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Weill F.,Hopitaux Universitaires Of Strasbourg | Kiesmann M.,Hopitaux Universitaires Of Strasbourg | Bousiges O.,Hopitaux Universitaires Of Strasbourg | Trivalle C.,Pole de Geriatrie | And 4 more authors.
NPG Neurologie - Psychiatrie - Geriatrie | Year: 2016

Objective: The titration of biomarkers in cerebrospinal fluid (CSF) is not included in the recommendations for the diagnostic approach to Alzheimer's disease (AD) in France. We set out to assess its interest in daily clinical practice. Materials and method: A retrospective observational study of all prescriptions for CSF biomarker titration between 1st November 2010 and 30th September 2012 in a day hospital (HDJ) and a Department of Geriatric Internal Medicine (SMIG) in the Centre mémoire de ressources et de recherche (CMRR) in the Strasbourg University Hospital (Alsace, France). Results: Ninety-seven patients (women: 60.8 %, mean age 80 ± 6.5 years) were considered. In HDJ (n = 50), the biomarkers were used for the positive diagnosis of AD (64.0 %) or differential diagnosis among other dementias (36.0 %). In SMIG (n = 47), the titration was performed to confirm AD (19.1 %), to look for a cognitive disorder underpinning delirium (17.0 %) or to diagnose dementia in patients with psychiatric disorders (29.8 %). For 49.5 % of the patients, the diagnosis of AD was confirmed, while the biomarkers contributed to confirming this aetiology in 9.2 % of cases. Uncertainty between MA and another aetiology remained for 10 patients. Comparative analyses of the levels of different biomarkers showed that the tau protein was observed at a significantly higher level in AD compared to vascular dementia (P = 0.003) and at a value close to significance for Parkinson's disease (P = 0.06). The profile observed with Ptau was similar, but significant in patients with Parkinson's dementia (P = 0.01). Regarding the Aβ1-42, the average levels were highest in vascular and Lewy body dementia (P < 0.0001 and < 0.01), and they were lower in Parkinson's dementia, without reaching significance (P = 0.12). Conclusion: This study explored of the use of AD biomarker measures in clinical practice. While their implementation is currently focused on the diagnosis of AD at a mild stage, these biomarkers showed their usefulness in situations where the clinical diagnosis is made difficult by a psychiatric disorder and/or delirium, or when neuropsychological investigations are unfeasible. © 2015 Elsevier Masson SAS. Source

Hequette-Ruz R.,CHRU de Lille | Paccalin M.,Pole de Geriatrie | Guery B.,Service Gestion du Risque Infectieux
Revue de Geriatrie | Year: 2015

The incidence and severity of Clostridium difficile-associated diarrhea (CDAD) has increased for the last fifteen years. Age is one of the main risk factor for Clostridium difficile infection (CDI); it is also associated with adverse outcomes (death, complicated course or recurrence). CDI treatment is based on general measures to reduce transmission, contributing factors elimination and antibiotic stewardship. Antibiotic therapy depends on CDI severity, number of previous episodes and risk factors of recurrence. Three molecules are currently available: metronidazole, vancomycin and fidaxomicin. Non-drug strategies such as fecal microbiota transplantation can be proposed to patients with multiple recurrences. © La Revue de Gériatrie. Source

Onen F.,Service de Geriatrie | Onen F.,French Institute of Health and Medical Research | Onen H.,Pole de Geriatrie
Psychologie et NeuroPsychiatrie du Vieillissement | Year: 2010

Obstructive Sleep Apnea Syndrome (OSAS) is characterized by repeated episodes of upper airway obstruction during sleep that result in intermittent hypoxemia and arousal. The prevalence of OSAS increases with aging, occurring in up to 25% of older adults and up to 48% in patients with Alzheimer's disease. OSAS causes hypoxia, fragmented sleep, daytime sleepiness, cognitive dysfunction, functional decline, and brain damage resulting from reduced cerebral blood flow, ischemic brain lesions, microvascular reactivity, white matter lesions, and grey matter loss. OSAS is considered as an independent risk factor for hypertension, stroke and mortality. The treatment of choice for OSAS is continuous positive airway pressure (CPAP). OSAS-related cognitive dysfunction has been shown in a variety of domains including attention, executive functioning, motor efficiency, working memory, and long-term episodic memory. Proposed mechanisms include hypoxemia, sleep fragmentation and inflammatory process, but it remains unclear which mechanisms underlie the relationship between OSAS and disturbances in the different cognitive domains. Recent studies suggest that OSAS may exacerbate cognitive functioning in dementia and that CPAP therapy can be applied to these patients and iimprove cognitive functioning. Source

Paccaun M.,Pole de Geriatrie | Belmin J.,University Pierre and Marie Curie
Revue de Geriatrie | Year: 2013

Lower respiratory tract infections are frequent in patients living in nursing homes. It is very important to distinguish the pneumonia from the bronchitis in order to give the most appropriate treatment and to increase the rational use of antibiotics. We propose herein a decision tree to help the therapeutic challenge. Source

Kiesmann M.,Pole de Geriatrie | Vogel T.,Pole de Geriatrie | Kaltenbach G.,Pole de Geriatrie | Mohr M.,Hopital de Hautepierre
Revue Neurologique | Year: 2010

Introduction: Cognitive disorders such as deficit of attention and executive and visuoconstructive dysfunctions occur in Parkinson's disease dementia (PDD). Memory impairment is not an early feature and statement not well delimited. Case report: A 78-year-old man with PDD underwent neuropsychological assessment and moreover demonstrated memory decline. After death, pathology examination of the brain and immunohistochemy analysis confirmed PD and showed Lewy body pathology (LBP) in the insula, limbic and especially in CA3 hippocampus areas. Hippocampus and gyrus parahippocampic also exhibited neurofibrillary tangles. Lack of senile plaque and lack of beta A4 amyloid deposition were noticeable in the whole brain examination. Conclusion: Severe executive dysfunctions are probably related to LBP and dysfunction in memory process may be related to DNF lesions in medial temporal area. © 2010 Elsevier Masson SAS. Source

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