Epidemiology of Parkinson's disease.

Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's. PD is considered a multifactorial disorder that results, in most cases, from the combined effects of multiple risk and protective factors, including genetic and environmental ones. This review discusses some of the methodological challenges involved in assessing the descriptive, prognostic and etiological epidemiological studies of PD, and summarizes their main findings.

Higher levels of endogenous estradiol are associated with frailty in postmenopausal women from the toledo study for healthy aging.

BACKGROUND: Adverse effects of higher endogenous estradiol (E2) levels on various clinical outcomes and on determinants of the frailty syndrome have recently been reported. However, there are no data about the potential relationship between E2 and frailty. We aimed to study the association between E2 levels and frailty among older postmenopausal women not taking hormonal therapy. METHODS: We used data from the Toledo Study for Healthy Aging, a Spanish population-based cohort study. Frailty was defined according to Fried's approach. Multivariate odds ratios (OR) and 95% confidence intervals (CI) associated with E2 levels were estimated using polytomous logistic regression. RESULTS: E2 levels decreased significantly with age and educational level, whereas they increased with body mass index, high-sensitivity C-reactive protein (hs-CRP), and impairment in Katz activities of daily living. Higher E2 levels were associated with the prevalence of frailty among women younger than 79 yr, but not in the oldest group (p interaction = 0.047). After adjustment, OR of frailty associated with a 1 sd increase of E2 was 1.51 (95% CI, 1.04-2.20; P = 0.03). We identified an interaction between E2 and hs-CRP on the prevalence of frailty (P value = 0.042). Women with both higher E2 and hs-CRP (defined as values into the upper tertile) had an age-adjusted OR of 4.2 (95% CI, 1.7-10.5; P = 0.002), compared with women with low levels of both E2 and hs-CRP. CONCLUSION: Higher E2 levels were associated with frailty in postmenopausal women. The synergism between higher E2 and hs-CRP levels suggests the existence of physiopathological mechanisms connecting inflammation and estrogen to frailty.

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.

Elevated plasma fibrin D-dimer as a risk factor for vascular dementia: the Three-City cohort study.

BACKGROUND: Hemostatic biomarkers have been associated with coronary heart disease (CHD) and stroke. However, few studies have investigated these associations in the elderly. Moreover, vascular factors may be involved in dementia. Data on the relationship between hemostatic biomarkers and dementia remain scarce. OBJECTIVES: Our study aimed to investigate the relationship between hemostatic biomarkers and the risk of CHD, stroke and dementia in an elderly population. PATIENTS/METHODS: In the Three-City cohort study including men and women aged > or = 65, we investigated the association of fibrinogen, D-dimer and von Willebrand factor with the 4-year incidence of arterial disease (CHD, n = 199; and stroke, n = 111) and dementia (n = 218). Measurements were performed for all cases and for a random sample of the entire cohort (n = 1254). Hazards ratios (HR) compared the last quintile with the first of each parameter's distribution and P-values refer to the test for linear trend across quintiles. RESULTS: Elevated fibrinogen was associated with the risk of CHD and myocardial infarction (HR = 2.20, P < 0.05 and 2.45 P < 0.05, respectively). Moreover, high D-dimer was associated with the risk of CHD among younger subjects (aged < 75, HR = 3.64, P < 0.01) but not older subjects (P for interaction = 0.01). Furthermore, the risk of vascular dementia (VaD) increased with D-dimer level (HR = 3.05, P < 0.01). CONCLUSIONS: In the elderly, elevated fibrinogen and D-dimer levels were associated with incident arterial disease. In addition, high D-dimer level could represent a new risk factor for VaD.

[Cued and uncued memory tests: norms in elderly adults from the 3 Cities epidemiological study]. / Test de rappel libre/rappel indicé à 16 items: normes en population générale chez des sujets âgés issues de l'étude des 3 Cités.

INTRODUCTION: The free and cued reminding test is often considered to be essential in the neuropsychological examination of elderly people consulting Memory Clinics. One of the reasons is that this test maximizes learning by inducing deep semantic processing and by controlling encoding and retrieval conditions. The aim of this study was to produce age, sex and educational level-adjusted normative data for this test. METHODS: These data were collected as part of the Three-City (3C) Study, a French population-based study on aging. RESULTS: The subsample of subjects analysed for this study included 1 458 non-institutionalised and non-demented elderly adults aged 65 and over. Norms were calculated according to age (65-70, 70-74, 74-78, 78-90), sex and educational level of the subjects (primary level versus and secondary or university level). CONCLUSION: The interest of this work is to provide to clinicians normative scores on the free and cued reminding test which can be used as an aid to interpret a patient's performance on a test widely used to detect episodic memory deficits in aging.