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Resume Propos. La plupart des patients atteints de la maladie d'Alzheimer sont pris en charge au domicile par un aidant informel. L'effet des differents facteurs de stress sur ces aidants represente le fardeau. Objectifs. Determiner (1) le niveau du fardeau des aidants informels de patients atteints de la maladie d'Alzheimer (2) les facteurs associes a un niveau eleve de fardeau. Methodes. Etude transversale des aidants informels de personnes âgees dementes se presentant a la consultation de services depsychogeriatrie, geriatrie ou neurologie dans 16 CHU francais. Les aidants de 531 patients ayant une demence legere a moderee ont ete interviewes avec un questionnaire structure centre sur les caracteristiques relatives aux aidants (notion de cohabitation avec le patient, fardeau ressenti evalue par l'echelle de Zarit) et les patients ont ete examines a l'inclusion pour evaluer leurs fonctions cognitives, l'existence de troubles fonctionnels et du comportement. Resultats. L'analyse logistique de regression a montre que les caracteristiques des patients (MMSE, troubles comportementaux,troubles nutritionnels), les caracteristiques des aidants (sexe feminin, nombre de tâches liees a l'aide, cohabitation) et e recours a des services medicaux etaient independamment associees a un niveau eleve de fardeau. Dans cette etude le fardeau eleve des aidants etait lie de facon independante a la severite de l'atteinte cognitive et aux troubles du comportement. Cependant, ni la duree de maladie ni les incapacites a realiser les activites de la vie quotidienne n'etaient liees au fardeau. Ces resultats peuvent orienter des interventions adaptees d'aide aux aidants informels.

Resume Introduction La forme sporadique de la maladie d'Alzheimer est la plus frequente et survient en general avec l'avance en âge, sous l'influence de facteurs, en particulier environnementaux et genetiques. Des travaux recents suggerent un certain nombre de facteurs protecteurs eventuels contre cette maladie. Actualites et points forts L'intervention de plusieurs genes a ete evoquee, parmi lesquels, l'allele 4 d de l'apolipoproteine E situe sur le chromosome 19. La physiopathogenie de la maladie n'est pas encore totalement elucidee. Des travaux recents laissent supposer que les anti-inflammatoires non steroidiens consommes aux longs cours previendraient la maladie d'Alzheimer. Par ailleurs, il semble qu'un traitement hormonal substitutif en post-menopause puisse jouer un role protecteur contre la maladie. Enfin, differents facteurs nutritionnels (vitamines E, B6 et B12) et biochimiques (homocysteine) semblent impliques dans le maintien des fonctions cognitives. Perspectives et projets Les differentes etudes interventionnelles actuellement en cours dans ce domaine devraient permettre le developpement de strategies preventives dans un avenir proche.

Approximately 6-8% of all persons aged >65 y have Alzheimer disease and the prevalence of the disease is increasing. Any intervention strategy aimed at decreasing risks or delaying the onset of the disease will therefore have a substantial effect on health care costs. Nutrition seems to be one of the factors that may play a protective role in Alzheimer disease. Many studies suggest that oxidative stress and the accumulation of free radicals are involved in the pathophysiology of the disease. Several studies have shown the existence of a correlation between cognitive skills and the serum concentrations of folate, vitamin B-12, vitamin B-6, and, more recently, homocysteine. However, nutritional factors have to be studied not alone but with the other factors related to Alzheimer disease: genetics, estrogen, antiinflammatory drug use, and socioeconomic variables. The objective of this article was to review recent studies in this field.

Background: -Epidemiologic studies have shown that weight loss is commonly associated with Alzheimer disease (AD) and is a manifestation of the disease itself. The etiology of weight loss in AD appears multifactorial. Hypotheses to explain the weight loss have been suggested (eg, atrophy of the mesial temporal cortex, biological disturbances, and higher energy expenditure); however, none have been proven. Objective: In the first part of this article, we describe weight loss in AD (epidemiologic data and hypotheses to explain weight loss and anorexia in AD). In the second part we report the results of a longitudinal study of the changes in nutritional variables in a cohort of patients with a probable diagnosis of AD. Design: We followed subjects with AD (based on criteria of the National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association) who were recruited from the Alzheimer's Disease Center in Toulouse. All subject underwent a nutritional, neuropsychologic, and functional evaluation. The Zarit scales were used to assess caregiver burden and caregiver reactions to the patients' behavioral and autonomic disorders. Results: We showed that only results of the Burden Interview and the Memory and Behavior Problems Checklist, which explored caregiver burden, predicted weight loss in AD. It is possible that caregivers who consider themselves overburdened by the disease process are not willing to invest adequate resources to allow AD patients to properly nourish themselves. Conclusion: Nutritional education programs for the caregivers of AD patients seem to be the best way to prevent weight loss and improve the nutritional status of these patients.

Resume Des etudes epidemiologiques montrent que la perte de poids est frequemment associee a la maladie d'Alzheimer. Ce serait meme une manifestation de la maladie elle-meme. La perte de poids est difficilement explicable etant donne que les sujets, presentant une demence de type Alzheimer, semblent conserver des apports nutritionnels satisfaisants. Plusieurs hypotheses sont formulees : majoration des depenses energetiques, perturbations biologiques, dysfonctionnement de la regulation du poids corporel, atrophie du cortex mesial temporal. Cependant, a ce jour, aucune etude n'a permis de conclure. Il semblerait que l'amelioration des problemes nutritionnels, a l'origine d'un certain nombre de complications (infections, escarres, grabatisation), soit une des meilleures strategies permettant de diminuer le fardeau de la maladie.

The objective of this cross-sectional study (whose baseline data were drawn from a longitudinal population study) was to determine if one-leg standing balance might be a useful marker of functional status in elderly persons independently living in an urban community (N = 512, mean age 73 +/- 7.0, 71.4% women). One-leg standing balance (ascertained by the Tinetti test) and functional status were obtained from a baseline gerontological assessment and follow-up questionnaires. Correlations were tested between one-leg balance and physical health and functional measurements. One-leg standing balance (OLSB) was abnormal in 24.7% of the population. At least one incapacity in instrumental activities of daily living (IADL) was found in 60.6% of those with OLSB abnormality, vs 45.5% in those with OLSB "adaptive" (borderline abnormal), and 33.3% in those with normal one-leg standing balance (p0.0001). Multivariate analysis showed 3 independent factors related to one-leg balance abnormality: age71 years (OR = 5.11, CI = 1.99-13.10); IADL deficit requiring help with transportation (OR = 3.61; CI = 1.15-11.40); and "poor" health status on the Iowa Self-Assessment Inventory (OR = 2.67, CI = 1.35-5.27). We conclude that one-leg standing balance may be a simple, predictive and inexpensive marker helpful in screening for low functional level and frailty in clinical practice.

Patterns of morbidity with age can be schematically represented in three situations: 1) as a progressive illness, such as Alzheimer's disease, leading to a relatively rapid functional decline. 2) as a catastrophic event, such as a stroke or hip fracture, leading to a decline in function with improvement after rehabilitation. 3) as normal aging with gradual progressive functional decline. Results from the New Mexico Aging Process Study provide some unique insights about the consequences of the effects of aging on the nutritional status of healthy elderly people. Between 1979 and 1989, anthropometric and biochemical markers as well as dietary intakes remained relatively constant in this healthy elderly population. Thus, the aging process alone may have little or no important consequences on the nutritional status of healthy elderly individuals. However, the adaptation of pancreatic and intestinal function to undernutrition and refeeding can be perturbed in these individuals.

Amongst factors associated with the institutional placement of elderly people with dementia, there has been little study of those related to malnutrition. We followed a cohort of 318 individuals with Alzheimer's disease (AD). Patients, who were all living at home at the start of the study were recruited from the outpatient service of a hospital unit specialising in AD. After one year, 20% of the patients had moved into institutional care. Multivariate analysis showed that a Mini nutritional Assessment score (MNA) of less than 25.5 (median score of the sample) and overeating behavioural problems (p=0.006) were risk factors for institutional placement. Nutritional problems are reversible and patients with a low MNA score could benefit from a thorough geriatric assessment, in order to slow or prevent institutional placement.

to study, versus placebo, the value of administering pancreatic extracts in elderly subjects suffering from denutrition.52 subjects over 70 years of age, living in the Toulouse region of France, were included in this study. Each subject was required to present with an impaired nutritional status of their food intake, anthropometric and laboratory markers.among the 52 patients included in the study, 26 received the placebo and 26 received a pancreatic extract (Créon 12,000). 88% of these patients were women and 12% were men, the mean age of patients was 87+/-6 years. The groups were comparable at entry into the study. Nutritional intake increased in the two groups. There was a non-significant increase in body weight in the treated group when compared with the placebo group.we think that in the future, it would be preferable to conduct studies in convalescent subjects, reducing the frequency of nutritional assessments (food intake on D0 and D90, to reduce interference with the patient's habits.

The aim of this study was to describe changes in dietary intakes with age in subjects aging normally within the Toulouse study. Daily caloric intakes were constant in both sexes and in the three age classes considered. Energy distributions among the meals were rather clearly modified in men: the contribution of breakfast and afternoon snacks increased while those of lunch and dinner decreased. Observations among women were less consistent but the contribution of dinner also decreased with age (from 33.3 to 30.7%). This decreased contribution from dinner was due to a change in its nutrient composition (fewer lipids and more carbohydrates) which change the nutrient constitution of the entire daily diet, and also from a change in structure (reduced contribution by the main dish and increased role of desserts). These results pose questions concerning the reasons behind this change (loss of appetite, more pronounced taste for sweets?) and requires additional study.

To present results from a two year prospective study on diet, 6 months before and 18 months after retirement. The studied population exhibited an increase in social and physical activities over time after retirement. A significant decrease in weight was found in men 18 months after retirement. Retired individuals reported taking more time for breakfast. 45.5% of retired individuals, compared to 25.5% before retirement, took more than 30 minutes for lunch than before retirement. The amount of dietary nutrients consumed remained the same before and after retirement. However, retired individuals ate out more often, and had guests more frequently. Nutrients' distribution is similar before and after retirement. Given a life expectancy of more than 20 years after retirement, it is necessary to initiate nutritional intervention.

Hypersensitivity to rectal distension is frequently observed in patients with irritable bowel syndrome (IBS). However, few data are available about the influence of age on rectal sensory thresholds and tone. The aim of this study was to measure rectal sensory thresholds and tone with a barostat in 12 healthy subjects (aged 86 +/- 4 years, eight females, four males) as compared with 12 young healthy male controls (26 +/- 1 years). Isobaric phasic distensions were performed in the fasted state (increment of 4 mmHg, steps of 5 min, interval of 5 min). Rectal tone changes were then measured as changes in volume of the barostat bag, the pressure being kept constant. After a baseline recording of 1 h, a 1000-kcal meal was served and the tone recorded until return to baseline. Rectal sensory thresholds were significantly higher in aged subjects. First sensation, sensation of urge to defaecate and sensation of pain were triggered at 21.1 +/- 3.2 mmHg, 30.4 +/- 5.4 mmHg and 40.5 +/- 5.0 mmHg, respectively, in aged subjects, vs 13.3 +/- 4.6 mmHg (P < 0.05), 20.7 +/- 1.0 mmHg (P < 0.001) 31.3 +/- 1.7 mmHg (P < 0.001) in controls. Rectal compliance was not significantly different between the two groups. Mean barostat bag volume was 104 +/- 13 mL in fasting aged subjects and 125 +/- 23 mL in controls (NS). After the meal, the barostat bag volume decreased by 69 +/- 11% during 85 +/- 17 min in aged subjects and 75 +/- 14% during 89 +/- 15 min in young controls (NS). Rectal sensory thresholds triggered by distension are increased in aged healthy subjects while compliance and tone are not different. Age should be considered as a confounding factor when studying rectal sensitivity and further studies in aged patients with IBS should include a group of control subjects within the same range of age as studied patients.

The treatment of cancer in the elderly can benefit from increasingly sophisticated methods that measure a patient's quality of life. These measures are both general and cancer specific and herald a new and enlightened approach to patient care. The care of the older patient must be seen in light of what is known about life expectancy, the outcome of treatment, an awareness of comorbidity, and the importance of informed consent and respect for the values and preferences of the individual patient. This article reviews the growing literature on quality of life research in cancer patients.

Epidemiologic studies show that weight loss is commonly associated with Alzheimer's disease. It would be a manifestation of the disease itself. It is not easy to explain weight loss as subjects with Alzheimer's disease have adequete caloric intakes. Several hypothesis are considered: increased energy expenditure, biologic disturbances, dysfunction in body weight regulation, mesial cortex temporal atrophy. However, at the present time, no study can give a proper explanation. The amelioration of nutritional problems, which lead to many complications (infections, bedsores, bedridden subjects, etc), could be one of the best strategies to lessen the burden of the disease.

Epidemiological studies of aging are usually confronted with the presence of numerous pathologies or environmental factors which make it difficult to identify the effects of aging individually. One way of reducing the variability among individuals is to use well defined criteria to select the study population. This is the choice that was made for the New Mexico and Toulouse Aging Process Studies, which were particularly turned towards successful aging. In this study we have sought to explain the diversity of states of health of the subjects of these two studies by means of an aging classification exploring the medical history, balance and walking, and the cognitive functions. This reveals that the poorer health of certain subjects (about 10% and 30% of the populations of Toulouse and Albuquerque respectively) is slightly associated with changes in eating behaviour relative to subjects who age successfully. We have, however observed a decrease in vitamin E intake in Toulouse associated with a reduction of lipids in the food. But the poorer state of health is predominantly explained by advancing age and the occurrence of pathological states. This study confirms that aging was generally successful in the two populations studied.

From the angle of both geriatrics and legal medicine, the elderly person who is attacked in the street is a victim in three ways. Purse snatching is an assault to which an elderly person is typically exposed in an urban environment. In this kind of attack, the age of the victim is a factor before, during and after the aggression.

Due to the multifactorial nature of falls in the elderly population, it is difficult to determine causal relationships for risk factors for falls. In some cases, other risk factors may play a role. For example, the association between poor nutrition status and falls has not been studied extensively. The association of commonly demonstrated nutritional deficiencies in the elderly with factors such as balance, gait, and mobility may lead to new insights into causes of falls in the elderly not previously established. In this article, we review how malnutrition can be a risk factor for falls, how falls can induce malnutrition, and the possible relationship between mobility and nutrition in the elderly.

The central functions of norepinephrine (NE) are a recent discovery: regulation of alertness and of the wakefulness-sleep cycle, maintenance of attention, memory and learning, cerebral plasticity and neuro-protection. The anatomical, histological, biochemical and physiological properties of the central noradrenergic system: extreme capacity for ramification and arborization; slow conduction, non-myelinized axons with extrasynaptic varicosities producing and releasing NE; frequency of co-transmission phenomena, and; neuromodulation with fiber effect responsible for improvement in the signal over background noise ratio and selection of significant stimuli form a true interface between the outside world and the central nervous system, notably for the neocortex in the context of the cognitive treatment of information. This central noradrenergic system is involved in the neurophysiology and the clinical features of cerebral aging (ideation-motor and cognitive function slowing down, loss of behavioral adjustment), neuro-degenerative disorders (SDAT, Parkinson's disease), certain aspects of depression and less obvious conditions (head injuries, sequelae of cerebrovascular accidents, sub-cortical dementia). The recent development of medications improving alertness (adrafinil, modafinil) with a pure central action and specifically noradrenergic, may contribute to an improvement in these multifactorial disorders.

Thyroid function tests of 179 euthyroid geriatric inpatients (83 +/- 6 yr) unaffected by acute diseases or malnutrition were investigated and compared with those of 76 ambulatory healthy younger subjects (42 +/- 13 yr). Elderly population was divided in three groups, respectively: group G I (n = 37, 65-78 yr), group G II (n = 64, 79-85 yr) and group G III (n = 78, over 85 yr). Severity-of-illness index of the patients was evaluated at entry in the study protocol. While total thyroxine (TT4), free triiodothyronine (FT3) and TSH levels remained unchanged, circulating total triiodothyronine (TT3) was significantly lower (113 +/- 32 vs 150 +/- 31 ng/dl, p less than 0.05) and free thyroxine (FT4) was significantly higher (12.4 +/- 2.7 vs 10.3 +/- 2.3 pg/ml, p less than 0.05) in aged people. Furthermore, TT3 decreased significantly from 130 +/- 36 in G I to 110 +/- 33 in G II and to 108 +/- 25 in G III (p less than 0.01), and FT4 increased progressively although not significantly in the same groups. A close correlation was found between TT3 and severity index in male observations only (r = -0.43, p less than 0.01), as well as between FT4 and severity index in both sexes (r = 0.51, p less than 0.001 for men, r = 0.21, p less than 0.01 for women). These data suggest that thyroid function tests have to be cautiously interpreted in a geriatric population, particularly in relation to the severity of the clinical state, and reference values should be determined for TT3 and FT4 in the ageing process.

This study reports on the tolerance and the pharmacological activity of pentosan polysulfate (PPS) administered to healthy volunteers for 10 days. Three groups of 10 subjects received either one daily injections of 100 mg of PPS by I. M. route (group I), or two daily injection of 50 mg of PPS by I. M. or S. C. route (groups II and III, respectively). In each group two random subjects received a placebo for the 10 days; on day 0, each subject was injected by a placebo. Clinical tolerance was checked by a daily physical examination; biological tolerance was assessed comparing the results of the main biochemical and haematological constants measured before starting the treatment (day 0) and 12 or 24 h after the end of the treatment (day 11). The pharmacological activity was measured on serial samples taken before treatment and between 1 and 6 h after the drug injection on days 1, 3 and 10; the results were compared to those obtained on day 0. Clinical tolerance was good. The biological side effects concern the transaminase levels and the platelet counts. An increase above the upper normal limit was observed in 18/24 and 3/24 for alanine and aspartic transaminase respectively. The mean platelet reduction ranged between 24 and 34% according to the groups. The drug injection induced a slight Quick time (PT) prolongation, no significant alteration of factors II, VII-X, V levels and of thrombin clotting time. The activated partial thromboplastin time (APTT) was significantly prolonged and there was a weak but significant circulating anti-Xa activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Up to about 10 years ago, dyslipidaemia discovered in patients aged more than 65 years was not treated, the associated cardiovascular risk being considered weak in comparison with other risk factors. More recently, because of the increase of the duration of life, these dyslipidaemias in elderly patients are increasingly being treated with lipid-lowering drugs such as fenofibrate.