Effectiveness of a specific care plan in patients with Alzheimer’s disease: cluster randomised trial (PLASA study)

Objective To test the effectiveness of a comprehensive specific care plan in decreasing the rate of functional decline in patients with mild to moderate Alzheimer’s disease compared with usual care in memory clinics

Decreased aortic growth and middle aortic syndrome in patients with neuroblastoma after radiation therapy

Background: Long-term CT follow-up studies are required in pediatric patients who have received intraoperative radiation therapy (IORT) and external beam radiation therapy (EBRT) to assess vascular toxicities and to determine the exact complication rate. Objective: To analyze with CT the effects of radiation therapy (RT) on the growth of the aorta in neuroblastoma patients.Materials and methods Abdominal CT scans of 31 patients with intraabdominal neuroblastoma (stage II–IV), treated with RT (20 IORT±EBRT, 11 EBRT alone), were analyzed retrospectively. The diameter of the abdominal aorta was measured before and after RT. These data were compared to normal and predicted normal aortic diameters of children, according to the model of Fitzgerald, Donaldson and Poznanski (aortic diameter in centimeters = 0.844 + 0.0599 × age in years), and to the diameters of a control group of children who had not undergone RT. Statistical analyses for the primary aims were performed using the chi-squared test, t-test, Mann-Whitney test, nonparametric Wilcoxon matched-pairs test and analysis of variance for repeated measures. Clinical files and imaging studies were evaluated for signs of late vascular complications of neuroblastoma patients who had received RT. Results: The mean diameter before and after RT and the growth of the aorta were significantly lower than expected in patients with neuroblastoma (P<0.05 for each) and when compared to the growth in a control group with normal and nonirradiated aortas. Among the patients who had received RT, there was no difference due to the type of RT. Seven patients from the IORT±EBRT group developed vascular complications, which included hypertension (five), middle aortic syndrome (two), death due to mesenteric ischemia (one) and critical aortic stenosis, which required aortic bypass surgery (two).Conclusion Patients with neuroblastoma who had received RT showed impaired growth of the abdominal aorta. Significant long-term vascular complications occurred in seven patients who received IORT±EBRT. Thus, CT evaluation of patients with neuroblastoma who receive RT should include not only reports of changes in tumor extension, but also documentation of perfusion, and the size and growth of the aorta and its branches over time

Neuroinflammatory processes in cognitive disorders:Is there a role for flavonoids and n-3 polyunsaturated fatty acids in counteracting their detrimental effects?

Neuroinflammatory processes are known to contribute to the cascade of events culminating in the neuronal damage that underpins neurodegenerative disorders such as Parkinson's and Alzheimer's disease. With the ageing population and increased cases of neurodegenerative diseases, there is a crucial need for the development of new strategies capable to prevent, delay the onset or treat brain dysfunction and associated cognitive decline. Growing evidence sheds light on the use of dietary polyphenols and n-3 long chain polyunsaturated fatty acids to improve cognitive performances and reduce the neuroinflammatory and oxidative stress responses occurring with age and neurodegenerative pathologies. This review will summarise the most recent information related to the impact and mechanisms underlying the neuroinflammatory processes in neurodegenerative disorders. We will also detail the current evidence indicating that flavonoids and n-3 polyunsaturated fatty acids are strong candidate in preventing neuroinflammation and modulating age-related memory decline, and will describe the potential mechanisms of action underlying their neuroprotective effects. As such, these dietary bioactives represent important precursor molecules in the quest to develop of a new generation of drugs capable of counteracting neuroinflammation and neurodegenerative diseases

Caring for a Person With Dementia on the Margins of Long-Term Care: A Perspective on Burden From 8 European Countries

© 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine Objectives To explore associations between carer burden and characteristics of (1) the informal carer, (2) the person with dementia, and (3) the care support network in 8 European countries. Design Cross-sectional study. Setting People with dementia judged at risk of admission to long-term care (LTC) facilities in 8 European countries (Estonia, Finland, France, Germany, Netherlands, Spain, Sweden, United Kingdom). Participants A total of 1223 people with dementia supported by community services at home or receiving day care or respite care and their informal carers. Measurements Variables regarding the informal carer included familial relationship and living situation. Variables relating to the person with dementia included cognitive functioning (S-MMSE), neuropsychiatric symptoms (NPI-Q), depressive symptoms (Cornell depression scale), comorbidity (Charlson Comorbidity Index), and physical functioning (Katz Activity of Daily Living [ADL] Index). The care support network was measured using hours of caregiving (ADLs, instrumental ADLs [IADLs], supervision), additional informal care support, and service receipt (home care, day care). Experience of carer burden was recorded using the Zarit Burden Interview. Logistic regression analysis was used to determine factors associated with high carer burden. Results Carer burden was highest in Estonia (mean 39.7/88) and lowest in the Netherlands (mean 26.5/88). High burden was significantly associated with characteristics of the informal carer (family relationship, specifically wives or daughters), of the person with dementia (physical dependency in ADLs; neuropsychiatric symptoms, in particular nighttime behaviors and irritability), the care support network (hours of caregiving supervision; receipt of other informal care support) and country of residence. Conclusion A range of factors are associated with burden in informal carers of people with dementia judged to be on the margins of LTC. Support for informal carers needs to take account of gender differences. The dual challenges of distressed behaviors and difficulties in ADLs by the person with dementia may be addressed by specific nonpharmacological interventions focusing on both elements. The potential protective effect of additional informal support to carers highlights the importance of peer support or better targeted home support services. The implementation of appropriate and tailored interventions to reduce burden by supporting informal carers may enable people with dementia to remain at home for longer

Perte de poids et maladie d'alzheimer (facteurs associés et prise en charge)

TOULOUSE3-BU Sciences (315552104) / SudocSudocFranceF

Entretien : Regards croisés sur la vraie et fausse porcelaine de Chine

La question du « vrai » et du « faux » agite de façon récurrente les milieux du marché de l’art et des musées. Elle est également présente en filigrane dans certaines publications universitaires abordant la matérialité des objets. Il s’agit d’une question complexe qui doit être saisie par les chercheurs dans sa dimension transdisciplinaire - recoupant l’histoire, l’histoire de l’art, l’archéologie ou l’histoire économique - tout comme elle doit être appréhendée dans sa dimension technique et matérielle mobilisant les sciences dures et le domaine de l’expertise. Elle ne peut également s’exonérer d’une approche purement esthétique et même morale. Cette multiplicité des approches, nécessaire à toute prise en compte globale du phénomène vrai/faux, est rendue d’autant plus problématique pour la porcelaine de Chine, dans la mesure où elle recoupe une terminologie qui peine à être posée. Le vocabulaire du « faux » en langue chinoise, anglaise ou française est ainsi très divers ; il traduit par ailleurs des réalités conceptuelles variées. Existe-t-il une « vraie » et/ou une « fausse » porcelaine de Chine ? Quels critères précis définissent aujourd’hui les frontières entre ce qui est vrai et ce qui ne l’est pas ? Ne peut-on considérer in fine l’unicité d’une pièce imitée comme l’expression d’un vrai ? La réponse à cette question sur un mode unique ne peut être évidemment satisfaisante. Doivent-être pris en compte des critères plus fins, propres aux amateurs, collectionneurs, artisans, marchands d’art ou chercheurs, qui véhiculent leurs propres définitions du « faux ». Cet entretien, mené par Sophie Duhem et Émilie Roffidal, a pour objectif de réunir des approches croisées de spécialistes du marché de l’art asiatique, de collectionneurs, d’universitaires et de conservateurs, autour de quatre axes : . les définitions et les perceptions de la fausse céramique chinoise . le repérage, les moyens et les stratégies mis en œuvre . la question déontologique (enjeux financiers, patrimoniaux, etc.) . des retours d’expériences de fais marquants ou d’anecdotes significatives sur ces questions du vrai et du faux.The question of the "true" and the "false" recurrently agitates the communities of art market and museums. It is also present in watermark in some academic publications about the materiality of objects. This is a complex issue that must be grasped by researchers in its transdisciplinary dimension - crossing history, art history, archeology or economic history - as it must be understood in its technical and material dimensions mobilizing the hard sciences and the field of expertise. It can not be exempted from a purely aesthetic and even moral approach. This multifaceted approache, necessary for any global consideration of the true / false phenomenon, is even more problematic for Chinese porcelain, since it includes a terminology difficult to set. Thus, the vocabulary of "false" in Chinese, English or French is very diverse; it also reflects various conceptual realities. Is there a "real" and/or a "false" Chinese porcelain? What precise criteria define today the boundaries between what is true and what is not? Can we not consider, in fine, the uniqueness of an imitated piece as the expression of a true? The answer to this question in a single mode can not be obviously satisfactory. Should be taken into account finer criteria, specific to amateurs, collectors, craftsmen, art dealers or researchers, who convey their own definitions of "false". This interview, led by Sophie Duhem and Émilie Roffidal, has for objective to gather crossed approaches of specialists of Asian art market, collectors, academics and curators auround four axes : . definitions and perceptions of false Chinese ceramic . location, implemented ways and strategies . ethical questions (financial, patrimonial stakes, etc.) . experiences feedback of landmarks or significant events on this topic of true and false.La cuestión de lo "verdadero" y de lo "falso" es un tema recurrente en el mercado del arte y en los círculos museísticos. También está sutilmente presente en algunas publicaciones académicas que tratan de la materialidad de los objetos. Se trata de una cuestión compleja que los investigadores deben abordar en su dimensión transdisciplinaria, es decir, la intersección entre historia, historia del arte, arqueología o historia económica, del mismo modo que deben tratarla en su dimensión técnica y material, en la que intervienen las ciencias duras y el sector de la pericia. Tampoco puede estar exenta de un enfoque puramente estético e incluso moral.Esta multiplicidad de enfoques, necesaria para cualquier consideración global del fenómeno verdadero/falso, se hace aún más problemática para la porcelana china, ya que se superpone a una terminología difícil de entender. El vocabulario de "falsificación" en chino, inglés o francés es, por tanto, muy diverso; también refleja diversas realidades conceptuales. ¿Existe una porcelana china "real" y/o "falsa"? ¿Qué criterios precisos definen hoy en día los límites entre lo que es cierto y lo que no lo es? ¿No podemos, en última instancia, considerar la singularidad de una pieza imitada como una expresión de una pieza real? La respuesta a esta pregunta de una sola vez no puede, por supuesto, ser satisfactoria. Cabe tener en cuenta criterios más refinados, específicos de los aficionados, coleccionistas, artesanos, comerciantes de arte o investigadores, que transmiten sus propias definiciones de "falsificación". Esta entrevista, realizada por Sophie Duhem y Émilie Roffidal, pretende reunir los enfoques cruzados de especialistas del mercado del arte asiático, coleccionistas, académicos y curadores en torno a cuatro temas principales:. definiciones y percepciones de la cerámica china falsa. la identificación, los medios y las estrategias aplicadas. la cuestión ética (cuestiones financieras, patrimoniales, etc.). experiencias o anécdotas sobre estas cuestiones de verdad y falsedad.

Diagnosis of Alzheimer's disease patients with rapid cognitive decline in clinical practice: interest of the deco questionnaire.

International audienceBackground: Patients with Alzheimer's disease (AD) who deteriorate rapidly are likely to have a poorer prognosis. There is a clear need for a clinical assessment tool to detect such a decline in newly diagnosed patients. Objective: To identify the predictive factors of rapid cognitive decline (RCD) in a cohort of patients with mild to moderate AD ; and to validate a self-questionnaire for caregivers as a diagnostic tool for rapid decline. Design and analysis: An open-label, observational, 12-month, multicenter, French study. Physicians were asked to record data of three eligible rivastigmine naïve (or on rivastigmine for < 1 year) AD patients. Risk factors of RCD and the detection power of the Détérioration Cognitive Observée scale (Deco), a 19 item self-questionnaire for caregivers, were assessed at endpoint using regression analyses. Results: Out of the 361 patients enrolled in the study, 91 (25.2%) were excluded due to loss of follow-up. Among subjects using cholinesterase inhibitors or memantine, 161 (59.6%) experienced a stabilization (29.2%) or an improvement (30.4%) in global functioning as measured by the CGI-C. Sixty of the remaining 204 patients retained for analysis (29.6%, CI 95% [23.4; 35.8]) lost three or more points on the MMSE score between the inclusion and one of the follow-up visit. In the multivariate logistic regression analysis, institutionalization, higher level of education and the loss of 3 points or more on the MMSE were found to be significant predictors of a rapid cognitive loss in this population. The threshold which maximizes the predictive values of the Deco score as a diagnostic tool of rapid cognitive decline was significantly different according to the age of the patient (below or over 75 years old). A score below 16 for patients < 75 years old and below 14 for patients ≥ 75 years old consistently predicted a RCD within the next year. Conclusion: The Deco test appears to be a simple tool to alert the physician to the possibility of an aggressive course of the disease which warrants particular management

Commentary on "A roadmap for the prevention of dementia II. Leon Thal Symposium 2008." The Multidomain Alzheimer Preventive Trial (MAPT): a new approach to the prevention of Alzheimer's disease.

International audienceBACKGROUND: Because no effective curative approaches are available, preventive approaches in the field of Alzheimer's disease (AD) are needed. We present the design of the ongoing Multidomain Alzheimer Preventive Trial (MAPT) Study. Several previous studies suggested that many factors may be involved in the occurrence of AD at late ages. Because of the probable multifactorial nature of AD, it seems logical to initiate multidomain interventions to examine their potential synergistic effects. The MAPT Study aims to evaluate the efficacy of a multidomain intervention (nutritional, physical, and cognitive training) and omega 3 treatment in the prevention of cognitive decline in frail elderly persons aged 70 years or over. The study also collects imaging and biological data that could be used in future AD prevention and treatment trials. METHODS: The MAPT Study is a 3-year, randomized, controlled trial conducted by university hospital practitioners specializing in memory disorders in four French cities (Bordeaux, Limoges, Montpellier, and Toulouse). The study plans to enroll 1200 frail elderly subjects on the basis of at least one of the following criteria: subjective memory complaint spontaneously expressed to a general practitioner, limitation in one instrumental activity of daily living (IADL), and slow walking speed. To demonstrate the protective effect of interventions, subjects are randomized into one of the following four groups: omega 3 alone, multidomain intervention alone, omega 3 plus multidomain intervention, or placebo (n = 300 each). The principal outcome measure is a change in cognitive function at 3 years, as determined by the Grober and Buschke Test. CONCLUSIONS: The MAPT Study is the first preventive trial involving multidomain interventions. Final results should be available in 2013