[Chronic pain, a clumsy body language]

Early psychological factors, including childhood traumas and personality, play a crucial role in the emergence and persistence of painful symptoms and appears to be frequent in patients with nociplastic pain. Patient care involves validating the reality of their pain and identifying various facets of their suffering, taking into account their individual history and context. A multimodal therapeutic approach, within a bio-psycho-social model, emphasizing psychotherapeutic care, is recommended.

Psychiatric disorders, personality traits, and childhood traumatic events predicting incidence and persistence of chronic pain: results from the CoLaus|PsyCoLaus study

ABSTRACT

Chronic pain (CP) is often accompanied by mental disorders (MDs). However, little is known concerning the long-term effect of MDs, personality traits, and early-life traumatic events (ETEs) on CP course. Accordingly, we aimed to prospectively assess the associations of major depressive disorders (MDDs), anxiety disorders, personality traits, and ETEs with the incidence and the persistence of CP in middle-aged and older community dwellers. Data stemmed from the 3 first follow-up evaluations of CoLaus|PsyCoLaus, a prospective cohort conducted in the general population of Lausanne (Switzerland). Diagnostic criteria for MDs and ETEs were elicited using semistructured interviews. CP and personality traits were assessed by self-rating questionnaires. Follow-up intervals were subdivided into 2 groups: those without (n = 2280) and those with (n = 1841) CP initially. The associations between the psychological variables and the occurrence or persistence of CP 5 years later were assessed using serially adjusted logistic regression models. Higher neuroticism (odds ratio [95% confidence interval] 1.21 [1.08; 1.36]) and extraversion (1.18 [1.06; 1.32]) were associated with higher 5-year CP incidence, whereas current (2.14 [1.34; 3.44]) and remitted MDD (1.29 [1.00; 1.66]) as well as lower extraversion (0.83 [0.74; 0.94]) were associated with persistence of CP. By contrast, ETEs and anxiety disorders were not associated with the incidence or persistence of CP. Our results suggest that personality traits are associated with both CP occurrence and persistence, whereas the MDDs may be more associated with CP persistence. Both personality and MDD are accessible to psychotherapy, and MDD is also accessible to pharmacotherapy. Hence, these therapeutic measures might decrease the risk of CP and its persistence.

Executive Profile of the Logopenic Variant of Primary Progressive Aphasia: Comparison with the Semantic and Non-Fluent Variants and Alzheimer’s Disease

The logopenic variant of primary progressive aphasia (lvPPA) shows different features from the non-fluent (nfvPPA) and semantic (svPPA) variants of PPA. Although language impairments remain the core symptoms, studies have highlighted the presence of executive disorders at the onset of the disease. Nevertheless, the results are contradictory, particularly in lvPPA. The aim of this study was to explore the executive profile of lvPPA. We compared executive functioning in lvPPA with the other two variants of PPA, Alzheimer’s disease (AD) and a cognitively healthy group. In total, 70 patients with PPA, 32 patients with AD, and 41 healthy controls were included. They underwent a comprehensive executive battery assessing short-term and working memory, inhibition, flexibility, planning, and initiation. The analyses showed significant differences between the lvPPA group and the control group, except on visuospatial spans and the Stroop test, and between the lvPPA group and the other PPA groups and the AD group for several tasks. Thus, this research highlighted the existence of an executive dysfunction from the onset of the disease in lvPPA but also in the other two variants of PPA.

Réponse sérologique après vaccination contre le coronavirus chez les patients atteints de rhumatisme inflammatoire chronique traités par DMARDs : une étude de cohorte et revue systématique avec méta-analyse

Introduction

La vaccination contre le coronavirus constitue l’une des pierres angulaires dans la gestion de la crise sanitaire liée au COVID-19. Alors que la vaccination confère une protection efficace chez les sujets immunocompétents, son immunogénicité dans la population atteinte de rhumatisme inflammatoire chronique (RIC) n’est pas clairement établie.

Patients et méthodes

Nous avons conduit une étude monocentrique rétrospective évaluant la réponse sérologique après deux doses de vaccination contre le coronavirus chez des patients adultes atteints de RIC et traités par traitements ciblés ou biologiques (n = 123). Les titres d’anticorps IgG dirigés contre la protéine spike du coronavirus (SARS-CoV-2) ont été mesurés après la seconde dose de vaccin. De plus, nous avons conduit une recherche systématique jusqu’au 31 septembre 2021 dans les bases de données PUBMED, preprint et littérature grise non encore publiée des études observationnelles des taux sérologiques après vaccination chez des patients atteints de RIC traités par médicaments ciblés ou biologiques (numéro d’enregistrement PROSPERO : CRD42021259410). Les études rapportant la taille d’échantillon, la date, le pays d’origine, le taux de séroconversion ont été incluses. Nous avons ensuite conduit une méta-analyse afin d’identifier des facteurs associés à la séroconversion.

Résultats

Sur nos 123 patients (âge médian 66 ans écart interquartile [EI] 57–75), 69,9 % ont séroconverti après 2 doses de vaccination. Les patients ayant eu une séroconversion étaient plus âgés que ceux qui n’en ont pas eu. Les patients traités par rituximab sont ceux qui ont le moins répondu à la vaccination. Nous avons identifié 20 études de séroprévalence en plus de notre cohorte, représentant un total de 4423 patients dans 11 pays. La méta-analyse a confirmé un impact négatif sur le taux de séroconversion du rituximab et dans une moindre mesure de l’abatacept, du léflunomide et du méthotrexate.

Conclusion

Le rituximab diminue la réponse sérologique à la vaccination contre le SARS-CoV-2 chez les patients atteints de RIC. Ce travail suggère également un impact négatif de l’abatacept, du méthotrexate ou du léflunomide particulièrement en cas d’association à un médicament biologique.

Processing of Facial Expressions of Emotions and Pain in Alzheimer’s Disease

Background: Alzheimer’s disease (AD) is a neurodegenerative pathology that disrupts processing of facial expressions of emotion. The impairment was demonstrated for negative emotions in tasks of matching, discriminating, and labeling facial expressions but no study has included the expression of pain in its protocol. Objective: The objective was to study the processing of emotional facial expressions in AD with a particular interest in pain expression. Methods: Twenty-seven controls, 15 mild AD patients, and 15 moderate AD patients had to perform four emotional tasks: identification of facial expressions, matching pain expressions, discriminating the intensity of pain expressions, and judging pain intensity. Results: Some emotions were less efficiently recognized by AD patients compared to controls (p <  0.001), specifically fear from the mild stage (p <  0.05), pain and disgust from the moderate stage (p <  0.05 and p <  0.001 respectively). The Exploratory Factor Analysis showed that recognition of pain and recognition of other discreet emotions were underpinned by two different latent factors. Performances on pain expression matching task and pain intensity discrimination task did not differ by group. (p = 0.334 and p = 0.787 respectively). Finally, moderate AD patients judged the pain less intensively than the Control group for both, moderate, and severe pain intensity (p <  0.001). Conclusion: Our data suggest that AD disrupts the recognition of pain expression along with recognition of fear and disgust. Additionally, AD patients seem to underestimate pain intensity compared to controls. The self-rated pain scales should be adapted to the pain processing deficit of AD patients.

Association between depressive symptoms and long-term heart rate variability in older women: Findings from a population-based cohort

INTRODUCTION

Cross-sectional studies highlighted changes in autonomic nervous system (ANS) activity in geriatric depression. However, few longitudinal studies assessed this link which remains still debated. We examined the longitudinal association between lifetime depression history, current depressive disorders, and the evolution of ANS activity in older community women.

METHODS

The present data stemmed from the PROOF study, a population-based cohort of 1011 community-dwellers followed-up at 2-year intervals for 10 years. Only data from female participants was analyzed (n = 508, mean age 68.5 ± 0.88 years), as very few men had depression in our population. Depressive symptoms and depression history were collected at baseline. Participants were classified in four groups according to presence or absence of history of depression (HD) or current depressive symptomatology (CD): HD+/CD+, HD-/CD+, HD+/CD- and HD-/CD-. ANS activity was assessed during the follow-up through 24-h heart rate variability (HRV). Longitudinal associations between depressive status and HRV indices during the follow-up were investigated using multivariate linear mixed models.

RESULTS

Compared to HD-/CD- group, women belonging to HD-/CD+ group had greater baseline parasympathetic tone, as measured by lower LF index and LF/HF balance. The longitudinal analysis exhibited a significant enhancement of LF/HF balance with time, measuring an increase of sympathetic tone in HD-/CD+ group.

CONCLUSION

Our findings suggest that late-onset depressive symptoms may be associated with subsequent autonomic dysregulation in older women. These results highlight the importance of detecting and managing depressive symptoms to limit their consequences on ANS functioning, and the risk of cardiovascular events.

Chronic pain and long-term dementia risk in older adults: Results from a 24-year longitudinal study

INTRODUCTION

Chronic pain (CP) was associated with cognitive impairment in previous studies. However, the longitudinal association between CP and dementia remains under debate. We aimed to assess the prospective link between CP and long-term dementia risk in a population-based cohort of older participants, considering covariables linked to CP and cognitive functioning.

METHODS

The study sample was selected from the PAQUID study, an ongoing cohort of older community-dwellers aged 65 years and over at baseline; Information regarding CP and analgesics consumption was collected using questionnaires. Dementia was clinically assessed every 2 years. The population was divided into 4 groups according to CP and analgesic drugs intake (CP+/A+, CP+/A-, CP-/A+, CP-/A-). An illness-death model was used to estimate the link between CP and incident dementia risk controlled for sex, educational level, comorbidities, depression, antidepressant drugs and analgesics.

RESULTS

Five hundred ninety three participants (364 women) who completed a CP questionnaire, were included. They were followed-up over 24 years (mean follow-up: 11.3 years, SD 7.3). A total of 223 participants (32.5%) had CP, among them 88 (38.6%) took analgesic drugs. Compared to CP-/A- group, CP+/A+ participants had a higher risk of developing dementia in the univariate model (hazard ratio (HR) = 1.73, 95%CI:1.18-2.56; p = 0.0051). However, these results did not persist in the multivariate models (aHR = 1.23, 95%CI:0.88-1.73; p = 0.23). No significant risk for dementia were observed in CP-/A+ and CP+/A- (HR = 1.30, 95%CI:0.84-2.01; p = 0.23 and HR = 1.36, 95%CI:0.95-1.96; p = 0.09, respectively).

CONCLUSION

Our results failed to show a significant relationship between the presence of CP and long-term dementia risk, suggesting that the cognitive decline associated with CP observed in the literature does not appear to be related to Alzheimer's disease or related disorders.

Anxiety symptoms during COVID-19 in older adults with psychiatric disorders

OBJECTIVE

During the COVID-19 pandemic, older people and patients with psychiatric disorders had an increased risk of being isolated. The French National Authority for Health has recommended a reinforced follow-up of these patients. Cross-sectional studies reported an increased risk of developing anxiety and depression during pandemic. The aim of our study was to identify factors associated with higher anxiety during the pandemic in older patients with psychiatric disorders.

METHODS

STERACOVID is a multicenter cohort study with 117 patients followed-up by phone in two French geriatric psychiatry units. In this work, we used cross-sectional data from a prospective follow-up conducted between January and May 2021.

RESULTS

We found that coping strategies, personality, and living conditions were associated with general anxiety (GA) level during the pandemic period. Higher GA was associated with less positive thinking coping strategy, more avoidance strategies, a lower level of extraversion, a higher level of neuroticism, more time spent watching the news, a higher feeling of loneliness, and a lack of physical contact.

FINDINGS

Our study identified factors associated with a poorer experience of pandemic crisis. Special attention should be paid to patients with a high level of neuroticism and a high feeling of loneliness. Support could aim to help patients use more functional strategies: reducing avoidance strategies and increasing positive thinking. Finally, reducing time watching news could also be an interesting prevention perspective.

CLINICAL TRIAL REGISTRATION

clinicaltrials.gov, identifier NCT04760795.

Stress, Personality, Attachment, and Coping Strategies During the COVID-19 Pandemic: The STERACOVID Prospective Cohort Study Protocol

BACKGROUND

Due to the lockdown linked to the COVID-19 pandemic, the French National Authority for Health has recommended reinforced follow-up of psychiatric patients, with particular attention to people over 65 years. Cross-sectional studies reported an increased risk of anxiety, depression, and suicide during this period. Older people with psychiatric disorders are at higher risk of developing severe COVID-19 and worsening their psychiatric symptoms.

OBJECTIVE

The main objective is to evaluate the link between coping strategies and the onset of post-traumatic stress disorder (PTSD) after lockdown. The secondary objective is to assess the psychological factors influencing lockdown experiences such as personality, attachment type, or coping strategies.

METHOD/DESIGN

this is a multicenter cohort study including 117 patients followed up by phone in two French geriatric psychiatry units. Sociodemographic variables, psychiatric diagnoses, lockdown conditions, coping strategies, anxiety, and depressive symptoms reported during the first lockdown will be collected retrospectively from the medical file. A first prospective assessment including personality traits, attachment type, and traumatic life events will be conducted at 12 months (T1). Follow-up visits assessing anxious-depressive symptoms and PTSD will be made 18 (T2) and 24 months (T3) after the first lockdown. The primary outcome measure is PTSD symptoms. Secondary outcomes measures are coping strategies, generalized anxiety, anxiety about the COVID-19 pandemic, and quality of life.

DISCUSSION

This study aims to determine if the type of coping strategies usually employed have an impact on the onset of PTSD after a lockdown period. It will also determine if these coping strategies are influenced by other factors such as sociodemographic variables, lockdown conditions, particular personality traits, attachment type, and traumatic life events. This study could help identify factors associated with a poorer experience of lockdowns and pandemic crisis in elderly patients followed in a psychiatric center, and guide support in future similar situations.

TRIAL REGISTRATION

ClinicalTrials.gov: http://clinicaltrials.gov/show/NCT04760795, Registered 18 February 2021.

Mental Health of People with Dementia During COVID-19 Pandemic: What Have We Learned from the First Wave?

BACKGROUND

People with dementia (PWD) and their caregivers are populations highly vulnerable to COVID-19 pandemic and its consequences. A better knowledge of the living conditions during the first lockdown is necessary to prevent the risk of poor mental health (PMH) in this population.

OBJECTIVE

The present study aimed to compare the mental health of caregivers of PWD living at home or in nursing-homes and to identify specific factors influencing their mental health.

METHODS

We conducted an anonymous cross-sectional online survey in France from March 17 to May 11, 2020. Three hundred and eighty-nine caregivers accompanying a PWD living at home (HC) and 159 accompanying a PWD living in a nursing home (NHC) participated in the study. Caregivers' mental health including anxiety, depression, stress, and burden was assessed with self-reported standardized scales.

RESULTS

Half of the caregivers exhibited PMH, including depression, anxiety, or self-reported stress. Similar PMH rates were provided whatever the PWD place of residence. Regarding HC, our results also highlighted a number of risk factors for PMH, including the fact that caregiver live with PWD, to give increased support to PWD, and to feel more isolated for managing PWD since lockdown.

CONCLUSION

PMH was observed for caregivers of PWD during lockdown, whatever PWD living place, suggesting that concern for PWD may explain more of caregiver distress than increased material tasks. In the future, it will be necessary to pay attention to caregivers after the crisis by estimating the longer-term impact on their mental health.

Does Cognitive Functioning Predict Chronic Pain in Older Adult? Results From the CoLaus|PsyCoLaus Longitudinal Study

Chronic pain (CP) and cognitive impairment are common in older adults. CP was found to be associated with cognitive impairment in many cross-sectional studies. However, their cross-sectional design precluded inference on temporality. Accordingly, we aimed to prospectively assess the association between cognitive functioning and the occurrence of CP in older community dwellers. Analyses were based on data of the first (FU1) and the second follow-up (FU2) of CoLaus|PsyCoLaus, a prospective cohort study conducted in the general population of Lausanne (Switzerland) including the participants aged 65 and over. Neuropsychological functioning including memory, language, attention and executive function was measured at FU1. CP was assessed at FU1 and FU2 by self-rating questionnaire. The association between cognitive scores and subsequent CP was determined using multiple logistic regressions. Among the 337 participants without CP at FU1, 107 (31.8%) developed CP at FU2. A significant association was observed between higher Stroop color-time and interference index at FU1 and a higher risk of CP at FU2 (OR = 1.02; P = .03 and OR = 1.49; P = .03, respectively). Our results suggest that patients with inhibitory deficit may be at higher risk of developing CP in the presence of painful events. A cognitive assessment could be recommended to identify frail patients in these situations. PERSPECTIVE: This study suggests that presence of inhibitory deficits is associated with a higher risk of developing subsequent CP in older adults. In the presence of painful events, a cognitive assessment should be recommended to identify frail patients and to manage them carefully.

[Scientific medicine and care relationship: From the therapeutic alliance to the therapeutic effect of the alliance]

The new paradigm of precision medicine in oncology questions today the respective place of evidence-based medicine and doctor-patient relationship. Based on the results of a randomized study comparing the efficacy of a homeopathic molecule in the prevention of nausea and vomiting induced by chemotherapy in non-metastatic breast cancer, this article extends and develops the discussion of maintaining an unresolved tension between medical art and medical science, between care and cure. This tension sets a base for the authors of the therapeutic alliance in medicine, defined as a dialectic constantly adjourned between the alliance of the doctor with the patient and his therapy, and the therapeutic effect of this alliance. Because if a policy or a public opinion were to promote an exclusively rational medicine deprived of the field of relation to care, or on the contrary a medicine based only on clinical sense and intuition, then respectively the ethics of care and the progress of therapy would be threatened. It is advisable to be aware of erring from the truth, amplified today by social networks, as much due to a tide of scientific positivism, as an excess of the "good caring soul". Taking into account the therapeutic alliance makes it possible to no longer oppose scientific medicine and care relationship.

COVID-19: Association Between Increase of Behavioral and Psychological Symptoms of Dementia During Lockdown and Caregivers' Poor Mental Health

BACKGROUND

From March 2020, the support and care systems for caregivers and people with dementia (PWD) were suspended or dramatically changed due to the lockdown during the world pandemic of COVID-19. Thus, these changes in living conditions have had deleterious consequences on the behavior of PWD and subsequently on their caregivers' mental health, the two being linked.

OBJECTIVE

Our study aimed to examine changes in behavior among PWD and to look for associations between the evolution of behavioral and psychological symptoms of dementia (BPSD) and caregivers' mental health in the context of COVID-19.

METHODS

The study was conducted among caregivers of PWD living at home in France. Caregivers were interviewed via an anonymous cross-sectional online survey during the first lockdown between April 15 and June 15, 2020.

RESULTS

Three hundred and eighty-nine caregivers accompanying a relative living at home participated in the study; 43.3%of the PWD presented a worsening of BPSD during the lockdown. With multivariate logistic regressions, a significant association was observed between "more BPSD" and burden, anxiety and depression, between "BPSD equivalent" and anxiety and depression, and between "emerging BPSD" and only depression.

CONCLUSION

The lockdown seems to have an impact on behavioral disorders in PWD and these disorders are associated with poorer mental health of caregivers. Our findings suggest attention should be given to caregivers of PWD who have BPSD before lockdown and the need for continued consultations and professional help in case of new lockdowns.

How do patients with Alzheimer's disease imagine their pain?

INTRODUCTION

Pain is underdiagnosed and undertreated in patients with Alzheimer's disease (AD). Pain management is of major importance in this population to limit behavioural and functional consequences. Our study aimed to assess the capacity of AD patients to represent pain using a questionnaire exploring daily painful situations and to determine the most appropriate pain scale assessment.

METHODS

Twenty-eight patients with mild AD, 21 with moderate AD and 28 matched controls underwent the Situation Pain Questionnaire (SP-Q) and assessed imaginary pain with four pain scales. Two scores were compared between the three groups: the P(A) discrimination score and the response bias β score. P(A) reflects the degree of discrimination between high-pain and low-pain events, whereas the β score means the degree to which situations are considered as painful.

RESULTS

Our results showed that AD patients hardly discriminated the high- from low-pain events. Compared to controls, the mean P(A) score was significantly lower for Mild AD (p < 0.03) and Moderate AD (p < 0.004). In addition, the β score indicated that the response bias is higher for AD patients (p < 0.01) in that they overestimated the level of pain.

CONCLUSION

The present results suggest that patients with Mild and Moderate AD are able to recognize and assess an imagined painful situation even though their pain tolerance is lower than that of controls. The pain scales used should be chosen according to the cognitive, sensorial and personal profiles of the patients.

SIGNIFICANCE

The present research is significant because it examines how patients with Alzheimer's disease understand and assess painful situations. Cognitive impairments can modify this ability. Pain is a sensory and subjective experience and to define its feeling can help us in our clinical practice.

Does Personality Predict Behavioral and Psychological Symptoms of Dementia? Results from PACO Prospective Study

BACKGROUND

Premorbid personality could play a role in the onset of behavioral and psychological symptoms (BPS) in Alzheimer's disease (AD) but prospective studies are lacking.

OBJECTIVE

The present study aimed at prospectively assessing the influence of premorbid personality traits on BPS evolution in a population of patients with prodromal or mild AD.

METHODS

We used a multicenter prospective cohort study of 237 patients followed-up for 18 months. The influence of personality traits on BPS evolution, measured with Neuropsychiatric Inventory (NPI), was assessed using linear mixed-effect models.

RESULTS

A principal components analysis of the 12 NPI behavioral domains yielded five factors labelled as psychotic symptoms, affective symptoms, behavioral dyscontrol, apathy/appetite symptoms, and sleep disorders. During the follow-up, higher neuroticism was significantly associated with a higher progression of affective symptoms (p < 0.0001), apathy/appetite symptoms (p = 0.002), sleep disorders (p = 0.001) as well as global NPI scores (p < 0.0001). Greater conscientiousness was related to a lower evolution of psychotic (p = 0.002), affective (p = 0.02) and apathy/appetite symptoms (p = 0.02), and global NPI score (p < 0.0001). Higher openness was associated with lower affective symptoms evolution (p = 0.01). A significant relationship was found between higher extraversion, lower affective symptoms (p = 0.02), and higher behavioral dyscontrol (p = 0.04).

CONCLUSION

The present analysis suggests that premorbid personality may influence the evolution of BPS in prodromal or mild AD. Given these results, it seems important to give more importance to personality assessment in early AD, in order to better identify and manage patients at risk of adverse behavioral changes.

Association between executive function and the evolution of behavioral disorders in Alzheimer's disease

OBJECTIVE

This study was aimed at evaluating the association between cognitive functioning and the occurrence of behavioral and psychological symptoms of dementia (BPSD) in patients with Alzheimer's disease (AD).

METHODS/DESIGN

The population is derived from the PACO cohort, including 237 patients with prodromal or mild AD. A neuropsychological tests battery exploring verbal and visual memory, language, attention, and executive functions was performed at baseline. BPSD were assessed at 6-, 12-, and 18-month follow-up with neuropsychiatric inventory (NPI).

RESULTS

Lower baseline performance on Stroop test interference score was associated with higher subsequent overall NPI scores (P = .006), subscores of anxiety/depression (P = .03), and apathy inventory (P = .01). Conversely, other executive functions, verbal or visual memory, and language performances were not associated with a higher risk of BPSD.

CONCLUSION

Our results suggest that poorer inhibition performance would be associated with a higher risk of 18-month BPSD occurrence, including anxiety, depression, and apathy. A better knowledge of the predictive factors of the BPSDs would make it possible to better identify the patients at risk, to propose preventive strategies and an earlier adapted care. J Am Geriatr Soc 68:-, 2020.

THU0097 PREDICTIVE VALUE OF IMMUNOLOGICAL AND IMAGING BIOMARKERS ON ACHIEVING GOOD CLINICAL RESPONSE AT 6 MONTHS IN RHEUMATOID ARTHRITIS PATIENTS TREATED BY INTRAVENOUS BDMARDS

Background:

RA is the most prevalent chronic inflammatory rheumatism, responsible of functional impairment.

Objectives:

To investigate the value of biological and imaging biomarkers on predicting good clinical response at 6 months, in RA patients initiating IV bDMARD.

Methods:

From 2008 to 2017, 317 RA patients fulfilling ACR 1987 and/or ACR-EULAR 2010 criteria for RA, initiated IV bDMARDs in our department of Rheumatology. Patients were excluded in cases of lack of information on disease activity assessment before and at 6 months of treatment and on immunological status and titers (ACPA, RF, ANA) at baseline. For patients receiving successive IV bDMARDs during this time period (n=30), a randomization permitted to select 1 treatment sequence for the analysis. On 173 patients eligible to the study, 4 were loss to follow-up and 14 stopped treatment due to adverse events before 6 months. Clinical, biological and imaging (US and RX) data were collected when available at baseline. US examination was performed on 12 joints (wrist, MCP2-3-5 and MTP2-3-5) with qualitative and quantitative evaluation on B mode and Power Doppler (PD) for synovitis, tenosynovitis and erosion. The modified Sharp/van der Heijde erosion score was performed by 2 independent readers blindly from clinical and US informations. Good clinical response was defined by a DAS 28 < 3.2 and/ or DAS 28 decrease > 1.2 at 6 months. Only variables with a p<0.2 in univariate analysis were included in the multivariate model.

Results:

On 155 RA patients, 11 present a disease duration < 2 year, 44 (28.3%) were on first line of IV bDMARDs and 111 patients received at least one IV bDMARD (mean 2.5 (1.3)).

Table 1.

Characteristics of the patients (n=155) at baseline

VariablesN (%)Mean (SD)Clinical characteristicsAge (years)54.8 (12.2)Female113 (72.9)Disease duration (months)166.9 (118.8)DAS 285.2 (1)TreatmentCorticosteroids / dose (mg/day)99 (85.3)10.9 (6)Monotherapy56 (36.1)IV bDMARDAbatacept27 (17.4)Infliximab11 (7.1)Rituximab84 (54.2)Tocilizumab33 (21.3)ImmunologyACPA + /titer(IU)132 (85.2)618.5 (791.0)RF + /titer (IU/ml)114 (74.5)184.7 (351.3)ANA + / level87 (56.1)1453 (3836)RadiographySharp’s erosion score (n=110)49.4 (46.2)USNb Erosion (n=95)3.0 (2.3)Nb B mode Synovitis (n=128)6.0 (4.1)Nb PD+ Synovitis (n=130)4.8 (3.8)Nb B mode Tenosynovitis (n=129)1.6 (2)Nb PD+ Tenosynovitis (n=129)1.3 (2.1)

At 6 months, 87 patients (56.1%) were in good clinical response. Predictive values of biomarkers are presented in table 2.

Table 2.

Variables predictive of a good clinical response at 6 months

BiomarkersResponseMultivariate Logistic regression AnalysisAllN = 101Response(N=60)OR (CI95%)P valueImmunology RF +7551 (68.0%)5.1 (1.8-14.4)0.002 ACPA +8756 (64.4%) ANA +5536 (65.5%)Radiography Erosive RA7448 (64.9%)Ultrasonography Erosive RA8855 (62.5%) Nb B mode synovitis10160 (59.4%)1.2 (1.1-1.4)0.002 Nb PD+ synovitis10160 (59.4%)

All qualitative variables with a p value <0.2 on bivariate analysis were incorporated in the multivariate model (RF +, ACPA +, US erosive RA, Nb B mode synovitis, Nb PD+ synovitis, RX erosive RA). Only patients with all data available are incorporated in the multivariate logistic regression analysis (n=101/155)

Conclusion:

We showed that positive RF was predictive of good clinical response to IV bDMARDs. For the first time, we demonstrated that number of US B-mode synovitis was also predictive to good clinical response.

Disclosure of Interests:

Stephane Giuliani Grant/research support from: BMS, Benjamin Laurent Grant/research support from: BMS, Hella MEZGHANI Employee of: BMS, Isabelle Duprat-Lomon Employee of: BMS, Amandine Luc Grant/research support from: BMS, Marcelo De carvalho Bittencourt Grant/research support from: BMS, Cedric BAUMANN Grant/research support from: BMS, Isabelle CHARY VALCKENAERE: None declared, Damien LOEUILLE: None declared

SAT0042 PREDICTIVE VALUE OF IMMUNOLOGICAL AND IMAGING BIOMARKERS ON ACHIEVING REMISSION AT 6 MONTHS IN RHEUMATOID ARTHRITIS PATIENTS TREATED BY INTRAVENOUS BDMARDS

Background:

RA is the most prevalent chronic inflammatory rheumatism, responsible of functional impairment.

Objectives:

To investigate the value of biological and imaging biomarkers on predicting DAS 28 remission at 6 months, in RA patients initiating IV bDMARD.

Methods:

From 2008 to 2017, 317 RA patients fulfilling ACR 1987 and/or ACR-EULAR 2010 criteria for RA, initiated IV bDMARDs in our department of Rheumatology. Patients were excluded in cases of lack of information on disease activity assessment before and at 6 months of treatment and on immunological status and titers (ACPA, RF, ANA) at baseline. For patients receiving successive IV bDMARDs during this time period (n=30), a randomization permitted to select 1 treatment sequence. On 173 patients eligible to the study, 4 were lost to follow-up and 14 stopped treatment due to adverse events before 6 months. Clinical, biological and imaging (US and RX) data, were collected when available at treatment initiation. US examination was performed on 12 targeted joints (wrist, MCP2-3-5 and MTP2-3-5) with qualitative and quantitative evaluation on B mode and Power Doppler (PD) for synovitis, tenosynovitis and erosion. The modified Sharp/van der Heijde erosion score was performed by 2 independent readers blindly from clinical and US informations. Remission was defined by a DAS 28 < 2.6 at 6 months. Only variables with a p<0.2 in univariate analysis were included in the multivariate model.

Table 1.

Characteristics of the patients (n=155) at baseline

Table 2.

Variables predictive of a DAS 28 remission at 6 months for IV bDMARDs

BiomarkersUnivariateAnalysisBivariate Logistic regression AnalysisDAS 28 remission(n= 33)No Remission(n=122)p valueOR (CI95%)Clinical dataNb of sequence >119 (57.6%)92 (75.4%)0.0520.4 (0.2-1.0)Radiography (n=110)Erosive RA22 (88.0%)61 (71.8%)0.1180.3 (0.1-1.3)US (n=127)Erosive RA28 (96.6%)82 (83.7%)0.1170.2 (0.0-1.4)Nb B mode synovitis7.7 (4.5)5.5 (3.9)0.0130.9 (0.8-1.0)Nb PD+ synovitis6.5 (5.0)4.3 (3.3)0.0310.9 (0.8-1.0)

All qualitative variables with a p value <0.2 on bivariate analysis were incorporated in the multivariate model (RF +, ACPA +, US erosive RA, Nb B mode synovitis, Nb PD+ synovitis, RX erosive RA). Only patients with all data available were incorporated in the multivariate logistic regression analysis (n=103/155). In multivariate analysis only the number of B mode synovitis was still significant with OR =1.1 (CI 95%: 1.0-1.3) (p<0,019).

Results:

On 155 RA patients, 11 had a disease duration < 2 year, 44 (28.3%) were on first line of IV bDMARDs and 111 patients received at least one IV bDMARD (mean 2.5 (1.3)).

Conclusion:

In RA patients treated by IV bDMARDs, number of PD+ synovitis on ultrasonography was the only predictive biomarker of DAS 28 remission.

Disclosure of Interests:

Benjamin Laurent Grant/research support from: BMS, Stephane Giuliani Grant/research support from: BMS, Hella MEZGHANI Employee of: BMS, Isabelle Duprat-Lomon Employee of: BMS, Amandine Luc Grant/research support from: BMS, Marcelo De carvalho Bittencourt Grant/research support from: BMS, Cedric BAUMANN Grant/research support from: BMS, Isabelle CHARY VALCKENAERE: None declared, Damien LOEUILLE: None declared

Evidence for a New Compact Symmetric Fission Mode in Light Thorium Isotopes

Taking benefit of the R3B/SOFIA setup to measure the mass and the nuclear charge of both fission fragments in coincidence with the total prompt-neutron multiplicity, the scission configurations are inferred along the thorium chain, from the asymmetric fission in the heavier isotopes to the symmetric fission in the neutron-deficient thorium. Against all expectations, the symmetric scission in the light thorium isotopes shows a compact configuration, which is in total contrast to what is known in the fission of the heavier thorium isotopes and heavier actinides. This new main symmetric scission mode is characterized by a significant drop in deformation energy of the fission fragments of about 19 MeV, compared to the well-known symmetric scission in the uranium-plutonium region.

A hidden mesencephalic variant of central pain

BACKGROUND

Central post-stroke pain (CPSP) can arise after lesions anywhere in the central somatosensory pathways, essentially within the spinothalamic system (STS). Although the STS can be selectively injured in the mesencephalon, CPSP has not been described in pure midbrain infarcts.

METHODS

Of more than 300 CPSP consecutive cases, we describe five patients who developed definite neuropathic pain following lesions circumscribed to the postero-lateral mesencephalon.

RESULTS

The mesencephalic lesion responsible for pain was always haemorrhagic and always involved the spinothalamic tract (STT), as demonstrated by suppressed laser-evoked potentials in every case, with or without preserved lemniscal function. In three cases the midbrain injury could be ascribed to trauma, presumably from the cerebellar tentorium. As a result of the paucity of sensory symptoms, the pain was considered as 'psychogenic' in two of the patients until electrophysiological testing confirmed STT involvement.

CONCLUSION

Postero-lateral midbrain lesions should be added to potential causes of CPSP. Because pain and spinothalamic deficits may be the only clinical sign, and because small lateral midbrain lesions may be difficult to trail with MRI, mesencephalic CPSP can be misdiagnosed as malingering or psychogenic pain for years.

SIGNIFICANCE

Selective spinothalamic injury caused by small lateral midbrain lesions is a very rare cause of central post-stroke pain that can remain undiagnosed for years. It appears to obey to haemorrhagic, sometimes post-traumatic lesions. Sudden development of contralateral burning pain with isolated spinothalamic deficits may be the only localizing sign, which can be easily objectively detected with electrophysiological testing.

Neuroticism-Withdrawal and Neuroticism-Volatility Differently Influence the Risk of Neuropsychiatric Symptoms in Alzheimer's Disease

BACKGROUND

Neuroticism is recognized as the personality domain that is most strongly associated with behavioral and psychological symptoms (BPS) of Alzheimer's disease (AD). Two sub-components of neuroticism have been recently isolated. Neuroticism-withdrawal (N-withdrawal) refers to the tendency to internalize negative emotion, whereas neuroticism-volatility (N-volatility) reflect the predisposition to externalize negative emotions.

OBJECTIVE

The objective of the current study was to investigate the specific influence of these two sub-components of neuroticism on BPS.

METHODS

One hundred eighty-seven patients with prodromal or mild AD were drawn from the PACO study (Personalité Alzheimer COmportement). Neuroticism and its facets were assessed at baseline using the NEO-PI-R inventory. N-withdrawal and N-volatility were isolated using a principal component analysis led on the six facets composing neuroticism. BPS were measured with the short version of Neuropsychiatric Inventory (NPI-Q) and collected at baseline, then every 6 months over an 18-month follow-up. Linear mixed-effect analyses were conducted to investigate the association between N-withdrawal, N-volatility, and the severity of BPS over the follow-up.

RESULTS

Mean age of the participant was 79.2±6.5; 59% were female; mean MMSE was 24.5±2.5. Both N-volatility and N-withdrawal were related with the NPI-Q (p < 0.001; p = 0,004). N-withdrawal was positively associated with anxiety (p = 0.001) and depression (p = 0.002), while N-volatility was positively related to delusions (p = 0.004), agitation/aggression (p < 0.001), irritability/volatility (p = 0.037), and apathy (p = 0.021).

CONCLUSION

The present study demonstrates that N-volatility and N-withdrawal influence the risk of developing BPS in a different way. These results highlight the relevance of considering sub-components of neuroticism when studying links between personality and BPS.

Preliminary results on the 233U α-ratio measurement at n_TOF

233U is the fissile nuclei in the Th-U fuel cycle with a particularily small neutron capture cross setion which is on average about one order of magnitude lower than its fission cross section. Hence, the measurement of the 233U(n, γ) cross section relies on a method to accurately distinguish between capture and fission γ-rays. A measurement of the 233U α-ratio has been performed at the n_TOF facility at CERN using a so-called fission tagging setup, coupling n_TOF 's Total Absorption Calorimeter with a novel fission chamber to tag the fission γ-rays. The experimental setup is described and essential parts of the analysis are discussed. Finally, a preliminary 233U α-ratio is presented.

Immediate Benefit of Art on Pain and Well-Being in Community-Dwelling Patients with Mild Alzheimer's

OBJECTIVE

The present report aims to evaluate whether singing intervention can bring an immediate benefit that is greater than the one provided by painting intervention on pain and well-being.

METHODS

Fifty-nine mild patients with Alzheimer disease were randomized to a 12-week singing (n = 31) or painting group (n = 28). In the present analysis, the immediate evolution of pain and well-being was compared across sessions between the 2 groups using mixed-effects models.

RESULTS

We observed a significant improvement in well-being for both singing and painting groups immediately after sessions, compared to the assessment before the sessions. We did not observe this improvement across the sessions for pain intensity measurement.

DISCUSSION

Our results revealed that both painting and singing interventions provide an immediate benefit on the patients' well-being.

Personality Traits are Related to Selective Cognitive Impairment in Early Alzheimer's Disease

BACKGROUND

A link between personality traits and cognitive performance has been shown in normal adults and elderly individuals. Very few studies have evaluated this link in Alzheimer's disease (AD).

OBJECTIVE

To better understand cognitive performance as regards to personality traits, our study was aimed to evaluate the role of premorbid personality on cognitive functioning in a population of patients presenting prodromal or mild AD.

METHODS

181 elderly with prodromal or mild AD participated in a cross-sectional, prospective cohort study. The participants completed a personality inventory and a neuropsychological battery exploring memory, attention, executive function, language, and praxis. Cognitive performance were compared according to the level of each personality trait, using multivariate MANOVA models.

RESULTS

A higher level of neuroticism was associated with lower performance at similarities test (D = 9.49, p = 0.003), delayed Free and Cued Selective Reminding test (D = 5.22, p = 0.02), and digit span score (D = 7.99, p = 0.006). A higher level of openness was related to better performance at similarities (D = 4.33, p = 0.04), letter fluency (D = 11.45, p = 0.001), and category fluency test (D = 5.85, p = 0.02). Neuroticism interfered negatively with cognitive functioning at the prodromal stage; the association between openness and cognitive function was observed at both prodromal and mild AD stage.

CONCLUSION

These results suggest that personality traits, in particular neuroticism and openness, modulate cognitive abilities in patients with early AD. These results encourage the development of stress management programs to prevent its negative effects on cognitive aging.

Preliminary results on the 233U capture cross section and alpha ratio measured at n_TOF (CERN) with the fission tagging technique

233U is of key importance among the fissile nuclei in the Th-U fuel cycle. A particularity of 233U is its small neutron capture cross-section, which is on average about one order of magnitude lower than the fission cross-section. The accuracy in the measurement of the 233U capture cross-section depends crucially on an efficient capture-fission discrimination, thus a combined set-up of fission and γ-detectors is needed. A measurement of the 233U capture cross-section and capture-to-fission ratio was performed at the CERN n_TOF facility. The Total Absorption Calorimeter (TAC) of n_TOF was employed as γ-detector coupled with a novel compact ionization chamber as fission detector. A brief description of the experimental set-up will be given, and essential parts of the analysis procedure as well as the preliminary response of the set-up to capture are presented and discussed.

Structural, Microstructural, and Metabolic Alterations in Primary Progressive Aphasia Variants

Neuroimaging studies have described the brain alterations in primary progressive aphasia (PPA) variants (semantic, logopenic, nonfluent/agrammatic). However, few studies combined T1, FDG-PET, and diffusion MRI techniques to study atrophy, hypometabolism, and tract alterations across the three PPA main variants. We therefore explored a large early-stage cohort of semantic, logopenic and nonfluent/agrammatic variants (N = 86) and of 23 matched healthy controls with anatomical MRI (cortical thickness), FDG PET (metabolism) and diffusion MRI (white matter tracts analyses), aiming at identifying cortical and sub-cortical brain alterations, and confronting these alterations across imaging modalities and aphasia variants. In the semantic variant, there was cortical thinning and hypometabolism in anterior temporal cortices, with left-hemisphere predominance, extending toward posterior temporal regions, and affecting tracts projecting to the anterior temporal lobes (inferior longitudinal fasciculus, uncinate fasciculus) and tracts projecting to or running nearby posterior temporal cortices: (superior longitudinal fasciculus, inferior frontal-occipital fasciculus). In the logopenic variant metabolic alterations were more extensive than atrophy affecting mainly the left temporal-parietal junction and extending toward more anterior temporal cortices. Metabolic and tract data were coherent given the alterations of the left superior and inferior longitudinal fasciculus and the left inferior frontal-occipital fasciculus. In the nonfluent/agrammatic variant cortical thinning and hypometabolism were located in the left frontal cortex but Broca's area was only affected on metabolic measures. Metabolic and tract alterations were coherent as reflected by damage to the left uncinate fasciculus connecting with Broca's area. Our findings provide a full-blown statistically robust picture of brain alterations in early-stage variants of primary progressive aphasia which has implications for diagnosis, classification and future therapeutic strategies. They demonstrate that in logopenic and semantic variants patterns of brain damage display a non-negligible overlap in temporal regions whereas they are substantially distinct in the nonfluent/agrammatic variant (frontal regions). These results also indicate that frontal networks (combinatorial syntax/phonology) and temporal networks (lexical/semantic representations) constitute distinct anatomo-functional entities with differential vulnerability to degenerative processes in aphasia variants. Finally, the identification of the specific damage patterns could open an avenue for trans-cranial stimulation approaches by indicating the appropriate target-entry into the damaged language system.

Pain and emotion as predictive factors of interoception in fibromyalgia

Introduction

This study investigated interoception in fibromyalgia (FM), a disorder characterized by chronic pain accompanied by mood deregulation. Based on observations on the relationship between somatosensory processing and pain in FM and considering the affective symptoms of this disorder, we tested in FM three dimensions of interoception: interoceptive accuracy (IA), interoceptive awareness (IAW) and interoceptive sensibility (IS).

Materials and methods

Twenty-one female FM patients (M_age = 50.3) and 21 female matched controls (M_age = 46.3) completed a heartbeat tracking task as an assessment of IA, rated confidence in their responses as a measure of IAW and completed the Multidimensional Assessment of Interoceptive Awareness as a measure of IS. Furthermore, they completed self-report scales that, according to a principal component analysis, targeted anxiety, emotional consciousness and pain-related affect and reactions.

Results

Multiple regression analyses showed that increased pain-related affect and reactions decrease IA in FM. When the results of each group were examined separately, such effect was found only in FM patients. On its turn, IS was predicted by emotional consciousness and pain-related affect and reactions, but these effects did not differ between FM and controls. Finally, none of the variables we used predicted IAW.

Discussion

Pain-related affect and reactions in FM patients can reduce their interoceptive ability. Our results help to better understand the integration between bodily signals and emotional processing in chronic pain.

One-Year Evolution of Behavioral and Psychological Symptoms of Dementia in Patients Initially Hospitalized in Cognitive Behavioral Units: The EVITAL Prospective Cohort

BACKGROUND

The 2008-2012 French Alzheimer's Plan has provided hospital Cognitive and Behavioral Units (CBU) to improve the management of patients with productive behavioral and psychological symptoms of dementia (BPSD). Little is known concerning the behavioral outcome of these patients after discharge.

OBJECTIVE

The present study investigated the long-term evolution of BPSD over one year after CBU discharge.

METHODS

The EVITAL cohort included 221 participants admitted to the CBUs of 3 French hospitals. BPSD were collected using the Neuropsychiatric Inventory (NPI) at admission and 3, 6, and 12 months after hospitalization. The global NPI score evolution was assessed using a linear mixed-effect model. A four-factor model of the NPI including behavioral dyscontrol, psychosis, mood, and agitation subscores was also analyzed.

RESULTS

Our analysis focused on 148 patients followed up during 12 months and evaluated at each visit. The global NPI score was 48.5 (SD 21.7) at baseline, 28.8 (SD 18.7) at 3-month, 23.2 (SD 16.4) at 6-month and 20.9 (SD 15.9) at 12-month follow-up. The score significantly decreased from baseline to follow-up (F = 109.3 p < 0.0001). Moreover, the decrease was observed for each NPI subscores. The Clinical Dementia Rating (CDR) scale score was significantly linked to the baseline NPI score (t = 2.76, p = 0.009). Conversely, the NPI decline was observed whatever the CDR level.

CONCLUSION

The present study showed a decrease in the global NPI score and all its subscores during the year following the CBU hospitalization, regardless of the initial CDR score.

Cerebral microbleeds and CSF Alzheimer biomarkers in primary progressive aphasias

OBJECTIVE

To reveal the prevalence and localization of cerebral microbleeds (CMBs) in the 3 main variants of primary progressive aphasia (PPA) (logopenic, semantic, and nonfluent/agrammatic), to identify the relationship with underlying Alzheimer pathology, and to explore whether CMBs contribute to language breakdown.

METHODS

We used a cross-sectional design in a multicenter cohort of 82 patients with PPA and 19 similarly aged healthy controls. MRI allowed for rating CMBs (2-dimensional gradient recalled echo T2*, susceptibility weighted imaging sequences) and white matter hyperintensities. CSF Alzheimer disease biomarker analyses available in 63 of the 82 patients provided the stratification of PPA into subgroups with patients who had or did not have probable underlying Alzheimer pathology.

RESULTS

The prevalence of CMBs was higher in patients with PPA (28%) than in controls (16%). They were more prevalent in logopenic PPA (50%) than in semantic PPA (18%) and nonfluent/agrammatic PPA (17%). The localization of CMBs was mainly lobar (81%) with no difference between the PPA variants. CMBs were more frequent in PPA patients with positive than with negative CSF Alzheimer disease biomarkers (67% vs 20%). Patients with and without lobar CMBs had similar volumes of white matter hyperintensities. Language and general cognitive impairment in PPA was unrelated to CMB rates.

CONCLUSIONS

CMB prevalence in PPA is higher than in healthy controls. CMBs were most prevalent in the logopenic variant, were related to underlying Alzheimer pathology, and did not affect the language/cognitive impairment. Our findings also suggest that CMB detection with MRI contributes to PPA variant diagnosis, especially of logopenic PPA, and provides an estimator of the underlying neuropathology.

Retrieving autobiographical experience of painful events in a phantom limb: brain concomitants in a case report

We report the case of a patient who had an important experience with painful events, allowing the investigation of brain concomitants to painful (P) memories in fMRI. The patient had to recall P events that were contrasted with non-painful (NP) memories. Painful memories of the right lower limb activated the left paracentral lobule,fronto-insular operculum and superior parietal cortex. Additionally, whilst the recall of non-painful events activated the hippocampus, the recall of painful events did not enhance the hippocampal signal to significant levels. These suggest that brain activations differ for the autobiographical recall of painful and non-painful memories.

Prompt fission gamma-ray emission spectral data for 239Pu(n,f) using fast directional neutrons from the LICORNE neutron source

Prompt fission gamma-ray spectra (PFGS) have been measured for the 239Pu(n,f) reaction using fast neutrons at Ēn=1.81 MeV produced by the LICORNE directional neutron source. The setup makes use of LaBr3 scintillation detectors and PARIS phoswich detectors to measure the emitted prompt fission gamma rays (PFG). The mean multiplicity, average total energy release per fission and average energy of photons are extracted from the unfolded PFGS. These new measurements provide complementary information to other recent work on thermal neutron induced fission of 239Pu and spontaneous fission of 252Cf.

High-precision measurement of isotopic fission yields of 236U*

We report on the second SOFIA experiment, dedicated to the fission yields of 236U*, analog to 235U(n,f). The measurement is based on the inverse kinematics method, using a relativistic, secondary beam of 236U. Both fission fragments are identified in mass and charge in the SOFIA recoil spectrometer. The obtained isotopic yields are compared with existing spectroscopy measurements and the elemental yields are used to discuss the treatment of the even-odd effect with energy in nuclear data libraries.

The role of navigation instruction at intersections for older drivers and those with early Alzheimer's disease

AIMS

Our purpose was to explore the effect of navigation instruction on older drivers' driving performance at left turn intersections. Left turns at intersections are particularly complex because they require many perceptive and cognitive abilities under considerable time pressure.

METHODS

Fifty-four participants were recruited: 18 drivers with early-stage Alzheimer's disease (AD), 18 neurologically healthy older drivers and 18 younger individuals. Various cognitive processes were measured, and 9 left turn maneuvers with or without navigation instruction were evaluated during an in-traffic road test. The psychomotor, planning and decision-making components involved in left turn were also analyzed closely.

RESULTS

Only older drivers (both healthy drivers and those with AD) were negatively affected by navigation instruction during the maneuver. The planning and decision-making components were more likely to be affected by the navigation instruction.

CONCLUSION

This finding highlights the importance of carefully considering the use of navigation instructions when developing navigation systems. Adapting this instruction is necessary to simplify our understanding of the real-world driving environment and to avoid increasing the cognitive load of older drivers.