[A critical review of available tools for evaluating memory enhancers in Alzheimer's disease]. / Une revue critique des instruments disponibles pour l'évaluation des médicaments promnésiants dans la maladie d'Alzheimer.

The study reviews critically the neuropsychological measurement tools available to assess the efficacy of potential memory enhancers in patients with Alzheimer's disease (AD). A review of some concepts concerning the characteristics of memory impairment in AD patients and of problems related to the selection of a study population provides a framework for this analysis. The tools available for efficacy evaluations are then classified according to their conceptual and formal characteristics: psychometric tests, rating scales and clinician global assessment tools. In each category the instruments were assessed according to several criteria: construct and ecological validity; sensitivity to changes in symptomatology; inter-rater reliability and the reliability of equivalent forms; feasibility for use with AD patients, especially brevity, to encourage their cooperation. Examining advantages, drawbacks and limitations of instruments in each category yields two conclusions: no single instrument scale or test battery fills all the criteria for a clinical trial, but these imperfect instruments are complementary. Accordingly, a battery including the three categories of instruments and allowing for investigation of the different memory systems has been proposed.

Predictors of life satisfaction amongst retired people in Paris.

BACKGROUND: The objective of the present study was to examine predictors of life satisfaction in a survey of retired men and women living in the Paris Metropolitan area. METHODS: In all 627 subjects took part in the first phase of the survey (1982-1983, T1), and 464 in the follow-up phase (1987-1988, T2) during which life satisfaction was evaluated, using the Life Satisfaction Index A (LSIA). Possible predictors were explored among the factors characterizing subjects at T1 and among those related to their occupational history. RESULTS: In the multivariate analyses, significant relationships were found between life satisfaction and the number of physical impairments and leisure activities, marital and mental health status and family relations. Taking into account the changes in these factors between the two phases of the survey increased the predictiveness of the regression models. CONCLUSIONS: These results confirm the links between life satisfaction and the factors generally recognized as its determinants. On the other hand, no effect of past occupational characteristics on life satisfaction long after retirement was shown.

[Verbal fluency and EEG coherence in Alzheimer's disease]. / Fluidité verbale et cohérence EEG dans la maladie d'Alzheimer.

EEG coherence of 16 derivations and a verbal fluency test were evaluated on 25 ambulatory patients suffering from Alzheimer's disease (age: 74 +/- 5.7). The aim of the study was to analyze coherence rate variations from different cortical areas in relation to the performance in the test. Coherence rates of each derivation with the other ones were calculated for four frequency bands from 0.5 to 13.5 Hz. Arithmetic averages of these rates were then calculated to obtain scalp averaged coherence rates. The patients were submitted to a verbal fluency test and divided into two groups according to their test score as compared to normative data: impaired (n = 10) and not impaired (n = 15). Results showed that averaged coherence rates of theta and alpha 1 frequency bands were significantly depressed in the impaired group in comparison with those of the not impaired group. Two cortical areas were concerned with this difference, the left temporo-occipital and frontal zones, in an independent way for the same subject. Moreover, we observed that the patients who where impaired in the verbal fluency test, also presented a significantly greater ancientness of the clinical symptoms as compared to the not impaired patients.

[The significance of quantified EEG in Alzheimer's disease. Changes induced by piracetam]. / Intérêt de l'EEG quantifié dans la maladie d'Alzheimer. Modifications induites par le piracétam.

One study was performed in 12 patients with presenile Alzheimer's disease (group I), the other one in 16 patients with mild senile dementia of Alzheimer type (group II). In each study, patients were divided into two randomized parallel groups, one receiving placebo, the other piracetam (9 g daily in group I piracetam and 2.4 g daily in group II piracetam) during three months, piracetam induced a decrease in EEG power on the 2-6 Hz range (group I piracetam), 3-5 Hz and 7 Hz (group II piracetam) and an increase of EEG power in the 9-11 Hz range (group I piracetam) and in the 10 Hz and 13 Hz frequencies (group II piracetam). There was also a significant improvement in the Trail Making Test part A in group II piracetam. Correlations between decreased EEG low frequency components and improvement in some psychometric tests were found significant in the two groups. It seems that the main effect of piracetam was to induce increased alertness. The same results were found in both studies; the good reproducibility suggests that EEG spectral analysis is a reliable tool in the assessment of psychotropic drug effects.

[Mortality and morbidity in a cohort of elderly Parisian managers followed for 14 years]. / Mortalité et morbidité d'une cohorte de cadres parisiens agés suivie pendant 14 ans.

A randomized sample of 180 male managers, 63-64 years old received a standardized medical examination at the four times of a longitudinal study (1975-78-82-88). The prevalence and incidence rates of principal chronic diseases were evaluated according to ICD-9. The incidence rates of surgery operations and death were calculated. The prevalence and incidence rates of some diseases definitely increase with age. On the contrary, the rates of others diseases declined. The individual differences in morbidity indexes are large and increased with age. The morbidity index is lowest at the beginning of the seventies. Cancers and cardiovascular diseases were respectively the first and second causes of death.

Almitrine-raubasine and cognitive impairment in the elderly: results of a 6-month controlled multicenter study.

Two-hundred four patients between 70 and 85 years of age were included in a double-blind randomized controlled multicenter study (almitrine-raubasine/placebo). Inclusion criteria were a complaint of cognitive disorders and an objective cognitive impairment evaluated by Folstein et al. "Mini-Mental State" (MMS) and by Sandoz Clinical Assessment for Geriatrics (SCAG). Patients were treated for 6 months and evaluations were performed at the beginning of the trial (T0), then 3 (T3) and 6 (T6) months later. Evaluations included a visual analogic self-rating scale and the following psychometric tests: Trail Making A (TMA), Shopping List Task, Word Fluency, Crossing Out Letters, Logical Memory, Digit Span, and Visual Retention. Anxiety and Depression Scales were also used to assess the effects of almitrine-raubasine on affective status. Statistical analysis involving the whole sample did not show any significant difference between the almitrine-raubasine and placebo groups concerning changes in assessment criteria from T0 to T6. However, these results may have been due to the wide heterogeneity of baseline performances in psychometric tests. To prevent this possible bias, further statistical analysis was performed for each psychometric test after patients had been divided into three classes according to baseline score levels. Considering scores on TMA and Digit Span for patients with scores in the intermediate class on TMA, almitrine-raubasine induced a significantly higher improvement in performance from T0 to T6 than that induced by placebo. On the other hand, no side effects were noted with almitrine-raubasine when compared with placebo. These data suggest that almitrine-raubasine enhances concentrated attention in patients with mild to moderate impairment of this function.

[Duxil and cognitive deficiency in the elderly. Results of a 6-month controlled multicenter study]. / Duxil et déficit cognitif chez les sujets âgés. Résultats d'une étude multicentrique contrôlée d'une durée de 6 mois.

Two hundred and four patients, 70-85 years old, were included in a double-blind (Duxil/placebo), controlled, multicentric study. The inclusion criteria were a subjective complaint of a cognitive deficiency and a cognitive deficit objectively determined using the Folstein mini-mental state test and the Sandoz geriatric clinical evaluation score. The patients, treated for 6 months, were examined at the onset of the study (T0), then 3 (T3) and 6 months (T6) later. The assessment criteria included: a visual self-evaluation test measuring cognitive function and the following psychometric tests: trail making A (TMA), memorization of a shopping list, verbal fluidity, letter identification, repetition of a story, immediate recall of numbers and immediate visual memory. Anxiety and depression evaluations were also used to assess the effects of Duxil on the affective state. Statistical analysis of the observations made on the entire population did not reveal a significant difference between the treated group and the control placebo group, in terms of assessment criteria, between T0 and T6. However, this lack of a difference could be explained, in part, by the very wide variation in the initial psychometric performance scores of the subjects. In an attempt to control this possible bias, another statistical analysis was made for each psychometric test, after the patients had been divided into 3 classes based on their initial performance scores. The results of this second analysis showed that Duxil was able to improve memory performances in TMA and number retention better than the placebo. However, this effect was limited to the group of patients whose initial scores were in the intermediate class for TMA. These findings suggest that Duxil improves the concentrating ability of patients with light to moderate deficits in this function.

Psychometric procedures for analysis of memory losses in the elderly.

This study aimed to assess and compare the discriminative validity of two psychometric procedures which have been proposed to investigate memory losses in elderly. The first one relies on the use of the serial position curve paradigm in a test of immediate memory, the second one being a single recognition task. These two procedures were applied to the five following groups of subjects: 95 young-elderly normals, 33 elderly normals, 26 patients with mild senile dementia of the Alzheimer type (SDAT), 17 patients with moderate or moderately severe SDAT and 24 elderly depressed patients. Results from both psychometric procedures confirm the findings of previous studies and support the view that memory impairment associated with SDAT is qualitatively different from that observed in normal aging or in depression. They also suggest that memory loss in elderly depressed patients differs only quantitatively from that of normal controls. However the recognition task seems to have the best validity to qualitatively discriminate the patients with mild dementia from both the normal controls and the elderly depressed patients.

[Aging of cognitive functions. Results of a longitudinal study]. / Le vieillissement des fonctions cognitives. Résultats d'une étude longitudinale.

This study had the two following purposes: to assess the age-related changes in the fluid and crystallized components of intelligence in subjects over age sixty five; to examine whether these age-related changes were linked to any biological, psychological and social factors. The sample was composed of 50 male subjects who were examined three times: in 1968, 1973 and 1977. At the beginning of the study, their age ranged from 60 to 79 years and they were all in good health. In the whole, their socio-economic level was high. At each wave of the study, these subjects were given the same battery of three mental tests: a vocabulary test, selected to assess crystallized intelligence; a perceptual test and a speeded digit coding test, both selected to assess fluid intelligence. Results show that the two components of intelligence have different aging trajectories over age sixty. On the vocabulary test, performances hold until an advanced age (about 75-80), then significantly decline. On the perceptual and digit coding tests, performances sharply and significantly decline with age, this decline looking approximately linear. Whatever the test used, individual differences in age-related changes in performance are found to be great. On vocabulary test, this variability is linked to two factors, independently of age: among subjects who have suffered from a cardio-arterial disease between wave 1 and wave 3, as well as in those who have not maintained an occupational activity, decline in performance is greater than in other subjects. On the two other tests, no factor was found to be significantly linked with change in performance between wave 1 and wave 3.

Heart rate, urinary catecholamines and anxiety responses during mental stress in men in their fifties and seventies.

Alterations with ageing in the responses of heart rate (HR), urinary excretion of free epinephrine (E) and norepinephrine (NE) and anxiety were investigated during mild mental stress. Forty-eight normal male volunteers were studied: in control conditions; when subjected to psychometric tests; and during recovery. Men in their seventies had lower baseline levels of HR, E and NE than men in their fifties. Several anxiety indices were positively correlated with E. HR and NE were positively correlated. During stress, mean HR and E levels increased in the two age groups by the same percentages. Mean HR and E levels returned to pre-stress values more slowly in the older age group.

[Retirement, psychological well-being and health: longitudinal study of a population of Parisian executives]. / Retraite, bien-être psychologique et santé: étude longitudinale d'une population de cadres parisiens.

A longitudinal study was carried out on a sample of 155 french male managers in order to test the hypothesis that retirement has negative effects on health and life satisfaction in upper white-collar workers. At wave 1 (in 1976) of the study, these 155 managers were all working full time. At wave 2 (in 1979), 105 were retired and 50 were still working full time. Results from the comparison of these two groups do not support this hypothesis. On the other hand, the data suggest that some psychological factors assessed at wave 1 are, independently of retirement, significantly related to changes occurred in health and life satisfaction between the two waves of the study.

[Health as felt by the subject and assessed by the physician. Methods for measurement and evaluation in a population of subjects in their sixties]. / Santé ressentie par le sujet et mesurée par son médecin. Méthodes de mesure et évaluation dans une population de sujets de la soixantaine.

The relationships between the self-assessment of general health, and that made by a physician have been repeatedly reviewed. However, little is known concerning the detailed ratings by subjects and by physicians of the functional status of the major organ systems of the body. This paper presents the use of autorating scales in such problems. Application of the technique is made on a population of elderly men of social position and income comparable to those of physicians; it is found that there is an agreement between physician and subject concerning the mean ratings given to the functional status of major organ systems. Both subjects and physician agree also in giving priority to the cardiovascular system in their assessment of the subject's general health.

Retirement and morbidity: a three-year longitudinal study of a French managerial population.

A longitudinal study was carried out on a randomized sample of Parisian male managers in order to assess the relationship between morbidity and retirement. In 1976 (wave 1), 180 subjects participated in the study. In 1979 (wave 2), 156 subjects were re-examined. Among those returning, 105 were retired and 51 were still working full time. To evaluate this relationship the two groups were compared with regard to changes in prevalence of principal diseases between the two waves, incidence in the interim and changes in a morbidity index. Popular belief, according to which retirement may cause an increase in morbidity, is not supported by the findings of this study. Furthermore, at wave 2, the prevalence rate of heart and artery disease was found to be significantly greater in the non-retirees than in the retirees, while these rates were similar at wave 1.

Factors related to sexual intercourse frequency in a group of French pre-retirement managers.

A group of 175 managerial Parisian males, 63 or 64 years old, still working full time were questioned about their sexual activity during a standardized medical examination. Twenty subjects in this group were impotent (ISs), the others, sexually potent (PSs), had had intercourse at least once during the course of the year. Distribution of PSs according to yearly frequency of sexual intercourse (YFSI) fits well with a log-normal distribution. Twenty-two factors assessing psychosocial variables, personality traits and measures of the state of health were studied. Stepwise procedures were used to select sequentially first the variables which best differentiate PSs from ISs, second the variables which best allow us to predict the YFSI among PSs. In our sample of elderly men, sexual potency and also YFSI are closely linked to age at the first intercourse and to certain personality traits. The state of health does not differentiate ISs from PSs, but is significantly linked to YFSI among PSs.

Can a protracted stay in the tropics permanently lower basal metabolic rates of European expatriates?

The basal metabolic rate (BMR) of 57 male and female French subjects, aged between 50 to 80 years, all in good health and normally active, was measured. All subjects had been long-term residents of the humid tropics and had returned to France at least one year earlier. Two groups, individuals born in France and those born in the humid tropics, were compared to paired randomized control groups of subjects born in France who had never lived outside France. Despite important inter-individual differences, there was a general trend towards a persistent drop of the BMR in both groups of former residents in the tropics.

Factors related to attitude towards retirement among French preretired managers and top executives.

This study aimed to investigate the determinants of a favorable attitude towards retirement among 175 male executives aged 63 or 64 and still professionally active. Findings were based on a questionnaire for attitude as well as a variety of other examinations designed to reveal the determinants involved. Multiple regression analysis indicated that four possible determinants are significantly related to a favorable attitude toward retirement: a good cardiovascular status, a poor state of vision, a high degree of life satisfaction and an important amount of time devoted to leisure activities. The relationship between commitment to work and attitude towards retirement was not found to be significant.