Alzheimer Disease: Rolland Y

Rolland Y, Abellan van Kan G, Vellas B. · Inserm, Toulouse, France; University of Toulouse III, Toulouse, France. · J Am Med Dir Assoc. · Pubmed #18585641 No free full text.

Abstract: A number of factors, including physical activity, may contribute to prevention of cognitive decline and delay the onset of dementia. In addition to its convincing multiple benefits, an increasing body of evidence suggests that an active life has a protective effect on brain functioning in elders. Physical activity may also slow down the course of Alzheimer's disease. These hypotheses have led to increasing research in this specific area during the past decade. This review systematically analyzes the current literature on Alzheimer's disease and the effect of physical activity. Epidemiological studies, short-term randomized controlled trials (RCTs) in nondemented participants, and biological research suggest that physical activity improves cognitive function in older subjects. The limitations of these works are discussed. No RCTs have yet demonstrated that regular physical activity prevents dementia. Additional challenging clinical interventional studies are needed to demonstrate this relationship, but accumulating evidence from biological research is available. Defining the optimal preventive and therapeutic strategies in terms of type, duration, and intensity of physical activity remain an open question. In the future, the prevention of Alzheimer's disease may be based on rules governing lifestyle habits such as diet, cognitive activity, and physical activity.

Gillette Guyonnet S, Abellan Van Kan G, Andrieu S, Barberger Gateau P, Berr C, Bonnefoy M, Dartigues JF, de Groot L, Ferry M, Galan P, Hercberg S, Jeandel C, Morris MC, Nourhashemi F, Payette H, Poulain JP, Portet F, Roussel AM, Ritz P, Rolland Y, Vellas B. · Service de Medecine Interne et de Gerontologie Clinique, Pavillon J.P. Junod, Centre Hospitalier Universitaire La Grave-Casselardit, Toulouse cedex 9, France. · J Nutr Health Aging. · Pubmed #17435956 No free full text.

Abstract: Cognitive impairment can be influenced by a number of factors. The potential effect of nutrition has become a topic of increasing scientific and public interest. In particular, there are arguments that nutrients (food and/or supplements) such as vitamins, trace minerals, lipids, can affect the risk of cognitive decline and dementia, especially in frail elderly people at risk of deficiencies. Our objective in this paper is to review data relating diet to risk of cognitive decline and dementia, especially Alzheimer's disease (AD). We chose to focus our statements on homocysteine-related vitamins (B-vitamins), antioxidant nutrients (vitamins E and C, carotenoids, flavonoids, enzymatic cofactors) and dietary lipids. Results of epidemiological studies may sometimes appeared conflicting; however, certain associations are frequently found. High intake of saturated and trans-unsaturated (hydrogenated) fats were positively associated with increased risk of AD, whereas intake of polyunsaturated and monounsaturated fats were protective against cognitive decline in the elderly in prospective studies. Fish consumption has been associated with lower risk of AD in longitudinal cohort studies. Moreover, epidemiologic data suggest a protective role of the B-vitamins, especially vitamins B9 and B12, on cognitive decline and dementia. Finally, the results on antioxidant nutrients may suggest the importance of having a balanced combination of several antioxidant nutrients to exert a significant effect on the prevention of cognitive decline and dementia, while taking into account the potential adverse effects of these nutrients. There is no lack of attractive hypotheses to support research on the relationships between nutrition and cognitive decline. It is important to stress the need to develop further prospective studies of sufficiently long duration, including subjects whose diet is monitored at a sufficiently early stage or at least before disease or cognitive decline exist. Meta analyses should be developed, and on the basis of their results the most appropriate interventional studies can be planned. These studies must control for the greatest number of known confounding factors and take into account the impact of the standard social determinants of food habits, such as the regional cultures, social status, and educational level.

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.

Nourhashémi F, Rolland Y, Vellas B. · Service de Médecine interne et de Gérontologie clinique, CHU Purpan-Casselardit, Toulouse. · Presse Med. · Pubmed #10916539 No free full text.

Abstract: FREQUENCY AND SEVERITY: Approximately 30% of all elderly subjects experience a fall at least once a year. Hip fractures is the most severe consequence. PREVENTIVE MEASURES: The prevention of falls and hip fractures implies different strategies depending on the population concerned. For most all older subjects in good general health, one of the important risk factors is an abnormal single-leg stance which can reveal equilibrium disorders. For more frail subjects (20% of the elderly population), all factors must be considered, including, sarcopenia, nutritional status, and cognitive function. INSTITUTIONALIZED SUBJECTS: For institutionalized subjects, generally with multiple disease states, falls usually signal poor health, aggravated by multiple medications. One of the most frequent diseases observed in this population is Alzheimer type dementia. Adapted multidimensional management must be initiated within the framework of an overall gerontology policy to prevent falls and their consequences in institutionalized subjects.

Rolland Y, Abellan van Kan G, Nourhashemi F, Andrieu S, Cantet C, Guyonnet-Gillette S, Vellas B. · Inserm, U558, Toulouse, France. · J Alzheimers Dis. · Pubmed #19276547 No free full text.

Abstract: Among elderly without cognitive impairment, poor physical performances have been reported to predict cognitive decline and dementia. Our aim was to explore the predictive value of balance impairment for cognitive decline in 686 community-dwelling Alzheimer's disease (AD) patients (REAL.FR study). Being unable to stand on one leg for five seconds or more defined balance impairment. Cognitive decline was assessed using the Mini-Mental Status Examination (MMSE) score. Co-morbidities, behavioral and psychological symptoms of dementia (BPSD) using the Neuropsychiatric Inventory score, medication, and level of education were assessed at the hospital. MMSE and balance were reported every six months during two years. Linear mixed model analyses were performed. At baseline, participants with balance impairment (15.2% of the sample) were significantly older, had a lower MMSE score and more BPSD, co-morbidities, and medication. After adjustment for the potential covariates, the presence of balance impairment at each assessment was associated with a mean MMSE decline of 9.2 (1.4) points at two years; having no balance impairment at each assessment was associated with a mean MMSE decline of 3.8 (0.3) points at two years (p < 0.001). An abnormal one-leg balance test is a marker of more advanced dementia and predicts a higher rate of cognitive decline.

Abellan van Kan G, Rolland Y, Nourhashémi F, Coley N, Andrieu S, Vellas B. · Inserm U558, Department of Geriatric Medicine, CHU Toulouse, Toulouse, France. · Dement Geriatr Cogn Disord. · Pubmed #19246908 No free full text.

Abstract: BACKGROUND/AIMS: To assess if cardiovascular disease risk factors (CVDRF) are predictive factors for poorer evolution of Alzheimer's disease (AD) patients in terms of cognitive decline. METHODS: The Réseau de la maladie d'Alzheimer - France (REAL.FR) study is a prospective multicentre cohort which has recruited 686 community-dwelling patients presenting mild to moderate AD. The presence of CVDRF and associated treatments was recorded at baseline. The rate of cognitive decline of AD patients was assessed using the Mini Mental State Examination (MMSE) and the Alzheimer Disease Assessment Scale cognitive subscale (ADAS-Cog), after 2 years of follow-up. RESULTS: Of the 629 patients at baseline, 268 (42.6%) had no CVDRF, 256 (40.7%) reported 1 CVDRF and 105 (16.7%) reported 2-3. At inclusion, hypertension was present in 44.1% of patients, hypercholesterolaemia in 22.6% and diabetes in 9.4%. No statistically significant differences (p values of 0.9 for MMSE and 0.8 for ADAS-Cog) in mean cognitive decline after 2 years of follow-up were found comparing different subgroups of patients with CVDRF to the non-CVDRF group. CONCLUSIONS: Although there is evidence that CVDRF contribute to the onset of AD, these results suggest that CVDRF may not be part of the underlying processes that affect progression of AD.

Gillette Guyonnet S, Abellan Van Kan G, Andrieu S, Aquino JP, Arbus C, Becq JP, Berr C, Bismuth S, Chamontin B, Dantoine T, Dartigues JF, Dubois B, Fraysse B, Hergueta T, Hanaire H, Jeandel C, Lagleyre S, Lala F, Nourhashemi F, Ousset PJ, Portet F, Ritz P, Robert P, Rolland Y, Sanz C, Soto M, Touchon J, Vellas B. · Gerontopole, Pole Geriatrie Gerontologie, Hopital La Grave-Casselardit, Toulouse. · J Nutr Health Aging. · Pubmed #18810298 No free full text.

Abstract: Alzheimer's disease (AD) is the most frequent form of dementia and according to the most recent estimation it affects nearly 27 million people in the world. The onset of the disease is generally insidious. It is becoming increasingly evident that the underlying pathophysiological mechanisms are active long before the appearance of the clinical symptoms of the disease. In the current context, it is important to develop strategies to delay the onset of cognitive decline. Delaying the onset by 5 years would reduce the prevalence by half at term, and a delay of 10 years would reduce it by three-quarters. The effectiveness of currently suggested preventive approaches remains to be confirmed, but certain strategies could be applied straight away to at-risk subjects. We propose that a health-promoting memory consultation should be set up for elderly persons who have attended a specialized memory consultation and in whom the diagnosis of dementia and of AD in particular, has not been established by standardized tools. Through this consultation, they would be offered full multidimensional investigation of all aspects of their health status, follow-up could be organized, general practitioners in private practice could be made more conscious of this population and the elderly could be made more aware of the risk factors to which they are exposed. The development of an information policy for the elderly would meet a present need. In our reflection, we must take into account the question of how to give this preventive consultation its due place in the healthcare pathway of the elderly person in order to ensure coordinated follow-up with all the other health professionals involved. The principle of the health-promoting memory consultation is undergoing validation in a large French multicentre preventive trial in 1200 frail elderly persons aged 70 years followed for three years, the Multidomain Alzheimer Preventive Trial (MAPT).

Nourhashemi F, Gillette-Guyonnet S, Andrieu S, Rolland Y, Ousset PJ, Vellas B, Anonymous00065. · Hôpital Casselardit, Service de Médecine Interne et de Gérontologie Clinique, 31059 Toulouse, France. · J Nutr Health Aging. · Pubmed #18373036 No free full text.

Abstract: OBJECTIVE: To describe the design anf baseline patient characteristics of a multicomponent specific care and assistance plan (PLASA) study in Alzheimer's Disease (AD). The study is designed to evaluate the effect of PLASA in AD primarily looking at change in functional capacity. DESIGN: Two-years prospective cluster randomized controlled trial comparing PLASA and usual care. SETTING: Forty-nine hospitals in France. PARTICIPANTS: 1120 community-dwelling AD. INTERVENTION: Patients in the intervention group are evaluated biannually using a standardized comprehensive global assessment. In the case of decline in any one domain a standardized study protocol recommends specific physician directed intervention in addition to information and training for the caregiver. MEASUREMENTS: Alzheimer Disease Cooperative Study-Activities of Daily Living scale, Resource Utilization in Dementia scale, Clinical Global Impression of Change. RESULTS: At baseline, the two groups were similar regarding patient and caregiver characteristics. The mean patient age was 79.61+5.72 years and the mean MMSE 19.73+4.01 for the whole cohort. Time since dementia diagnosis was about 1.37+1.65 years in the whole cohort. Almost a third of the patients lived alone at baseline. Mean monthly time spent in caregiving in the whole cohort was 52.70+71.83 hours for instrumental activities and 17.73+51.38 hours for basic activities. CONCLUSION: Persons with dementia suffer different losses at different stages of the disease and therefore accurate assessment of abilities and losses is critical to assist the person in planning for their future and for care needs. The PLASA intervention study is ongoing with 2 year follow-up to be completed in 2007.

Rolland Y, Andrieu S, Cantet C, Morley JE, Thomas D, Nourhashemi F, Vellas B. · Service de Médecine Interne et de Gérontologie Clinique, Pavillon Junot, Hôpital La Grave-Casselardit, 170 avenue de Casselardit, Toulouse, France. · Alzheimer Dis Assoc Disord. · Pubmed #17334270 No free full text.

Abstract: We evaluated the predictive value of wandering behavior at baseline for nutritional status, disability, institutionalization, and mortality in 686 Alzheimer disease community-dwelling subjects enrolled in the prospective REAL.FR study, France. Wandering behavior was defined using the Neuro-Psychiatric Inventory. The Mini-Nutritional Assessment and Katz Activity of Daily Living (ADL) scale were administered every 6 months during the 2 years of the study. Dementia severity was assessed using the Mini-Mental State Examination. Behavioral disturbances, comorbidities, medication, health care support, and burden status of the caregiver were assessed at the baseline visit. Outcomes of the 83 (12.2%) wanderers were compared with those of the nonwanderers. In the whole sample 30.1%/year subjects lost weight, 27.8%/year worsened their nutritional status, 55.1%/year decreased their ADL score, 11%/year reduced their ability to walk, 13.5%/year were institutionalized, and 6.2%/year died. Wanderers differed from nonwanderers by a higher frequency of decline of the ADL score (P<0.001), and institutionalization (P<0.001). Adjusted for baseline characteristics, risk of worsening the nutritional status, weight loss, decreased ADL score, and death were not statistically different between wanderers and nonwanderers. Risk for undernutrition and death are not increased in wanderers. Their higher risk of ADL disabilities and institutionalization are partly explained by their baseline characteristics.

Rolland Y, Pillard F, Klapouszczak A, Reynish E, Thomas D, Andrieu S, Rivière D, Vellas B. · Internal Medicine Service and Gerontology Clinic, Hôpital La Grave-Casselardit, Toulouse, France. · J Am Geriatr Soc. · Pubmed #17302650 No free full text.

Abstract: OBJECTIVES: To investigate the effectiveness of an exercise program in improving ability to perform activities of daily living (ADLs), physical performance, and nutritional status and decreasing behavioral disturbance and depression in patients with Alzheimer's disease (AD). DESIGN: Randomized, controlled trial. SETTING: Five nursing homes. PARTICIPANTS: One hundred thirty-four ambulatory patients with mild to severe AD. INTERVENTION: Collective exercise program (1 hour, twice weekly of walk, strength, balance, and flexibility training) or routine medical care for 12 months. MEASUREMENTS: ADLs were assessed using the Katz Index of ADLs. Physical performance was evaluated using 6-meter walking speed, the get-up-and-go test, and the one-leg-balance test. Behavioral disturbance, depression, and nutritional status were evaluated using the Neuropsychiatric Inventory, the Montgomery and Asberg Depression Rating Scale, and the Mini-Nutritional Assessment. For each outcome measure, the mean change from baseline to 12 months was calculated using intention-to-treat analysis. RESULTS: ADL mean change from baseline score for exercise program patients showed a slower decline than in patients receiving routine medical care (12-month mean treatment differences: ADL=0.39, P=.02). A significant difference between the groups in favor of the exercise program was observed for 6-meter walking speed at 12 months. No effect was observed for behavioral disturbance, depression, or nutritional assessment scores. In the intervention group, adherence to the program sessions in exploratory analysis predicted change in ability to perform ADLs. No adverse effects of exercise occurred. CONCLUSION: A simple exercise program, 1 hour twice a week, led to significantly slower decline in ADL score in patients with AD living in a nursing home than routine medical care.

Rolland Y, Payoux P, Lauwers-Cances V, Voisin T, Esquerré JP, Vellas B. · Service de Médecine Interne et de Gérontologie Clinique, Hôpital La Grave-Casselardit, 170 avenue de Casselardit, 31300 Toulouse, France. · Int J Geriatr Psychiatry. · Pubmed #16116584 No free full text.

Abstract: BACKGROUND: Among behavior disturbance during Alzheimer's disease (AD), wandering is one of the most common. Different psychological processes have been suggested to explain the wandering behavior. The aim of this study was to examine whether wandering during AD was associated with cerebral perfusion patterns measured by (99 m)Tc-labeled bicisate (ECD) brain SPECT. METHODS: We compared SPECT scans of 13 AD subjects with wandering behavior (sex ratio M/F, 4/9; age, 73.1 years, SD 7.4; Mini Mental Status Examination score, median 20 interquartile range [16-23]), 13 AD subjects without wandering behavior (matched for age [ +/- 2 years], sex and MMSE score [ +/- 2 points]) and 13 healthy controls (matched for age [ +/- 2 years] and sex) without cognitive impairment. Wandering was defined on the Neuro-Psychiatric Inventory. Score of leukoaraiosis, assessed with the scale of Blennow and number of lacuna infarction were compared on CT scan. SPECT imaging was compared using statistical parametric mapping (SPM 2). RESULTS: There were no significant differences between the groups in term of educational level and CT scan analysis. SPECT imaging was consistent with the diagnosis of AD in both wanderers and AD subjects without wandering behavior. Despite similar clinical dementia severity, wanderers had more severely reduced regional cerebral blood flow (rCBF) in the left parietal-temporal lobe than AD subjects without wandering behavior. CONCLUSION: Wandering behavior could be facilitated by a specific patterns of cerebral blood flow. Wandering, as a physical activity, could also enhance the recruitment of the cortical network.

Rolland Y, Gillette-Guyonnet S, Nourhashémi F, Andrieu S, Cantet C, Payoux P, Ousset PJ, Vellas B. · Service de médecine interne et gérontologie clinique, CHU Purpan, Pavillon Junod, 170, avenue de Casselardit, 31300 Toulouse, France. · Rev Med Interne. · Pubmed #14710453 No free full text.

Abstract: PURPOSE: Wandering is a common problem among patients with Alzheimer's disease. Few studies have examined this problematic behaviour in the community. The aim of the present study was to increase our understanding of wandering during Alzheimer's disease in subjects living in the community. METHODS: We studied 571 patients with Alzheimer's disease living in the community. Objective cognitive status was assessed using a series of standardized neuropsychological tests. Nutritional assessment, risk of fall, autonomy were assessed as well as the burden of their family. The behavioural abnormalities of patients were assessed with their caregiver using the Neuro-Psychiatric Inventory. Patients with or without wandering were described. RESULTS: Prevalence of wandering was 12.6%. Patients with wandering appeared to have more severe cognitive impairment, less autonomy and were undernourished. Behavioural and psychological signs significantly associated with wandering were delirium, aggressiveness, irritability, depression, anxiety, euphoria, apathy, desinhibition and eating behaviour disorder. Subtype of Alzheimer's disease patients seemed to have frontal release behaviour. CONCLUSION: Wandering is a common behaviour in Alzheimer's disease patients living in the community. Special care must be organized to help those frail patients and their caregivers.

Andrieu S, Rolland Y, Nourhashemi F, Vellas B. · No affiliation provided · Servir. · Pubmed #12012860 No free full text.

This publication has no abstract.

Nicolas AS, Andrieu S, Nourhashémi F, Rolland Y, Vellas B. · Hĵpital La Grave-Casselardit, Pavillon J.P. Junod, Toulouse, France. · Nutr Rev. · Pubmed #11519674 No free full text.

This publication has no abstract.

Gillette-Guyonnet S, Nourhashemi F, Andrieu S, de Glisezinski I, Grandjean H, Rolland Y, Riviere D, Vellas B. · Department of Gerontology and Internal Medicine, Purpan University Hospital, Toulouse, France. · J Nutr Health Aging. · Pubmed #10936904 No free full text.

Abstract: OBJECTIVES: To study appendicular muscle mass in women with Alzheimer's disease (AD) to investigate the association between sarcopenia and AD. To examine the AD associated changes in body fat distribution. DESIGN: a cross-sectional study of 32 women with AD and 32 healthy age and bone mineral density matched women. Setting: Toulouse, France. RESULTS: No differences were noted in fat free soft tissue mass or Appendicular Skeletal Muscle (ASM) mass between AD women and control women. The difference of ASM (kg) /height2 (m)2, used as an index of relative skeletal muscle mass, was not statistically significative between the two groups. The prevalence of sarcopenia increased from 21.9 % in healthy elderly women to 40.6 % in AD women but the difference was not statistically significant. No statistically significant relationship emerged between sarcopenia and AD (OR= 0.41, CI 0.12-1.4). Moreover, total body fat mass was significantly lower in women with AD than in the age -, sex - and bone mineral density - matched controls. CONCLUSION: AD are not necessary linked to sarcopenia. The decrease in adipose tissue in women with AD could be one more factor involving estrogen deficiency in the etiology of the disease.

Nourhashémi F, Ousset PJ, Guyonnet S, Andrieu S, Rolland Y, Adoue D, Vellas B, Albarède JL. · Service de médecine interne et de gérontologie clinique, hôpital Purpan-Casselardit, CHU, Toulouse, France. · Rev Med Interne. · Pubmed #10909152 No free full text.

Abstract: INTRODUCTION: Sporadic Alzheimer's disease is the most frequent form of dementia and appears to be associated with increasing age and certain genetic and environmental factors. Some studies have recently been published on potential protective factors. CURRENT KNOWLEDGE AND KEY POINTS: Several genes appear to be involved; one of the most common is the ApoE4 allele on chromosome 19. The physiopathology is not elucidated, but recent studies have shown a protective effect for NSAIDs, estrogen, nutritional factors (vitamins E, B6 and B12) as well as some biochemical amino acids (homocysteine). FUTURE PROSPECTS AND PROJECTS: Interventional studies are now in progress and some preventive approaches will soon be available.

Rolland Y, Rival L, Pillard F, Lafont C, Rivére D, Albaréde J, Vellas B. · Service de &Mgrave;decine du Sport et d'Exploration Fonctionnelle Respiratoire, CHU Purpan, 31059 Toulouse Cedex, France. · J Nutr Health Aging. · Pubmed #10842423 No free full text.

Abstract: BACKGROUND: Physical activity delays loss of autonomy in the elderly. In patients with Alzheimer disease (AD), physical activity could be a useful strategy in therapeutic management by delaying loss of functional independence and the usual complications of the disease. OBJECTIVE: To determine, using standardized tools, the effects on autonomy (ADL, IADL), cognitive function (MMS), nutritional status (MNA), behavioral problems (NPI) and risk of falls (Tinetti test) of a physical exercise program in patients with AD. DESIGN: Twenty-three subjects (13 men and 10 women, aged 71-92 years, mean 78 years) with AD (mean MMS 16, range 1-23) carried out for a mean of 7 weeks (5-12 weeks) a program of endurance exercise (walking, exercise bicycle) adapted to their individual capacities. Standardized gerontological evaluation was performed before and after the study. RESULTS : No significant change in autonomy (ADL, IADL) was observed. There was an improvement in the MNA (p<0.001) and the MMS (p<0.001). Risk of falls (p<0.01) and behavioral problems (p<0.05) decreased. These results were obtained without increasing family workload. CONCLUSION : We suggest that physical activity is a therapeutic option which can reduce nutritional and behavioral complications and risk of falls in subjects with AD.