Progression of Alzheimer disease in Europe: data from the European ICTUS study

The clinical progression of Alzheimer disease (AD) was studied in European subjects under treatment with AChE inhibitors (AChE-I) in relation to geographical location over a 2-years period. One thousand three hundred and six subjects from 11 European countries were clustered into 3 regions (North, South, West) and investigated with biannual follow-up over 2 years. Primary outcomes were cognitive, functional and behavioral measures. Caregiver burden, hospital admission and admission to nursing home were also recorded. Participant cognitive function declined non-linearly over time (MMSE: -1.5 pts/first year, -2.5 pts/second year; ADAScog: + 3.5 pts/first year, + 4.8 pts/second year), while the progression of behavioral disturbances (NPI scale) was linear. Neither scale showed regional differences, and progression of the disease was similar across Europe despite different health care systems. Functional decline (ADL, IADL) tended to progress more rapidly in Southern Europe (p=0.09), while progression of caregiver burden (Zarit Burden Interview) was most rapid in Northern Europe (5.6 pts/y, p=0.04). Incidences of hospital admission (10.44, 95%CI: 8.13-12.75, p < 0.001) and admission to nursing home (2.97, 95%CI: 1.83-4.11, p < 0.001) were lowest in Southern Europe. In general cognitive and functional decline was slower than in former cohorts. European geographical location reflecting differences in culture and in health care system does not impact on the progression of AD but does influence the management of AD subjects and caregiver burden.

Dietary vitamin D intake and muscle mass in older women. Results from a cross-sectional analysis of the EPIDOS study

OBJECTIVES

Vitamin D intake may prevent physical performance decline through prevention of muscle mass loss. Our objective was to determine whether low dietary intakes were associated with low muscle mass (MM).

DESIGN AND PARTICIPANTS

Cross-sectional analysis of 1989 community-dwelling women (mean age 80.5±3.8years) from the EPIDémiologie de l'OStéoporose (EPIDOS) study were assessed at baseline.

MEASUREMENTS

Low intakes of vitamin D (<70µg/week) were estimated from the weekly dietary vitamin D intakes (self-administered food frequency questionnaire). Low MM was defined according to the appendicular skeletal muscle mass index assessed using Dual Energy X-ray Absorptiometry, divided by square height of less than 5.45 kg/m2. Usual gait speed defined physical performance. Age, sun exposure, co-morbidities, education level, living arrangements, recreational physical activity, dietary protein and calcium intakes, bone mineral density, handgrip strength, and body mass index were considered as potential confounders. Multivariate logistic regression analyses assessed the association between low vitamin D intakes and low MM.

RESULTS

Two-hundred and nine (10.5%) women with low MM were compared to 1,780 women with normal MM. In final model, obesity/overweight (Adjusted Odds Ratios, aOR=0.09; 95%CI [0.05-0.17]), malnutrition (aOR=3.90; 95%CI [2.74-5.54]) and low handgrip strength (aOR=2.33; 95%CI [1.44-3.77]; p<0.001) were statistically associated with a low MM status.

CONCLUSION

No association with low MM has been reported regarding low dietary intakes of vitamin D.

End-of-life care for persons with advanced Alzheimer disease: design and baseline data from the ALFINE study

CONTEXT

Alzheimer disease (AD) is the most common cause of dementia. Most affected individuals survive to an advanced stage of dementia, which is under-recognized as a terminal illness.

OBJECTIVES

Our objectives were to better understand the clinical trajectory of advanced AD and to identify the palliative care needs of these patients.

METHODS

This was an observational prospective study of AD patients in severe stage of disease included after a hospitalization in geriatric wards. They were followed up every three months during 2 years. At each visit, interviews provided data regarding: pain (Elderly Pain Caring Assessment scale), pressure ulcers, eating patterns, daily medications and use of health services. This paper describes the design of the ALFINE study and the characteristics of the recruited cohort.

RESULTS

112 patients were recruited (mean age: 84.03 + 6.96) years; 76.79% were women. Mean time since diagnosis of AD was 5.28 years. Pressure ulcers were observed in 42 patients. Pain assessment with the EPCA showed a mean score of 8.58. One third of patients with an EPCA score of more than 7 (median) had no analgesics. More than half of patients had been treated with antibiotics during the three months before inclusion in the study and 33 patients were still receiving antibiotics at inclusion. Two third of patients had been hospitalized in the month before inclusion.

CONCLUSION

End-of-life care for individuals with end-stage AD is increasingly important because of the rising number of patients with this disease. Health care systems and clinicians should make efforts to ameliorate the suffering of patients and their caregivers.

Structure, morphology and magnetic properties of Mg((x))Zn((1 - x))Fe2O4 ferrites prepared by polyol and aqueous co-precipitation methods: a low-toxicity alternative to Ni((x))Zn((1 - x))Fe2O4 ferrites

The synthesis and properties of Mg((x))Zn((1 - x))Fe(2)O(4) spinel ferrites as a low-toxicity alternative to the technologically significant Ni((x))Zn((1 - x))Fe(2)O(4) ferrites are reported. Ferrite nanoparticles have been formed through both the polyol and aqueous co-precipitation methods that can be readily adapted to industrial scale synthesis to satisfy the demand of a variety of commercial applications. The structure, morphology and magnetic properties of Mg((x))Zn((1 - x))Fe(2)O(4) were studied as a function of composition and particle size. Scanning electron microscopy images show particles synthesised by the aqueous co-precipitation method possess a broad size distribution (i.e. ∼ 80-120 nm) with an average diameter of the order of 100 nm ± 20 nm and could be produced in high process yields of up to 25 g l(-1). In contrast, particles synthesised by the polyol-based co-precipitation method possess a narrower size distribution with an average diameter in the 30 nm ± 5 nm range but are limited to smaller yields of ∼ 6 g l(-1). Furthermore, the polyol synthesis method was shown to control average particle size by varying the length of the glycol surfactant chain. Particles prepared by both methods are compared with respect to their phase purity, crystal structure, morphology, magnetic properties and microwave properties.

Diagnosis of Alzheimer's disease patients with rapid cognitive decline in clinical practice: interest of the Deco questionnaire

BACKGROUND

Patients with Alzheimer's disease (AD) who deteriorate rapidly are likely to have a poorer prognosis. There is a clear need for a clinical assessment tool to detect such a decline in newly diagnosed patients.

OBJECTIVE

To identify the predictive factors of rapid cognitive decline (RCD) in a cohort of patients with mild to moderate AD ; and to validate a self-questionnaire for caregivers as a diagnostic tool for rapid decline.

DESIGN AND ANALYSIS

An open-label, observational, 12-month, multicenter, French study. Physicians were asked to record data of three eligible rivastigmine naïve (or on rivastigmine for < 1 year) AD patients. Risk factors of RCD and the detection power of the Détérioration Cognitive Observée scale (Deco), a 19 item self-questionnaire for caregivers, were assessed at endpoint using regression analyses.

RESULTS

Out of the 361 patients enrolled in the study, 91 (25.2%) were excluded due to loss of follow-up. Among subjects using cholinesterase inhibitors or memantine, 161 (59.6%) experienced a stabilization (29.2%) or an improvement (30.4%) in global functioning as measured by the CGI-C. Sixty of the remaining 204 patients retained for analysis (29.6%, CI 95% [23.4; 35.8]) lost three or more points on the MMSE score between the inclusion and one of the follow-up visit. In the multivariate logistic regression analysis, institutionalization, higher level of education and the loss of 3 points or more on the MMSE were found to be significant predictors of a rapid cognitive loss in this population. The threshold which maximizes the predictive values of the Deco score as a diagnostic tool of rapid cognitive decline was significantly different according to the age of the patient (below or over 75 years old). A score below 16 for patients < 75 years old and below 14 for patients ≥ 75 years old consistently predicted a RCD within the next year.

CONCLUSION

The Deco test appears to be a simple tool to alert the physician to the possibility of an aggressive course of the disease which warrants particular management.

Balneotherapy, prevention of cognitive decline and care the Alzheimer patient and his family: outcome of a multidisciplinary workgroup

According to the latest forecasts of the INSEE - Institut National de la Statistique et des Etudes Economiques (National Statistics and Economic Studies Institute), ageing of the French population will increase between 2005 and 2050: whereas 20.8% of the population living in continental France reached the age of 60 years or more in 2005, this proportion would be of 30.6% in 2035 and 31.9% in 2050. In 2050, 22.3 million persons will have reached the age of 60 years or more compared to 12.6 million in 2005, increasing by 80% in a 45-year period. In line with the actual age pyramid, ageing is unavoidable, as those who will reach 60 years of age in 2050 are already born (in 1989 or before). This expansion will be most important between 2006 and 2035, when the numerous "baby-boom" generations born between 1946 and 1975, will reach these ages. In future years, lifespan improvement will only emphasize this increase. Even if life expectancy stabilizes at the 2005 level, the number of seniors reaching 60 years or more would still increase to 50% between 2005 and 2050. This issue is identical in all countries of the European Union. Ageing is a major risk factor for dementia that will considerably worsen in the next years, if no curative therapies are found. Today, 25 million persons in the world suffer from Alzheimer's disease (AD). In France, it is estimated that 860,000 persons are affected and that 225,000 news cases are annually diagnosed. After 75 years of age, more than 20% of women and 13% of men are concerned. Forecasts for the coming years are frightening. Considering ageing of the population, the number of Alzheimer's disease cases should raise to 1.3 million in 2020 (20 patients for 1000 inhabitants) ant 2.1 million in 2040 (30 patients for 1000 inhabitants).

Observation of indigenous polycyclic aromatic hydrocarbons in 'giant' carbonaceous antarctic micrometeorites

Two-step laser desorption/laser ionization mass spectrometry (microL2 MS) was used to establish the nature and mass distribution of polycyclic aromatic hydrocarbons (PAHs) in fragments of fifteen 'giant' (approximately 200 microns) carbonaceous Antarctic micrometeorites (AMMs). Detectable concentrations of PAHs were observed in all AMMs showing a fine-grained matrix. The range of integrated PAH signal intensities varied between samples by over two orders of magnitude. No evidence of contamination whilst in the Antarctic environment could be found. The dramatic variation of both PAH signal intensities and mass distributions between AMMs along with comprehensive contamination checks demonstrates that particles are not exposed to terrestrial PAHs at or above detection limits, either subsequent, during or prior to collection. Comparison of the observed PAH distributions with those measured in three carbonaceous chondrites [Orgueil (CI1), Murchison (CM2) and Allende (CV3)] under identical conditions demonstrated that marked differences exist in the trace organic composition of these two sources of extraterrestrial matter. In general, AMMs show a far richer distribution of unalkylated 'parent' PAHs with more extended alkylation series (replacement of -H with -(CH2)n-H; n = 1, 2, 3 ...). The degree of alkylation loosely correlates with a metamorphic index that represents the extent of frictional heating incurred during atmospheric entry. A search for possible effects of the chemical composition of the fine-grain matrix of host particles on the observed PAH distributions reveals that high degrees of alkylation are associated with high Na/Si ratios. These results, in addition to other observations by Maurette, indicate that 'giant' micrometeorites survive hypervelocity (> or = 11 km s-1) atmospheric entry unexpectedly well. Because such micrometeorites are believed to represent the dominant mass fraction of extraterrestrial material accreted by the Earth, they may have played a significant role in the prebiotic chemical evolution of the early Earth through the delivery of complex organic matter to the surface of the planet.

Experimental indication of a naphthalene-base molecular aggregate for the carrier of the 2175 angstroms interstellar extinction feature

Experiments where the simple polycyclic aromatic hydrocarbon (PAH) naphthalene (C10H8) is subjected to the energetic environment of a plasma have resulted in the synthesis of a molecular aggregate that has ultraviolet spectral characteristics that suggest it provides insight into the nature of the carrier of the 2175 angstroms interstellar extinction feature and may be a laboratory analog. Ultraviolet, visible, infrared, and mass spectroscopy, along with gas chromatography, indicate that it is a molecular aggregate in which an aromatic double ring ("naphthalene") structural base serves as the electron "box" chromophore that gives rise to the envelope of the 2175 angstroms feature. This chromophore can also provide the peak of the feature or function as a mantle in concert with another peak provider such as graphite. The molecular base/chromophore manifests itself both as a structural component of an alkyl-aromatic polymer and as a substructure of hydrogenated PAH species. Its spectral and molecular characteristics are consistent with what is generally expected for a complex molecular aggregate that has a role as an interstellar constituent.

Biological half-life of aerosolized 99mTc-diethylenetriaminepentaacetate in various lung regions of clinically normal beagles

The biological half-life (TB) of aerosolized 99mTc-diethylenetriaminepentaacetate was determined in 14 lung regions of 18 clinically normal Beagles. Three groups of lung regions or volumes were identified on the basis of significantly (P < 0.05) different TB. Group A (mean +/- SD TB, 82 +/- 21 minutes) included the transversely oriented cranial and caudal nonperihilar regions. Group B (mean +/- SD, 61 +/- 15 minutes) represented all sagittally oriented lung regions and the entire lung field. Group C (mean +/- SD, 49 +/- 11 minutes) included the transversely oriented cranial and caudal perihilar regions. Clearance of 99mTc-diethylenetriaminepentaacetate is considered a function of transepithelial transport into the blood, as well as bronchial transport via the mucociliary transport mechanism.