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Brain implants are increasingly used to treat neurological disorders and diseases. However, the brain foreign body response (FBR) elicited by implants affects neuroelectrical transduction and long‐term reliability limiting their clinical adoption. The mismatch in Young's modulus between silicon implants (≈180 GPa) and brain tissue (≈1–30 kPa) exacerbates the FBR, resulting in the development of flexible implants from polymers such as polyimide (≈1.5–2.5 GPa). However, a stiffness mismatch of at least two orders of magnitude remains. The study introduces 1) the first mechanically matched brain implant (MMBI) made from silicone (≈20 kPa); 2) new microfabrication methods; and 3) a novel dissolvable sugar shuttle to reliably implant MMBIs. MMBIs are fabricated via vacuum‐assisted molding using sacrificial sugar molds and are then encased in sugar shuttles that dissolved within 2 min after insertion into rat brains. Sections of rat neocortex implanted with MMBIs, polydimethylsiloxane (PDMS) implants, and silicon implants are analyzed by immunohistochemistry 3 and 9 weeks post‐implantation. MMBIs result in significantly higher neuronal density and lower FBR within 50 µm of the tissue‐implant interface compared to PDMS and silicon implants, suggesting that materials mechanically matched to brain further minimize the FBR and can contribute to better implant functionality and long‐term reliability. [ABSTRACT FROM AUTHOR]

Background: OnabotulinumtoxinA (OnaA) injection in glabella area appears to be a promising treatment for major depression. However, one major concern of placebo‐controlled studies on botulinum toxin injections is to ensure adequate blinding. Patients and Methods: In this context, all subjects of this trial received the active product (OnaA). After randomization, 58 patients with resistant major depressive disorder (MDD) received OnaA either in the glabella area (N = 29) or in the crow's feet area (N = 29). Subjects were blinded to the supposedly effective area against resistant depression and the examiner was not aware of the injected area. The primary outcome measure was the proportion of responders (50% or greater decrease in MADRS [Montgomery and Asberg Depression Rating Scale] score from baseline) in glabella group versus crow's feet group at week 6 after the OnaA injection. Results: The number of responders was significantly higher in the glabella group than in the crow's feet group with 13 responders out of 29 patients (44.8%) in the glabella group and five out of 28 patients (17.9%) in the crow's feet group (p = 0.029). The rate of psychomotor agitation as measured by item 9 of the Hamilton Depression Rating Scale (HAM‐D), associated with a shorter span of psychiatric disorder, was a potent positive predictive factor of positive response to treatment. Conclusion: We conclude that OnaA injected in the glabella muscles is an effective and well‐tolerated treatment for MDD. We suggest that patients with a high score at item 9 of the HAM‐D might be a subgroup of best responders. We assume that OnaA may act as a modulator of the activity of the primary sensorimotor cortex and then of the amygdala. Trial Registration: ClinicalTrials.gov identifier: NCT03484754 [ABSTRACT FROM AUTHOR]

Background/Aims: Alzheimer disease (AD) is particularly devastating, with no cure, no means of prevention, and no proven way to slow progression. AD is associated with the worsening of cognitive function attributable to a variety of factors of which little is known. Our main objective was to determine factors associated with rapid cognitive decline (RCD) in older AD patients. Methods: We conducted a 12-month, prospective, multi-centre cohort study. Community-living individuals aged ≥65 years with mild-to-moderate AD were included. RCD was defined as the loss of ≥3 points/year in the Mini-Mental State Examination (MMSE) score. Potential individual-level predictors were collected at baseline. Results: A total of 521 individuals were included. The mean age was 80.8 ± 9.0 years and 66.0% were females. The average baseline MMSE score was 20.5 ± 4.5. The incidence of RCD was 40.9% (95% confidence interval [CI], 36.7–45.1). RCD was more common in patients with moderate (53.5%) than mild (22.3%) AD. The factors associated with RCD were: a parental history of dementia (odds ratio [OR], 2.32 [95% CI, 1.24–4.21], p = 0.011), psychotic symptoms (OR, 2.06 [95% CI, 1.22–3.48], p = 0.007), malnutrition (OR, 1.61 [95% CI, 1.06–2.63], p = 0.028), and the female gender (OR, 1.48 [95% CI, 1.03–2.15], p = 0.036). An MMSE score < 20 at treatment onset was also associated with RCD (p < 0.001). Conclusion: The factors associated with RCD were an MMSE score < 20 at treatment onset, female gender, psychotic symptoms, malnutrition, and a family history of dementia. These results may be directly relevant to patients, their families, and their physicians, enabling early anticipation of difficult clinical trajectories and poor functional outcomes. [ABSTRACT FROM AUTHOR]

Résumé Les réactions cutanées associées à une prise médicamenteuse sont fréquentes. Elles représentent 20 % des notifications spontanées et peuvent compliquer 2 à 3 % des hospitalisations. Les effets indésirables liés à la prise de médicaments psychotropes sont nombreux mais la fréquence des toxidermies est rare dans la littérature, probablement sous-notifiée. L’objectif de cet article est de faire un état des lieux des divers cas de réactions cutanées déclarés dans la population suite à la prise d’un traitement psychotrope. Une recherche bibliographique a donc été effectuée sur différentes bases de données (EBM Reviews, PubMed, Web of Science, PsycINFO et PsycArticles) en utilisant les termes anglais de « rash », « cutaneous » et le nom des médicaments incriminés. Un certain nombre de réactions cutanées d’origine médicamenteuses sont rapportées, dans la littérature, sous psychotropes. De nombreux cas de réactions urticariennes, des érythèmes ou des exanthèmes maculopapuleux ont été décrits. Ces réactions ne sont pas anodines puisqu’elles peuvent provoquer une prolongation d’hospitalisation et, dans une faible proportion, le décès. Une réaction cutanée sévère doit faire arrêter le médicament incriminé. Une connaissance de ces toxidermies sous psychotropes doit être acquise par tous les praticiens utilisant cette classe médicamenteuse. Il convient de garder en mémoire que chaque médicament prescrit doit être considéré comme potentiellement capable de provoquer, parmi les effets indésirables, des réactions cutanées. Ainsi, les psychotropes n’échappent pas à cette règle et le prescripteur ainsi que le patient doivent être sensibilisés à ce type d’effet indésirable. Introduction Skin reactions associated with drug are common. They represent 20 % of spontaneous reporting and may complicated 2 to 3 % of hospitalizations. Adverse effects associated with psychotropic drugs are common. The frequency of drug reactions is rare but probably underreported. The aim of this article is to list cutaneous reactions reported in international publications. Method A literature review of cutaneous adverse effect reported with psychotropic drug administration was performed using data basis (EBM Reviews, PubMed, Web of Science, PsycINFO et PsycArticles) with terms “rash”, “cutaneous” and drugs names. Results A number of drug skin reactions with psychotropic drugs related in the literature. Many cases of urticarial reactions, erythema or maculopapular rashes are described. These reactions may cause a prolongation of hospitalization. Indeed, a number of fatal cases are found such as DRESS syndrome or Stevens-Johnson syndrome. Faced with serious skin reaction, the offending drug should be stopped. Knowledge of such psychotropic drug eruptions should be acquired by all practitioners using this drug class. Conclusion Practitioners should keep in mind that each prescribed drug must be considered potentially able to cause adverse skin reactions. Psychotropic drugs are not exceptions to this rule and psychiatrists and patients should be aware of this phenomenon. [ABSTRACT FROM AUTHOR]

Background The aim of this study is to look at the correlation between the presence of apathy measured by Marin's scale and family complaints related to withdrawal and the loss of motivation, or depression. The multicentre study was performed on 58 non-demented elderly people, 132 outpatients with Alzheimer's-type dementia, as well as their main caregiver. Methods After agreement of the patients and the family, the patients were assessed using different scales: Cornell's for depression, Marin's for apathy, MMS for cognitive disorders, and IRG for dependence. At the same time, two self-administered questionnaires were given to the patients' families: one concerning a list of complaints scored from 1 to 4 relating to various disorders and the other addressing the boundary ambiguities translated from Boss' questionnaire. The 58 non-demented people were 81.20 years old±13.75. One hundred and thirty-two demented patients were included: 39 men and 93 women. The mean age was 79.47 years±9.03. Results The first family complaint relates to the loss of motivation (65%). Apathy and depression occur more frequently in dementia, in particular when the MMS is degraded. Depression and apathy attracted a high complaint score. In our study the score of boundary ambiguity is higher among patients with a weak cognitive status. A high level of ambiguity is accompanied by a high score of family complaints. When the family complaint concerning the loss of motivation is present, apathy is significantly more common. Family complaints about withdrawal and loss of motivation are frequently present, and are congruent with the actual presence of apathy in the patient. It bears witness to the distress felt by families faced with the loss of ability noted in the demented person. The family's difficulties are increased by the patient's depression. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

[Display omitted] • A comprehensive and unique machine learning-based peptidomic approach. • Electrical current conditions modulate peptide separation and bioactivities. • 1 s/1s polarity reversal intensify the process despite peptides rapid reorientation. • 10 s/1s generates antibacterial recovery fraction and antifungal feed fraction. • The polarization concentration phenomena influence peptides' selective migration. Industrial wastewaters are significant global concerns due to their environmental impact. Yet, protein-rich wastewaters can be valorized by enzymatic hydrolysis to release bioactive peptides. However, achieving selective molecular differentiation and eventually enhancing peptide bioactivities require costly cascades of membranes. In this study, a complex porcine cruor hydrolysate, containing 150 well-characterized peptides and demonstrating only an antifungal activity, was used as a model solution to evaluate the impact of current modes (continuous electrical current (CC), pulsed electric field (PEF) and polarity reversal (PR)) and the combination of pulse/pause-reversal pulse duration (10 s/1 s and 1 s/1 s) during peptides separation by an electromembrane process. The data analysis was assisted by a machine learning (ML)-based peptidomic approach to identify which of the 45 physicochemical characteristics of the peptides explain migration, or lack thereof, during electrodialysis with filtration membrane, a generic electromembrane process. The results demonstrated, for the first time, that electric current conditions modulate the population of recovered peptides and their associated fraction bioactivities. ML models identified the main features correlated to peptide migration, allowing tentative explanations of the underlying peptide selective migration phenomena. For CC-PEF 10 s/1 s–PR 10 s/1 s, isoelectric point (pI) (importance of 63.1%) and molecular weight (MW) (17.7%) were most important. For PEF 1 s/1 s, pI (53.9%), MW (23%) and GRAVY score (6.2%) played major roles. Finally, for PR 1 s/1 s, MW (82.5%), GRAVY score (5.5%) and tyrosine content (1.1%) were the key features. In addition, CC, PEF 10 s/1 s and PR 10 s/1 s allowed the production of two reusable fractions, an antibacterial recovery fraction and a feed fraction retaining antifungal activity, which aligns with the concept of circular economy. [ABSTRACT FROM AUTHOR]

Objectives: Our study aimed at estimating the prevalence of neuropsychiatric symptoms and investigating associated factors among older adults living in two countries in Central Africa (Central African Republic [CAR] and Republic of Congo [ROC]).Methods: The EPIDEMCA multicentre population-based study was carried out in rural and urban areas of CAR and ROC between 2011 and 2012 among people aged 65 and over. After cognitive screening using the Community Screening Interview for Dementia, participants with low performances underwent neurological examination including the brief version of the Neuropsychiatric Inventory Questionnaire (NPI-Q). Multivariate logistic regression analyses were performed to identify factors independently associated with neuropsychiatric symptoms in this population.Results: NPI-Q data were available for 532 participants. Overall, 333 elderly people (63.7%) reported at least one neuropsychiatric symptom. The prevalence of neuropsychiatric symptoms was 89.9% (95% CI, 84.6-95.1) in participants with dementia, 73.4% (95% CI, 65.1-81.7) in participants with mild cognitive impairment (MCI), and 48.7% (95% CI, 42.9-54.6) in participants with no MCI nor dementia after neurological examination (P < 0.0001). The most common symptoms were depression, anxiety, and irritability. Participants living in Gamboma, with normal hearing and with friends in the community, were less likely to present neuropsychiatric symptoms. Physical disability, difficulties in eating, female sex, and dementia were significantly associated with neuropsychiatric symptoms.Conclusion: Neuropsychiatric symptoms are common among older people with neurocognitive disorders in CAR and ROC. Our results confirm those from previous studies in Nigeria and Tanzania. Nevertheless, knowledge of these symptoms remains limited in sub-Saharan Africa, hampering their appropriate management. [ABSTRACT FROM AUTHOR]

Objective: We aimed at estimating the seroprevalence of Toxoplasma gondii (T. gondii) infection in older adults living in Central Africa and investigating its association with dementia using data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) programme.Methods: A cross-sectional multicentre population-based study was carried out among participants aged 73 (±7) years on average, living in rural and urban areas of the Central African Republic and the Republic of Congo between November 2011 and December 2012. Blood samples were collected from each consenting participant. The detection of anti-T. gondii immunoglobulin G antibodies was performed in 2014 in France using a commercially available ELISA kit. Participants were interviewed using a standardised questionnaire including sociodemographic characteristics. DSM-IV criteria were required for a diagnosis of dementia. Multivariate binary logistic regression models were used to assess the association between toxoplasmosis infection and dementia.Results: Among 1662 participants, the seroprevalence of toxoplasmosis was 63.0% (95% confidence interval (CI): 60.7-65.3) overall, 66.6% (95%CI: 63.4-69.8) in Central African Republic and 59.4% (95%CI: 56.1-62.7) in the Republic of Congo. In multivariate analyses, toxoplasmosis status was significantly associated with increasing age (P = 0.006), Republic of Congo (P = 0.002), urban area (P = 0.001) and previous occupation (P = 0.002). No associations between dementia and toxoplasmosis status or anti-T. gondii IgG titres were found.Conclusion: Toxoplasma gondii infection was not associated with dementia among older adults in Central Africa. Our findings are consistent with previous studies and add to the knowledge on the relationship between T. gondii infection and neurological disorders. [ABSTRACT FROM AUTHOR]

Background: Repetitive behaviors (RBs) are a well-known symptom of Alzheimer's disease (AD); however, they have been little studied and have not been the subject of any specific literature review. Objective: To conduct a systematic review of all studies to document RBs in AD. Methods: An extensive literature search combining five databases and a meta-analysis were conducted to investigate the frequency, nature, and cognitive correlates of RBs in AD. Results: Ten studies were included in the review. Seven studies out of ten investigated the frequency of RBs in patients with AD, which ranged from 52.3% to 87%. A meta-analysis showed an overall frequency of 66.3% (95% CI: 55.5; 77.1) of patients exhibiting RBs in AD, but important heterogeneity was observed between studies. Three studies investigated the predominant nature of RBs in AD. Verbal RBs, complex behavioral stereotypies, and simple motor stereotypies have been identified to different degrees depending on the level of dementia. Most verbal RBs are underpinned by episodic memory impairment, while simple motor stereotypies and complex behavioral stereotypies are mostly underpinned by executive dysfunction. Conclusions: The current review seems to suggest that there are two types of mechanisms underpinning RBs involved in AD. The first is observed especially in the mild stages of the disease and is mediated by episodic memory impairment. The second occurs later and is mediated by executive impairment. Additional studies should be conducted to improve the knowledge about RBs in AD and thus improve their management. Systematic review registration number: PROSPERO 2022: CRD42022310027 [ABSTRACT FROM AUTHOR]

It is increasingly being recognized that new declarative, consciously accessible information can be learned in anterograde amnesia, but it is not clear whether this learning is supported by episodic or semantic memory. We report a case of a 55-year-old man who experienced severe amnesia after limited damage to the medial temporal lobe following neurosurgical complications. His general cognitive performance and knowledge of new French words and public events that occurred before and after the onset of amnesia were assessed. Performance remained satisfactory on post-morbid vocabulary and public events, with a drop in performance observed for very recent public events only, while knowledge of very recent vocabulary was comparable to that of the control subjects. The implications of these findings for our understanding of the underlying learning mechanisms are discussed. This is the first report of acquisition of consciously accessible postmorbid knowledge of public events in a patient with severe amnesia. [ABSTRACT FROM AUTHOR]

Background: Patients with psychosis frequently use a variety of psychotropic medicines, many of which have anticholinergic effects that can impair cognition. Therefore, this study aimed to evaluate whether there is an association between medications used for neuropsychological disorders/symptoms and cognition in patients with schizophrenia, focusing on their anticholinergic load and antipsychotic doses. Study design: A cross-sectional study between July 2019 and Mars 2020 at the Psychiatric Hospital of the Cross-Lebanon enrolled 120 inpatients diagnosed with schizophrenia. The total anticholinergic burden was calculated based on the Anticholinergic Drug Scale (ADS), and the chlorpromazine equivalent dose was calculated using the Andreasen method to assess the relative antipsychotic dose. Also, the objective cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) tool. Study results. A significantly higher BACS total score (r = -0.33, p < 0.001), higher verbal memory (r = -0.26, p = 0.004), higher working memory (r = -0.20, p = 0.03), higher motor speed (r = -0.36, p < 0.001), and higher attention and speed of information processing (r = -0.27, p = 0.003) were significantly associated with lower chlorpromazine equivalent dose. Higher ADS (Standardized Beta (SB) = -.22; p =.028), higher chlorpromazine equivalent dose (SB = -.30; p =.001), and taking mood stabilizer medications (SB = -.24; p =.004) were significantly associated with lower cognition. Conclusion: This study confirms that the cognitive functions of chronic patients with schizophrenia may be affected by medications and their anticholinergic burden. More studies are needed to explain the role of cholinergic neurotransmission and general neurochemical mechanisms in the cognitive impairment of patients with schizophrenia. [ABSTRACT FROM AUTHOR]

[Display omitted] • Hydrolysis of Calf-cruor followed the same enzymatic mechanisms as adult bovine hemoglobin. • Peptic hydrolysis of Calf-cruor at pH 2 and pH 3 for 180 min promoted antibacterial activity. • Peptic hydrolysis of Calf-cruor at pH 3 for 30 min promoted antifungal activity. • PLS-DA allowed the identification of antimicrobial peptides from complex solutions. • Three new antifungal peptide sequences α(47–80), β(130–145), and β(102–109) were identified. Calf cruor (C-cru) is an understudied source of antimicrobial peptides that can be used for meat product biopreservation under a circular economy framework. This study assessed the impact of pH and peptic hydrolysis duration of C-cru on the enzymatic mechanism, peptide population, and antimicrobial activities (antibacterial, antifungal, and anti-yeast). The results showed that peptic hydrolysis of C-cru has similar enzymatic mechanisms to adult bovine hemoglobin, fostering the development of a zipper mechanism at pH 2 and 3, while the one-by-one mechanism is promoted at pH 4 and 5. The antimicrobial activities suggested that peptic hydrolysis at pH 2 and 3 for 180 min fostered higher antibacterial activity, while peptic hydrolysis at pH 3 for 30 min favored both antifungal and anti-yeast activities. Furthermore, a supervised machine learning tool was applied for the first time to peptidomic data enabling the elucidation of α(47–80), β(130–145), and β(102–109) as new antifungal peptide sequences. [ABSTRACT FROM AUTHOR]

Background: Patients with schizophrenia have a particularly low level of insight into their illness compared to people with other mental health disorders. The objectives of the study were to evaluate: 1) subjective cognitive complaints in individuals with schizophrenia in comparison with health controls, 2) the relation between subjective cognitive complaint (SCC) and objective cognitive performance in the patients group, and 3) factors related to cognitive complaint, such as depression, insight, autonomy, and psychological symptoms. Methods: Cross-sectional study was conducted between July 2019 and March 2020 enrolled 120 patients with schizophrenia disorders, selected from the Psychiatric Hospital of the Cross (HPC) – Lebanon and 60 healthy controls. The Self-Assessment Scale of Cognitive Complaints in Schizophrenia (SASCCS) was used to measure people living with schizophrenia perception of their cognitive impairment, while the Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate their cognitive functioning. Results: A significant difference was found between schizophrenia patients and healthy controls in all neurocognition and SASCCS tests. The hierarchical regression analysis showed that the BACS total score (Beta = −.06, p =.04), the PANSS general psychopathology (Beta =.29, p =.003), higher depression (Beta =.75, p =.003) were significantly associated with higher SCC. However, higher autonomy (Beta = − 6.35, p =.001) was significantly associated with lower SCC. A Structural equation model showed that the two most contributing variables were general psychopathology (Standardized Beta (SB):.33, p < 0.001) and autonomy (SB: −.29, p < 0.001). Conclusion: A significant proportion of patients with schizophrenia could estimate their cognitive impairment. It also showed a positive correlation between depression and activity of daily living with SCC, suggesting that this aspect should be investigated alongside the clinical symptoms when a patient with schizophrenia presents with SCC. [ABSTRACT FROM AUTHOR]

Background: Assessment of cognitive disorders in schizophrenia is becoming a part of clinical and research practice by using batteries that differ widely in their content. The Brief Assessment of Cognition in Schizophrenia (BACS) was developed to cover the main cognitive deficits of schizophrenia. The objective of this study was to assess concurrent validity of the Arabic version of the BACS with a standard neurocognitive battery of tests in Lebanese patients with schizophrenia and healthy controls. Methods: A sample of 120 stable inpatients diagnosed with schizophrenia and 60 healthy controls received the Arabic version of the BACS in a first session, and a standard battery in a second session. Results: Mean duration of completion for the BACS was 31.2 ± 5.4 min in patients with schizophrenia. All tests demonstrated significant differences between controls and patients (p <.01). Principal components analysis demonstrated that a one-factor solution best fits our dataset (64.8% of the variance). High Cronbach alpha was found (.85). The BACS composite scores were significantly correlated with the standard battery composite scores in patients (r =.73, p <.001) and healthy controls (r =.78, p <.001). Also, correlation analysis between the BACS sub-scores and the standard battery sub-scores showed significant results (p <.05). Conclusion: Results showed that the Arabic version of the BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls and it is a useful tool for assessing cognition in patients with schizophrenia and could be used in clinical practice in Lebanon. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Neuropsychiatric symptoms are common in dementia. Limited data are available concerning their association with dementia in developing countries. Our aim was to describe the severity of neuropsychiatric symptoms among older people, evaluate the distress experienced by caregivers, and assess which neuropsychiatric symptoms were specifically associated with dementia among older adults in Central Africa. DESIGN: This study is part of the EPIDEMCA program, a cross‐sectional multicenter population‐based study. SETTING: The EPIDEMCA program was conducted from November 2011 to December 2012 in urban and rural areas of the Central African Republic and the Republic of the Congo. PARTICIPANTS: Participants were older people (≥65 y) included in the EPIDEMCA program who underwent a neuropsychiatric evaluation. The sample included overall 532 participants, of whom 130 participants had dementia. MEASUREMENTS: Neuropsychiatric symptoms were assessed with the brief version of the Neuropsychiatric Inventory including the evaluation of severity and associated distress. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision, criteria were followed to diagnose dementia. A logistic regression model was used to identify associated neuropsychiatric symptoms. RESULTS: The prevalence of neuropsychiatric symptoms was 89.9% (95% confidence interval = 84.6‐95.1) among people living with dementia. The overall median severity score for neuropsychiatric symptoms was 9 [interquartile range [IQR] = 6‐12], and the overall median distress score was 7 [IQR = 4‐10]. Overall median scores of both severity and distress were significantly increased with the number of neuropsychiatric symptoms, the presence of dementia, and dementia severity. Depression, delusions, apathy, disinhibition, and aberrant motor behavior were associated with dementia after multivariate analysis. CONCLUSION: This report is one of the few population‐based studies on neuropsychiatric symptoms among older people with dementia in Sub‐Saharan Africa and the first one evaluating the severity of those symptoms and distress experienced by caregivers. Individual neuropsychiatric symptoms were strongly associated with dementia in older people and require great attention considering their burden on populations. J Am Geriatr Soc 68:180–185, 2019 [ABSTRACT FROM AUTHOR]

Background: There are a few validated tools capable of assessing the dimensions essential for the diagnosis of dementia and cognitive disorders in sub-Saharan Africa. Objectives: Our aim was to develop an adapted tool, the Central African – Daily Functioning Interference (DFI) scale. Methods: An initial 16-item scale of activity limitations and participation restrictions was completed by 301 participants with low cognitive performances to assess their level of DFI. A psychometric evaluation was performed using Item Response Theory. Results: A unidimensional 10-item scale emerged with a reasonable coverage of DFI (thresholds range: –1.067 to 1.587) with good item discrimination properties (1.397–4.076) and a high reliability (Cronbach's al pha = 0.92). The cutoff for detecting 96% of those with dementia was with a latent score ≥0.035 that corresponds to the LAUNDRY limitation. Conclusions: These results provide valuable support for the reliability and internal validity of an operational 10-item scale for DFI assessment used in Central Africa for the diagnosis of dementia in the elderly. [ABSTRACT FROM AUTHOR]

Background Alzheimer's disease (AD) causes progressive loss of memory and disability, especially in older people. As worldwide population grows older, AD is responsible for an important social and economical burden in many nations. People suffering from AD may experience health-related stigma that influences their attitudes towards seeking assistance. The STIG-MA survey describes perceived stigma against AD in a French population. Methods The STIG-MA questionnaire was completed anonymously by people attending an awareness campaign about AD in Creuse, France, in September 2010. Participants answered 10 questions about how they would feel or react if they had AD. Stigma scores were compared by age, activity, and interest in AD. Results Thirty-three percent of people attending the campaign filled out the survey. Most were women (85%) younger than 50 years (59%); 10% were older people (older than 75 years). Twenty-one percent worked in health or social fields. Interest in AD was professional (48%), related to family (41%), or personal (11%). Professionals in health fields expressed the highest levels of stigma ( p = 0.02). Low stigma was most frequent in older people ( p = 0.05). Type of interest did not influence stigma. Shame, loss of self-esteem, and fear of exclusion were expressed the most. Conclusion The STIG-MA survey confirms that AD is a stigmatizing condition in France. The difference between perceived stigma of older people, those most exposed to AD, and that of health professionals may influence attitudes towards screening and care. Further studies of perceived stigma in these populations are necessary to adapt intervention strategies. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives To investigate the association between peripheral arterial disease ( PAD) and dementia in native elderly African populations. Design Two successive door-to-door cross-sectional surveys in the general population. Settings Representative districts of Bangui (Central African Republic) and Brazzaville (Republic of Congo). Participants Population aged 65 and older. Measurements Peripheral arterial disease was defined as an ankle-brachial index ( ABI) of 0.90 or less. Cognitive screening was performed using the Community Screening Interview for Dementia and the Five-Word Test. Diagnosis of dementia was confirmed after further neuropsychological tests and neurological examination according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Multivariate logistic regression models were used to quantify the association between PAD and dementia in those populations, with adjustments for cardiovascular disease ( CVD) and other variables. Results A significant association was observed between PAD and prevalent dementia (odds ratio ( OR) = 2.43, 95% confidence interval ( CI) = 1.44-4.13, P = .001), even after adjustment for age, city, sex, CVD risk factors, education, and depressive disorders ( OR = 2.37, 95% CI = 1.31-4.26, P = .004). This association was stronger with lower ABI. Conclusion These findings support the hypothesis of a link between atherosclerosis (represented by a low ABI) and cognitive disorders in native Africans and are similar to previous reports in African Americans and other ethnic groups. [ABSTRACT FROM AUTHOR]

Objectives To investigate the association between peripheral arterial disease ( PAD) and dementia in native elderly African populations. Design Two successive door-to-door cross-sectional surveys in the general population. Settings Representative districts of Bangui (Central African Republic) and Brazzaville (Republic of Congo). Participants Population aged 65 and older. Measurements Peripheral arterial disease was defined as an ankle-brachial index ( ABI) of 0.90 or less. Cognitive screening was performed using the Community Screening Interview for Dementia and the Five-Word Test. Diagnosis of dementia was confirmed after further neuropsychological tests and neurological examination according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Multivariate logistic regression models were used to quantify the association between PAD and dementia in those populations, with adjustments for cardiovascular disease ( CVD) and other variables. Results A significant association was observed between PAD and prevalent dementia (odds ratio ( OR) = 2.43, 95% confidence interval ( CI) = 1.44-4.13, P = .001), even after adjustment for age, city, sex, CVD risk factors, education, and depressive disorders ( OR = 2.37, 95% CI = 1.31-4.26, P = .004). This association was stronger with lower ABI. Conclusion These findings support the hypothesis of a link between atherosclerosis (represented by a low ABI) and cognitive disorders in native Africans and are similar to previous reports in African Americans and other ethnic groups. [ABSTRACT FROM AUTHOR]

Risk factors for dementia in American and European countries have been well investigated. However, little research has been carried out in sub-Saharan Africa, where life events as well as environmental, socio-economic, and modifiable risk factors (i.e., cardiovascular risk factors) may differ. Two cross-sectional surveys were conducted in representative samples of the older general population living in Bangui (Central African Republic) and Brazzaville (Congo). Dementia was defined according to the DSM-IV criteria. Multivariate regression analyses were performed in order to identify independent factors associated with dementia. Among the 977 elderly Africans included in this analysis, 75 (7.6%) were diagnosed as having dementia. Increasing age, female gender, hypertension, a body mass index <18.5 kg/m2, depressive symptoms, and the lack of a primary education were significantly associated with dementia. Among life events, the death of one parent during childhood and recently having moved house were also associated with dementia. Beyond the usual risk factors for dementia, this study highlights the role of stressful events in low-income countries. Factors associated with dementia in African countries seem different from established factors in high-income countries and require further investigation. [ABSTRACT FROM AUTHOR]

Depression is often overlooked in elderly nursing home residents because symptoms may be masked or dismissed as an inevitable consequence of ageing. Current tools for the detection of depression in institutionalised older people are not always specific. Aims: To construct and verify an instrument with which to detect depression in elderly nursing home residents (NH-SDI). Method: Firstly for the construction, 328 elderly people were selected at random from the residents of 17 nursing homes in France, and examined by a single investigator. The examination included a psychiatric assessment, an evaluation of cognitive function using the MMSE, an evaluation of depressive state using four different instruments (mini-GDS, Goldberg, DMAS, CSDD), and assessment of any changes in behaviour in those suffering from dementia, using the NPI. A second stage was to confirm NH-SDI in 99 institutionalised subjects. Results: Following the selection of items, we created a scale of 16 dichotomous items (NH-SDI). The internal consistency was satisfactory (a Cronbach¼0.85), as was its reliability with a sensitivity of 85.1% and a specificity of 86.5% for a cut-off score above 5. Conclusions: The NH-SDI appears to be a useful instrument for the detection of depression in nursing homes and can easily be applied by healthcare staff as part of routine procedures. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To investigate the association between a low ankle-brachial index (ABI) and several grades of cognitive disorders: cognitive impairment, dementia and Alzheimer''s disease (AD), in the general population. Methods: We performed a systematic review of the literature, including all prospective, longitudinal or cross-sectional studies assessing both peripheral artery disease (PAD), defined by a low ABI, and cognitive function. Results: 12 publications were included in this review, of whom 6 reported cross-sectional analysis and 6 reported longitudinal analysis. All except one reported a significant association between a low ankle-brachial index and cognitive impairment, dementia or AD. Beyond cognitive impairment, patients with PAD are at an increased risk to develop dementia or Alzheimer''s disease. Conclusion: In this review, we confirm that a low (<0.90) ABI can be considered as a marker of cognitive impairment and dementia. ABI provides independent and supplemental information on subject''s susceptibility to develop cognitive disorders, along its usefulness to predict cardiovascular diseases (CVD). Given its availability, easiness, safety to patients and low cost, the ABI could be useful in clinical practice and research in the field of cognitive diseases. [Copyright &y& Elsevier]

Background: Data on dementia from low- and middle-income countries are still necessary to quantify the burden of this condition. This multicenter cross-sectional study aimed at estimating the prevalence of dementia in 2 large cities of Central Africa. Methods: General population door-to-door surveys were conducted in the districts of Bangui (Republic of Central Africa) and Brazzaville (Congo) in elderly aged ≥65 years. The subjects were screened with the Community Screening Interview for Dementia and the Five-Words Test. Diagnosis of dementia was made according to the DSM-IV criteria and to the clinical criteria proposed by the NINCDS-ADRDA for Alzheimer's disease. Results: We enrolled 496 subjects in Bangui and 520 in Brazzaville. The prevalence of dementia was estimated at 8.1% (95% CI = 5.8-10.8) in Bangui and 6.7% (95% CI = 4.7-9.2) in Brazzaville. Conclusion: The prevalence of dementia in urban areas of Central Africa is close to those observed in high-income countries. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Behavioral and psychological symptoms in dementia (BPSD) are very common, with 90% of patients experiencing at least one during the course of the disease. One-third of persons with dementia have depressive symptoms, and concomitant BPSD are very likely. Objective This study aimed to characterize the psychological and behavioral manifestations of depression in patients with dementia. Methods We recruited patients with dementia from several nursing homes in the Limousin region of France. Depression was as diagnosed by the Cornell Scale for Depression in Dementia (CSDD) with a cut-off of 7, and BPSD were assessed using the Neuropsychiatric Inventory (NPI). Results Of 319 patients with dementia, 42.9% (n = 137) were depressed and 75.9% (n = 242) had BPSD. All BPSD were significantly (p < 0.0001) more prevalent among depressed patients, but no significant differences were observed according to sex and age. The NPI showed that the most common additional symptoms in depressed patients were agitation (43.2%), anxiety (42.3%) and irritability (40.1%). Four NPI-based factors were indentified (63.9% of the common variance): factor 1 (disinhibition, irritability, agitation, anxiety), factor 2 (sleep disturbance, aberrant motor behavior, apathy), factor 3 (elation, hallucination, delirium) and the last with eating disorders. Depression in dementia patients was significantly associated with disinhibition, irritability, agitation, and anxiety. Conclusion BPSD are common and a major problem. Before addressing them as isolated symptoms, it is important to consider comorbidity with depression in order to optimize the therapeutic approach. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Stigma is a major burden of epilepsy. In sub-Saharan Africa the few studies that addressed epilepsy stigma emphasize enacted, rather than perceived, stigma. This inattention may compromise clinical management and delay help seeking, thereby contributing to the treatment gap. We assessed perceived stigma and identified sociocultural and psychological factors explaining greater stigma among people with epilepsy (PWE) in Benin. PWE included in this study were ascertained using a door-to-door survey in the general population in a Beninese rural area. We applied both qualitative and quantitative research methods to assess stigma and patient’s experience and beliefs. An Explanatory Model Interview Catalogue (EMIC) and verbally administered questionnaires provided data for demographic, clinical, and sociocultural features. Sociocultural features were evaluated in terms of illness-related experience and sociocultural representations of epilepsy. Depression and anxiety were also screened. Eighty PWE were included. About 68.7% reported feeling stigmatized. Multivariate regression revealed that factors independently associated with perceived stigma were experience of social isolation (p < 0.001), experience of marital problems (p < 0.01), and presence of anxiety disorder (p < 0.01). Perceived stigma is an important issue in epilepsy in Benin. Social factors seem to be more influential than sociocultural representation of epilepsy. Insofar as research is needed in other African countries to determine the nature and relevant features of stigma to improve treatment and control. [ABSTRACT FROM AUTHOR]

Background/Aims: Dementia is increasing as a priority public health problem because of the ageing of the world population. Our goal was to estimate dementia and cognitive impairment prevalence in an elderly population of rural Benin. Methods: In a door-to-door survey, elderly people aged 65 years and above were screened using the Community Screening Interview for Dementia and the Five-Word Test. Results: The prevalence of cognitive impairment was 10.4% and that of dementia was 2.6%. Age, current depressive disorder and absence of the APOE ε2 allele were significantly associated with cognitive impairment. Conclusion: Prevalence of dementia and cognitive impairment appears to be lower in this study than in developed countries. Copyright © 2009 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background Alzheimer's disease and related syndromes have heavy social and human consequences for the patient and his family. Beyond the neuropsychiatric effects of specific therapies for dementia, one of today's challenges is the quality of life for both patients and their informal caregivers. Objectives This survey tends to determine parameters influencing caregivers' quality of life, and its possible link with patients' quality of life. Methods A scale measuring caregivers' quality of life, developed from data from previous PIXEL studies was used. It is a questionnaire composed of 20 items. The scale was related to the socio-demographic data of both patients and their main caregivers, to the ADRQL scale (Alzheimer Disease Related Quality Life) of Rabins for the QoL of dementia patients, to the patients medical and therapeutic data, specially a neuropsychological inventory: Folstein's cognition test, Cornell's depression scale, the fast battery of frontal assessment, Katz's dependence index, Cummings' neuropsychiatric inventory for behavioral and psychological symptoms of dementia and to a physician evaluation of caregiver's depression. Results One hundred patients diagnosed with dementia who live at home with their principal caregivers were recruited for this survey. Patients were 80.2 ± 6.8 years old and caregivers were 65.7 ± 12.8 years old. The caregivers' quality of life was correlated to the quality of life of the patients they cared for, the importance of behavioral disorders, and the duration of dementia evolution. Women caregivers had a worse quality of life and were more depressive than men. Discussion Caregivers' and patients' quality of life are related and both share a community of distress. Copyright © 2005 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Study of the problems and requirements of the main caregiver providing home care for dementia patients that have resulted in the patient being institutionalised. To determine the reasons for placing the dementia patient in an institution. Self-administered questionnaire of 48 questions on the patient and caregiver, including a list of complaints, given to the main caregiver. Medical questionnaire on the patient filled in by the geriatrician. Data were collected from 109 questionnaires concerning 75 females with dementia (84.7 +/- 6.7 years) and 34 demented males (80.8 +/- 7.4 years). In two-thirds of cases the main caregiver was a female, aged 61.1 +/- 12.1 years. Cognitive disorders were not the main reasons for institutionalizing patients. The most frequent caregiver complaint at the time of institutionalisation was incontinence, followed by withdrawal. The caregiver's main problem resulting in institutionalisation was dependence, with behavioural disorders in second place. A treatment with anticholinesterase for dementia was associated with a live-in career being provided for 20 months longer than in the case of patients not receiving this treatment. Statistical analysis revealed 6 groups of separate caregiver-patient situations. On the one hand there were those patients who appeared to be easy for the caregiver to cope with: those with no problems, docile patients and passive patients not opposing care. In these cases the caregiver was most often young and male, or not directly related to the patient. On the other hand there were 3 other groups: patients with inappropriate motor behaviours, violent/agitated patients and unmotivated patients who opposed care. These patients lived with an elderly caregiver who had been looking after the patient for several years. Caregivers' requirements are for help with coping with and preventing dependence. The caregiver suffers terribly from a lack of relief, particularly when young. It is necessary to change the focus of home care for dementia patients towards preventing loss of autonomy and its consequences and to allow for periods of relief for home caregivers. [ABSTRACT FROM AUTHOR]

ContextStudy of the problems and requirements of the main caregiver providing home care for dementia patients that have resulted in the patient being institutionalised. ObjectivesTo determine the reasons for placing the dementia patient in an institution. ResourcesSelf-administered questionnaire of 48 questions on the patient and caregiver, including a list of complaints, given to the main caregiver. Medical questionnaire on the patient filled in by the geriatrician. ResultsData were collected from 109 questionnaires concerning 75 females with dementia (84.7 ± 6.7 years) and 34 demented males (80.8 ± 7.4 years). In two-thirds of cases the main caregiver was a female, aged 61.1 ± 12.1 years. Cognitive disorders were not the main reasons for institutionalising patients. The most frequent caregiver complaint at the time of institutionalisation was incontinence, followed by withdrawal. The caregiver's main problem resulting in institutionalisation was dependence, with behavioural disorders in second place. A treatment with anticholinesterase for dementia was associated with a live-in carer being provided for 20 months longer than in the case of patients not receiving this treatment. Statistical analysis revealed 6 groups of separate caregiver-patient situations. On the one hand there were those patients who appeared to be easy for the caregiver to cope with: those with no problems, docile patients and passive patients not opposing care. In these cases the caregiver was most often young and male, or not directly related to the patient. On the other hand there were 3 other groups: patients with inappropriate motor behaviours, violent/agitated patients and unmotivated patients who opposed care. These patients lived with an elderly caregiver who had been looking after the patient for several years. DiscussionCaregivers' requirements are for help with coping with and preventing dependence. The caregiver suffers terribly from a lack of relief, particularly when young. ConclusionIt is necessary to change the focus of home care for dementia patients towards preventing loss of autonomy and its consequences and to allow for periods of relief for home caregivers. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

ContextProspective study of the complaints, problems and requirements of the main caregiver providing home care for dementia patients. ObjectivesTo determine the complaints of home caregivers, how they are interrelated and what causes them. ResourcesSelf-administered questionnaire of 42 questions on the patient and caregiver, including a list of complaints, given to the main caregiver. Medical questionnaire on the patient filled in by the attending physician, usually a specialist, freelance or salaried doctor. Results408 sets of records were compiled, concerning 236 demented women (77.1 ± 0.47 years) and 172 demented men (75.7 ± 0.57 years). In two-thirds of cases, the main caregiver was a woman aged 60.6 ± 0.79 years. Female caregivers were more vulnerable than male caregivers. The most frequent caregiver complaint, regardless of the stage of the disease, concerned loss of motivation and withdrawal. The patient's awareness of the disorder was accompanied by a reduction in motor dysfunction and aggressiveness, but associated with a higher frequency of the complaint regarding loss of motivation reported by the caregiver. The caregivers' problems concerned mainly the absence of relief and the impossibility of having any time to themselves. Caregivers' requests for information concerned medical information, care structures and day care facilities. DiscussionThe attending physician comes into close contact with the patient, but must take into account the patient's environment. The physician can provides a separate analysis to the caregiver and does not completely answer to certain family questions or needs. He or she is not the family's prime source of information. The caregivers' requirements relate to the areas that are the attending physician's responsibility: the development and characteristics of the disease. The caregiver is anxious about the patient's future and is trapped by his or her involvement in the care, suffering greatly from the lack of relief. ConclusionsIt is necessary to change the focus of home care for dementia patients to fit the context in which they live and to allow for periods of relief for home caregivers. Copyright © 2002 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

A correction to the article "Epidemiology of dementia in Central Africa (EPIDEMCA): protocol for a multicentre population-based study in rural and urban areas of the Central African Republic and the Republic of Congo," by Pascal Mblesso et al, published in a previous issue is presented.

A letter to the editor is presented which is concerned with violence and accusations of witchcraft against older people with dementia being seen in central and western Africa.