Alzheimer Disease: Belmin J

Belmin J, Anonymous00255. · Service de Gériatrie and Université Paris 6, Hôpital Charles Foix, 94205 Ivry-sur-Seine, France. · J Nutr Health Aging. · Pubmed #17315078 No free full text.

Abstract: BACKGROUND: Weight loss is a frequent condition in Alzheimer's disease patients and is responsible for complications and impaired quality of life. Practical guidelines for the diagnosis and management of weight loss in Alzheimer's disease are lacking. AIM: To elaborate practical guidelines for the diagnosis and management of weight loss in Alzheimer's disease. METHODS: Following a literature review, a set of statements about weight loss in Alzheimer's disease were proposed to a 23-member nationwide expert panel drawn from French geriatricians selected by the organisation committee. Statements were discussed and modified with the experts during a meeting and modified according to their remarks. By the means of a postal questionnaire each expert was then asked to rate each statement on a 9-point appropriateness scale, 1 being highly inappropriate and 9 highly appropriate. Analysis was based on the median and the range of the ratings. To avoid the influence of extreme or atypical opinions, the two ratings the furthest from the median were excluded from analysis for each statement. Agreement/disagreement about the statements was determined using the RAND/UCLA methodology. RESULTS: Of the 23 statements selected by the expert panel and submitted for rating, 17 obtained the agreement of the expert panel. Practical guidelines were produced from these 17 statements. CONCLUSION: These expert panel ratings, based on the best evidence currently available, provide comprehensive guidelines to appropriately diagnose, manage and prevent weight loss in Alzheimer's disease.

Belmin J, Léger JM. · No affiliation provided · Presse Med. · Pubmed #17855044 No free full text.

This publication has no abstract.

Belmin J, Verny M. · No affiliation provided · Presse Med. · Pubmed #16969323 No free full text.

This publication has no abstract.

Pariel-Madjlessi S, Opéron C, Péquignot R, Konrat C, Léonardelli S, Belmin J. · Service de gériatrie et consultation mémoire, Hôpital Charles Foix et Faculté de médecine Pierre et Marie Curie (Université Paris VI), Ivry-sur-Seine (94). · Presse Med. · Pubmed #17628389 No free full text.

Abstract: Dementia is a deterioration in several cognitive functions that affects daily living and is observed in the absence of impaired vigilance. Dementia may be revealed by symptoms of memory loss but also by a loss of functional autonomy, onset of depression or by behavioral problems; it may also be recognized during a screening examination. Evaluation of cognitive functions is an essential stage of this diagnosis. Simple tests that any physician can perform provide a first approach. A more detailed cognitive evaluation by a specialist or neuropsychologist is then necessary (except in advanced cases). Once dementia is diagnosed, a causal investigation is required to assess its severity and extent, in order to organize management. Lack of recognition of dementia in the elderly and delay in its diagnosis raise the question of screening to detect it at an earlier stage.

Belmin J, Péquignot R, Konrat C, Pariel-Madjlessi S. · Service de gériatrie et consultation mémoire, Hôpital Charles Foix et Université Paris VI, Ivry-sur-Seine (94). · Presse Med. · Pubmed #17601697 No free full text.

Abstract: Management of Alzheimer disease is based on drug and nondrug treatments. Specific drug treatment includes acetylcholinesterase inhibitors and memantine. They show moderate efficacy superior to that of placebo for global condition, cognitive disorders, need for care, and behavioral problems, but do not prevent further decline. These treatments remain underused. The efficacy of psychotropic drugs (antidepressants, neuroleptics, and antipsychotic agents) in treating behavioral problems is not well documented. Nondrug activities and interventions have not been sufficiently evaluated scientifically. These involve interventions against the consequences of the disease (loss of autonomy, malnutrition) and helping patients' family caregivers. Among these activities, the best evaluated and most interesting are: educational programs for caregivers, occupational therapy at home, and interventions at home by nurses specially trained as case managers.

Gillette Guyonnet S, Abellan Van Kan G, Alix E, Andrieu S, Belmin J, Berrut G, Bonnefoy M, Brocker P, Constans T, Ferry M, Ghisolfi-Marque A, Girard L, Gonthier R, Guerin O, Hervy MP, Jouanny P, Laurain MC, Lechowski L, Nourhashemi F, Raynaud-Simon A, Ritz P, Roche J, Rolland Y, Salva T, Vellas B, Anonymous00256. · No affiliation provided · J Nutr Health Aging. · Pubmed #17315079 No free full text.

Abstract: Weight loss, together with psychological and behavioural symptoms and problems of mobility, is one of the principal manifestations of Alzheimer's disease (AD). Weight loss may be associated with protein and energy malnutrition leading to severe complications (alteration of the immune system, muscular atrophy, loss of independence). Various explanations have been proposed such as atrophy of the mesial temporal cortex, biological disturbances, or feeding behaviours; however, none has been proven. Prevention of weight loss in AD is a major issue. It requires regular follow-up and must be an integral part of the care plan. The aim of this article is to review the present state of scientific knowledge on weight loss associated with AD. We will consider four points: the natural history of weight loss, its known etiological factors, its consequences and the various management options.

Thomas P, Lalloué F, Preux PM, Hazif-Thomas C, Pariel S, Inscale R, Belmin J, Clément JP. · University Department of Psychogeriatrics & Memory Clinic CH Limoges, France. · Int J Geriatr Psychiatry. · Pubmed #16323256 No free full text.

Abstract: 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.

Belmin J. · Hôpital Charles Foix, Université Paris Nord, Ivry-sur-Seine. · Presse Med. · Pubmed #12947602 No free full text.

Abstract: COPING WITH CHRONIC STRESS: Family members are the first-line caregivers for elderly patients with dementia living at home. Giving care to a demented patient has an important impact on the mood, quality-of-life, physical and psychological health of family aids: frequent episodes of depression, immunity disorders, altered capacity for wound healing, increased consumption of psychotropic drugs and increased mortality. INTERVENTIONS FOR FAMILY AIDS: Helping family caregivers is an integral part of modern care for Alzheimer's disease: social and financial support, medical assistance. Several specific interventional programs have been proposed, either alone or as part of a multiple-component program: educational sessions, group support, psychotherapy, respite care. NECESSARY DEVELOPMENTS: The results of studies assessing the effects of different types of interventions have shown that they reduce the cure giver's burden and depression, and patient's symptoms while improving the caregiver's feeling of well-being and his/her knowledge, and competence. Multiple-component interventions are the most effective. Research in this area should be developed in France, including an examination of the feasibility of such studies which are highly dependent on the cultural and social context of care as well as on the efficacy and the cost of the interventions.

Zekry D, Duyckaerts C, Belmin J, Geoffre C, Moulias R, Hauw JJ. · Laboratoire de Neuropathologie Raymond Escourolle, Hôpital de la Salpêtrière, INSERM U 106 and 360, Association Claude Bernard, Pierre et Marie Curie University, 47 Bd de l'Hôpital, 75013 Paris, France. · Acta Neuropathol. · Pubmed #12898153 No free full text.

Abstract: Abeta peptide deposits are observed in brain cortical and leptomeningeal microvessels in a few families, in patients with Alzheimer's disease and in cognitively normal elderly subjects. These deposits, which cause Abeta amyloid angiopathy, are usually associated with other lesions induced by Abeta peptide and tau pathologies. To investigate the consequences of cerebral amyloid angiopathy on arterial morphology and search for correlations with the degree of cognitive impairment, we carried out a prospective clinicopathological and morphometric study in 29 institutionalized elderly patients cognitively normal or affected with sporadic dementia associated with Alzheimer-type lesions, cerebral infarcts or both. We measured the external and internal diameters of arteries 40-120 microm wide, containing moderate or severe Abeta deposits, and of unaffected arteries in the temporal and frontal lobes. We found no differences in the mean external diameters. In contrast, the mean internal diameters of vessels with moderate Abeta deposits were smaller than those of unaffected vessels. Conversely, the internal diameters of severely affected vessels were larger than those of unaffected vessels. This suggests that arterial walls become thicker during the early stages of amyloid angiopathy, and the diameter of the lumen decreases, whereas during advanced stages, the walls become thinner and the lumen becomes larger. In addition, we assessed the overall severity of amyloid angiopathy. This showed that thinner arterial walls and the severity of amyloid angiopathy were correlated to dementia. In a multivariate model that integrates the other macroscopic and microscopic lesions that may be implied in the mechanism of cognitive impairment, the severity of amyloid angiopathy per se explained 10% of the variability in the cognitive impairment.

Zekry D, Duyckaerts C, Belmin J, Geoffre C, Herrmann F, Moulias R, Hauw JJ. · Laboratoire de Neuropathologie Raymond Escourolle, Hôpital de la Salpêtrière, INSERM U 106 and 360, Association Claude Bernard, Pierre et Marie Curie University, Paris, France. · Neurobiol Aging. · Pubmed #12498955 No free full text.

Abstract: Vascular dementia appears rarer than previously thought, but the contribution of vascular lesions to cognitive impairment in Alzheimer's disease (AD) affected patients (mixed dementias) is now recognized as frequent. The role of strategic areas of the brain involved in the cognitive decline induced by vascular lesions and their relative contributions to the severity of the dementing process remain poorly understood. We determined the relationship between the severity of clinical dementia and the volume of different brain areas affected by infarcts in a prospective clinicopathological study in elderly patients. A volumetric study of the functional zones of Mesulam's human brain map affected by vascular lesions was made and correlations between quantified neuropathological data and the severity of dementia were performed in cases with large vascular lesions only, pure AD, and both lesions. The severity of cognitive impairment was significantly correlated with the total volume of infarcts but in a multi-variate model the volume destroyed in the limbic and heteromodal association areas, including the frontal cortex and in the white matter explained 50% of the variability in MMSE and GDS. The total volume of ischemic lesions explained only 0.1-5% of the variability in MMSE and GDS. Age only explained an extra of 0.1-1.6%. This study confirms that infarcts located in strategic areas have a role in the mechanism of cognitive impairment and brings a key for their quantification. It may be useful for developing neuropathological criteria in multi-infarct and mixed dementias.

Zekry D, Duyckaerts C, Belmin J, Geoffre C, Moulias R, Hauw JJ. · Laboratoire de Neuropathologie Raymond Escourolle, Hôpital de la Salpêtrière, 47-83, Bd de l'Hôpital, 75651, Paris, Cedex 13, France. · J Neurol. · Pubmed #12420093 No free full text.

Abstract: Clarifying the etiology of dementia is one of the most difficult diagnostic challenges, especially in the elderly. We examined the accuracy of clinical criteria to distinguish Alzheimer's disease (AD) and dementia associated with infarcts of the brain, either isolated (vascular dementia) or associated with degenerative lesions (mixed dementia). We carried out a prospective clinico-neuropathological study in a selected series of hospitalized patients. We evaluated the clinical aspects of 33 patients aged over 75 years by use of the criteria and scores of DSMIII, NINCDS-ADRDA, Loeb and Gandolfo, ADDTC and NINDS-AIREN and the Hachinski Ischemic Score. The neuropathological diagnosis was considered to be the gold standard. When comparing clinical criteria and neuropathology, the agreement was moderate for Hachinski's score (0.50) and Loeb's score (0.43) and substantial for the ADDTC (0.63) and the NINDS-AIREN (0.67). When mixed dementias were excluded, the agreement between all clinical criteria and scores and the pathological diagnosis rose to 0.88. Hachinski's score was the most sensitive (0.89) and the NINDS-AIREN the most specific (0.86) for the diagnosis of vascular dementia. In conclusion, all sets of clinical criteria distinguished pure AD from vascular dementia with a high accuracy whereas mixed dementia was clinically under-recognized. The NINDS-AIREN criteria were the most discriminating for the accurate identification of patients with mixed dementia.

Zekry D, Duyckaerts C, Moulias R, Belmin J, Geoffre C, Herrmann F, Hauw JJ. · Laboratoire de Neuropathologie Raymond Escourolle, Hôpital de la Salpêtrière, INSERM U 106 and 360, Association Claude Bernard, Pierre et Marie Curie University, 47 Bd de l'Hôpital, 75013 Paris, France. · Acta Neuropathol. · Pubmed #11935264 No free full text.

Abstract: The relative importance of vascular and Alzheimer's disease (AD) lesions, their interaction in the development of cognitive impairment and the very existence of mixed dementia induced by the potentiation of both mechanisms remain controversial. The aim of this study was to assess whether the patients with infarcts and lacunes have fewer plaques and tangles than those without vascular lesions, for similar severity of clinical dementia. We performed a prospective clinicopathological study in elderly patients of a long-stay care unit. The severity of clinical dementia was assessed by psychometry performed according to standardized methods less than 6 months before death. A volumetric study of cerebral vascular lesions was performed at post-mortem study of the brain. The density of neuritic plaques (SP), Amyloid beta focal deposits (A beta FD), and neurofibrillary tangles (NFT) in the temporal and frontal isocortex was quantified. According to DSM III criteria, 28 of the 33 patients for whom autopsies were performed had dementia. Twenty-four of the included patients had degenerative or vascular lesions, or both. The volume of infarcts and lacunes was significantly correlated with the severity of cognitive impairment. The density of SP, A beta FD and NFT in the temporal and frontal isocortex was significantly lower when vascular lesions were present. For similar clinical severity of dementia, there were fewer AD lesions in patients with vascular lesions than in those without vascular lesions.

Pariel-Madjlessi S, Madjlessi A, Fremont P, Belmin J. · Service de Médecine Interne Gériatrique, Hôpital René Muret, 93270 Sevran. · Encephale. · Pubmed #11760691 No free full text.

Abstract: To take care of elderly patients in psychiatric hospital sets specific problems. It is interesting to know the mode, the frequency, and the reasons of these hospitalizations, to improve the medical care given to these subjects. We made a prospective study with elderly patients hospitalized in a psychiatric institution. The results were completed in discussions with the medical care staff. During the study (January and February 1997), 112 elderly patients, about more than 60 years old, were hospitalized in Villejuif' specialized hospital (inpsychiatric units). Informations about social facts, main psychiatric previous, reasons of the hospitalization, the caring and the evolution of these subjects were collected. The main important reflexion we did observe was the significant difference between elderly patients hospitalized in psychiatric units, with or without psychiatric previous before the age of 60. Those who were hospitalized at the first time in psychiatric units before 60, presented a medium aged population, younger than the other group. They also presented more delusion with psychosis, were more frequently hospitalized longly in psychiatric units, took neuroleptics, and their somatic associate pathologies were less difficult to take care of. In the second group including the elderly patients without psychiatric previous before 60, we did observe very different characteristics: the diagnosis of most of the patients is dementia; these elderly subjects leaved mostly at home, they presented more sadness, aggression, or social inappropriate behaviour. Depression is a more frequent diagnosis. This study of all the elderly patients admitted in a psychiatric hospital confirmed the population's heterogeneity. The existence of an hospitalisation in psychiatric unit before sixty represented a pertinent test to a major and simple approach of these differences. The psychiatric unit which receives more and more elderly patients take care of their differences to the organisation of care needs between the gerontopsychiatric patients types. The patients with a late gerontopsychiatric's disease could need a specific hospitalization in gerontopsychiatric units, especially organised to deliver psychiatric cares and somatic cares, including medical geriatric practicer and medical care staff formed to the dependence need care.