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Background Independence is related to the aging process. Loss of independence is defined as the inability to make decisions and participate in activities of daily living (ADLs). Independence is related to physical, psychological, biological, and socioeconomic factors. An enhanced understanding of older people’s independence trajectories and associated risk factors would enable the develop early intervention strategies. Methods Independence trajectory analysis was performed on patients identified in the Unité de Prévention de Suivi et d’Analyse du Vieillissement (UPSAV) database. UPSAV cohort is a prospective observational study. Participants were 221 community-dwelling persons aged ≥75 years followed for 24 months between July 2011–November 2013 and benefits from a prevention strategy. Data were collected prospectively using a questionnaire. Independence was assessed using the “Functional Autonomy Measurement System (Système de Mesure de l’Autonomie Fonctionnelle (SMAF))”. Group-based trajectory modeling (GBTM) was performed to identify independence trajectories, and the results were compared with those of k-means and hierarchical ascending classifications. A multinomial logistic regression was performed to identify predictive factors of the independence trajectory. Results Three distinct trajectories of independence were identified including a “Stable functional autonomy (SFA) trajectory” (53% of patients), a “Stable then decline functional autonomy decline (SDFA) trajectory” (33% of patients) and a “Constantly functional autonomy decline (CFAD) trajectory” (14% of patients). Not being a member of an association, and previous fall were significantly associated of a SDFA trajectory (P P Conclusions Community-living older persons exhibit distinct independence trajectories and the predictive factors. The evidence from this study suggests that the prevention and screening for the loss of independence of the older adults should be anticipated to maintaining autonomy.

Introduction: Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance. Methods: It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models. Results: Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%–69.1%] and 23.7% [95% CI: 20.1%–27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1–4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9–3.7). Conclusion: In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.

Management of oropharyngeal dysphagia (OD) is mainly based on modifying liquid viscosity and solid consistency in order to preserve oral feeding while avoiding unsafe swallowing. Adding thickening powders (TP) to water is the most common practice in patients suffering from OD to liquids, but ready-to-use gelled waters (RGW) can also be proposed. The main objective of this study was to assess the efficacy of a RGW and a TP on swallowing in hospitalized patients with different OD etiologies. This open, crossover, multicenter trial recruited thirty hospitalized patients with OD to liquids, confirmed by positive 3-ounce water test or positive Practical Aspiration Screening Scheme test. The patient’s ability to swallow 120 g of a RGW (IDDSI level 4) and a drink prepared with TP (nectar viscosity; NTP, 291 cP, IDDSI level 2; or if necessary, honey; HTP, 769 cP, IDDSI level 3) was evaluated in a random order at 1- to 3-day intervals. The main criterion was the efficacy of each product, defined as the proportion of patients who successfully swallowed without immediate reflexive cough. The RGW and TP were successfully swallowed in respectively 93.3% (95% CI: 77.9–99.2) and 82.8% (95% CI: 64.2–94.2) of patients with different dysphagia etiologies (stroke, neurodegenerative diseases, or aging) and unable to swallow thin water. Taste and texture of both study products were well appreciated by patients, with a preference for the RGW over TP. Therefore, the use of these thickened products could be part of the therapeutic strategy for patients with OD to liquids.

Hip fracture is a frequent and serious condition in the elderly. We conducted a retrospective cohort study to answer the following questions: (1) Could treatment in an orthogeriatric unit help to reduce the average length of stay for patients aged over 75 years admitted to hospital for the treatment of a hip fracture?; and (2) Could such treatment influence the post-operative outcomes of patients with hip fracture? Our study included 534 patients admitted to hospital between January 2017 and December 2018 for surgical treatment of a hip fracture. We compared 246 patients who received traditional orthopaedic care with 288 patients treated in an orthogeriatric unit. Our cohort included 410 women (77%). The average age was 87.5 ± six years, and 366 patients (68%) were living at home prior to the fracture. A statistically significant difference in median length of stay (from 10 to 9 days) was observed between patients who did and did not receive orthogeriatric unit treatment (groups 1 and 2; 95% CI: 0.64; 2.59; p = 0.001). There was no difference in pre-operative delay, intra-hospital mortality rate, place of recovery, rate of institutionalisation after six months, or the number of new fractures at 6 months between the groups. The mortality rate after six months was 23.6% and 21.3% in groups 1 and 2, respectively; the difference was not significant. Orthogeriatric unit treatment reduced the median length of stay by one day, in line with most previous studies. According to Pablos-Hernandez et al., multifaceted orthogeriatric treatment is most effective. In our study, only 38% of the patients received surgical treatment within 48 hours, where early surgery is key for reducing the length of hospital stay. The intrahospital mortality rate was 2.6%, which is comparable to literature data. The discharge rate did not differ by orthogeriatric treatment status, which is also consistent with previous findings (e.g. Gregersen et al.). Lastly, the mortality rate after six months was slightly reduced by orthogeriatric care. In line with this, Boddaert et al. reported a difference in mortality rate after six months between groups who did and did not receive orthogeriatric treatment (15% vs. 24%).

Introduction: The prevalence of neurocognitive disorders (NCDs) increases with age and is associated with cognitive impairment. Older patients with NCD admitted to the emergency department (ED) are readmitted after discharge to home more often than those without NCD. Comprehensive geriatric assessment (CGA) is effective for improving clinical outcomes in older patients; however, the usefulness of CGA for older patients with NCD admitted to the ED has not been investigated. The main objective of our study is to assess the effectiveness of a geriatric emergency medicine unit (GEMU) for elderly patients with NCD admitted to the ED. Methods: This historical cohort study included patients aged 75 years and older with NCD admitted to the ED of Limoges University Hospital in France over a 4-year period. We compared patients treated in our hospital’s GEMU, the MUPA unit (exposed group), and patients who received standard care by emergency physicians (control group). The primary end point was the incidence of 30-day readmissions. Results: The study included 801 patients admitted to the ED between January 1, 2015, and December 31, 2018 (400 in the exposed group). Of those, 72.5% were female, and the mean age was 87 ± 5 years. After adjusting for confounding factors, the 30-day readmission rate was significantly associated with the MUPA unit intervention. Conclusion: CGA in a GEMU improved health outcomes in elderly patients with NCD in the ED. We recommend that all EDs include a geriatric team, such as the MUPA unit, to treat all patients with NCD admitted to the ED.

Introduction Proximal femur fractures are common and dangerous in older adults, given the high short-term mortality rate. While surgical treatment is vital, medical orthogeriatric care may reduce the 6-month mortality rate; however, this has not been determined on a broad scale in France. This led us to conduct a retrospective study to answer the following questions: (1) Does delayed surgical treatment impact the 6-month mortality rate? (2) Are there correctable medical factors that impact the 6-month mortality? Hypothesis Delayed surgical treatment is not an isolated risk factor for higher 6-month mortality after proximal femur fracture. Methods We included all patients 75 years or older who had suffered a proximal femur fracture requiring surgical treatment. This allowed us to analyze the medical records of 476 patients retrospectively. We documented their comorbidities and pre-, intra- and postoperative characteristics. A univariate then multivariate analysis was done to identify risk factors for mortality at 6 months. Results In the univariate analysis, time to surgery of more than 48 hours increased the risk of dying at 6 months by 1.5 fold (Odds ratio (OR) = 1.57/95% CI: 1–2.48/p = 0.04). However, this risk factor was not significant in the multivariate analysis since it is not an independent risk factor. In the multivariate analysis, anticoagulants (OR = 2/95% CI: 1.13–3.50/p = 0.02), dementia (OR = 2.2/95% CI: 1.32–3.59/p = 0.002), peripheral artery disease (OR = 2.9/95% CI: 1.10–7.70/p = 0.03), 2-point drop in hemoglobin count from preoperative to postoperative (OR = 1.9/95% CI: 1.05–3.12/p = 0.04), male sex (OR = 1.82/95% CI: 1.05–3.12/p = 0.04), age above 85 years (OR = 5.26/95% CI: 1.49–5.26/p = 0.002) and Charlson comorbidity index ≥ 7 (OR = 2.13/95% CI: 1.29–3.52/p = 0.003) were statistically associated with mortality at 6 months. Discussion/Conclusion Our study found that the patients most at risk for dying within 6 months of a hip fracture were males, older than 85 and have associated medical conditions (Charlson index ≥ 7). Prior anticoagulant treatment increases the time to surgery in our study and therefore increases the risk of these patients dying within 6 months. Treatment of these at-risk patients should ensure that their underlying medical conditions are not made worse, while providing treatment within 48 hours. Patients taking anticoagulants must be monitored carefully to ensure surgical treatment is not delayed. Level of evidence IV, retrospective study without control group.

Background Hyponatremia is the most common electrolyte disorder in older adults and it can increase morbidity and mortality. Approximately one in three older adults fall each year; mild chronic hyponatremia can predispose this group to injurious falls and fractures and serum levels of sodium can also influence bone health. Little is known regarding the association between mild chronic hyponatremia and injurious fall prevalence in elderly patients admitted to the Emergency Department (ED). Therefore, the present study investigated the link between mild hyponatremia and the risk of injurious falls in elderly patients admitted to the Emergency Geriatric Medicine Unit (The MUPA Unit). Methods This cross-sectional study was conducted over 4 months and included patients ≥75 years of age who were admitted to the MUPA Unit of University Hospital Center of Limoges (France). Sociodemographic factors, fall events, comorbidities, medications, and sodium levels were assessed (hyponatremia was considered as sodium level < 136 mEq/L). Additionally, the short Comprehensive Geriatric Assessment (short-CGA), the Frailty score on the Short Emergency Geriatric Assessment (SEGA), and the Katz Activity of Daily Living (ADL) scale were administered. Results Of the 696 cases included in the final analysis, the mean age was 86.1 ± 5.6 years and 63.1% were female. The prevalence of falls was 27.9% (95% confidence interval [CI]: 24.6–31.2%) and that of mild hyponatremia was 15.9% (95% CI: 13.2–18.6%). The prevalence rate of mild hyponatremia was 13.2% (95% CI: 10.1–16.3%) in patients without falls and 26.1% (95% CI: 19.8–32.4%) in patients admitted for falls. Mild hyponatremia was significantly associated with falls (P < 0.001) and the adjusted odds ratio (OR) was 3.02 (95% CI: 1.84–4.96). Conclusions Because mild hyponatremia might be a risk factor for injurious falls and ED admission, determination of sodium levels during basic biomarker assessment on ED admission could be an important component of fall prevention strategies for the elderly.

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Background Stroke causes functional decline, psychological disorders and cognitive impairments that affect activities of daily living and quality of life. Although physical activity (PA) is beneficial in stroke recovery, PA recommendations are rarely met after hospital discharge. There is presently no standard strategy for monitoring and inciting PA at home during the subacute phase of stroke recovery. The main aim of this study is to evaluate the effects of a home-based physical activity incentive and education program (Ticaa’dom) on functional capacity in subacute stroke patients. Methods This study is a comparative prospective, observer-blinded, monocentric, parallel, randomized controlled clinical trial. This study will include 84 patients: 42 patients in the home-based physical activity incentive group (HB-PAI) and 42 in the control group (CG). The intervention group will follow the HB-PAI program over 6 months: their PA will be monitored with an accelerometer during the day at home while they record their subjective perception of PA on a chart; they will observe a weekly telephone call and a home visit every three weeks. The CG will receive traditional medical care over 12 months. The main study outcome will be the distance on a 6-minute walk test. Secondary outcomes will include measurements of lower limb strength, independence level, body composition, cardiac analysis, fatigue and depression state. Discussion The results of this trial will demonstrate the value of implementing the Ticaa’dom program during the subacute phase of stroke recovery. Trial registration ClinicalTrials.gov, NCT01822938. Registered on 25 March 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2410-9) contains supplementary material, which is available to authorized users.

International audience; We investigated the association between elevated plasma concentrations of circulating soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) and injurious falls and mortality over a 5-year period. We studied the prospective relationship between levels of circulating adhesion molecules and falls in 680 community-dwelling participants in the MOBILIZE Boston Study. The mean sVCAM-1 (±SD) concentration was 1192 ± 428 ng/mL. Over 5-years of follow-up, 10.2% of participants died. The baseline sVCAM-1 (±SD) concentration was 1434 ± 511 ng/mL in those who died vs. 1162 ± 402 ng/mL in those who survived (P

Introduction Neuropsychiatric symptoms (NPSs) in elderly patients with dementia are frequent in long-term care facilities (LTCFs) and are associated with adverse events. Telemedicine is an emerging way to provide consultation and care to dependent LTCF residents who may not have easy access to specialty services. Several studies have evaluated telemedicine for dementia care but to date, no study has evaluated its impact in the management of NPS in patients with dementia living in LTCF. Methods and analysis The Dementia in long-term care facilities: Telemedicine for the management of neuropsychiatric symptoms (DETECT) study is a 24-month multicentre prospective cluster randomised controlled study with two arms: a control arm (usual care) and an intervention arm (telemedicine consultation) for NPSs management. DETECT enrolled 20 LTCFs. The primary outcome is based on the acceptability of the telemedicine among the LTCF staff which will be assessed in the intervention group by quantitative and qualitative indicators. The rate of unscheduled hospitalisations and/or consultations due to disruptive NPSs, psychotropic drug use and health costs will be described in both groups. Approximately, 200 patients are expected to be recruited. Ethics and dissemination The study protocol was approved and sponsored by the French Ministry of Health. The study received ethical approval from the Toulouse University Hospital Institutional Review Board. We will communicate the final results to the public via conferences and results will also be submitted for publication in international peer-reviewed scientific journals. Trial registration number NCT02472015.

Dental neglect and high levels of unmet dental needs are becoming increasingly prevalent among elderly residents of long-term care facilities, although frail, elderly, and dependent populations are the most in need of professional dental care. Little is known about the validity of teledentistry for diagnosing dental pathology in nursing home residents., To evaluate the accuracy of teledentistry for diagnosing dental pathology, assessing the rehabilitation status of dental prostheses, and evaluating the chewing ability of older adults living in nursing homes (using direct examination as a gold standard)., Multicenter diagnostic accuracy study performed in France and Germany., Eight nursing homes in France and Germany., Nursing home residents with oral or dental complaints, self-reported or reported by caregivers, willing to receive oral or dental preventive care. In total, 235 patients were examined. The mean age was 84.4 ± 8.3 years, and 59.1% of the subjects were female., The patients were examined twice. Each patient was his or her own control. First, the dental surgeon established a diagnosis by reviewing a video recorded in the nursing home and accessed remotely. Second, within a maximum of 7 days, patients were examined conventionally (face-to-face) by the same surgeon who established the initial diagnosis., All residents received a comprehensive clinical examination in their home by a trained geriatrician and underwent a dental hygiene evaluation that used the Silness-Loe and Greene-Vermillion dental hygiene assessment indices. The diagnoses established via the video recording and in the face-to-face setting were compared. The main outcome measure was number of dental pathologies., In total, 128 (55.4%) patients had a dental pathology. The sensitivity of teledentistry for diagnosing dental pathology was 93.8% (95% confidence interval [CI] 90.7-96.9), and the specificity was 94.2% (95% CI 91.2-97.2). Among the 128 cases of dental pathology identified by teledentistry, 6 (4.8%) were false positives. The teledentistry assessments were quicker than the face-to-to-face examinations (12 and 20 minutes, respectively)., Teledentistry showed excellent accuracy for diagnosing dental pathology in older adults living in nursing homes; its use may allow more regular checkups to be carried out by dental professionals.

Background Elevated plasma soluble vascular cell adhesion molecule-1 (sVCAM-1) is a presumed marker of endothelial dysfunction, both in the brain and systemic circulation. Impairments in memory and cognition have been associated with cardiovascular diseases, but little is known about their relationships to abnormal cerebral endothelial function. Methods We studied the cross-sectional association between sVCAM-1 and markers of cerebrovascular hemodynamics and cognitive function in 680 community-dwelling participants in the MOBILIZE Boston Study, aged 65 years and older. Cognitive function was assessed using the Hopkins Verbal Learning Memory Test and Trail Making Tests (TMTs) A and B. Global cognitive impairment was defined as Mini-Mental State Examination (MMSE) score less than 24. sVCAM-1 was measured by ELISA assay. Beat-to-beat blood flow velocity (BFV) and cerebrovascular resistance (CVR = mean arterial pressure / BFV) in the middle cerebral artery were assessed at rest by transcranial Doppler ultrasound. Results sVCAM-1 concentrations were higher among participants with an MMSE score

Background According to the CDC, falls rank among the leading causes of accidental death in the United States, resulting in significant health care costs annually. In this paper we present information about everyday lifestyle decisions of the older adult that may help reduce the risk of falling. We pursued two lines of inquiry: first, we identify and then test known mutable fall risk factors and ask how the resolution of such problems correlates with changes in fall rates. Second, we identify a series of everyday lifestyle options that persons may follow and then ask, does such engagement (e.g., engagement in exercise programs) lessen the older adult’s risk of falling and if it does, will the relationship hold as the count of risk factors increases? Methods Using a secondary analysis of lifestyle choices and risk changes that may explain fall rates over one year, we drew on a data set of 13,623 community residing elders in independent housing sites from 24 US states. All older adults were assessed at baseline, and a subset assessed one year later (n = 4,563) using two interRAI tools: the interRAI Community Health Assessment and interRAI Wellness Assessment. Results For the vast majority of risk measures, problem resolution is followed by lower rate of falls. This is true for physical measures such as doing housework, meal preparation, unsteady gait, transferring, and dressing the lower body. Similarly, this pattern is observed for clinical measures such as depression, memory, vision, dizziness, and fatigue. Among the older adults who had a falls risk at the baseline assessment, about 20 % improve, that is, they had a decreased falls rate when the problem risk improved. This outcome suggests that improvement of physical or clinical states potentially may result in a decreased falls rate. Additionally, physical exercise and cognitive activities are associated with a lower rate of falls. Conclusions The resolution of risk problems and physical and cognitive lifestyle choices are related to lower fall rates in elders in the community. The results presented here point to specific areas, that when targeted, may reduce the risk of falls. In addition, when there is problem resolution for specific clinical conditions, a decreased risk for falls also may occur.

Soluble vascular cell adhesion molecule-1 (sVCAM-1) is associated with hypertension, vascular inflammation, and systemic endothelial dysfunction. We evaluated whether elevated plasma sVCAM-1 is associated with impaired cerebrovascular function and mobility impairments in elderly people. We studied the cross-sectional relationships between plasma sVCAM-1 level, gait speed, and cerebrovascular hemodynamics, and its longitudinal relationship with falls in 680 community-dwelling participants aged ≥65 years in the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston Study. Falls were recorded prospectively for 1 year on daily calendars. sVCAM-1 was measured by ELISA assay and beat-to-beat blood flow velocity in the middle cerebral artery during rest and in response to changes in end-tidal CO 2 was measured by transcranial Doppler ultrasound. sVCAM-1 concentration was 1094±340 ng/mL in normotensives, 1195±438 ng/mL in controlled hypertensives, and 1250±445 ng/mL in uncontrolled hypertensives ( P =0.008). The mean resting blood flow velocity and cerebral vasomotor range were, respectively, 41.0±10.3 cm/s and 1.3±0.4 cm/s per millimeter of mercury. Elevated sVCAM-1 levels indicative of endothelial dysfunction were associated with reduced resting blood flow velocity ( P =0.017) and cerebral vasomotor range ( P =0.0048). Elevated sVCAM-1 levels were associated with slower gait speed (P =0.0011) and an increased odds of injurious falls (odds ratio, 2.4; 95% confidence interval, 1.4–4.2; P =0.0028). An elevated sVCAM-1 level may be a marker of cerebral blood flow dysregulation because of endothelial damage from hypertension. It may also signal the presence of cerebral microvascular disease and its clinical consequences, including slow gait speed and falls.

International audience; Conflicting data on the relationship between antihypertensive medications and falls in elderly people may lead to inappropriate undertreatment of hypertension in an effort to prevent falls. We aimed to clarify the relationships between the chronic use of different classes of antihypertensive medications and different types of falls, to determine the effect of medication dose, and to assess whether the risk of falls is associated with differences in cerebral blood flow. We assessed demographics, clinical characteristics, and chronic antihypertensive medication use in 598 community-dwelling people with hypertension, aged 70 to 97 years, then followed them prospectively for self-reported falls using monthly calendar postcards and telephone interviews. Antihypertensive medication use was not associated with an increased risk of falls. Participants reporting use of angiotensin-converting enzyme inhibitors had a significantly decreased 1-year risk of injurious falls (odds ratio, 0.62; 95% confidence interval, 0.39-0.96), whereas those using calcium channel blockers had a decreased risk of all falls (odds ratio, 0.62; 95% confidence interval, 0.42-0.91) and indoor falls (odds ratio, 0.57; 95% confidence interval, 0.36-0.91), compared with participants not taking these drugs. Larger doses of these classes were associated with a lower fall risk. Participants taking calcium channel blockers had higher cerebral blood flow than those not taking these medications. In relatively healthy community-dwelling elderly people, high doses of antihypertensive agents are not associated with an increased risk of falls.

International audience; Introduction: This study contributes to assess the impact of an additional task on the gait parameters in elderly people with dementia. Summary of facts: Each patient completed a locomotor test in situation of single and dual-task. The gait quality was assessed using the Locometrix to collect the following parameters: speed, stride length, cadence, regularity, power. Conclusion: The gait quality of patients is significantly impaired in dual-task situation. Consideration must be conducted to provide a specific program activity for these patients to maintain their autonomy.

International audience; : Is epilepsy truly an "African ailment"? We aimed to determine this, since international health agencies often refer to epilepsy as an African disease and the scientific literature has spoken the same tone. Various published materials, mainly reports, articles, were used to gather Asian and African evidence on various aspects of epilepsy and many of its risk and associated factors. Our results suggest that in no way can epilepsy be considered as an African ailment and such characterization is most likely based on popular beliefs rather than scientific evidence. In comparison to Africa, Asia has a 5.0% greater burden from all diseases, and is 17.0% more affected from neuropsychiatric disorders (that include epilepsy). Given that more countries in Asia are transitioning, there may be large demographic and lifestyle changes in the near future. However these changes are nowhere close to those expected in Africa. Moreover, 23 million Asians have epilepsy in comparison to 3.3 million Africans and 1.2 million sub-Saharan Africans. In comparison to Africa, Asia has more untreated patients, 55.0% more additional epilepsy cases every year, because of its larger population, with greater treatment cost and possibly higher premature mortality. Of several associated factors discussed herein, many have more importance for Asia than Africa. The current state of epilepsy in Asia is far less than ideal and there is an urgent need to recognize and accept the importance of epilepsy in Asia. In no way can epilepsy be considered as an African ailment. This is most likely based on popular beliefs rather than scientific evidence. A PowerPoint slide summarizing this article is available for download in the Supporting Information section here.

International audience; PURPOSE: We aimed to determine the incidence and case-fatality of first-ever status epilepticus (SE) among the general population living in La Reunion Island, a French overseas territory in the Indian Ocean near Madagascar. METHODS: We recruited cases (1st July 2004-30th June 2005) in a population-based manner using neurology, neurosurgery, electroencephalogram, emergency, paediatric and neuroradiology services; emergency medical aid service; emergency and admission service of private and public clinics; neurologists (public and private); private paediatricians and practitioners of various rural hospitals. All cases had an electroencephalogram (EEG) and were assessed by an epileptologist. Standard definition and classification schemes were used. Those with known epilepsy were not part of this analysis. RESULTS: Sixty-five cases (males: n=41, 63.1%) had epileptologist-confirmed SE, with 38.5% (n=25) being >60 years of age. Global incidence rate was 8.52/100 000 (95% confidence interval 6.5-10.5). A bimodal age distribution with high frequency and incidence among young (60 years) (frequency: 40.0%; incidence 35.0/100,000) was observed. We found that 60%, 32.3%, 6.7% had convulsive, partial and non-convulsive SE respectively (1% remained unclassified). Of the cases identified, 44.6%, 38.5%, 16.9% had unprovoked, provoked or cryptogenic seizures respectively. The most important aetiological factors identified included: stroke (27.7%), alcoholism/toxicity (18.5%), cryptogenic (16.9%), infections (10.8%). Mortality was 18.5%. CONCLUSION: The incidence of SE incidence in La Reunion Island was lower than that described elsewhere. The status type was found to be dependent on aetiology and age. The study confirms that SE is more frequent in men and in older adults and is associated with significant short-term case mortality.

Background:The worldwide population is ageing and the proportion of elderly aged 60 and over is expected to dramatically rise in Low and Middle Income Countries (LMIC). The epidemic of dementia will not spare those countries, where the largest increases in numbers of people affected are estimated. Besides, dementia is still understudied in sub-Saharan Africa (SSA) compared to other regions. This paper describes the protocol for the 'Epidemiology of Dementia in Central Africa' population-based study, which aims at estimating the prevalence of dementia in two countries of Central Africa and investigating possible risk factors.Methods/Design:A multicenter population-based study was carried out in Central African Republic and Republic of Congo between 2011 and 2012 including both urban and rural sites in each country. Around 2000 participants aged ≥65 years old were interviewed in total using the Community Screening Interview for Dementia (CSI-D), the GMS-AGECAT and the CERAD's 10-word list. Elderly with low performance to the cognitive part of the CSI-D (COGSCORE ≤ 24.5) were then clinically assessed by neurologists and underwent further psychometrical tests. DSM-IV and NINCDS-ADRDA criteria were required for dementia and Alzheimer's disease (AD) diagnoses respectively. The algorithmic 10/66 dementia diagnosis was also determined. Petersen's criteria were required for the diagnosis of Mild Cognitive Impairment. Sociodemographic, and environmental factors including vascular, nutritional, biological, psychosocial and lifestyle factors were collected in each setting in order to investigate factors associated with dementia. Blood sampling was realized to investigate genetic variations that could modify the risk of dementia.Discussion:For now, no large epidemiological study has been undertaken to compare the prevalence of dementia in both rural and urban areas within SSA countries. This programme will provide further evidence regarding the prevalence of dementia in SSA, and also the possible rural/urban disparities existing with associated factors. Furthermore, the genetics of AD in those populations will be addressed.

Introduction: Since 2002, with the creation of Centers of Memory Resources and Research (CMRR), considerable progress has been made in France regarding the administrative and institutional framework within which Alzheimer's disease (AD) is managed. In this study, we explore three approaches that can help optimize the inclusion of patients in clinical trials related to AD. They are as follows: to assess communication concerning clinical trials on AD in French CMRR, to analyze the internal organization of these centers concerning the dynamics of inclusion, and to evaluate screening tools used. Methods: A national, descriptive, cross-sectional survey was conducted in all CMRR in France between May 1 and July 31, 2011, using a self-administered questionnaire. All investigators, subinvestigators and the relevant CMRR personnel were involved. Results: A total of 75% of the CMRR participated, and about 30% of the physicians contacted responded positively to the survey. Only 50% reported having communicated with health care professionals at least once in the previous 3 months, and less than 50% had communicated occasionally with the general public. A total of 75% of those surveyed had a research group but only half of the groups were active, 50% of the physicians did not have a consultation time dedicated to study recruitment, and 75% of the respondents had a screening tool in their CMRR but over half of them were not satisfied with it. Conclusion: This investigation provides a basis for improving the screening of patients by both internal organizational development and adaptation of tools already available. Improvement requires promoting regular communication that is appropriate and targeted to health care professionals, smaller memory centers, associations and the public, and therefore, familiarizing the whole population with clinical research on AD.

International audience