction of therapeutic effect. The neurobiological process underlying the inhibition of activity includes functional deficits in the prefrontal cortex and abnormalities in dopamine neurotransmission. Future investigations of psychomotor retardation should help improve the understanding of the pathophysiological mechanisms underlying mood disorders and contribute to improving their therapeutic management.

Although the relationship between age-related cognitive decline and saccadic eye movement (SEM) deficits has been outlined, specific cognitive alterations underlying age-related changes in saccadic performance remain unclear. This study attempted to better understand the nature of aging effects on SEMs. We compared SEMs in younger and older adults in prosaccade (PS) and antisaccade (AS) tasks under gap, step, and overlap conditions. We also examined relationships between these performances and several neuropsychological scores. Twenty-eight younger adults (YA), 24 older adults under 65 years (OA 65) of age completed a neuropsychological evaluation, PS and AS tasks. Our results showed that latencies, AS cost, time to correct AS errors, and uncorrected AS, increased with aging. YA showed higher overlap effects than OA>65 and OA

Introduction Cognitive evaluation of young subjects is now widely carried out for non-traumatic diseases such as multiple sclerosis, HIV, or sleep disorders. This evaluation requires normative data based on healthy adult samples. However, most clinicians use a set of tests that were normed in an isolated manner from different samples using different cutoff criteria. Thus, the score of an individual may be considered either normal or impaired according to the norms used. It is well established that healthy adults obtained low-test scores when a battery of tests is administered. Thus, the knowledge of low base rates is required so as to minimize false diagnosis of cognitive impairment. The aim of this study was twofold (1) to provide normative data for RAPID-II battery in healthy adults, and (2) estimate the proportion of healthy adults having low scores across this battery. Methods Norms for the 44 test scores of the RAPID-II test battery were developed using the overall sample of 335 individuals based on three categories of age (20 to 29, 30 to 39, and 40 to 49 years) and two educational levels: Baccalaureate or higher educational degree (high educational level), lower than baccalaureate (low educational level). The 5th, 25th, 50th, and 75th percentiles were calculated from the six age and education subsamples and used to define norms. The frequency of low scores on the RAPID-II battery was calculated by simultaneously examining the performance of 33 primary scores. A low score was defined as less than or equal to the 5th percentile drawn from the six age and education normative subsamples. In addition, the percentages of low scores were also determined when all possible combinations of two-test scores across the RAPID-II were considered in the overall normative sample. Results Our data showed that 59.4% subjects of the normative sample obtained at least one or more low score. With more than 9 test scores, this percentage was equal to 0% in the normative sample. Among all combinations of two-test scores, 96% had a false positive rate Conclusion Low scores are very common in young healthy subjects and are more obvious when simultaneously analyzing test scores across a battery of tests and are thus not necessarily indicative of cognitive impairment. The combinations of two-test scores can be a useful tool to improve the interpretation of low scores.