Awareness dimensions and associated factors in Alzheimer's disease

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

Reconnaissance des expressions faciales émotionnelles et théorie de l’esprit dans la schizophrénie : la difficulté à identifier les états mentaux d’autrui serait-elle liée à un trouble de la reconnaissance des émotions faciales ?

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Impact immédiat d’une infection liée à la Covid-19 et du confinement consécutif sur les résidents d’un Ehpad

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 (χ² = 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 à une épidémie de Covid-19 ayant affecté 76 des 97 résidents d’un Ehpad, nous avons évalué l’impact de cette période de cluster sur la santé physique et psycho-cognitive des résidents pronostiquant notamment une altération en fonction de leur dépendance cognitivo-comportementale. Méthodes : Nous avons retenus vingt-deux variables relatives : aux données démographiques (5) ; aux prises en charge spécifiques liées à l’infection (6) ; aux pathologies somatiques et troubles psycho-comportementaux avant l’épidémie (6) et après la période de cluster (5). Résultats : Onze résidents diagnostiqués positifs sont décédés. Neuf ont été transférés en unité Covid et 35 étaient asymptomatiques. Les troubles consécutifs à la période de cluster concernaient la majoration des comportements perturbateurs et la dénutrition lorsque des antécédents existaient déjà (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 réduction des capacités motrices. Nous n’avons pu objectiver d’autres facteurs explicatifs spécifiques à ces altérations. Conclusion : Notre hypothèse principale en lien avec la dépendance cognitivo-comportementale n’apparaît pas totalement validée. L’impact de la période de cluster est resté modéré notamment grâce aux moyens médico-soignants dont l’Ehpad disposait. L’avantage d’un dispositif médicalisé et l’inconvénient des restrictions liées au confinement est discuté au regard de questions éthiques

Self-disorders in individuals with attenuated psychotic symptoms: contribution of a dysfunction of autobiographical memory

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

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

Reconnaissance des expressions faciales émotionnelles et théorie de l’esprit dans la schizophrénie : la difficulté à identifier les états mentaux d’autrui serait-elle liée à un trouble de la reconnaissance des émotions faciales ?

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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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