Geriatrie et Psychologie Neuropsychiatrie De Vieillissement最新文献

Metacognition, the ability to monitor and regulate one's own cognitive processes, is subject to varying degrees of modification in patients suffering from neurodegenerative diseases. The literature suggests the existence of dissociations within metacognitive abilities, with some patients exhibiting, for example, specific impairments in self-assessing their memory (and not other cognitive domains). The specific assessment of metacognition in patients' social-cognitive abilities is underdeveloped, although it has significant implications for both clinical and theoretical purposes. This narrative review aims to (i) list the main tools for assessing metacognition, underlining the presence (or absence) of social cognition items in particular; (ii) highlight the issues involved in this type of assessment, both from a clinical point of view, to support patients and their families, and from a theoretical perspective, concerning advances in cognitive modeling. Recommendations regarding the most appropriate tools for clinical practice are formulated and perspectives are discussed.

The growing prevalence of the Alzheimer's disease (AD) is an increasing public health concern that led to French recommendations for timely AD diagnosis and patient management as well as a territorial coverage of specialized structures [Memory Centers including Resources and Memory Research Centers (RMRC) and Memory Consultations (MC)]. In view of the potential availability of Disease Modifying Therapies (DMTs), this French observatory aimed to describe the current organization of the Memory Centers, and the care pathway of patients suffering from early AD. Overall, 12 of the 28 RMRC and 44 of the 250 MC solicited by the Federation of Memory Centers participated in this study. RMRC and MC differed in the practicing specialists (neurologists in 100 % and 41 % of the structures, respectively; geriatricians in 58 % and 95 %), and in the median yearly number of patients with early AD (192 and 99). The majority of patients were referred to RMRC and MC by a general practitioner (42 % and 51 %, respectively) or a private neurologist (19 % and 6 %). The time between referral and the first visit to the Memory Center was shorter in MC compared to RMRC (<3 months: 51 % versus 34 %). Cerebrospinal fluid biomarkers were assessed in the majority of patients in 75 % of RMRC and 14 % of MC. A care plan was proposed for the majority of patients whatever the Memory Center was (RMRC: 91 %, MC: 84 %) unlike psychological support (21 % and 29 %, respectively) and therapeutic education (14 % and 9 %). According to more than 2/3 of the RMRC the referral delays, the number of patients with early AD, and the monitoring schedule (including MRIs and clinical assessments) will be very impacted by the potential availability of DMTs. A similar impact was only perceived by around half of the MC. This study highlighted the key challenges raised by these new therapies.

The prevalence of frailty determines the proportion of the population that will experience intercurrent events and dependency. The aim was to assess the prevalence and factors associated with frailty using the modified SEGA grid.

Method: This was a cross-sectional descriptive study. The primary endpoint was frailty, assessed using the modified SEGA grid.

Results: The prevalence of frail and very frail people was jointly estimated at 33%. In multivariate analysis, gender, lifestyle and marital status did not appear to be associated with frailty. However, the IAVL score was associated with frailty OR=0.21 (95% CI 0.06 to 0.68; p=0.009). EVS is also associated with frailty for mild pain OR= 12.12 (95% CI 2.49 to 59.08; p=0.007).

Conclusion: Our results independently show the association between IAVL and frailty, with a one-unit increase in IAVL score being less associated with frailty.

Screening for frailty syndrome, a marker of mortality risk, dependence, and institutionalization, is currently recommended in primary care to prevent its consequences effectively. Elderly diabetic individuals represent a significant and growing proportion of general practitioners' patient population, but their frailty status compared to the non-diabetic population is poorly understood. To study the relationship between diabetes and frailty in individuals aged 75 and older in general medicine. A total of 309 patients were included, among them 64 were diabetic patients, with a male/female ratio of 0.72. The proportion of frail elderly people was comparable between diabetics (24 %) and non-diabetics (27.6 %), as was the mean Fried score (1.78 vs. 1.56; not significant). Subgroup analysis revealed a significant difference in the risk of frailty, which was multiplied by 2.14 in diabetics without complications compared with non-diabetics, [95 % CI=2.03 to 2.25, p<2e(-16)]. Larger-scale studies at multiple outpatient sites should be conducted in general medicine among subjects aged over 75. Frailty management should be continued and carried out in patients whether they are diabetic or not.

Younger adults have difficulties identifying emotional facial expressions from faces covered by face masks. It is important to evaluate how face mask wearing might specifically impact older people, because they have lower emotion identification performance than younger adults, even without face masks. We compared performance of 62 young and 38 older adults in an online task of emotional facial expression identification using masked or unmasked pictures of faces with fear, happiness, anger, surprise, and neutral expression, from different viewpoints. Face masks affected performance in both age groups, but more so in older adults, specifically for negative emotions (anger, fear), in favour of the saliency hypothesis as an explanation for the positive advantage. Additionally, face masks more affected emotion recognition on profile than on three-quarter or full-face views. Our results encourage using clearer and full-face expressions when dealing with older people while wearing face masks.