The "Protocole d'Examen Cognitif de la Personne Agée - Lausanne" (PECPA-L): a cognitive assessment tool for the French-speaking elderly in Switzerland.

OBJECTIVE: The main objective of this study was to validate and normalize, in the French-speaking population of Switzerland, an empirically derived structured cognitive assessment scale for the elderly. METHOD: 237 healthy elderly and 115 elderly with mild-to-moderate dementia as well as a preliminary sample of 27 subjects with MCI, all community-dwelling, were assessed using the PECPA-L for its validation and normalization using Crohnbach's alpha, rank comparisons, and AUROC measures. RESULTS: The internal consistency of the PECPA-L was good (Crohnbach's Alpha=0.79). The discriminating power of the PECPA-L between the normal elderly and the mildly to moderately demented (AUROC=0.940) and those with MCI (AUROC=0.925) was high. Normal aging does not influence all cognitive domains equally; therefore, the subscores of the PECPA-L vary in their discriminating power between the normal and the demented elderly, with gnosis abilities having the least (AUROC=0.719) and delayed memory performance having the highest (AUROC=0.927) discriminating power. Normative data according to age and education are provided. CONCLUSIONS: The PECPA-L is a highly appropriate tool for the detection and documentation of early cognitive impairment in the French-speaking population in Switzerland while accounting for age and education.

[The Audioscope III in family practice: an instrument suitable for the diagnosis of hearing loss in comparison with the regular audiometer]. / De audioscope III in de huisartspraktijk: een geschikt instrument voor het vaststellen van slechthorendheid in vergelijking met de screeningsaudiometer.

OBJECTIVE: To compare the results of hearing tests performed with the Audioscope III and the classical audiometer. DESIGN: Cross-sectional study. SETTING: Two general practices in South Limburg, the Netherlands. METHOD: The hearing of 115 patients aged 55-93 years who visited the practice for any reason was tested with the Audioscope III and subsequently with the screening audiometer, in two silent examination rooms. The tests were performed independently by two general practice trainees. Finally, the subjects were asked which instrument they preferred. An ear was diagnosed as 'hard or hearing' if the Fletcher index measured with the audiometer was > 30 dB or if, with the Audioscope III, 1, 2, 3 or 4 tones were not heard at 40 dB. RESULTS: Depending on the number of tones not heard, the agreement between the measuring results ranged from 65 to 86%. If subjects during the examination with the Audioscope III failed to hear > or = 2 tones at 40 dB, the conclusion 'hardness of hearing', judged by the audiometric results, was correct in all cases. Conversely, the proportion of ears incorrectly diagnosed as 'not abnormal' at this limit was 39%. Hearing tests with the Audioscope III took little time (0.5-4 minutes) and were in general tolerated well. CONCLUSION: The Audioscope III is a useful instrument in situations in which there is a high prevalence of auditory disorders, for instance in general practices with a relatively elderly patient population.

[Incidence of headache following intradural anesthesia with 26 gauge needles depending on whether the punction is done with the bevel perpendicular or parallel to the dura mater fibers]. / Incidencia de cefaleas tras anestesia intradural con agujas del número 26 según que la punción sea con el bisel perpendicular o paralelo a las fibras de la duramadre.

OBJECTIVES: To determine the incidence of headache after lumbar puncture, we prospectively studied 270 patients who underwent intradural anesthesia for programmed urologic, traumatologic, general, and gynaecologic surgery. PATIENTS AND METHODS: The mean age of the patients was 55.6 +/- 16.9 years. There were significant differences between the age of women (54.8 +/- 15.5 years) and men (56.4 +/- 18.4 years). Intradural anesthesia was performed with a Becton-Dickinson 26G needle with a Quincke tip. Patients were randomly divided into two groups according to that puncture was directed parallel (group 1) or perpendicular (group 2) to the dura-mater fibers. When the spinal liquid dripped through the needle, 2 ml of a 0.75% (15 mg) solution of bupivacaine and 0.2 ml of a 50% (100 mg) solution of glucose were injected. No special measures were undertaken during the postoperative phase. The incidence of headache was analyzed 72 hours after puncture. RESULTS: One patient of group 1 (0.66%) and 6 patients of group 2 (5%) presented headache. This difference was not statistically significant. Differences between the incidence of headache in women (4.05%) and in men (2.15%) were also not significant.

[Methodology of a long-term study of senile dementia]. / Méthodologie d'une étude longitudinale de la démence sénile.

The longitudinal method aims to point out phenomena that are bound with time. It is thus particularly fit for the study of ageing as it is proved by many large American research programs. It is also useful to follow during a limited period (short term) the natural history of pathologic entities as degenerative illnesses. After mentioning the fundamental conditions of any longitudinal approach, the program of this study on senile dementia is described. Each case is followed for 2 years, with an examination every 6 months. This later is based on anamnestic, psychiatric, neurologic and functional items as well as on intellectual functions and EEG. A sample of 50 cases should be collected. After a period of 3 years prospection 91 cases were found of which on 31 fitted. The difficulty of recruitement is bound to several factors: the little knowledge of senile dementia frequency in the general population, the poor criteria used in their choices by non-specialists as the directors of homes, the refusals and the withdrawals. Difficulties in establishing contact with patients showing behavioral troubles are underlined as well as cooperative problems with the surroundings. The repetition, at regular periods, of psychological tests sets the problem of learning. In the way of senile dementia it should decrease with the illness evolution thus bringing the overestimation of initial capacities, the gap becomming artifically greater between performances at the beginning and at the end of the observation.

[Neuropsychological study of an autonomous aged population]. / Etude neuropsychologique d'une population âgée autonome

In order to adjust the tests used in a study on degenerative dementia a group of independent aged volunteers has been formed and submitted to neuropsychological tests on instrumental functioning. Among them: 25% obtained normal results - 55% showed light instrumental deficiencies which were however not significant of brain damage - 22% had a global impairment of instrumental functions but without memory troubles. This relatively high percentage of impaired old people posed the problem of the normality of the sample chosen. As it mostly came from elderly communities it is possible to think that these gather more or less psychically or socially disfavoured aged people. The frequency of cortical impairments urges to think that they should be followed up to determine whether these symptoms are normal or if these are the signs of a degenerative evolution; in which case the neuropsychological approach would no longer be selective.