Cortico-basal degeneration is a relatively uncommon cause of degenerative parkinsonism in the elderly. From a clinical point of view, it manifests as a cortico-basal syndrome (CBS), featuring a highly asymmetrical akinetic-rigid syndrome, dystonia, myoclonus and cognitive-behavioral impairment with predominant apraxia. Other clinical phenotypes are possible, including variants with mainly language or behavioral impairment, or with axial, symmetrical parkinsonism resembling progressive supranuclear palsy (PSP). Current diagnostic criteria take into account the heterogeneity of clinical presentations. However, a diagnosis of certainty can only be reached by a pathological study, with the evidence of TAU-positive intraneuronal inclusions. Indeed SCB may be underpinned by other lesional substrates, ranging from frontotemporal degeneration to Alzheimer's disease. Symptom management must be early, multidisciplinary and adapted to the progression of the disorder. The identification of the pathological substrate is an essential prerequisite for pathophysiological therapeutic trials.
皮质基底层变性是导致老年退行性帕金森病的一个相对少见的原因。从临床角度来看,它表现为皮质基底综合征(CBS),其特征是高度不对称的动-僵综合征、肌张力障碍、肌阵挛和认知-行为障碍,以肢体瘫痪为主。还可能出现其他临床表型,包括以语言或行为障碍为主的变异型,或类似于进行性核上性麻痹(PSP)的轴向对称性帕金森病。目前的诊断标准考虑到了临床表现的异质性。然而,只有通过病理研究,并有 TAU 阳性的神经元内包涵体的证据,才能得出确定的诊断。事实上,从额颞叶变性到阿尔茨海默病等其他病变基质也可能导致 SCB。症状管理必须是早期的、多学科的,并适应疾病的发展。病理基质的确定是病理生理学治疗试验的重要前提。
{"title":"[Cortico-basal syndrome and cortico-basal degeneration: From the clinical diagnosis to the lesional substrate for an adapted care].","authors":"Dario Saracino","doi":"10.1684/pnv.2024.1145","DOIUrl":"https://doi.org/10.1684/pnv.2024.1145","url":null,"abstract":"<p><p>Cortico-basal degeneration is a relatively uncommon cause of degenerative parkinsonism in the elderly. From a clinical point of view, it manifests as a cortico-basal syndrome (CBS), featuring a highly asymmetrical akinetic-rigid syndrome, dystonia, myoclonus and cognitive-behavioral impairment with predominant apraxia. Other clinical phenotypes are possible, including variants with mainly language or behavioral impairment, or with axial, symmetrical parkinsonism resembling progressive supranuclear palsy (PSP). Current diagnostic criteria take into account the heterogeneity of clinical presentations. However, a diagnosis of certainty can only be reached by a pathological study, with the evidence of TAU-positive intraneuronal inclusions. Indeed SCB may be underpinned by other lesional substrates, ranging from frontotemporal degeneration to Alzheimer's disease. Symptom management must be early, multidisciplinary and adapted to the progression of the disorder. The identification of the pathological substrate is an essential prerequisite for pathophysiological therapeutic trials.</p>","PeriodicalId":51244,"journal":{"name":"Geriatrie et Psychologie Neuropsychiatrie De Vieillissement","volume":"22 1","pages":"93-102"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alteration of the general state of health is a frequent clinical situation as reason for hospital admission of older adults, although there is no consensus on criteria of the diagnostic approach. Our objective was to study whether thorax, abdomen and pelvis tomography is useful for the diagnosis and determination of a specific care pathway for hospitalized patients over 80 years old with alteration of the general state without identified clinical explanation. retrospective observational monocentric study at a French University Hospital, with the inclusion of all hospitalized patients who had a tomography following for alteration of general state without identified clinical explanation between January 2019 and June 2020. The primary endpoint was the presence of a diagnosis on the tomography report. We studied 48 files of patients (aged 86.2 ± 3.4 years on average). Tomography provided a diagnosis in 60.4% of cases. Factors significantly related to usefulness of tomography were weight loss and duration of weight loss. Among the diagnosed patients, specific actions were taken for 86.2% of them. Our study suggests that thoracic-abdominal-pelvic tomography is useful to examine the alteration of general state in older patients without identified clinical explanation, particularly for those presenting with unintentional weight loss. That suggests that it is probably preferable to use the correct symptoms description instead of alteration of general state.
{"title":"[Utilité de la tomographie thoraco-abdomino-pelvienne chez les patients âgés hospitalisés pour altération de l'état général].","authors":"Pauline Boussard, Emilie Menand, Estelle Le Pabic, Aline Corvol, Joaquim Prud'homm, Dominique Somme","doi":"10.1684/pnv.2024.1148","DOIUrl":"https://doi.org/10.1684/pnv.2024.1148","url":null,"abstract":"<p><p>Alteration of the general state of health is a frequent clinical situation as reason for hospital admission of older adults, although there is no consensus on criteria of the diagnostic approach. Our objective was to study whether thorax, abdomen and pelvis tomography is useful for the diagnosis and determination of a specific care pathway for hospitalized patients over 80 years old with alteration of the general state without identified clinical explanation. retrospective observational monocentric study at a French University Hospital, with the inclusion of all hospitalized patients who had a tomography following for alteration of general state without identified clinical explanation between January 2019 and June 2020. The primary endpoint was the presence of a diagnosis on the tomography report. We studied 48 files of patients (aged 86.2 ± 3.4 years on average). Tomography provided a diagnosis in 60.4% of cases. Factors significantly related to usefulness of tomography were weight loss and duration of weight loss. Among the diagnosed patients, specific actions were taken for 86.2% of them. Our study suggests that thoracic-abdominal-pelvic tomography is useful to examine the alteration of general state in older patients without identified clinical explanation, particularly for those presenting with unintentional weight loss. That suggests that it is probably preferable to use the correct symptoms description instead of alteration of general state.</p>","PeriodicalId":51244,"journal":{"name":"Geriatrie et Psychologie Neuropsychiatrie De Vieillissement","volume":"22 1","pages":"69-75"},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lou Cady, Marie Costes, Emilie Andres, Franck Dillinger, Dominique Somme
The practice of telemedicine in nursing homes is a solution to improve the quality of care for residents. Its application also seems to be beneficial for the professionals involved, but it faces obstacles. The objective of this study is to explore the effects of the implementation of teleconsultations in nursing homes on the professional practices of the stakeholders involved. A qualitative focus group study was conducted with professionals involved in the implementation of teleconsultations. The data was analyzed using an inductive approach similar to grounded theory. The 18 participants included in the study were unanimous and consensual about the benefits of telemedicine. They observed changes in work relationships, particularly the key role of caregivers in coordinating care. However, they feared a deterioration in doctor-patient relationships. The practice of telemedicine was considered time-consuming, which could hinder its dissemination. No general practitioner participated in this study, showing they had reservations about the practice. The Covid-19 pandemic had an impact on the development of teleconsultations within the institutions involved. Telemedicine is acclaimed by the nursing homes teams and the doctors required, particularly through the effects on training and the added value it can bring to their practice. Telemedicine also allows to provide care that is otherwise not available. However, the care process needs to be simplified. In addition, there are obstacles to the involvement of general practitioners, which should be studied in order to optimize the coordination of care for the residents of the nursing homes.
{"title":"[Cross-perspectives on telemedicine in nursing homes: a survey of professionals involved in the setting-up of teleconsultations in nursing homes in Rennes area].","authors":"Lou Cady, Marie Costes, Emilie Andres, Franck Dillinger, Dominique Somme","doi":"10.1684/pnv.2023.1112","DOIUrl":"10.1684/pnv.2023.1112","url":null,"abstract":"<p><p>The practice of telemedicine in nursing homes is a solution to improve the quality of care for residents. Its application also seems to be beneficial for the professionals involved, but it faces obstacles. The objective of this study is to explore the effects of the implementation of teleconsultations in nursing homes on the professional practices of the stakeholders involved. A qualitative focus group study was conducted with professionals involved in the implementation of teleconsultations. The data was analyzed using an inductive approach similar to grounded theory. The 18 participants included in the study were unanimous and consensual about the benefits of telemedicine. They observed changes in work relationships, particularly the key role of caregivers in coordinating care. However, they feared a deterioration in doctor-patient relationships. The practice of telemedicine was considered time-consuming, which could hinder its dissemination. No general practitioner participated in this study, showing they had reservations about the practice. The Covid-19 pandemic had an impact on the development of teleconsultations within the institutions involved. Telemedicine is acclaimed by the nursing homes teams and the doctors required, particularly through the effects on training and the added value it can bring to their practice. Telemedicine also allows to provide care that is otherwise not available. However, the care process needs to be simplified. In addition, there are obstacles to the involvement of general practitioners, which should be studied in order to optimize the coordination of care for the residents of the nursing homes.</p>","PeriodicalId":51244,"journal":{"name":"Geriatrie et Psychologie Neuropsychiatrie De Vieillissement","volume":"21 4","pages":"457-467"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
According to the World Health Organisation (WHO), recent decades have seen a major increase in the number of elderly people in Africa. Persistent infectious diseases are responsible for high morbidity and mortality in this immuno-senescent population, making vaccination an effective preventive measure. In developed countries, vaccination programs are in place and regularly updated. In sub-Saharan Africa, however, vaccination is still reserved for children, and access for seniors remains limited by a number of factors. The aim of this study was to use a systematic review to demonstrate the relevance of vaccination in this field, and to propose an appropriate vaccination schedule. Ultimately, vaccines against influenza, pneumococcus (23-valent), herpes zoster, diphtheria, pertussis and tetanus should be systematically recommended. Others may be discussed, depending on the fragility of the patient's condition.
{"title":"[Vaccination in the elderly in sub-Saharan Africa: Relevance and scheduling model].","authors":"Massamba Ba, Assane Sall, Rokhaya Djajhete, Dalahata Ba, Mamadou Coume","doi":"10.1684/pnv.2023.1113","DOIUrl":"10.1684/pnv.2023.1113","url":null,"abstract":"<p><p>According to the World Health Organisation (WHO), recent decades have seen a major increase in the number of elderly people in Africa. Persistent infectious diseases are responsible for high morbidity and mortality in this immuno-senescent population, making vaccination an effective preventive measure. In developed countries, vaccination programs are in place and regularly updated. In sub-Saharan Africa, however, vaccination is still reserved for children, and access for seniors remains limited by a number of factors. The aim of this study was to use a systematic review to demonstrate the relevance of vaccination in this field, and to propose an appropriate vaccination schedule. Ultimately, vaccines against influenza, pneumococcus (23-valent), herpes zoster, diphtheria, pertussis and tetanus should be systematically recommended. Others may be discussed, depending on the fragility of the patient's condition.</p>","PeriodicalId":51244,"journal":{"name":"Geriatrie et Psychologie Neuropsychiatrie De Vieillissement","volume":"21 4","pages":"410-418"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Agenda.","authors":"","doi":"10.1684/pnv.2023.1140","DOIUrl":"10.1684/pnv.2023.1140","url":null,"abstract":"","PeriodicalId":51244,"journal":{"name":"Geriatrie et Psychologie Neuropsychiatrie De Vieillissement","volume":"21 4","pages":"517-518"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Clara Burel, Guillaume Chapelet, Gilles Berrut, Michel Weber, Jean-Baptiste Ducloyer
Visual disorders are often under-diagnosed and under-treated in older patients. The main objective was to evaluate the percentage of patients having an ophthalmological follow-up corresponding to the recommendations of the Syndicat national des ophtalmologistes de France (SNOF). This prospective observational multicentre study included all patients aged 65 years or older presenting to their general practitioner in two medical practices from May to October 2021. Of the 113 patients included, 86 (76,1 %) had adequate ophthalmological follow-up, 14 consulted an ophthalmologist, and a therapeutic decision was made for nine patients. Follow-up of patients was generally as recommended. Screening for visual disorders for patients with no recent follow-up was beneficial. This screening must be integrated into a global approach, as the Integrated Care for Older People (ICOPE) of the World Health Organization (WHO), in order to be more relevant and effective.
{"title":"[Evaluation of ophthalmological follow-up of patients over 65 years old in primary care].","authors":"Clara Burel, Guillaume Chapelet, Gilles Berrut, Michel Weber, Jean-Baptiste Ducloyer","doi":"10.1684/pnv.2023.1115","DOIUrl":"10.1684/pnv.2023.1115","url":null,"abstract":"<p><p>Visual disorders are often under-diagnosed and under-treated in older patients. The main objective was to evaluate the percentage of patients having an ophthalmological follow-up corresponding to the recommendations of the Syndicat national des ophtalmologistes de France (SNOF). This prospective observational multicentre study included all patients aged 65 years or older presenting to their general practitioner in two medical practices from May to October 2021. Of the 113 patients included, 86 (76,1 %) had adequate ophthalmological follow-up, 14 consulted an ophthalmologist, and a therapeutic decision was made for nine patients. Follow-up of patients was generally as recommended. Screening for visual disorders for patients with no recent follow-up was beneficial. This screening must be integrated into a global approach, as the Integrated Care for Older People (ICOPE) of the World Health Organization (WHO), in order to be more relevant and effective.</p>","PeriodicalId":51244,"journal":{"name":"Geriatrie et Psychologie Neuropsychiatrie De Vieillissement","volume":"21 4","pages":"419-426"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cognitive disorders are now well known in schizophrenia, but their evolution over time and particularly during aging remains poorly described. Current evidence indicates that cognitive deficits including attention, working memory, verbal learning and memory, and executive functions are present in 80% of individuals with schizophrenia, which, on average, are around two standard deviations below that in healthy controls. Cognitive impairments are important predictors of functioning in daily life, including quality of life, inability to live independently and unemployment. From a lifespan perspective, they are evident in infancy (18 months) and continually increase between infancy and adulthood (20 years) in full-scale IQ and most of cognitive domains, accelerating during the prodromal phase. Cognitive deficits are significant predictor of the psychotic transition, and they stabilize after the first psychotic episode until the age of fifty suggesting that cognitive deficits are mainly established before the prodromal phases of psychosis. Time course of cognitive impairments in elderly patients with schizophrenia appears to be more heterogeneous. While the data suggest that they are stable with advancing age, a subgroup of institutionalized older patients stands out for a significant cognitive decline, without it being possible to determine the causal direction of this association. The twofold increased risk of developing neurodegenerative dementia in this population, combined with institutionalization, could partly explain this cognitive decline in some patients. Long-term longitudinal studies in older adults with schizophrenia are clearly needed, particularly in France. Protective factors such as recovery-focused and psychosocial approaches need to be studied in this population, which has a 15-year shorter life expectancy than the general population.
{"title":"[Cognitive functioning in schizophrenia: a lifespan perspective].","authors":"Stephane Raffard","doi":"10.1684/pnv.2023.1142","DOIUrl":"10.1684/pnv.2023.1142","url":null,"abstract":"<p><p>Cognitive disorders are now well known in schizophrenia, but their evolution over time and particularly during aging remains poorly described. Current evidence indicates that cognitive deficits including attention, working memory, verbal learning and memory, and executive functions are present in 80% of individuals with schizophrenia, which, on average, are around two standard deviations below that in healthy controls. Cognitive impairments are important predictors of functioning in daily life, including quality of life, inability to live independently and unemployment. From a lifespan perspective, they are evident in infancy (18 months) and continually increase between infancy and adulthood (20 years) in full-scale IQ and most of cognitive domains, accelerating during the prodromal phase. Cognitive deficits are significant predictor of the psychotic transition, and they stabilize after the first psychotic episode until the age of fifty suggesting that cognitive deficits are mainly established before the prodromal phases of psychosis. Time course of cognitive impairments in elderly patients with schizophrenia appears to be more heterogeneous. While the data suggest that they are stable with advancing age, a subgroup of institutionalized older patients stands out for a significant cognitive decline, without it being possible to determine the causal direction of this association. The twofold increased risk of developing neurodegenerative dementia in this population, combined with institutionalization, could partly explain this cognitive decline in some patients. Long-term longitudinal studies in older adults with schizophrenia are clearly needed, particularly in France. Protective factors such as recovery-focused and psychosocial approaches need to be studied in this population, which has a 15-year shorter life expectancy than the general population.</p>","PeriodicalId":51244,"journal":{"name":"Geriatrie et Psychologie Neuropsychiatrie De Vieillissement","volume":"21 4","pages":"477-485"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139545894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Morgane Houix, Ilia Humbert, Guillaume Mabileau, Guillaume Chapelet, Anne Sauvaget, Bénédicte Gohier, Sophie Armand-Branger, Jean-François Huon, Fanny D'Acremont, Samuel Bulteau
Adverse drug reactions (ADRs) are a major public health issue, especially when it comes to the elderly. Potentially inappropriate prescribing (PIP) are one of the causes of ADRs in older people. A PIP can be defined as a prescription for which the benefit/risk ratio is unfavourable compared to other therapeutic alternatives. Psychotropic drugs are the second highest risk class for ADRs in the elderly. In order to reduce the prevalence of PIP, prescription assistance tools have been created. An inventory of PIP of psychotropic drugs in older patients hospitalized in psychiatry units was carried out in a French regional setting in 2019. A criteria grid was established based on 2 tools: STOPP/START criteria and Laroche's list adapted to French practice. This grid targeted each class of psychotropic drugs, drugs with a high anticholinergic burden and non-recommended combinations of psychotropic drugs. Three hundred forty-seven patients were included. A high prevalence of PPI was found for each class of psychotropic drugs. The highest prevalence of PPI was found among benzodiazepines (90.3%): long-term prescription, long half-life drugs, respiratory insufficiency or cognitive impairment condition. 56.5% of the subjects had a not-recommended combination of psychotropic drugs (prescription of drugs of the same pharmacotherapeutic class), 26% had a PIP of antipsychotics: prescription for insomnia, use of phenothiazine, 11.8% of drugs with anticholinergic properties and 7.4% of antidepressants: especially prescription of tricyclic drugs. These results obtained on a large population underline the interest of considering the specificities of prescriptions in the elderly. It shows both the interest and the limits of the current criteria defining the PIP in the context of a hospitalization in psychiatry for an acute disorder in elderly subjects.
药物不良反应 (ADR) 是一个重大的公共卫生问题,尤其是对老年人而言。潜在的不适当处方(PIP)是造成老年人药物不良反应的原因之一。潜在不适当处方的定义是,与其他治疗方法相比,效益/风险比不利的处方。精神药物是老年人发生药物不良反应的第二大风险类别。为了降低 PIP 的发生率,我们开发了处方辅助工具。2019 年,在法国的一个地区环境中,对在精神病科住院的老年患者进行了精神药物 PIP 普查。根据两种工具建立了一个标准网格:STOPP/START 标准和 Laroche 清单,并根据法国的实际情况进行了调整。该网格针对每一类精神药物、抗胆碱能负荷较高的药物和非推荐的精神药物组合。共纳入 347 名患者。发现每一类精神药物的 PPI 患病率都很高。苯二氮卓类药物的 PPI 发生率最高(90.3%):长期处方、长半衰期药物、呼吸功能不全或认知障碍。56.5%的受试者使用了不推荐的精神药物组合(处方同一药物治疗类别的药物),26%的受试者使用了抗精神病药物 PIP:处方用于失眠、使用吩噻嗪,11.8%的受试者使用了具有抗胆碱能特性的药物,7.4%的受试者使用了抗抑郁药物:尤其是处方三环类药物。这些在大量人口中得出的结果突出表明,考虑老年人处方的特殊性很有意义。这表明,在老年人因急性精神障碍而住院治疗的情况下,目前界定 PIP 的标准既有意义,也有局限性。
{"title":"[How potentially inapropriate are psychotropic drugs prescribing in acute psychiatric unit for the elderly? Results from a large multicentric audit in France].","authors":"Morgane Houix, Ilia Humbert, Guillaume Mabileau, Guillaume Chapelet, Anne Sauvaget, Bénédicte Gohier, Sophie Armand-Branger, Jean-François Huon, Fanny D'Acremont, Samuel Bulteau","doi":"10.1684/pnv.2023.1137","DOIUrl":"10.1684/pnv.2023.1137","url":null,"abstract":"<p><p>Adverse drug reactions (ADRs) are a major public health issue, especially when it comes to the elderly. Potentially inappropriate prescribing (PIP) are one of the causes of ADRs in older people. A PIP can be defined as a prescription for which the benefit/risk ratio is unfavourable compared to other therapeutic alternatives. Psychotropic drugs are the second highest risk class for ADRs in the elderly. In order to reduce the prevalence of PIP, prescription assistance tools have been created. An inventory of PIP of psychotropic drugs in older patients hospitalized in psychiatry units was carried out in a French regional setting in 2019. A criteria grid was established based on 2 tools: STOPP/START criteria and Laroche's list adapted to French practice. This grid targeted each class of psychotropic drugs, drugs with a high anticholinergic burden and non-recommended combinations of psychotropic drugs. Three hundred forty-seven patients were included. A high prevalence of PPI was found for each class of psychotropic drugs. The highest prevalence of PPI was found among benzodiazepines (90.3%): long-term prescription, long half-life drugs, respiratory insufficiency or cognitive impairment condition. 56.5% of the subjects had a not-recommended combination of psychotropic drugs (prescription of drugs of the same pharmacotherapeutic class), 26% had a PIP of antipsychotics: prescription for insomnia, use of phenothiazine, 11.8% of drugs with anticholinergic properties and 7.4% of antidepressants: especially prescription of tricyclic drugs. These results obtained on a large population underline the interest of considering the specificities of prescriptions in the elderly. It shows both the interest and the limits of the current criteria defining the PIP in the context of a hospitalization in psychiatry for an acute disorder in elderly subjects.</p>","PeriodicalId":51244,"journal":{"name":"Geriatrie et Psychologie Neuropsychiatrie De Vieillissement","volume":"21 4","pages":"496-505"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eline Thirion, Solveig Rouissi, Virginie Dauphinot, Antoine Garnier-Crussard, Marie-Hélène Coste, Pierre Krolak-Salmon
The development of non-pharmacological interventions, including animal-assisted therapy (AAT), is an encouraging method for the care of people with Alzheimer's disease (AD). A single-center, randomized, single-blind, controlled intervention study was proposed to compare immediate well-being measured by a visual analog scale (EVIBE) as primary outcome between the intervention group (AAT combined with cognitive stimulation) and the control group (cognitive stimulation only) in AD patients. Secondary outcomes were explored, such as well-being after intervention (also with the EVIBE), cognitive performance (measured by Alzheimer's Disease Assessment Scale, cognitive part GRECO version), behavioral and psychological symptoms of dementia (with the Neuropsychiatric Inventory Behavioral Scale-Nursing Home Version), current depressive symptomatology (with the 30 items Geriatric Depression Scale [GDS 30]) and anxiety (by the State-Trait Anxiety Inventory). Forty-two patients were included, 22 in the intervention group and 20 in the control group. The mean age was 82.5 years and mean MMSE score 19.2 in the control group and 81.4 years and mean MMSE score 18.4 in the TAA group. The results show a significant effect of the intervention on well-being after four weeks (p = 0.048), but no significant effect on cognitive functioning, behavioral and psychological symptoms of dementia. This study shows a small effect of TAA on well-being four weeks after the end of the intervention. The assessment of well-being by another measurement tool and the collection of observations made by the care team could be explored in future studies, which could require a larger sample and a longer follow-up.
{"title":"[Impact of animal-assisted therapy on well-being in patients with Alzheimer's disease (ELIAUT study)].","authors":"Eline Thirion, Solveig Rouissi, Virginie Dauphinot, Antoine Garnier-Crussard, Marie-Hélène Coste, Pierre Krolak-Salmon","doi":"10.1684/pnv.2023.1134","DOIUrl":"10.1684/pnv.2023.1134","url":null,"abstract":"<p><p>The development of non-pharmacological interventions, including animal-assisted therapy (AAT), is an encouraging method for the care of people with Alzheimer's disease (AD). A single-center, randomized, single-blind, controlled intervention study was proposed to compare immediate well-being measured by a visual analog scale (EVIBE) as primary outcome between the intervention group (AAT combined with cognitive stimulation) and the control group (cognitive stimulation only) in AD patients. Secondary outcomes were explored, such as well-being after intervention (also with the EVIBE), cognitive performance (measured by Alzheimer's Disease Assessment Scale, cognitive part GRECO version), behavioral and psychological symptoms of dementia (with the Neuropsychiatric Inventory Behavioral Scale-Nursing Home Version), current depressive symptomatology (with the 30 items Geriatric Depression Scale [GDS 30]) and anxiety (by the State-Trait Anxiety Inventory). Forty-two patients were included, 22 in the intervention group and 20 in the control group. The mean age was 82.5 years and mean MMSE score 19.2 in the control group and 81.4 years and mean MMSE score 18.4 in the TAA group. The results show a significant effect of the intervention on well-being after four weeks (p = 0.048), but no significant effect on cognitive functioning, behavioral and psychological symptoms of dementia. This study shows a small effect of TAA on well-being four weeks after the end of the intervention. The assessment of well-being by another measurement tool and the collection of observations made by the care team could be explored in future studies, which could require a larger sample and a longer follow-up.</p>","PeriodicalId":51244,"journal":{"name":"Geriatrie et Psychologie Neuropsychiatrie De Vieillissement","volume":"21 4","pages":"506-516"},"PeriodicalIF":0.6,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}