ABSTRACT
INTRODUCTION: In recent years knowledge about Alzheimer's disease (AD) presented a major change since the availability of new diagnostic criteria incorporating biomarkers within the known cl inical criteria. Such criteria were elaborated by NIA-AA (National Institute on Aging - Alzheimer's Association) for clinical use and IWG (International Working Group) for research purpose. The aim of this study is to investigate the use of complementary examinations included in the NIA-AA and IWG criteria in a memory clinic characterized by a heterogenous population of patients. METHODS: We retrospectively reviewed patient's characteristics of cases consulting between 01/01/2010 and 31/12/2013 based on the implementation of three additional tests: neuropsychological testing, measurement of cerebrospinal fluid (CSF) biomarkers and brain MRI. Patients were compared according to their origins. RESULTS: 919 patients' medical records were included in the study, 20 % of which were from immigrant background. Non-European Union migrants underwent less neuropsychological testing and more lumbar punctures in comparison with the local population. CONCLUSION: CSF biomarkers allow defining an objective diagnostic component of AD by suppressing the variability due to language, culture, education and the clinical presentation of the disease. Despite the known use in the research domain but not yet validated for clinical use, the IWG criteria are applied in heterogeneous populations with a high percentage of migrants, especially when the results of the neuropsychological testing are poorly contributive. We expect recommendations for clinical use of the CSF biomarkers or better cognitive assessment methods for these populations in the future.
INTRODUCTION: A ce jour, notre vision de la maladie d'Alzheimer (MA) connaît un changement majeur depuis l 'apparition de nouveaux critères diagnostiques incorporant des biomarqueurs aux critères cliniques connus. La NIA-AA (National Institute on Aging - Alzheimer's Association) en a élaboré pour la pratique courante et l'IWG (International Working Group) pour le domaine de la recherche. L'objecti f de cette étude est d'analyser la réalisation des examens complémentaires cités dans les critères NIA-AA et IWG au sein d'une clinique de la mémoire rassemblant une population hétérogène. METHODES: Nous avons revu de manière rétrospective les caractéristiques de patients ayant consulté entre le 1/01/2010 et le 31/12/2013 selon 3 paramètres : la réalisation ou non de l'examen neuropsychologique, du dosage de biomarqueurs dans le liquide céphalo-rachidien (LCR) et de l'imagerie par résonance magnétique cérébrale. Les patients ont ensuite été comparés selon leur origine. RESULTATS: Sur les 919 dossiers analysés dans l'étude, 20 % des patients sont issus de l'immigration. Les migrants non européens ont reçu moins d'examens neuropsychologiques et plus de ponctions lombaires que les patients belges. CONCLUSIONS: Les biomarqueurs du LCR permettent de définir une composante diagnostique objective de la MA en supprimant les variables liées à la langue, la culture, la scolarité et l'expression de la maladie. Malgré leur application connue dans le domaine de la recherche mais actuellement non validée en clinique, les critères IWG prédominent en pratique dans les populations hétérogènes comprenant un haut taux de migrants lorsque les examens neuropsychologiques sont peu contributifs. Des recommandations d'utilisation des biomarqueurs du LCR en pratique courante ou des outils d'évaluation cognitive plus performants dans ces types de population sont attendues.
Subject(s)
Alzheimer Disease/diagnosis , Diagnostic Techniques, Neurological , Aged , Aged, 80 and over , Alzheimer Disease/cerebrospinal fluid , Alzheimer Disease/psychology , Biomarkers/cerebrospinal fluid , Diagnostic Techniques, Neurological/standards , Disease Progression , Female , Humans , Male , Neuropsychological Tests , Retrospective StudiesABSTRACT
Cognitive assessment among foreign patients is a growing need for several reasons: foreign patients have a different culture, they have an insufficient command of the language of the consulting center, and the available cognitive tools are largely unsuitable. For these reasons, we developed a non-verbal test of long-term memory called the Brumory test. This test is based on incident encoding of 48 colored images followed by retrieval by recognition. We compared the performance of indigenous participants with that of immigrant participants (mainly from Morocco). Immigrant participants did not speak French properly and had a low educational level. The results indicate no significant difference in memory performance between the two groups of participants. Moreover, the instructions were easily understood by immigrant participants, despite the fact they do not master French. We conclude that the Brumory test is an appropriate test to assess memory among foreign non-French-speaking patients people with low educational level.
Subject(s)
Memory Disorders/diagnosis , Memory Disorders/psychology , Memory, Long-Term , Neuropsychological Tests , Adult , Cognition , Educational Status , Emigrants and Immigrants , Female , France , Humans , Language , Male , Middle Aged , Morocco , Psychomotor Performance , Reproducibility of ResultsABSTRACT
INTRODUCTION: Early damage to episodic memory encoding and consolidation processes has been demonstrated in dementia of the Alzheimer type. However, in the domain of verbal episodic memory assessment, there are few diagnostic tools adapted to the old and oldest old as far as ease of administration and accuracy of normative data are concerned. Classic tasks are either too effortful (like the free recall/cued recall of 16 items), not sensitive enough (like the 5 words test), or insufficiently accurate for people above 70 years old in terms of normative data. AIM: The aim of this study was to develop a reduced task (in terms of number of items and number of trials) assessing verbal episodic memory in people aged between 70 and 89 years old. METHODS: The task (GERIA-12) used the same procedure as the RL/RI-16 task but the list comprised only 12 words and there were only 2 learning trials. In order to assess consolidation processes, we included 2 delayed recall trials, one after 20 minutes and the other after 24 hours. We also calculated indexes adapted from the Item-Specific Deficit Approach developed by Wright et al., which has the advantage of providing measures specific to encoding, consolidation and retrieval processes. Standardization was done with data from 220 people aged between 70 and 89 years old and belonging to 3 education levels. RESULTS: We obtained a significant effect of age and education level: scores decrease with age and increase with education. Norms have thus been calculated taking those two variables into consideration. Concerning the standardization, Barona method has been used for free recall scores while percentiles have been used for all other scores (total recall, free recall, encoding, consolidation and retrieval indexes). Normative data are also provided for intrusions and perseverations. CONCLUSION: This new task allows encoding, consolidation and retrieval processes assessment in older people and has the following advantages: the procedure is more suitable (ease and time of administration), there are accurate normative data for old and oldest old people, and there are normative data for two delayed recalls (at 20 minutes and at 24 hours).
Subject(s)
Memory Disorders/diagnosis , Memory Disorders/psychology , Memory, Episodic , Neuropsychological Tests , Aged , Aged, 80 and over , Educational Status , Female , Humans , Learning , Male , Mental Recall , Psychomotor Performance , Reference Standards , Reproducibility of ResultsABSTRACT
Hashimoto's encephalopathy (HE) is an infrequent disease with no well-known physiopathology. Status epilepticus is rarely reported in association with HE. We describe the 7-year evolution of a young woman who presented with recurrent status epilepticus as the main complication of HE. This evolution was especially marked by the occurrence of steroid-refractory symptoms and a poor outcome with persistent cognitive and behavioral consequences. We point out that the frontal lobes are especially implicated in these symptoms. This patient highlights the risk of multiple relapses and the need for a long follow-up period. We describe her clinical and paraclinical features, compare this patient to similar case reports, and comment on her outcome.
