ABSTRACT
PURPOSE: Alzheimer's disease (AD) evolves over about ten years with cognitive decline that can be considered as linear. Comorbidities are frequent in geriatric population. The major objective of this study is to determine whether comorbidity influences natural history of AD. MATERIALS AND METHODS: This is a prospective, multicentric French study (REAL.FR) of a cohort of ambulatory patients suffering from AD from a mild to a moderately severe stage, with a Mini-Mental State between 10 and 26, and followed with a caregiver. We evaluated the comorbidities and they were quantified using the Charlson index. RESULTS: We analysed 579 AD patients enrolled between April 2000 and June 2002. Majority of patients were women (72%). Average age and MMS average score were respectively 77.4 +/- 7.1 and 20.1 +/- 4.5. Cardiovascular diseases were the most frequent comorbid conditions (34%), before sensorial handicap (23%), and neurological diseases (18%) apart from dementia. Four AD patients groups differed according to the comorbidities figures, from none to more than three (maximum 8). Average Charlson index was 1.5 +/- 0.9. CONCLUSION: The follow-up of the four AD patients groups, differentiated by the comorbidities figures, should allow to precise the influence of comorbidities on the AD evolution. Charlson index could be used to quantify the comorbidities in the cohort's follow-up. However, this index, validated in a cohort of cancer patients, show limits for its use in geriatric population.
Subject(s)
Alzheimer Disease/complications , Alzheimer Disease/pathology , Cardiovascular Diseases/etiology , Aged , Aged, 80 and over , Cardiovascular Diseases/epidemiology , Comorbidity , Female , Humans , Incidence , Male , Prognosis , Prospective StudiesABSTRACT
FRAMIG 2000 is a population-based survey of medical and therapeutic management of migraine in France. A total of 312 migraine sufferers were first identified from a representative sample of 4689 adult subjects using a validated questionnaire based on the IHS migraine diagnostic criteria and administered by telephone. Subjects were then interviewed using a branching questionnaire and a computer-assisted interview technique. Although 80% were self-aware of their migrainous state, 82% of migraine sufferers had no medical follow-up for migraine. The proportion of migraine sufferers who did not consult decreased slightly with increasing migraine-related disability (from 87% for subjects in MIDAS grade I to 68% for those in MIDAS grade IV). Migraine sufferers declared to effectively control only four attacks out of 10 after the first intake of the usual treatment. Only 6% of subjects in the survey received a prophylactic treatment for migraine whereas 22% were in MIDAS grade III or IV. These data show that the burden of migraine does not result from a deficit in diagnosis but instead from a deficit in patient information on the proper use of current effective treatments of migraine.
Subject(s)
Analgesics/therapeutic use , Attitude to Health , Migraine Disorders/drug therapy , Migraine Disorders/epidemiology , Patient Education as Topic/statistics & numerical data , Practice Patterns, Physicians'/statistics & numerical data , Risk Assessment/methods , Adolescent , Adult , Aged , Female , France/epidemiology , Health Care Surveys , Humans , Male , Middle Aged , Patient Compliance/statistics & numerical data , Prevalence , Risk Factors , Treatment OutcomeABSTRACT
Alterations in membrane fluidity affect, via an effect on the ease with which proteins may change conformation, the activity of various enzymes and transport systems. Recent experiments have shown that toxic injury is frequently associated with modifications in physical state and/or lipid composition of plasma membranes. Such modifications are likely to play a role in cell dysfunction, especially in epithelial cells whose optimal function depends on the polarity in membrane fluidity between apical and basolateral domains.
