[A trans-hospital pilot programme for onco-geriatry. The experience of the CHC-Liege]. / Programme pilote trans-hospitalier d'onco-gériatrie.

The authors offered to 296 consecutive cancer patients aged > or = 70 to undergo a joint comprehensive geriatric and oncological assessment. After pluridisciplinary discussion, several reflections have emerged: the need in 15 - 32% of cases to reinforce the role of the paramedical staff; the correlation between age, low clinical indices, alteration of renal function as well as geriatric characteristics; 67% of evaluated cases presented a significant geriatric profile; recommendations for patients' management in relation to their pattern of frailty and health aging (standard, adapted or palliative treatment).

Evaluation of biological rhythms in elderly cancer patients. A complementary translational research within the frame of the trans-hospital pilot program of oncogeriatrics launched at CHC-Liège.

Thanks to the sponsoring of Belgian Cancer Plan, we have launched a trans-hospital project of oncogeriatrics implying any concerned actors from medical (oncology, geriatrics, various specialties) and paramedical staffs (nurses, physiotherapists, ergotherapists, dieteticians, social workers, psychologists…). We aim to recruit 300 consecutive patients aged over 70 and presenting with a new diagnosed cancer. They will benefit from both detailed Comprehensive Geriatrical (CGA) and Oncological (COA) assessments. A multidisciplinary concertation will try to define for each patient an individualized treatment planning taking into account CGA, CGO, co-morbidities, predictive indexes of chemotherapy toxicity (MAX2, i.e.). Detailed records will be obtained in collaboration with the data-management staff. Furthermore, a complementary translational research will include patients for a simple evaluation of their circadian rhythmicities through cortisol titration at 8a.m. and 4p.m. and actometry recordings of the rest-activity rhythms. Future steps could be developed aiming at the restoration of circadian structure disturbances with revalidation (physical exercise, tai-chi, yoga) and resynchronization (melatonin, hydrocortisone, bright light…) programs.

Gait analysis in elderly adult patients with mild cognitive impairment and patients with mild Alzheimer's disease: simple versus dual task: a preliminary report.

UNLABELLED: SUMMARY BACKGROUND/AIMS: The aim of this study was to assess gait characteristics during simple and dual task in patients with mild cognitive impairment (MCI) and compare them with those of healthy elderly subjects and mild Alzheimer's disease (AD) patients. METHODS: We proposed a gait analysis to appreciate walking (simple task and dual task) in 14 MCI, 14 controls and six AD subjects who walked at their preferred speed. A 20-second period of stabilized walking was used to calculated stride frequency, stride length, symmetry and regularity. Speed walking was measured by electrical photocells. RESULTS: Variables measured during simple and dual tasks showed an alteration of motor function as well in mild AD patients as in MCI patients. CONCLUSION: At the end of this preliminary study, we defined a specific gait pattern for each cognitive profile. Further researches appear necessary to enlarge the study cohort.

[Assessing fall risk and preventing falls in the elderly]. / Peut-on aider le patient agé a risque de chutes?

Assessment of fall risk in the elderly is clearly documented in the literature. However, intervention preventive strategies are not well identified. Two types of methods can be discussed: on the one hand, classical techniques using different tests and exercises in balance with materials and/or sensitization by dual task; on the other hand, rhythmic exercises. Their results and value are not quite established and further studies are needed to assess their prospective benefit, even if they seem interesting in some Parkinson's population. Physical activity and global fall management allow a better outcome in different gait parameters of the elderly.

The value of instrumental gait analysis in elderly healthy, MCI or Alzheimer's disease subjects and a comparison with other clinical tests used in single and dual-task conditions.

In the elderly, gait disorders and cognitive frailty may influence each other and increase the risk of falling. The aim of the present study was to determine gait parameters in elderly people with different cognitive profiles (controls, individuals with mild cognitive impairment [MCI] and Alzheimer's disease [AD] patients) with the Locometrix three-axis accelerometer and establish whether or not this tool is more useful than conventional clinical tests (the timed "get up and go" test, the pull test and the single-leg balance test). Study subjects were all over 65, living at home and free of known gait impairments. A neuropsychological battery was applied to 14 control subjects, 14 MCI subjects and six AD patients. A motor evaluation (in single- and dual-task paradigms) was performed with three conventional clinical tests and the Locometrix (standardized gait). Our results showed that in a single-task paradigm, the Locometrix was more accurate than validated, conventional tests and generated a characteristic gait profile for each of the three cognitive profiles. In a dual-task paradigm, the gait of MCI subjects more closely resembled that of AD patients than that of control subjects. We conclude that the Locometrix is a high-performance tool for defining gait profiles, which correspond to given cognitive profiles. The use of a dual-task paradigm is a good way to screen for gait abnormalities in MCI.

[Gait disorders in the elderly]. / Les troubles de la marche de la personne âgée.

Falls are frequent in the elderly and are responsible for an increased morbi-mortality. The elderly who has a tendency to fall is at higher risk of repeated hospitalisation and of institutionalisation. A link between cognitive and gait disorders is put forward by several recent studies. This paper is concerned with the various gait abnormalities encountered in the elderly, especially seriale gait, and the means to detect them.

[Autoimmunity in endocrinology: general principles]. / Auto-immunité endocrinologie: principes généraux.

The thymus is a crucial meeting place between the major systems of cell-to-cell communication, the nervous, the endocrine and the immune systems. More specifically, the thymus is the site for establishment of central T cell self-tolerance of neuroendocrine principles. The different factors--genetic, environmental, sexual--that intervene in the pathogenesis of autoimmune endocrinopathies are briefly reviewed here. Current research try to evidence that a thymic dysfunction, a defect in central self-tolerance could play an important role in the development of organ-specific autoimmune diseases, or cell-specific such as type 1 diabetes.

[Autoimmune polyendocrine syndrome (APS)]. / Les syndromes polyendocrines auto-immuns (APS).

As a complement to basic research, thorough clinical investigation of rare diseases may provide fundamental elements which improve our understanding of still obscure pathophysiologic mechanisms. This is the case with immunoendocrinopathy syndromes. Since Addison's pioneer observations in the 19th century, physicians have known that some individuals and their families may be affected by several spontaneous endocrine insufficiencies that are associated with autoimmune extra-endocrine processes. APS-I or APECED syndrome appears in children firstly affected by recurrent muco-cutaneous candidiasis and hypoparathyroidism, followed by adrenocortical insufficiency and by other autoimmune processes. APS-I is a monogenic disorder resulting from one mutation in the AIRE gene. The protein encoded by AIRE is a nuclear transcription factor the precise target of which is still not known. AIRE is mainly expressed by cells playing a crucial role in the establishment of central T cell self-tolerance (medullary epithelium, macrophages and dendritic cells of the thymus). APS-I must be considered in children affected with recurrent candidiasis without any sign of primary immune deficiency. Scientific investigation of the biological nuclear events controlled by AIRE has to be pursued. Undoubtedly, their deciphering will increase our knowledge of the mechanisms responsible for the establishment of central T cell self-tolerance and will open novel strategies for managing many autoimmune diseases. APS-II is a more common syndrome characterized by adrenocortical insufficiency spontaneously occurring in non tuberculous adults and associated with autoimmune thyroiditis and/or type 1 diabetes. Contrary to APS-I, APS-II is linked to genetic loci of the major histocompatibility complex. There is no adrenal insufficiency in APS-III which includes autoimmune thyroiditis, type 1 diabetes, and other autoimmune extra-endocrine processes (like pernicious anemia and vitiligo).

[Autoimmune thyroiditis]. / Les thyroïdites auto-immunes.

The continuum of clinical phenotype between different autoimmune thyroid diseases and mainly the common pathophysiological mechanisms have lead to a novel classification of these disorders into three types: (1) Type 1 autoimmune thyroiditis (euthyroidism associated with the presence of anti-thyroglobulin and anti-thyroperoxydase autoantibodies); (2) Type 2 autoimmune thyroiditis or Hashimoto's disease (hypothyroidism with anti-thyroglobulin and anti-thyroperoxydase autoantibodies). Postpartum thyroiditis falls into this category and is characterized by transient hyperthyroidism followed by hypothyroidism; and (3) Type 3 autoimmune thyroiditis or Graves-Basedow's disease (hyperthyroidism with anti-TSH receptor "stimulating" auto-antibodies, often associated with anti-thyroglobulin and anti-thyroperoxydase autoantibodies). Thyroid orbitopathy often complicates Type 3 autoimmune thyroiditis and is thought to result from an autoimmune response against an autoantigen common to thyroid and orbital fibroblasts/adipose cells. We present the actualized knowledge about the immunological parameters that can be detected and quantified in autoimmune thyroid diseases, about the pathophysiological mechanisms involved in these disorders, and about the options of their treatment that are currently offered to the medical community.