La rétropulsion du sujet âgé: mise au point sur un symptôme grave et proposition d'une échelle pour une évaluation quantifiée

Resume Propos Bien qu'il n'existe a l'heure actuelle aucune donnee epidemiologique sur la retropulsion, ce trouble postural semble relativement frequent chez le sujet âge fragile. Actualites et points forts La retropulsion se caracterise par un dejettement posterieur du tronc en position assise, une insuffisance d'avancee du tronc dont la projection du tronc au sol est situee en arriere de la base de sustentation lors du passage assis–debout et une tendance a la chute en arriere en position debout. Plusieurs situations pathologiques aussi bien somatiques (lesions cerebrales degeneratives, ischemiques, traumatiques), que psychosomatiques (syndrome de desadaptation psychomotrice, alitement pr…

Le « tri par carte » : une méthode de recherche devenant outil d’aide à la décision dans les situations de fin de vie du patient Alzheimer

PSYCHOBEHAVIORAL DISORDERS, ORTHOSTATIC HYPOTENSION, AND FALLS RELATED TO A PHEOCHROMOCYTOMA IN A VERY ELDERLY SUBJECT: A CASE REPORT

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.

AN ATYPICAL CASE OF GIANT CELL ARTERITIS (HORTON'S DISEASE) ASSOCIATED WITH FACIAL SWELLING, CONFUSION, AND PERICARDITIS IN AN ELDERLY WOMAN

Analysis of postural control in elderly subjects suffering from Psychomotor Disadaptation Syndrome (PDS).

PDS is a geriatric affliction, described in 1999, characterized by postural impairments, including backward disequilibrium, freezing, a deterioration in the ability to anticipate postural adjustments, anxiety and fear of falling, inducing loss of autonomy. This study compared 10 subjects suffering from PDS, aged 87.3+/-4.9 years, with 10 control subjects, aged 85.4+/-7.9 years concerning postural control (body sway amplitude). In all participants, postural control was assessed using the SwayStar system in natural (spontaneous) and standardized stances, eyes open and eyes closed over a period of 40 s. It was found that: (1) with eyes open, subjects with PDS showed greater body sway amplitude…

Aging affects the mental simulation/planning of the "rising from the floor" sequence.

We investigated the effect of aging on the ability to mentally simulate/plan a complex sequential action of the whole body, namely "rising from the floor". Forty-four non-demented elderly people (mean age: 85.2±5.5 years) and 20 young people (mean age: 26.6±4.9 years) were included in the study. They were required to put in order six images representing the main movements necessary to get up from a sitting position on the floor. We showed that older subjects had poorer performance-both in terms of proportion of success and response time-than their younger counterparts. These results are in line with previous findings showing age-related alterations in action simulation/action planning proce…

''A case of meningitis due to Achromobacter xylosoxidans denitrificans 60 years after a cranial trauma''

International audience; ''Background: Achromobacter xylosoxidans (AX) is a non-fermentative aerobic Gram-negative bacillus. It is an opportunistic pathogen and the causative agent of various infections. We report an original case of late posttraumatic meningitis due to AX denitrificans. Case Report: An 83-year-old man was hospitalized for acute headache, nausea and vomiting. The emergency brain computer tomography (CT) scan did not reveal any anomaly. In his medical history, there was an auditory injury due to a cranial trauma incurred in a skiing accident 60 years earlier. Cytobiochemical analysis of the cerebrospinal fluid (CSF) revealed increased levels of neutrophils and proteins. The C…

Concerning mistreatment of older people: clinical and ethical thoughts based on a study of known cases.

International audience; Following a report by the Health Ministry recommending a greater implication of general practitioners (GP) in the diagnosis and care of mistreated older people, we wanted to evaluate what was actually their role in this matter. A study was made of files of mistreated older persons referred to the social services in a Parisian suburb. For each file, we noted who raised the first suspicions of mistreatment, who diagnosed it, what happened next, and what precisely the GP's role was. Out of 600 files, we found 12 cases, concerning 14 persons (two couples). Although all the patients had health problems requiring frequent consultations with their GP, none of these situatio…

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…

Syndrome de désadaptation psychomotrice

Resume Propos Nous decrivons le syndrome de desadaptation psychomotrice et rapportons les recentes avancees concernant sa physiopathologie et sa therapeutique. Il y a 20 ans, l'equipe du Pr Gaudet le decrivait sous l'appellation « syndrome de regression psychomotrice » avant d'etre rebaptise sous sa nouvelle denomination a la fin des annees 1990. Actualites et points forts Le syndrome de desadaptation psychomotrice represente une decompensation de la fonction posturale, de la marche et des automatismes psychomoteurs, liee a une perturbation de la programmation posturomotrice suite a une deterioration des structures sous-corticofrontales. Il associe des troubles posturaux (retropulsion), des…

Marche et démences

Resume Objectifs Decrire les troubles de la marche (TM) au cours des demences primitives, leurs consequences et l’interet de leur prevention et reeducation. Methode Analyse des articles les plus pertinents disponibles sur Medline concernant la marche et la demence. Resultats La prevalence des TM et de l’equilibre dans la demence de type Alzheimer varie de 9 a 52 %. Les marches frontale et apraxique y sont decrites. Dans la demence vasculaire, les TM a type de marches hemiparetique, frontale et unsteady, sont observes chez plus de 71 % de patients et sont probablement un marqueur precoce de cette demence. Bien qu’en pratique clinique les TM semblent frequents dans la demence a corps de Lewy …

Clinical determinants of failure in balance tests in elderly subjects

We assessed the role of clinical and biological parameters on performance in four balance tests in elderly subjects. An observational study was conducted in the Center for Preventive Medicine of Nancy (France) in 2368 community-living elderly subjects aged 60 and older. Body mass index (BMI), Mini-Mental State Examination (MMSE), clock test, "Health score" and use of psychotropic drugs (UPD) were assessed. Participants performed four balance tests: "one-leg-stand" (OLS), "timed-up-and-go" (TUG), "rise-from-the-floor" (RFF) and "sit-to-stand" (STS). The statistical analysis showed that women were almost twice as likely to fail balance tests as men. In both women and men, the following determ…

Multidisciplinary management in geriatric day-hospital is beneficial for elderly fallers: A prospective study of 28 cases

We determined whether management including medical, psychological, and physiotherapeutic approaches, over a period of 6 weeks, has a beneficial effect on motor abilities, psychological status, and independence of elderly fallers with psychomotor disadaptation syndrome (PDS). We included 28 subjects (mean age 81.4 years). They were assessed from a medical, motor, and psychological point of view at both the inclusion and the end of the multidisciplinary intervention. A follow-up was conducted with multidisciplinary assessment at 6 and 9 months after the beginning of the study in order to evaluate duration of benefits of the management. The statistical analysis concerned only subjects who took…

A new formula for correction of total calcium level into ionized serum calcium values in very elderly hospitalized patients

International audience

"Card sorting" : a tool for research in ethics on treatment decision-making at the end of life in Alzheimer patients with a life threatening complication

Abstract Background End stage dementia is a particularly difficult aspect of care for patients with Alzheimer's disease and related dementias. In care institutions, caregivers and family are concerned by treatment decision-making for an acute life threatening complication occurring in Alzheimer patients at the end of life. How should the best treatment pathway be decided: to treat or not to treat? Which arguments are used for decision-making? These are mainly ethical questions which are currently difficult to express and investigate. Methods/Design Cross sectional multicentre study of clinical cases involving 67 health centres (university hospitals, general hospitals, local hospitals and ho…

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…

''Assessment of the use of hypolipidemic agents (HAs), mainly statins, in elderly subjects aged 80 years and more in Burgundy: Analysis of 13,211 patients''

Manckoundia, Patrick | Lorenzini, Mathieu | Disson-Dautriche, Anne | Petit, Jean-Michel | Lorcerie, Bernard | Debost, Emmanuel | Menu, Didier | Pfitzenmeyer, Pierre; International audience; ''Only few studies have investigated the use of HA in elderly subjects and there are no data in very elderly subjects. We assessed the prescription of HA and analyzed the relationship between such prescriptions and frailty markers among persons aged 80 and more in an observational study. We recorded the prescriptions for 13,211 patients aged 80-109 years and affiliated to the "Mutualite-Sociale-Agricole (MSA)'' of Burgundy over a 1-month period. The prescription of a HA among all included patients, and t…

Is backward disequilibrium in the elderly caused by an abnormal perception of verticality? A pilot study

International audience; OBJECTIVE: We hypothesised that backward disequilibrium (BD), defined by a posterior position of the centre of mass with respect to the base of support, could be caused by a backward tilt in the perception of verticality. METHODS: The relationship between BD, the perception of verticality, and the history of falls in 25 subjects aged 84.5+/-7.4 years was analysed. An original ordinal scale, the BD scale (BDS), was used to quantify BD. Postural (PV) and haptic verticals (HV) were measured in sagittal plane. RESULTS: BDS scores closely correlated with the number of falls (r = 0.81, p =10(-5)). The more the PV was tilted backward, the greater the BDS scores (r = -0.95, …

Assessment of cardiac autonomic nervous activity in frail elderly people with postural abnormalities and in control subjects

Heart rate variability (HRV), which is considered to reflect the activity of the autonomic nervous system (ANS), has been shown to decline with age. The aim of the present study was to explore cardiac ANS in older patients showing frontal-subcortical dysfunction with "Psychomotor Disadaptation Syndrome" (PDS), through the 24-h HRV. We enrolled 14 patients with PDS (mean age: 84.5+/-6.9 years), they were compared to 13 frail control subjects (mean age: 80.6+/-6.7 years). Cardiac ANS activity was assessed by 24-h ECG recordings from three leads with a Holter digital monitor. The decrease in cardiac ANS activity observed in PDS subjects was greater than the alteration found in normally aging s…

Décompensation cardiorespiratoire au cours d’une polyarthrite rhumatoïde

Rheumatoid arthritis (RA) may include rare extra-articular manifestations, and particularly cardiopulmonary involvement. We report a 83-year-old woman, with RA, who presented with both pulmonary and heart failures that were related to the RA, resulting from the presence of mediastinal and axillary lymph nodes, and pleural and pericardial effusions. This was confirmed by the dramatic improvement after a specific treatment of RA.

Comparison of motor strategies in sit-to-stand and back-to-sit motions between healthy and Alzheimer’s disease elderly subjects

We studied the kinematics of shoulder displacement during sit-to-stand and back-to-sit in 6 healthy elderly subjects and six elderly subjects with mild to moderate Alzheimer's disease in order to elucidate the impact of Alzheimer's disease on motor planning and control processes. During sit-to-stand, Alzheimer's disease subjects reduced their forward displacement and started their upward displacement earlier than healthy elderly subjects. Furthermore, shoulder path curvatures were more pronounced for upward compared with downward displacement in healthy elderly group, in contrast with Alzheimer's disease group. Temporal analysis found that: 1) for both groups, profiles of velocity of sit-to…