[Anatomy of the CMRR and proposition of functioning]. / Anatomie des CMRR et proposition de fonctionnement.

OBJECTIVES: The main objective was to have a view of the functioning of the Centers Memory of Resources and Research (CMRR) to identify the difficulties which can interfere in the industrial clinical trials. The secondary objective was to make a proposal to optimize them. METHODOLOGY: Questionnaires were given in all CMRRs. RESULTS: One hundred thrity-five questionnaires were retrived (26 centers answered on the 27 that exist). Some elements appeared as strong structural factors but some weaknesses were highlighted such as: insufficient staff, lack of dedicated areas, lack of communication, activities multiplications, functional unit (UF) subdivision. CONCLUSION-PROPOSITION: After a Strenghts-Weakness-Opportunities-Threats (SWOT) analysis, we kept 3 main axis to improve: information and formation diffusion, transdisciplinary meetings establishment, better mobilization of doctors for clinical trials. We think that a special "clinical trail" unit within each CMRR should be created. It will enhance the level, the competences and the reactivtity of each clinical trial center which will lead to better collaboration with big pharmaceutical companies.

Specific psychological and behavioral symptoms of depression in patients with dementia.

UNLABELLED: Behavioral and psychological symptoms in dementia (BPSD) are very common, with 90% of patients experiencing at least one during the course of the disease. One-third of persons with dementia have depressive symptoms, and concomitant BPSD are very likely. OBJECTIVE: This study aimed to characterize the psychological and behavioral manifestations of depression in patients with dementia. METHODS: We recruited patients with dementia from several nursing homes in the Limousin region of France. Depression was as diagnosed by the Cornell Scale for Depression in Dementia (CSDD) with a cut-off of 7, and BPSD were assessed using the Neuropsychiatric Inventory (NPI). RESULTS: Of 319 patients with dementia, 42.9% (n =137) were depressed and 75.9% (n = 242) had BPSD. All BPSD were significantly (p < 0.0001) more prevalent among depressed patients, but no significant differences were observed according to sex and age. The NPI showed that the most common additional symptoms in depressed patients were agitation (43.2%), anxiety (42.3%) and irritability (40.1%). Four NPI-based factors were indentified (63.9% of the common variance): factor 1 (disinhibition, irritability, agitation, anxiety), factor 2 (sleep disturbance, aberrant motor behavior, apathy), factor 3 (elation, hallucination, delirium) and the last with eating disorders. Depression in dementia patients was significantly associated with disinhibition, irritability, agitation, and anxiety. CONCLUSION: BPSD are common and a major problem. Before addressing them as isolated symptoms, it is important to consider comorbidity with depression in order to optimize the therapeutic approach.

Paraoxonase 1 activity: a new vascular marker of dementia?

Paraoxonase 1 (PON1), an A-esterase with peroxidase-like activity present on the surface of HDL, decreases the peroxidation of LDL. Serum PON1 activity (PON1a) decreases with aging and in disorders associated with a high risk of adverse cardiovascular events (acute myocardial infarction, diabetes mellitus, and chronic renal failure). The implication of vascular factors in Alzheimer-type dementia (ATD) is strongly suspected. We measured PON1a by spectrophotometry using the paraoxon substrate in 180 healthy subjects (controls; mean age: 75.3 +/- 8.9 years; 98 women) and 154 patients admitted for cognitive testing. According to criteria, 45 patients had mild cognitive impairments (MCI; mean age: 75.6 +/- 9.3 years; 28 women), 60 had ATD (mean age: 75.6 +/- 8.3 years; 47 women), and 49 had vascular dementia (VaD; mean age: 77.5 +/- 7.2 years; 33 women). Mean PON1a was lower in VaD (0.25 +/- 0.1 U/mL) than in controls or ATD (both 0.41 +/- 0.2 U/mL, p < 0.01). Mean PON1a values in MCI (0.34 +/- 0.2 U/mL) and ATD (0.41 +/- 0.2 U/mL) were not significantly different. In multiple linear regression, PON1a was negatively correlated with male sex, age, and VaD, and positively correlated with ATD (each correlation p < 0.001). As shown in other high-risk cardiovascular disorders, PON1a seems to be a reliable marker of VaD. Its modification in Alzheimer's disease supports the implication of vascular risk factors in this type of dementia.