Sleep apnea syndrome in an elderly population admitted to a geriatric unit : prevalence and effect on cognitive function

International audienceBackground Sleep apnea leads to cognitive impairment in older patients, but its association with neurodegeneration remains controversial, and most studies do not distinguish between the more common obstructive form (OSAS) and the rarer central form (CSAS). Objective The purpose of this study was to assess the prevalence of the different forms of sleep apnea in a cohort of cognitively impaired elderly patients (>70 years) and to investigate their associations with cognitive deficit, weighted against known risk factors for neurodegeneration. Methods Overnight polygraphy was performed for 76 consecutive patients admitted to our geriatric unit. Their cognitive function was assessed using the Mini Mental-State Exam (MMSE), Mattis Dementia Rating Scale (MDRS) and Stroop test. Multivariable analyses were performed to determine associations between cognitive function and independent variables describing demographics, sleep apnea measures, and cardiovascular risk factors. Results The cohort comprised 58 women and 18 men aged a mean of 84 years (range, 73-96). Sleep apnea syndrome (SAS) was diagnosed in 48 patients (63%), of which 31 (41%) with OSAS and 17 (22%) with CSAS. Multivariable regression analysis revealed that MDRS was lower in patients with OSAS (beta = -10.03, p = 0.018), that Stroop Colors and Words delays increased with AHI (beta = 0.17, p = 0.030 and beta = 0.31, p = 0.047) and that that Stroop Interference delay was higher in patients with CSAS (beta = 24.45, p = 0.002). Conclusion Sleep apnea is thus highly prevalent in elderly patients with cognitive impairment. OSAS was associated with lower general cognitive function, while CSAS was only associated with increased Stroop Interference delays. Elderly patients with cognitive deficit could benefit from sleep apnea screening and treatment

Decreased Cerebrospinal Fluid Flow Is Associated With Cognitive Deficit in Elderly Patients

Background: Disruptions in cerebrospinal fluid (CSF) flow during aging could compromise protein clearance from the brain and contribute to the etiology of Alzheimer’s Disease (AD).Objective: To determine whether CSF flow is associated with cognitive deficit in elderly patients (>70 years).Methods: We studied 92 patients admitted to our geriatric unit for non-acute reasons using phase-contrast magnetic resonance imaging (PC-MRI) to calculate their ventricular and spinal CSF flow, and assessed their global cognitive status, memory, executive functions, and praxis. Multivariable regressions with backward selection (criterion p < 0.15) were performed to determine associations between cognitive tests and ventricular and spinal CSF flow, adjusting for depression, anxiety, and cardiovascular risk factors.Results: The cohort comprised 71 women (77%) and 21 (33%) men, aged 84.1 ± 5.2 years (range, 73–96). Net ventricular CSF flow was 52 ± 40 μL/cc (range, 0–210), and net spinal CSF flow was 500 ± 295 μL/cc (range, 0–1420). Ventricular CSF flow was associated with the number of BEC96 figures recognized (β = 0.18, CI, 0.02–0.33; p = 0.025). Spinal CSF flow was associated with the WAIS Digit Span Backward test (β = 0.06, CI, 0.01–0.12; p = 0.034), and categoric verbal fluency (β = 0.53, CI, 0.07–0.98; p = 0.024) and semantic verbal fluency (β = 0.55, CI, 0.07–1.02; p = 0.024).Conclusion: Patients with lower CSF flow had significantly worse memory, visuo-constructive capacities, and verbal fluency. Alterations in CSF flow could contribute to some of the cognitive deficit observed in patients with AD. Diagnosis and treatment of CSF flow alterations in geriatric patients with neurocognitive disorders could contribute to the prevention of their cognitive decline

L'impact vasculaire et respiratoire dans les pathologies neurodégénératives

L'âge, les facteurs de risque vasculaire, l'inactivité physique sont connus comme facteurs de risque des syndromes démentiels.Le sommeil joue un rôle majeur dans la physiologie cérébrale. Le syndrome d'apnée du sommeil (SAS) est une pathologie fréquente chez les sujets âgés, surtout chez ceux souffrant de pathologie démentielle. Les études chez les patients atteints d'hypertension, et/ou de fibrillation atriale montrent une prévalence 2 à 3 fois plus élevée de SAS. Le cerveau et sa vascularisation forment un ensemble avec le coeur et les poumons qui fournissent l'apport en énergie et en oxygène. Une dynamique harmonieuse entre ces trois organes est nécessaire au fonctionnement physiologique du cerveau et un dysfonctionnement de cet ensemble pourrait engendrer une altération cognitive. Ce travail a pour but d'analyser les liens entre l'altération du débit vasculaire de la macro-circulation témoin de l'activité cardiaque, la pulsatilité du liquide céphalospinal reflétant l'hydrodynamique cérébrale, les paramètres respiratoires en lien avec les apnées du sommeil, et le statut cognitif du sujet âgé. En nous basant sur les résultats des bilans clinique, biologique, neuropsychologique, de l'imagerie par résonnance magnétique (morphologie et flux), des holters tensionnel et rythmique dans une population de 95 patients âgés cognitivement altérés, nous avons analysé les relations entre les paramètres concernant le cerveau, le coeur et les poumons. Cette approche révèle une relation entre ces trois systèmes et la cognition. La découverte d'une prévalence de plus de 70% de SAS dans cette population associée à d’autres résultats inattendus devrait faire l'objet de travaux ultérieursAge, vascular disorders, and lack of physical activity are known risk factors for dementia syndromes. Sleep has an important role in cerebral physiology. Sleep apnea syndrome (SAS) is common in elderly patients, especially in those with dementia. It was reported that the prevalence of SAS is 2 to 3 times higher in patients with arterial hypertension and/or atrial fibrillation. The brain and its vascular system cannot be considered separately from the heart and the lungs, which provide energy and oxygen supply. Cognitive alterations do not reflect the function of the brain only, and balanced dynamics between all these organs is necessary to maintain neurological functions. Therefore, the aim of this dissertation was to analyze the impact of altered cerebral blood flow in macrocirculation reflecting cardiac activity, pulsatility of the cerebrospinal fluid reflecting cerebral hydrodynamics, and SAS reflecting respiratory function on the cognitive status of elderly patients. Based on a clinical examination, geriatric and neuropsychological assessment, blood tests, structural magnetic resonance imaging, phase-contrast magnetic resonance imaging, 24-hour ambulatory blood pressure measurement, and 24-hour electrocardiogram in the population of 95 elderly patients aged 75 years and older, and suffering from neurodegenerative diseases, we analyzed the correlations between the neurological, cardiac, and respiratory parameters. This approach allowed an identification of associations between the abnormalities in these 3 systems and cognitive function. An unexpected finding, among some other abnormalities, was the prevalence of SAS exceeding 70%, which will be the subject of future researc

La pratique de la gynécologie médicale et obstétrique des médecins généralistes en Picardie (les obstacles, les attentes, les besoins en formation)

Ce travail a été réalisé pour vérifier l hypothèse selon laquelle, les médecins généralistes de la région Picarde ne pratiqueraient pas suffisamment la gynécologie et/ou l obstétrique dans leurs cabinets. Des informations personnelles telles que l âge et le sexe, et des informations professionnelles telles que le mode, l année et la zone d installation, les modalités de prise en charge des cas cliniques les plus courants en gynécologie et en obstétrique et des précisions sur la formation initiale et complémentaire des médecins généralistes, ont fait l objet d un recueil par le biais d un questionnaire de 72 items. Les réponses ont été recueillies, et traitées selon les strictes règles de la statistique aboutissant à des résultats qui ont été interprétés individuellement mais également d une manière bi ou multivariée après l application de croisements adéquats. 352 médecins généralistes ont participé à l enquête. 82 % pratiquent la gynécologie médicale et 81 % pratiquent la gynécologie obstétrique régulièrement. Les médecins généralistes se sentent suffisamment formés pour réaliser des frottis (87 %), suivre des grossesses (84 %), poser et retirer des implants contraceptifs (33 %), poser et retirer des stérilets (24 %). 19 % de médecins généralistes s estiment capable d accoucher une femme enceinte à domicile. Le traitement de toutes ces données a permis de conclure que les médecins généralistes, en Picardie, possèdent globalement un savoir théorique de bon niveau en matière de gynécologie et d obstétrique, mais qu ils ne le mettent pas forcement en pratique dans leurs cabinets. Cela à cause de quelques obstacles parfois matériels et souvent par manque d un chaînon entre la théorie et l application finale que représente la formation pratique (stages, ateliers, séminaires ). Toutes ces constatations m ont amenée à formuler des solutions pragmatiques, espérant contribuer, certes modestement, à une grande réflexion sur l amélioration des pratiques professionnelles, et dans l intérêt de la santé publique en maintenant les médecins généralistes comme pivot du système de soins.This study was undertaken to verify the hypothesis that general practitioners in the region of Picardy do not practice sufficiently gynecology and/or obstetrics. Personal data such as age, gender, professional data, mode of practice, the year of initiating practice, catchment area, performance in gynecology and obstetrics according to most frequent clinical cases encountered in general practice and data on university, postgraduate and any additional education were collected from 72-item questionnaires. Responses were submitted to statistical analysis both individually and using a multivariate approach. A total of 352 GPs answered the questionnaire. Of them 82 % practice regularly gynecology and 81 % obstetrics. GPs believe they are adequately educated to perform cytology (87 %), monitor pregnant women (84 %), insert and remove contraceptive implants (33 %), insert and remove coils (24 %). Nineteen percent GPs believe they are capable of delivering babies at home. The present study shows that GPs in Picardy have a good theoretical knowledge of gynecology and obstetrics, but they do not necessarily use this knowledge in practice. The main reason is a lack of equipment and no translation of theory into practice (trainings, courses, seminars ). These findings prompted me to propose pragmatic solutions which may contribute to the improvement of practice and from the viewpoint of public health gains to maintain a pivotal role of GPs.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Arterial hypertension impact on cerebral blood flow in patients with Alzheimer’s disease

BACKGROUND: Studies show the potential deterioration of brain vascularization and probable involvement of hypertension in Alzheimer disease (AD). OBJECTIVE: The objective was to evaluate the potential impact of hypertension on cerebral vascular flows in a sample of Alzheimer's patients. METHODS: 19 patients with AD, including 10 with hypertension (aHT+) and 9 without hypertension (aHT-) were recruited. They underwent clinical evaluation and phase-contrast MRI protocol for flow assessment. Cerebral arterial flow distributions were evaluated using kurtosis and skewness indices at the intracranial and extracranial levels. RESULTS: No significant differences were found in the mean arterial flow, pulse flow and kurtosis between the levels in the AD aHT+ population. There was a significant difference in skewness between extra- and intracranial levels (p = 0.01). No significant differences were found in the mean arterial flow between the levels in the AD aHT- population. A significant difference was observed in the pulse flow (p = 0.03), kurtosis (p = 0.02) and skewness (p = 0.008) between the levels. At the extracranial level we did not find any significant differences in the mean arterial flow, pulse flow or skewness between aHT+ and aHT-. There was a significant difference in kurtosis at the extracranial level between the aHT+ and aHT- (p = 0.03). At the intracranial level, there were no significant differences in all parameters. CONCLUSION: Results showed a difference between cerebral vasculature in AD for aHT+ and aHT- groups. This is probably related to the loss of arterial compliance induced by the degradation of the vascular system.</p

The role of PC-MRI in neurodegenerative diseases

INTRODUCTION: Neurodegenerative diseases, a major public health problem, could have a vascular origin. Phase-contrast magnetic resonance imaging (PC-MRI) enables reliable, non-invasive, and rapid measurements of cerebrospinal fluid (CSF) and blood flows, and evaluation of the mechanical coupling between cerebral blood and CSF flows throughout the cardiac cycle (CC). OBJECTIVES: Our purpose was to evaluate the potential of PC-MRI to the study of cerebral blood and CSF flows in patients with neurodegenerative diseases such as Alzheimer’s disease (AD), Mild cognitive impairment with amnesic disorders (MCIa) and Vascular Dementia (VD). METHODS: The elderly population consisted of 20 AD (age: 80 ± 5 years); 12 AD patients with vascular cerebral lesions (ADvasc) (age: 81 ± 5 years), 10 MCIa patients (age: 80 ± 7 years), and 8 VD patients (age: 78 ± 7 years) were identified. They underwent the same PC-MRI protocol and were compared to 13 age-matched Healthy Elderly (HE) (age: 71± 9 years). Arterial blood pressure was analyzed to detect patients with hypertension. RESULTS: Significantly higher cerebral blood and CSF flows were observed in HE when compared to VD, AD and ADvasc, (p&lt;0.05), but not MCIa patients who yielded the highest cerebral arterial and venous blood flows and stroke volumes compared to the other patients, (p&lt;0.05). The highest oscillations of CSF were also detected in MCIa patients (p&lt;0.05). CONCLUSION: Our preliminary data suggests an increase in cerebral arterial blood and CSF flows in MCIa. PC-MRI provides a new hydrodynamic view, which may help evaluate a potential role of cardiovascular alterations in neurodegenerative diseases.</p

Estimation of the Lateral Ventricles Volumes from a 2D Image and Its Relationship with Cerebrospinal Fluid Flow

Purpose. This work suggests a fast estimation method of the lateral ventricles volume from a 2D image and then determines if this volume is correlated with the cerebrospinal fluid flow at the aqueductal and cerebral levels in neurodegenerative diseases. Materials and Methods. FForty-five elderly patients suffering from Alzheimer’s disease (19), normal pressure hydrocephalus (13), and vascular dementia (13) were involved and underwent anatomical and phase contrast MRI scans. Lateral ventricles and stroke volumes were assessed on anatomical and phase contrast scans, respectively. A common reference plane was used to calculate the lateral ventricles’ area on 2D images. Results. The largest volumes were observed in hydrocephalus patients. The linear regression between volumes and areas was computed, and a strong positive correlation was detected (R2=0.9). A derived equation was determined to represent the volumes for any given area. On the other hand, no significant correlations were detected between ventricles and stroke volumes (R2≤0.15). Conclusion. Lateral ventricles volumes are significantly proportional to the 2D reference section area and could be used for patients’ follow-up even if 3D images are unavailable. The cerebrospinal fluid fluctuations in brain disorders may depend on many physiological parameters other than the ventricular morphology

Communication during the COVID-19 pandemic: evaluation study on self-perceived competences and views of health care professionals

PURPOSE The aims of this study were to describe communication experiences while wearing a mask during COVID-19 pandemic in 2020, to identify possible mask-related barriers to COVID-19-adapted communications and to investigate whether the ABC mnemonic (A: attend mindfully; B: behave calmly; C: communicate clearly) might address these. METHODS This study was a cross-sectional, voluntary, web-based survey between January and February 2021. A 22-item survey was developed using the Surveymonkey platform and question styles were varied to include single choice and Likert scales. The respondents were also asked to view a short video presentation, which outlined the ABC mnemonic. CHERRIES (Checklist for Reporting Results of Internet E-Surveys) was used to ensure completeness of reporting. Diverging stacked bar charts were created to illustrate Likert scale responses. RESULTS We received 226 responses. The respondents were mostly women (60.2%) and the majority worked in a teaching hospital (64.6%). The majority of the respondents indicated issues related to lack of time during clinical encounters, uncertainty about how to adapt communication, lack of personal protective equipment, lack of communication skills and lack of information about how to adapt their own communication skills. In addition, the participants indicated acknowledging emotions and providing information using clear, specific, unambiguous, and consistent lay language while wearing a mask were among the main communication challenges created during the COVID-19 pandemic. Finally, the study showed significantly improved self-perceived competency regarding key communication after watching the short video presentation. CONCLUSION Effective communication in medical encounters requires both verbal and nonverbal skills