Potentially inappropriate medication use in older adults with mild-moderate Alzheimer's disease:Prevalence and associations with adverse events

Aim: Potentially inappropriate medication (PIM) use is prevalent in older adults and is associated with adverse events, hospitalisation and mortality. We assessed the patterns and associations of PIM use in older adults with mild-to-moderate Alzheimer's Disease (AD), who may represent a particularly vulnerable group. Design: Analysis of data from NILVad, an 18-month Randomised Control Trial of Nilvadapine in mild-to-moderate AD. The v2 STOPP criteria were applied in duplicate to identify PIM use. Associations between PIM use and adverse events/unscheduled healthcare visits in addition to the associations between PIM use and AD progression were evaluated. Setting and Participants: 448 older adults with mild-to-moderate AD from 23 centres in nine European countries. Results: Of 448 participants (mean age: 72.56 ± 8.19 years), over half (55.8%) were prescribed a PIM with 30.1% being prescribed 2+ PIMs. The most frequent PIMs were (i) long-term benzodiazepines (11.6% N = 52/448), (ii) selective serotonin reuptake inhibitors without appropriate indication (11.1% N = 50/448), and (iii) Proton-Pump Inhibitors (PPIs) without appropriate indication (10.7% N = 48/448). Increasing number of PIMs was associated with a greater risk of adverse events (IRR 1.17, 1.13-1.19, P < 0.001), serious adverse events (IRR 1.27; 1.17-1.37, P < 0.001), unscheduled hospitalisations (IRR 1.16, 1.03-1.30, P = 0.016) and GP visits (IRR 1.22, 1.15-1.28, P < 0.001). PIM use was not associated with dementia progression. Conclusions and Implications: PIM use is highly prevalent in mild-to-moderate AD and is associated with adverse events and unscheduled healthcare utilisation. Further attention to de-prescribing in this vulnerable group is warranted

Le suicide des personnes âgées (à propos de 37 patients hospitalisés en 2003 au CHU d'Amiens pour tentative de suicide)

Le suicide des personnes âgées est un problème méconnu et sous estimé. Pourtant, 3500 personnes de plus de 65 ans se donnent la mort chaque année, ce qui représente un tiers des suicides en France. Le faible taux "d'échec" et la violence des moyens utilisés témoignent d'une volonté indiscutable de mourir. Nous rapportons dans ce travail les principales caractéristiques de la crise suicidaire du sujet âgé. Puis, par le biais d'un questionnaire envoyé aux médecins traitants, nous recherchons les facteurs de risque, les signes annonciateurs et les événements de vie précédant le passage à l'acte de 37 patients hospitalisés au CHU d'Amiens en 2003 pour tentative de suicide. Nous nous intéressons aussi à la relation médecin-malade dans cette période pré suicidaire ainsi qu'au ressenti des médecins généralistes face au suicide des personnes âgées en général. La symptomatologie atypique de la crise suicidaire du sujet âgé rend le dépistage difficile. Les plaintes du patient sont peu spécifiques et facilement mise sur le compte du vieillissement normal. Et la dépression, principal facteur de risque, est encore sous diagnostiquée. Avec le vieillissement de la population, le suicide des personnes âgées va vraisemblablement devenir de plus en plus fréquent. Il semble donc utile de mieux former les médecins au dépistage et à la prise en charge de la crise suicidaire du sujet âgéAMIENS-BU Santé (800212102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Added value of 18F-florbetaben amyloid PET in the diagnostic workup of most complex patients with dementia in France: A naturalistic study

International audienceIntroductionAlthough some studies have previously addressed the clinical impact of amyloid positron emission tomography (PET), none has specifically addressed its selective and hierarchical implementation in relation to cerebrospinal fluid analysis in a naturalistic setting.MethodsThis multicenter study was performed at French tertiary memory clinics in patients presenting with most complex clinical situations (i.e., early-onset, atypical clinical profiles, suspected mixed etiological conditions, unexpected rate of progression), for whom cerebrospinal fluid analysis was indicated but either not feasible or considered as noncontributory (ClinicalTrials.gov: NCT02681172).ResultsTwo hundred five patients were enrolled with evaluable florbetaben PET scans; 64.4% of scans were amyloid positive. PET results led to changed diagnosis and improved confidence in 66.8% and 81.5% of patients, respectively, and altered management in 80.0% of cases.DiscussionHigh-level improvement of diagnostic certainty and management is provided by selective and hierarchical implementation of florbetaben PET into current standard practices for the most complex dementia cases

Plasma amyloid levels within the Alzheimer's process and correlations with central biomarkers

International audienc