20 research outputs found

    Awareness dimensions and associated factors in Alzheimer's disease

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    International audienceABSTRACTObjectives – We recently reported the major role depression and apathy in awareness among Alzheimer patients, using the stage of the disease as an exposure factor and exploring different assessment methods. We aimed here to explore the different dimensions of awareness using the various domains of awareness assessed by different sub-scales in awareness scales.Method – Sixty-one Alzheimer patients were examined using four awareness scales relating to three assessment methods : (a) patient-caregiver discrepancy; (b) clinical rating; and (c) prediction of performance discrepancy. Global cognition, executive functioning, autonomy, depression and apathy were also assessed. Multivariate logistic models were performed using disease stage as an exposure factor for awareness scales and sub-scales. Correlations across the different factors and patient and caregiver awareness ratings were computed.Results – The patient-caregiver discrepancy and clinical rating methods (a, b) both identified the factors associated with awareness, in the overall scales and the sub-scales as being depression and/or apathy. Depression correlated with patient self-ratings while apathy correlated with caregiver-ratings. The prediction of performance discrepancy method (c) identified different factors in the overall scale, executive factors in three sub-scales involving executive domains and memory factor in a subscale involving mnesic domain.Discussion – The awareness scales using a referential based on a human rating (a, b) suggest that awareness is unidimensional with depression impacting self-reports and apathy influencing caregiver/clinical reports. Those with referential based on a test rating (c) appear more associated with the dimensions assessed. This highlights the role of the reference system for awareness assessment in Alzheimer’s disease

    Impact immĂ©diat d’une infection liĂ©e Ă  la Covid-19 et du confinement consĂ©cutif sur les rĂ©sidents d’un Ehpad

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    International audienceIntroduction: Following the Covid-19 epidemic affecting 76 of the 97 residents (78.3 %) in a French nursing home, we assessed the impact of this cluster period on the physical and psycho-cognitive health of the residents, expecting in particular to observe effects that were dependent on their state of cognitive-behavioural dependence. Methods: We retained twenty-two variables, 5 relating to demographic data, 6 to the specific care linked to Covid-19 infection, 6 to somatic pathologies and psycho-behavioural disturbances before the epidemic and 5 to the period following it. Results: Eleven residents among those diagnosed positive died. Nine were transferred to a Covid unit, and 35 were asymptomatic. The main consequences of the period of infections were in particular behavioural, nutritional, and motor. A history of disruptive behaviours before the appearance of the cluster increased the risk of an aggravation of these behaviours by four (RR = 3.9, IC95 % = 1.38–11.02, p = 0.0042). Twenty per cent of the residents presented under-nutrition at the end of lockdown, but no specific risk factors could be identified. However, states of under-nutrition for the whole of 2020 were significantly more frequent than in 2019, in particular severe cases (χÂČ = 5.43, p = 0.02). A history of under-nutrition in the previous year increased twofold the likelihood of under-nutrition in the following year (RR = 2.07, IC95 % = 1.14–3.74, p = 0.02). The Covid cluster period also had an effect on the functional autonomy of certain patients. Conclusion: Our main hypothesis relating to cognitive-behavioural dependence was not completely validated. The impact of the occurrence of the cluster remained moderate, in particular because of the care resources afforded by the nursing home. The advantages of a “medicalised” facility, and the problems associated with the restrictions of lockdown, are viewed in the light of ethical considerations.Introduction : Suite Ă  une Ă©pidĂ©mie de Covid-19 ayant affectĂ© 76 des 97 rĂ©sidents d’un Ehpad, nous avons Ă©valuĂ© l’impact de cette pĂ©riode de cluster sur la santĂ© physique et psycho-cognitive des rĂ©sidents pronostiquant notamment une altĂ©ration en fonction de leur dĂ©pendance cognitivo-comportementale. MĂ©thodes : Nous avons retenus vingt-deux variables relatives : aux donnĂ©es dĂ©mographiques (5) ; aux prises en charge spĂ©cifiques liĂ©es Ă  l’infection (6) ; aux pathologies somatiques et troubles psycho-comportementaux avant l’épidĂ©mie (6) et aprĂšs la pĂ©riode de cluster (5). RĂ©sultats : Onze rĂ©sidents diagnostiquĂ©s positifs sont dĂ©cĂ©dĂ©s. Neuf ont Ă©tĂ© transfĂ©rĂ©s en unitĂ© Covid et 35 Ă©taient asymptomatiques. Les troubles consĂ©cutifs Ă  la pĂ©riode de cluster concernaient la majoration des comportements perturbateurs et la dĂ©nutrition lorsque des antĂ©cĂ©dents existaient dĂ©jĂ  (respectivement : RR = 3,9, IC95 % = 1,38–11,02, p = 0,0042 ; RR = 2,07, IC95 % = 1,14–3,74, p = 0,02), ainsi que la rĂ©duction des capacitĂ©s motrices. Nous n’avons pu objectiver d’autres facteurs explicatifs spĂ©cifiques Ă  ces altĂ©rations. Conclusion : Notre hypothĂšse principale en lien avec la dĂ©pendance cognitivo-comportementale n’apparaĂźt pas totalement validĂ©e. L’impact de la pĂ©riode de cluster est restĂ© modĂ©rĂ© notamment grĂące aux moyens mĂ©dico-soignants dont l’Ehpad disposait. L’avantage d’un dispositif mĂ©dicalisĂ© et l’inconvĂ©nient des restrictions liĂ©es au confinement est discutĂ© au regard de questions Ă©thiques

    A Meta-Analysis of Autobiographical Memory Studies in Schizophrenia ă Spectrum Disorder

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    International audienceMeta-analyses and reviews on cognitive disorders in schizophrenia have ă shown that the most robust and common cognitive deficits are found in ă episodic memory and executive functions. More complex memory domains, ă such as autobiographical memory (AM), are also impaired in ă schizophrenia, but such impairments are reported less often despite ă their negative impact on patients' outcome. In contrast to episodic ă memory, assessed in laboratory tasks, memories of past personal events ă are much more complex and directly relate to the self. The meta-analysis ă included 20 studies, 571 patients with schizophrenia spectrum disorder, ă and 503 comparison subjects. It found moderate-to-large effect sizes ă with regard to the 3 parameters commonly used to assess AM: memory ă specificity (g = -0.97), richness of detail (g = -1.40), and conscious ă recollection (g = -0.62). These effect sizes were in the same range as ă those found in other memory domains in schizophrenia; for this reason, ă we propose that defective memories of personal past events should be ă regarded as a major cognitive impairment in this illness

    Effects of depression and cognitive impairment on quality of life in older adults with schizophrenia spectrum disorder: Results from a multicenter study

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    A comprehensive model of predictors of quality of life in older adults with schizophrenia: results from the CSA study

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