5 research outputs found
Neuropsychological assessment of elderly populations with low-educational level
Lâimpact du niveau dâĂ©tudes sur les performances cognitives est largement connu. Aussi, lâĂ©valuation des sujets de bas ou trĂšs bas niveau dâĂ©tudes est un rĂ©el challenge pour les cliniciens. Dâune part, les outils habituellement utilisĂ©s dans le bilan du sujet ĂągĂ© ne sont pas adaptĂ©s aux individus analphabĂštes ou de bas niveau dâĂ©ducation, et, dâautre part, les normes nĂ©cessaires Ă lâinterprĂ©tation des scores cognitifs ne prennent pas suffisamment en considĂ©ration cette population de bas niveau scolaire. Ainsi, la question que pose ce travail de thĂšse est de savoir comment optimiser lâĂ©valuation neuropsychologique de ces sujets de bas niveau scolaires. Lâobjectif poursuivi par la premiĂšre Ă©tude de cette thĂšse est de dĂ©terminer sâil existe un effet propre du fait de savoir lire et Ă©crire indĂ©pendamment de celui de la scolarisation. Pour rĂ©pondre Ă cette question, nous avons pu accĂ©der aux donnĂ©es recueillies dans la cohorte mexicaine de CoyoacĂĄn qui a la particularitĂ© dâavoir un Ă©chantillon important de sujets nâayant jamais Ă©tĂ© scolarisĂ©s. Cette premiĂšre Ă©tude a montrĂ© que des sujets nâayant jamais accĂ©dĂ© au systĂšme Ă©ducatif mais ayant des notions rudimentaires de lecture et dâĂ©criture acquises de maniĂšre informelle, ont des performances plus Ă©levĂ©es Ă tous les tests considĂ©rĂ©s, hormis pour le Set test dâIsaacs (IST), que des sujets ne sachant pas lire et Ă©crire. Ainsi, ces rĂ©sultats illustrent lâeffet des capacitĂ©s de lecture et dâĂ©criture, un effet distinct de lâeffet du niveau de scolarisation. Une seconde difficultĂ© Ă laquelle doivent faire face les cliniciens est lâabsence de normes adaptĂ©es aux sujets de bas niveau dâĂ©tudes. Ainsi, un travail autour de lâĂ©laboration de normes adaptĂ©es aux sujets de bas niveau dâĂ©tudes a Ă©tĂ© rĂ©alisĂ© dans la cohorte de CoyoacĂĄn et nous a permis dâĂ©laborer des normes pour le Mini Mental State Examination (MMSE), le Rappel libre/Rappel indicĂ© 16 items (RL/RI-16) et lâIST, jusque-lĂ inexistantes pour la population ĂągĂ©e mexicaine et qui a la particularitĂ© de prĂ©senter une forte proportion de sujets de bas niveau dâĂ©tudes. Un second travail de normalisation a Ă©tĂ© rĂ©alisĂ© dans la cohorte AMI, une cohorte menĂ©e en milieu rural dans le dĂ©partement de la Gironde dans laquelle la proportion de sujets de bas niveaux est plus Ă©levĂ©e quâen population gĂ©nĂ©rale, pour un nouveau test de mĂ©moire visuo-spatiale, le test des gobelets pour lequel nous avons Ă©galement Ă©tudiĂ© sa validitĂ© dans la dĂ©tection de la dĂ©mence. Ces normes classiques, corrigĂ©es pour des variables dĂ©mographiques sont essentielles Ă lâinterprĂ©tation des scores cognitifs. Dans le mĂȘme temps, dans le cas de la dĂ©mence oĂč lâĂąge et le niveau dâĂ©tudes sont deux facteurs de risque majeurs, cette pratique habituelle de corriger pour ces variables afin dâĂ©tablir ou de prĂ©dire un diagnostic de dĂ©mence peut ĂȘtre remise en question. Si des travaux antĂ©rieurs ont montrĂ© que lâutilisation de scores corrigĂ©s diminue la qualitĂ© de dĂ©tection de la dĂ©mence, la derniĂšre Ă©tude de cette thĂšse a montrĂ© quâil en est de mĂȘme lorsquâil sâagit de prĂ©dire la dĂ©mence : les sujets qui deviennent dĂ©ments Ă court terme sont mieux classĂ©s lorsque les scores ne sont pas corrigĂ©s que lorsquâils sont corrigĂ©s pour lâĂąge et le niveau dâĂ©tudes. Ainsi, loin de rĂ©gler le vaste problĂšme de lâĂ©valuation du sujet de bas niveau dâĂ©tudes, cette thĂšse tente dâapporter des Ă©lĂ©ments pragmatiques au clinicien sous la forme de tests ou de normes adaptĂ©es, mais aussi des Ă©lĂ©ments de rĂ©flexion sur lâutilisation de ces scores.The effect of education on cognitive performances and neuropsychological assessment outcomes has been well documented so far. Indeed, the assessment of cognitive performance of individuals with low and very low educational level remains a major clinical challenge for several reasons. Firstly, conventional cognitive assessment tools used with elderly patients are not suitable for illiterate or poorly instructed individuals. Secondly, traditional norms used to identify strengths and weaknesses of cognitive performance are not sensible enough to detect cognitive impairments among illiterate or scarcely instructed individuals. Therefore, how to improve the neuropsychological assessment of individuals with low formal educational level is the main research question of this doctoral thesis. To adequately answer to this prior question, four studies have been conducted. The aim of the first study presented in this thesis was to investigate the specific effect of literacy acquisition on cognitive performances independently of education. For this work, we used data collected from the CoyoacĂĄn study, a Mexican population-based cohort which presents an important sample of uneducated participants. The main finding of this study was that participants who never attended school but counting with informal literacy abilities, presented better performances for all cognitive tests, except for the Isaacs Set test (IST), compared to their uneducated illiterate counterparts. These findings illustrate the specific effect of literacy skills acquisition on cognitive performances independently of the influence of schooling. The lack of adapted comparative norms is the second major challenge of neuropsychological assessment of individuals with low-educational level. Consequently, our second study aimed at establishing comparative norms for the MMSE, the Free and Cued Selective Reminding Test and the IST, three tests widely used for cognitive evaluation in elderly people. Of note, these norms were specifically established for the Mexican elderly population, which presents a high rate of illiteracy and low-educational level. Finally, a third study aiming at establishing comparative norms for a new visuo-spatial memory-test: the goblets test. For this study, we used data collected from the AMI cohort study which is conducted in rural areas in the South-West of France. Within this third study we also studied the validity of this test in detecting dementia illness. These comparative norms are necessary to interpret cognitive scores. However, as age and education are major risk factors for dementia, correcting for these demographic variables to improve the accuracy of detection or prediction of dementia may be questionable. Consistently with other studies showing that dementia detection accuracy is compromised when corrected scores are used; findings of our last study showed that regarding dementia prediction accuracy, participants developing dementia, in the short term, are better classified when using uncorrected scores for age and education than the corrected ones. To conclude, cognitive assessment of elderly individuals with low-educational level remains still a major clinical barrier to correctly diagnose dementia. However, besides providing clinicians with several pragmatic inputs such as cognitive tests and appropriated comparative norms, we believe that our findings will encourage clinical reflection regarding the use of these scores
Neuropsychological assessment of elderly populations with low-educational level
Lâimpact du niveau dâĂ©tudes sur les performances cognitives est largement connu. Aussi, lâĂ©valuation des sujets de bas ou trĂšs bas niveau dâĂ©tudes est un rĂ©el challenge pour les cliniciens. Dâune part, les outils habituellement utilisĂ©s dans le bilan du sujet ĂągĂ© ne sont pas adaptĂ©s aux individus analphabĂštes ou de bas niveau dâĂ©ducation, et, dâautre part, les normes nĂ©cessaires Ă lâinterprĂ©tation des scores cognitifs ne prennent pas suffisamment en considĂ©ration cette population de bas niveau scolaire. Ainsi, la question que pose ce travail de thĂšse est de savoir comment optimiser lâĂ©valuation neuropsychologique de ces sujets de bas niveau scolaires. Lâobjectif poursuivi par la premiĂšre Ă©tude de cette thĂšse est de dĂ©terminer sâil existe un effet propre du fait de savoir lire et Ă©crire indĂ©pendamment de celui de la scolarisation. Pour rĂ©pondre Ă cette question, nous avons pu accĂ©der aux donnĂ©es recueillies dans la cohorte mexicaine de CoyoacĂĄn qui a la particularitĂ© dâavoir un Ă©chantillon important de sujets nâayant jamais Ă©tĂ© scolarisĂ©s. Cette premiĂšre Ă©tude a montrĂ© que des sujets nâayant jamais accĂ©dĂ© au systĂšme Ă©ducatif mais ayant des notions rudimentaires de lecture et dâĂ©criture acquises de maniĂšre informelle, ont des performances plus Ă©levĂ©es Ă tous les tests considĂ©rĂ©s, hormis pour le Set test dâIsaacs (IST), que des sujets ne sachant pas lire et Ă©crire. Ainsi, ces rĂ©sultats illustrent lâeffet des capacitĂ©s de lecture et dâĂ©criture, un effet distinct de lâeffet du niveau de scolarisation. Une seconde difficultĂ© Ă laquelle doivent faire face les cliniciens est lâabsence de normes adaptĂ©es aux sujets de bas niveau dâĂ©tudes. Ainsi, un travail autour de lâĂ©laboration de normes adaptĂ©es aux sujets de bas niveau dâĂ©tudes a Ă©tĂ© rĂ©alisĂ© dans la cohorte de CoyoacĂĄn et nous a permis dâĂ©laborer des normes pour le Mini Mental State Examination (MMSE), le Rappel libre/Rappel indicĂ© 16 items (RL/RI-16) et lâIST, jusque-lĂ inexistantes pour la population ĂągĂ©e mexicaine et qui a la particularitĂ© de prĂ©senter une forte proportion de sujets de bas niveau dâĂ©tudes. Un second travail de normalisation a Ă©tĂ© rĂ©alisĂ© dans la cohorte AMI, une cohorte menĂ©e en milieu rural dans le dĂ©partement de la Gironde dans laquelle la proportion de sujets de bas niveaux est plus Ă©levĂ©e quâen population gĂ©nĂ©rale, pour un nouveau test de mĂ©moire visuo-spatiale, le test des gobelets pour lequel nous avons Ă©galement Ă©tudiĂ© sa validitĂ© dans la dĂ©tection de la dĂ©mence. Ces normes classiques, corrigĂ©es pour des variables dĂ©mographiques sont essentielles Ă lâinterprĂ©tation des scores cognitifs. Dans le mĂȘme temps, dans le cas de la dĂ©mence oĂč lâĂąge et le niveau dâĂ©tudes sont deux facteurs de risque majeurs, cette pratique habituelle de corriger pour ces variables afin dâĂ©tablir ou de prĂ©dire un diagnostic de dĂ©mence peut ĂȘtre remise en question. Si des travaux antĂ©rieurs ont montrĂ© que lâutilisation de scores corrigĂ©s diminue la qualitĂ© de dĂ©tection de la dĂ©mence, la derniĂšre Ă©tude de cette thĂšse a montrĂ© quâil en est de mĂȘme lorsquâil sâagit de prĂ©dire la dĂ©mence : les sujets qui deviennent dĂ©ments Ă court terme sont mieux classĂ©s lorsque les scores ne sont pas corrigĂ©s que lorsquâils sont corrigĂ©s pour lâĂąge et le niveau dâĂ©tudes. Ainsi, loin de rĂ©gler le vaste problĂšme de lâĂ©valuation du sujet de bas niveau dâĂ©tudes, cette thĂšse tente dâapporter des Ă©lĂ©ments pragmatiques au clinicien sous la forme de tests ou de normes adaptĂ©es, mais aussi des Ă©lĂ©ments de rĂ©flexion sur lâutilisation de ces scores.The effect of education on cognitive performances and neuropsychological assessment outcomes has been well documented so far. Indeed, the assessment of cognitive performance of individuals with low and very low educational level remains a major clinical challenge for several reasons. Firstly, conventional cognitive assessment tools used with elderly patients are not suitable for illiterate or poorly instructed individuals. Secondly, traditional norms used to identify strengths and weaknesses of cognitive performance are not sensible enough to detect cognitive impairments among illiterate or scarcely instructed individuals. Therefore, how to improve the neuropsychological assessment of individuals with low formal educational level is the main research question of this doctoral thesis. To adequately answer to this prior question, four studies have been conducted. The aim of the first study presented in this thesis was to investigate the specific effect of literacy acquisition on cognitive performances independently of education. For this work, we used data collected from the CoyoacĂĄn study, a Mexican population-based cohort which presents an important sample of uneducated participants. The main finding of this study was that participants who never attended school but counting with informal literacy abilities, presented better performances for all cognitive tests, except for the Isaacs Set test (IST), compared to their uneducated illiterate counterparts. These findings illustrate the specific effect of literacy skills acquisition on cognitive performances independently of the influence of schooling. The lack of adapted comparative norms is the second major challenge of neuropsychological assessment of individuals with low-educational level. Consequently, our second study aimed at establishing comparative norms for the MMSE, the Free and Cued Selective Reminding Test and the IST, three tests widely used for cognitive evaluation in elderly people. Of note, these norms were specifically established for the Mexican elderly population, which presents a high rate of illiteracy and low-educational level. Finally, a third study aiming at establishing comparative norms for a new visuo-spatial memory-test: the goblets test. For this study, we used data collected from the AMI cohort study which is conducted in rural areas in the South-West of France. Within this third study we also studied the validity of this test in detecting dementia illness. These comparative norms are necessary to interpret cognitive scores. However, as age and education are major risk factors for dementia, correcting for these demographic variables to improve the accuracy of detection or prediction of dementia may be questionable. Consistently with other studies showing that dementia detection accuracy is compromised when corrected scores are used; findings of our last study showed that regarding dementia prediction accuracy, participants developing dementia, in the short term, are better classified when using uncorrected scores for age and education than the corrected ones. To conclude, cognitive assessment of elderly individuals with low-educational level remains still a major clinical barrier to correctly diagnose dementia. However, besides providing clinicians with several pragmatic inputs such as cognitive tests and appropriated comparative norms, we believe that our findings will encourage clinical reflection regarding the use of these scores
The DMS 48: norms and diagnostic proprieties for Alzheimer\textquotesingles disease in elderly population from the AMI cohort study
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Compensatory mechanisms in higher-educated subjects with Alzheimerâs disease: a study of 20 years of cognitive decline
A better knowledge of long-term trajectories of cognitive decline is a central feature of the study of the process leading to Alzheimerâs dementia. Several factors may mitigate such decline, among which is education, a major risk factor for Alzheimerâs disease. The aim of our work was to compare the pattern and duration of clinical trajectories before Alzheimerâs dementia in individuals with low and high education within the PAQUID cohort involving 20 years of follow-up. The sample comprises 442 participants with incident Alzheimerâs disease (27.2% were male)â171 with low education (mean age = 86.2 years; standard deviation = 5.3 years) and 271 with higher education (mean age = 86.5; standard deviation = 5.4)âand 442 control subjects matched according to age, sex and education. At each visit and up to the 20-year follow-up visit, several cognitive and clinical measures were collected and incident cases of Alzheimerâs disease clinically diagnosed. The evolution of clinical measures in pre-demented subjects and matched controls was analysed with a semi-parametric extension of the mixed effects linear model. The results show that the first signs of cognitive decline occurred 15 to 16 years before achieving dementia threshold in higher-educated subjects whereas signs occurred at 7 years before dementia in low-educated subjects. There seemed to be two successive periods of decline in higher-educated subjects. Decline started âŒ15 to 16 years before dementia with subtle impairment restricted to some cognitive tests and with no impact during the first 7 to 8 years on global cognition, cognitive complaints, or activities of daily living scales. Then, âŒ7 years before dementia, global cognitive abilities begin to deteriorate, along with difficulties dealing with complex activities of daily living, the increase in self-perceived difficulties and depressive symptoms. By contrast, lower-educated subjects presented a single period of decline lasting âŒ7 years, characterized by decline concomitantly affecting specific and more global cognitive function along with alteration in functional abilities. This study demonstrates how early cognitive symptoms may emerge preceding Alzheimerâs dementia particularly in higher-educated individuals, for whom decline occurred up to 16 years before dementia. It also demonstrates the protective role of education in the clinical trajectory preceding Alzheimerâs dementia. We suggest that the initial decline in cognition occurs at the onset of comparable Alzheimerâs disease pathology in both groups, and is associated with immediate decline to dementia in the lower education group. In contrast, higher education protects against further cognitive decline for âŒ7 years until pathology becomes more severe