[Beneficial effect of a cognitive behavioral and multidisciplinary program in Alzheimer Disease on spouse caregiver anxiety: French study ELMMA]. / Bénéfice d'un programme cognitivo-comportemental et pluridisciplinaire de prise en charge de la maladie d'Alzheimer sur l'anxiété du conjoint : étude française ELMMA.

INTRODUCTION: Over the last decade, several programs have been developed for caregivers of Alzheimer disease patients. In France however, studies exploring their effects are still scarce. We conducted a study to compare two different interventions: a structured multidisciplinary program versus a classical intervention designed for Alzheimer disease patients and their spouses. METHODS: Sixteen couples (Alzheimer's disease patient and spouse) residing in our administrative district participated in this monocentric study. For at least two years, these couples participated in a multidisciplinary program (n=8 couples) or received usual care (n=8 couples). The multidisciplinary program involved biannual consultations with a neurologist, a neuropsychologist and a psychologist, in addition to an annual meeting, stratified on the patient's MMSE score, for spouses). Usual care involved biannual consultations with the neurologist. The multidisciplinary program included a psychological intervention based on cognitive behavioral theories and centered on psycho-education, problem solving, adaptation strategies and on prevention of depression and anxiety. The spouses and the patients evaluated the 2-year follow-up during clinical interviews, completed by questionnaires. Sociodemographic data were noted for the patients and their spouses. Levels of depression and anxiety (Mini International Neuropsychiatric Inventory, Montgomery and Asberg Depression Scale, State-Trait Anxiety Inventory), perceived stress (Perceived Stress Scale) and care burden (Zarit Burden Inventory) were evaluated in spouses. Levels of cognitive impairment (Mini Mental State Examination), autonomy (Instrumental Activities of Daily Living), psychological state (Montgomery and Asberg Depression Scale, Covi Anxiety Scale), and behavioral symptoms frequency (Neuropsychiatric Inventory) were assessed in patients. RESULTS: The main significant result showed that the spouses' state of anxiety was lower among participants in the multidisciplinary program, compared with the classical neurological intervention. It also was found that the spouses and the patients who participated in this multidisciplinary program were less depressed. CONCLUSION: This study shows that a multidisciplinary structured intervention, with only two annual consultations and one annual meeting for spouses, can contribute to decrease significantly the spouses' state of anxiety. Further studies including a larger number of subjects should be conducted to confirm these findings.

VBM anticipates the rate of progression of Alzheimer disease: a 3-year longitudinal study.

OBJECTIVE: To determine whether regional atrophy or neuropsychological factors can predict the rate of decline in patients with mild Alzheimer disease (AD). BACKGROUND: Despite important implications for planning the care and treatment strategy, few prognostic factors of severe AD progression are known. METHODS: Twenty-three patients with mild AD were followed up every 6 months over the course of 3 years. At baseline, patients with AD and 18 controls underwent a neuropsychological battery and a brain MRI. At the end of the 3 years, patients with AD were dichotomized into slow decliners (SLD) or fast decliners (FD) groups on the basis of their decline in Mini-Mental State Examination score over time. We compared baseline cognitive performance and imaging data using voxel-based morphometry (VBM). RESULTS: SLD and FD groups did not differ in age, gender, level of education, mean estimated duration of illness, and standard neuropsychological data at inclusion, except for the Attentional Battery of the Cambridge Neuropsychological Tests Automated Battery (speed processing in shifting condition). VBM comparison between SLD and FD groups demonstrated more gray matter tissue loss in the FD group in the medial occipitoparietal areas, especially in the precuneus, the lingual gyrus, the cuneus, and the surrounding cortex of the parieto-occipital sulcus bilaterally. CONCLUSION: Voxel-based morphometry analysis demonstrated that patients who will have a faster decline at 3 years already had a more extensive cortical atrophy than SLD patients, especially in the medial occipitoparietal areas, which was not yet detected by clinical and neuropsychological assessment.