Telemedicine for the acute management of stroke in Burgundy, France: an evaluation of effectiveness and safety

Background In the context of the development of telemedicine in France to address low thrombolysis rates and limited stroke infrastructures, a star-shaped telestroke network was implemented in Burgundy (1.6 million inhabitants). We evaluated the safety and effectiveness of this network for thrombolysis in acute ischemic stroke patients. Methods One hundred and thirty-two consecutive patients who received intravenous thrombolysis during a telemedicine procedure (2012–2014) and 222 consecutive patients who were treated at the stroke center of Dijon University Hospital, France (2011–2012) were included. Main outcomes were the modified Rankin scale (mRS) score and case fatality at 3 months. Com…

Physical Activity and Amyloid-β Brain Levels in Elderly Adults with Intact Cognition and Mild Cognitive Impairment

Objectives To examine the associations between amyloid-β brain deposition and physical activity (PA) in elderly adults without dementia and to investigate whether the association has a dose-response relationship. Design Cross-sectional study. Setting French community-dwelling people. Participants Elderly adults with normal or mildly impaired cognition (mean age 74.7 ± 4.2; 60.4% female) with available information on current self-reported PA and amyloid-β brain deposition measured using positron emission tomography (PET) using the PET-ligand florbetapir F 18 (n = 268). Measurements A standardized uptake value ratio (SUVR) was obtained for each subject. Participants were divided according to …

Post-Stroke Cognitive Impairment: High Prevalence and Determining Factors in a Cohort of Mild Stroke

BACKGROUND Because of the aging population and a rise in the number of stroke survivors, the prevalence of post-stroke cognitive impairment (PSCI) is increasing. OBJECTIVE To identify the factors associated with 3-month PSCI. METHODS All consecutive stroke patients without pre-stroke dementia, mild cognitive disorders, or severe aphasia hospitalized in the Neurology Department of Dijon, University Hospital, France (November 2010 - February 2012) were included in this prospective cohort study. Demographics, vascular risk factors, and stroke data were collected. A first cognitive evaluation was performed during the hospitalization using the Mini-Mental State Exam (MMSE) and the Montreal Cogni…

In the here and now: Short term memory predictions are preserved in Alzheimer's disease

According to neuropsychological models of anosognosia, there is a failure to transfer on-line awareness of dysfunction into a more generalised long term belief about memory function in Alzheimer's disease. This failure results in specific metamemory deficits for global predictions: patients overestimate their performance before the task but are able to monitor their memory performance after having experienced the task. However, after a delay, they are still not able to make accurate predictions. As previous work has mainly focused on long-term memory, the present study investigates this issue in short-term and working memory. Using both global and item-by-item metacognitive judgements in a …

The Early Indicators of Functional Decrease in Mild Cognitive Impairment

OBJECTIVES: Motor deficiency is associated with cognitive frailty in patients with Mild Cognitive Impairments (MCI). In this study we aimed to test the integrity of the muscle synergy involved in an arm-pointing movement in MCI patients, non-impaired functionally. Thus, we were able to test the hypothesis that early motor indicators exist in this population at a preclinical level. METHODS: The electromyographic signals were collected for 11 muscles in 3 groups: Young Adults (YA), Aged Adults (AA), and MCI patients. The AA and MCI groups presented the same functional status. Each subject performed twenty arm-pointing movements from a standing position. RESULTS: The main differences were (1) …

Évaluation du jugement temporel après l'introduction d'un stimulus émotionnel de nature olfactive : apport dans le diagnostic différentiel entre la maladie d'Alzheimer et les troubles de l'humeur

Revue non indexée dans le JCR.; La multiplicité des termes et des théories concernant les émotions rend leur évaluation particulièrement complexe. La majorité des évaluations actuelles ne prend en compte que l’expérience psychique de l’individu et omet la part implicite des processus émotionnels. Les procédures d’amorçage permettent d’étudier ce type de traitement inconscient. En nous appuyant sur les paradigmes d’amorçage affectif et les modèles d’horloge interne, nous avons élaboré un paradigme d’amorçage émotionnel. Il consiste en une tâche de jugement temporel après l’introduction d’un stimulus émotionnel. En temps normal, l’introduction d’un tel stimulus va créer une activation de l’ho…

Le jugement d’oubli dans la maladie d’Alzheimer

International audience; IntroductionAvez-vous déjà eu l’impression d’oublier quelque chose ? Le sentiment d’oubli est très commun dans la vie quotidienne mais a été très peu étudié expérimentalement.ObjectifsL’objectif de cette étude est d’évaluer les jugements d’oubli sur des tâches de mémoire sémantique et épisodique dans le vieillissement normal et dans la maladie d’Alzheimer.Patients et méthodesCinquante jeunes adultes, 35 personnes âgées et 33 patients Alzheimer ont été testés. Les participants effectuaient soit des jugements d’oubli, soit des jugements de rappel sur 2 tâches de mémoire. Pour la tâche de mémoire sémantique, les participants devaient rappeler toutes les régions de Franc…

Les accidents vasculaires cérébraux : ce qui a changé au début du xxie siècle

Resume Introduction Les accidents vasculaires cerebraux (AVC) faisaient partie, il y a 20 ans, des pathologies medicales mobilisant peu de ressources techniques et humaines car atteignant les sujets âges et ne disposant pas de therapeutiques efficaces. Cette pathologie etait alors grevee d’une mortalite precoce elevee au-dela de 25 %. C’etait l’epoque de l’attitude contemplative face a un AVC. Le developpement de l’epidemiologie de populations des AVC a permis de demontrer qu’ils n’etaient pas l’apanage du sujet âge et que 25 % d’entre eux survenaient avant 60 ans et en periode d’activite professionnelle. L’arrivee de la fibrinolyse et la mise en place des unites neurovasculaires ont transf…

Les accidents vasculaires cérébraux du sujet âgé : ce que nous a appris l’épidémiologie du sujet jeune

Stroke in the elderly has more major differences compared to young people: it is the first complication of atherothrombosis disease associated with the following risk factors: hypertension, diabetes, hypercholesterolemia, tobacco consumption and sleep apnea syndrome; AVC is the first consequence of atrial fibrillation; from a clinical point of view, seizure at the onset of the stroke is more frequent; prognosis is characterized by a high risk of dementia (20%); primary and secondary prevention is very efficacious even in very old patients, not only on the risk of stroke, but also on the risk of dementia; time trends at Dijon show a slight decrease of incidence rates of stroke only over 85 y…

Diagnostic Procedures in Ischaemic Stroke Patients with Dementia. A Population-Based Study

Background Dementia is a frequent condition in stroke patients. Aims To investigate the effect of dementia on access to diagnostic procedures in ischaemic stroke patients. Methods All cases of ischaemic stroke from 2006 to 2010 were identified from the population-based Stroke Registry of Dijon, France. Patients' characteristics were recorded, as was the use of brain computed tomography scans, brain magnetic resonance imaging, electrocardiogram, echocardiography, and Doppler ultrasonography of the cervical arteries. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Logistic regression models were used to evaluate the associations between d…

Trends in the incidence of ischaemic stroke in young adults between 1985 and 2011: the Dijon Stroke Registry

Recent data have suggested that stroke incidence in young people may be rising. In this population-based study, we aimed to determine whether the incidence of stroke in people aged55 years old had changed over the last three decades.All cases of first-ever stroke (ischaemic stroke, spontaneous intracerebral haemorrhage, and undetermined stroke) occurring in Dijon, France, from 1985 to 2011 were prospectively collected from a population-based registry. Incidence rates were calculated and temporal trends were analysed by age groups and stroke subtypes using a Poisson regression to estimate incidence rate ratios (IRR). Risk factors and premorbid treatments were analysed.Over the 27-year study …

N-Acetylaspartate/Creatine and Choline/Creatine Ratios in the Thalami, Insular Cortex and White Matter as Markers of Hypertension and Cognitive Impairment in the Elderly

International audience; Abstract: Our objective was to investigate the influence of hypertension on N-acetylaspartate (NAA) and choline (Cho) ratios in brain tissues in a community-dwelling elderly population. Brain flexibility was also evaluated with regard to the same metabolite ratios. Proton magnetic resonance spectroscopy (MRS) and the Trail Making Test (TMT) were performed in 80 subjects (75.7 +/- 4 years old) from the Three-City Study. Fifty-eight participants had hypertension. The NAA/creatine (Cr) and Cho/Cr ratios were obtained in the insular cortex, the thalami and the deep periventricular white matter. In addition, the B-A score of the TMT was evaluated. Uniand multi-variate ana…

Syndrome démentiel du sujet âgé lié à un traitement par acide valproïque : à propos d’un cas

In addition to the usual adverse effects, the chronic use of the valproic acid can entail dementia syndrome. We describe the case of a 68-year-old woman who had presented a dementia syndrome due to the use of valproic acid for one year. This drug was prescribed in order to prevent a potential convulsive crisis after an ischemic stroke in a patient who did not have a history of epilepsy. This case shows that each clinician must be careful about all medications consumed by the patient in the face of cognitive disorders.

One-year survival of demented stroke patients: data from the Dijon Stroke Registry, France (1985-2008)

Background and purpose:  Dementia is a frequent condition after stroke that may affect the prognosis of patients. Our aim was to determine whether post-stroke dementia was a predictor of 1-year case-fatality and to evaluate factors that could influence survival in demented stroke patients. Methods:  From 1985 to 2008, all first-ever strokes were recorded in the population-based stroke registry of Dijon, France (150 000 inhabitants). Dementia was diagnosed during the first month following stroke, according to DSM-III and DSM-IV criteria. Survival was evaluated at 1 year and multivariate analyses were performed using Cox proportional hazards to identify independent predictive factors. Results…

Fatty Acid Profiles in Demented Patients: Identification of Hexacosanoic Acid (C26:0) as a Blood Lipid Biomarker of Dementia

Background: Several lipid metabolism alterations have been described in the brain and plasma of Alzheimer’s disease (AD) patients, suggesting a relation between lipid metabolism alteration and dementia. 15 16 Objective: We attempted to identify blood fatty acids as biomarkers of dementia. 17 Methods: Fatty acid profiles were established using gas chromatography with or without mass spectrometry on matched plasma and red blood cells (RBCs) of demented patients diagnosed with AD, vascular dementia, or other dementia, and compared with a control group of elderly individuals. The severity of dementia was evaluated with the Mini-Mental State Examination test. 18 19 20 Results: Fatty acid analysi…

The Clock'N Test as a Possible Measure of Emotions: Normative Data Collected on a Non-clinical Population.

International audience; Objective: At present emotional experience and implicit emotion regulation (IER) abilities are mainly assessed though self -reports, which are subjected to several biases. The aim of the present studies was to validate the Clock'N test, a recently developed time estimation task employing emotional priming to assess implicitly emotional reactivity and IER. Methods: In Study 1, the Clock' N test was administered to 150 healthy participants with different age, laterality and gender, in order to ascertain whether these factors affected the test results. In phase 1 participant were asked to judge the duration of seven sounds. In phase 2, before judging the duration of the…

Potential Roles of Peroxisomes in Alzheimer's Disease and in Dementia of the Alzheimer's Type

In Alzheimer's disease (AD) and dementia of the Alzheimer's type (DAT), the role played by peroxisomes is not well known. Peroxisomes are present in all eukaryotic cells, with the exception of erythrocytes. They are involved in the β-oxidation process of long-chain fatty acids, very-long-chain fatty acids, and branched-chain fatty acids. They participate in the α-oxidation of phytanic acid, the biosynthesis of bile acids, and the breakdown of eicosanoids. Peroxisomes are also involved in the synthesis of specific fatty acids such as docosahexaenoic acid (DHA), which is essential for the brain and retina, and plasmalogens (PLGN), which play crucial roles in neural cells and are essential com…

Faut-il réaliser un « Mini-Mental State Examination » chez tout sujet âgé hypertendu ?

Hypertension constitutes a recognized risk factor of vascular dementia but also of Alzheimer-type dementia. Various longitudinal studies showed that midlife blood pressure level is one of the factors conditioning the onset of dementia syndrome in late life. The high risk of dementia is linked to leukoaraiosis, vascular rigidity, microcirculation disorders, oxidative stress, blood pressure fluctuations including orthostatic hypotension and strokes, all of those being associated with hypertension. Numerous clinical trials showed the positive effect of effective treatment of hypertension on the prevention of cognitive disorders and dementias. Thus, screening and early management of dementia an…

Alzheimer's disease associated with sporadic cerebral amyloid angiopathy in an elderly patient

Serum 25-hydroxyvitamin D predicts severity and prognosis in stroke patients

Background and purpose We aimed to evaluate the association between 25-hydroxyvitamin D (25(OH)D) levels and both clinical severity at admission and outcome at discharge in stroke patients. Methods From February 2010 to December 2010, consecutive stroke patients admitted to the Department of Neurology of Dijon, France, were identified. Clinical information was collected. Serum concentration of 25(OH)D was measured at baseline. Stroke severity was assessed at admission using the NIHSS score. Functional impairment was evaluated at discharge using the modified Rankin scale (m-Rankin). Multivariate analyses were performed using logistic regression models. Results Of the 386 recorded patients, s…

Utilisation des antidépresseurs chez les sujets âgés déments : données actuelles

Resume La depression et les symptomes comportementaux et psychologiques de la demence (SCPD) ont un impact important sur l’evolution de la maladie dementielle car ils favorisent l’acceleration du declin cognitif et influencent le pronostic fonctionnel et vital. Le prescripteur doit etre particulierement prudent dans le maniement des antidepresseurs chez le sujet âge car la plupart des etudes ont certes inclus des patients âges d’au moins 65 ans, mais rarement de plus de 75 ans ; ces patients etant en outre selectionnes sur l’absence de tout critere de fragilite. Ainsi, les inhibiteurs de la recapture selectifs de la serotonine (IRSS), qui semblaient initialement ne comporter que peu de risq…

Temporal trends in the premorbid use of preventive treatments in patients with acute ischemic cerebrovascular events and a history of vascular disease: The Dijon Stroke Registry (1985–2010)

Although secondary prevention in patients with arterial vascular diseases has improved, a gap between recommendations and clinical practice may exist.We aimed to evaluate temporal trends in the premorbid use of preventive treatments in patients with ischemic cerebrovascular events (ICVE) and prior vascular disease.Patients with acute ICVE (ischemic stroke/TIA) were identified through the population-based stroke registry of Dijon, France (1985-2010). Only those with history of arterial vascular disease were included and were classified into four groups: patients with previous coronary artery disease only (CAD), previous peripheral artery disease only (PAD), previous ICVE only, and patients w…

Prestroke antiplatelet therapy and early prognosis in stroke patients: the Dijon Stroke Registry

Background and purpose Previous antiplatelet therapy (APT) in cardiovascular prevention is common in patients with first-ever stroke. We aimed to evaluate the prognostic value of APT on early outcome in stroke patients. Methods All first-ever strokes from 1985 to 2011 were identified from the population-based Stroke Registry of Dijon, France. Demographic features, risk factors, prestroke treatments and clinical information were recorded. Multivariate analyses were performed to evaluate the associations between pre-admission APT and both severe handicap at discharge, and mortality at 1 month and 1 year. Results Among the 4275 patients, 870 (20.4%) were previously treated with APT. Severe han…

The Impact of World and European Football Cups on Stroke in the Population of Dijon, France: A Longitudinal Study from 1986 to 2006

Background: Acute stress may trigger vascular events. We aimed to investigate whether important football competitions involving the French football team increased the occurrence of stroke. Methods: We retrospectively retrieved data of fatal and nonfatal stroke during 4 World Football Cups (1986, 1998, 2002, and 2006) and 4 European Championships (1992, 1996, 2000, and 2004), based on data from the population-based Stroke Registry of Dijon, France. One period of exposure was analyzed: the period of competition extended to 15 days before and after the competitions. The number of strokes was compared between exposed and unexposed corresponding periods of preceding and following years using Poi…

Temporal trends in early case-fatality rates in patients with intracerebral hemorrhage.

Objective:To assess whether temporal trends in very early (within 48 hours) case-fatality rates may differ from those occurring between 48 hours and 30 days in patients with spontaneous intracerebral hemorrhage (ICH).Methods:All cases of ICH that occurred in Dijon, France (151,000 inhabitants), were prospectively collected between 1985 and 2011, using a population-based registry. Time trends in 30-day case fatality were analyzed in 3 periods: 1985–1993, 1994–2002, and 2003–2011. Cox regression models were used to evaluate associations between time periods and case fatality within 48 hours and between 48 hours and 30 days, after adjustments for demographics, risk factors, severity, and ICH l…

Factors associated with early recurrence at the first evaluation of patients with transient ischemic attack.

Abstract We aimed to identify factors easily collected at admission in patients with transient ischemic attack (TIA) that were associated with early recurrence, so as to guide clinicians’ decision-making about hospitalization in routine practice. From September 2011 to January 2013, all TIA patients who were referred to the University Hospital of Dijon, France, were identified. Vascular risk factors and clinical information were collected. The etiology of the TIA was defined according to the results of complementary examinations performed at admission as follows: large artery atherosclerosis (LAA-TIA) TIA, TIA due to atrial fibrillation (AF-TIA), other causes, and undetermined TIA. Logistic…