Alzheimer Disease: Fremont P

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.

Jacus JP, Martin C, Ailleret-Jean C, Courcet L, Delmotte-Tsocanakis G, Faraldi O, Hamon-Vilcot B, Heurteux V, Labram A, Lutzler P, Planques B, Rethore V, Trivalle C, Fremont P. · Service de gérontologie du Dr Despoisses, GH P. Brousse, Villejuif. · Presse Med. · Pubmed #11603264 No free full text.

Abstract: OBJECTIVE: The cognitive aging of psychotic patients is still poorly apprehended and sometimes wrongly compared with demential or pseudo-demential deterioration. We studied the impact of chronic psychosis on cognitive performance in the elderly. PATIENTS AND METHODS: We estimated cognitive performance in two groups of 15 patients each among persons on old-age pensions or living in geriatric nursing homes. One group included patients who had already showed dissociative or non-dissociative chronic psychosis and the other group persons with no previous psychotic signs. Cognitive estimations were made on the basis of Folstein's Mini Mental State (MMS) score and Signoret's Battery of Cognitive Efficacy (BEC 96). Results obtained in the two groups were compared with the Mann and Whitney non-parametric test. RESULTS: The psychiatric patients showed a significant deficiency compared with the others for memory and executive functions and also a much broader range of scores on the BEC96 that demonstrated deficiency among the psychiatric patients. DISCUSSION: Though these findings must be interpreted with caution, they do demonstrate a trend similar to that observed in young schizophrenics and also to that of the cognitive performances observed in older schizophrenics and demented subjects. Patients with dissociated or non-dissociated psychotic disorders show an apparent relative cognitive deficiency irrespective of age. The psychotic elderly appear to exhibit a cognitive clash much more than a simple pseudo-demential deficiency.

Bazin N, Fremont P. · SHU de Psychiatrie, Hôpital Richaud, Versailles. · Presse Med. · Pubmed #10827797 No free full text.

Abstract: ADVANTAGES OF EARLY DIAGNOSIS: Better prognosis and quality of life for patients with Alzheimer's disease and their caregivers depends on early diagnosis as specific treatment (anticholinesterase drugs) early in the disease process can have a beneficial effect on cognition and psychiatric or behavioral disorders. In addition early diagnosis gives the physician the opportunity to provide adapted advice for the patient and caregivers especially important in preventing complications and helping the family cope with the inevitable disruption of the family pattern caused by the disease, a situation which is particularly for the "designated caregiver". PREDEMENTIA STATES: The question of early diagnosis raises several types of problems. Defining the limits of the disease is particularly difficult: when does Alzheimer type dementia start? what is the definition of predementia? A growing body of work suggests that it is warranted to identify patients at risk of developing Alzheimer type dementia since, according to certain authors, they can benefit from specific treatment. RISK FACTORS: The only fully recognized risk factors are age, family history of dementia and presence of the allele epsilon 4 of the apolipoprotein E gene. There are probably several other risk factors. Their identification is a current subject of debate. TOOLS FOR EARLY DIAGNOSIS: Psychometric tests have been shown to provide specific information useful for interpreting the clinical assessment which must focus on detecting early signs and exploring even minimal memory deficiencies.

Fremont P. · CH de Lagny, Lagny-sur-Marne. · Encephale. · Pubmed #10609100 No free full text.

Abstract: The management of Alzheimer's disease is currently undergoing profound upheavals. The advent of specific treatments for the disease is largely responsible for those changes. Psychiatrists are directly involved in that approach. They play a very important role in the pluridisciplinary approach to patients and their families. The management of the disease shows, in fact, that management consists in long-term accompaniment of the patient, of course, but also of the family, qualified as the "natural caregiver", and that the two are indissociable. A review of the natural course of the disease enables restitution of the concomitant progress of the entourage's experience and the problems encountered by the family. The various studies on caregivers stress the importance of the psychological burden, the risk of depression and, above all, the position of behavioral symptoms in their quality of life. WHO has formulated recommendations concerning caregivers, and while they are simply common sense, they deserve to be restated: carefully evaluating their capacities and work load and informing them on the disease may enable them to benefit from support and, above all, enable periods of respite to be arranged. Lastly, the resources available for management need to be understood, even though the list is far from complete and a certain number of resources have yet to be fully evaluated and defined.