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Onen S.H.,Unite geriatrique devaluation et de traitement des troubles du sommeil | Onen F.,Service de medecine geriatrique
NPG Neurologie - Psychiatrie - Geriatrie

Frequently, patients with Alzheimer's disease spend their nights in a state of restlessness and their days in a state of sleepiness. Sometimes these patients present delayed sleep phase pattern characterized by an inability to fall asleep at a desired conventional time together with an inability to awaken at a desired and socially acceptable time (they tend to fall asleep some hours after midnight and have difficulty waking up in the morning). These sleep-wake disturbances became increasingly more marked with the progression of the disease. The sleep-wake disturbances in elderly people and particularly in patients with Alzheimer's disease may result from changes at different levels: a reduction of environmental synchronizers or their perception, a lack of mental and physical activity, an age or disease related anatomical change with loss of functionality of the biological clock. In Alzheimer's disease patients, controlling sleep-wake disturbances with sedative drugs often increases both sleep disturbance and cognitive dysfunction. A chronobiological approach with bright-light therapy, melatonin administration, and sleep hygiene may be an interesting therapeutic alternative in the management of sleep-wake disorders in Alzheimer patients. The aim of these therapeutics is to improve sleep and diurnal activity, and consequently to increase the quality of life in patients with Alzheimer's disease and their caregivers. © 2009 Elsevier Masson SAS. All rights reserved. Source

Saint-Aubert L.,French Institute of Health and Medical Research | Saint-Aubert L.,Toulouse 1 University Capitole | Sagot C.,Service de medecine geriatrique | Wallon D.,University of Rouen | And 15 more authors.
Journal of Alzheimer's Disease

We report the case of a 65-year-old woman, clinically diagnosed with the logopenic variant of primary progressive aphasia (PPA), and carrier of C9ORF72 expansion, despite cerebrospinal fluid biomarkers suggesting Alzheimer's disease (AD). She underwent structural MRI, metabolic PET, and amyloid PET imaging using florbetapir. Comparison with healthy controls revealed widespread hypometabolism, left sided cortical atrophy, and an increased cortical amyloid load. No difference in amyloid binding was found between the patient and predemential AD patients. This case provides evidence of amyloidopathy in a carrier of C9ORF72 expansion exhibiting a clinical profile of the logopenic variant of PPA. © 2014 - IOS Press and the authors. All rights reserved. Source

Ricanet-Delannoy A.,Service de Soins de Suite et Readaptation Geriatrique | Kim B.-A.,Service de medecine geriatrique | Comte B.,Service de Geriatrie
Revue de Geriatrie

Myasthenia Gravis (MG) is an uncommon autoimmune disease, usually described in young adults. However it may occur in older patients. We report the case of a 74 years-old female who developed myasthenia during rehabilitation after orthopedic surgery. Clinical symptoms can be nonspecific as reported in this case. In the geriatric population, MG diagnosis can be difficult and the symptoms related either to other comorbidities or other diagnosis. Clinicians may keep this diagnosis in mind because MG may have severe consequences on functional status and lead to severe dependence in geriatric patients. Efficient treatments can reduce symptoms and allow functional rehabilitation. Source

Onen F.,Service de medecine geriatrique | Onen S.-H.,Unite geriatrique devaluation et de traitement des troubles du sommeil
NPG Neurologie - Psychiatrie - Geriatrie

Obstructive sleep apnea syndrome (OSAS) is a highly prevalent condition in older adults. Despite its high prevalence, OSAS is significantly under diagnosed and under treated in this population. Several factors underlie the lack of recognition of OSAS in older adults. One important factor may be the atypical clinical presentation of the disorder. Age-related physiological changes, multiple comorbidities with possible disease - disease interactions, and the effects of multiple medication may be responsible for atypical manifestations of OSAS. Older individuals with sleep apnea are often unaware of the nighttime symptoms of this condition and rarely complain of daytime sleepiness. However, falls, cognitive impairment, stroke, glaucoma, and impaired quality of life are unspecific but frequently associated conditions in the elderly with OSAS. Definitive diagnosis depends on polysomnography (PSG), usually requiring costly overnight laboratory testing. In addition, PSG is inconvenient for some elderly patients with multiple comorbid conditions. A simple bedside test, the Observation-based Nocturnal Sleep Inventory (ONSI), is useful to screen sleep apnea in the elderly. The ONSI may be practical in situations in which PSG is initially impractical or in populations with comorbidities to help define further diagnostic and treatment options. Tolerance to continuous positive air pressure in elderly symptomatic OSAS patients is similar to that of younger patients. Elderly patients with untreated OSAS have high healthcare utilization because of cardiovascular disease morbidity and use of cardiovascular and psychotropic medication. © 2010. Source

Bonnefoy M.,Service de medecine geriatrique | Bonnefoy M.,French Institute of Health and Medical Research | Bonnefoy M.,University of Lyon | Gilbert T.,Service de medecine geriatrique | Gilbert T.,University of Lyon
Cahiers de l'Annee Gerontologique

Nutritional intake and maintaining the balance between energy and nitrogen levels are major determining factors when it comes to ageing and good health. Nutrition plays a vital role in the onset, prevention and management of frailty syndrome in the elderly. Epidemiological studies have confirmed that frailty and its components are associated with an insufficient intake of protein, energy and micronutrients. Prevention of frailty should therefore incorporate the latest guidelines for recommended energy and protein intake. Such guidelines are not available for the majority of micronutrients, but minimal recommended daily intake requirements should be followed. Recent epidemiological investigations have shown the benefit of specific lifestyles, such as the Mediterranean diet which includes food that is rich in anti-oxidants and n-3 polyunsaturated fatty acids. Treatment pathways for sarcopenia and frailty may be proposed in light of such research: specific amino acids, polyunsaturated fatty acids and a diet high in pulses, however their benefit needs to be confirmed in a wider population. Nutrition must be combined with exercise and physical activity in order to increase anabolism, boost energy levels and improve functional capabilities. © 2015, Springer-Verlag France. Source

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