Publications by authors named "Claude Jeandel"

66 Publications

Consensus of experts from the French Society of Geriatrics and Gerontology on the management of heart failure in very old subjects.

Arch Cardiovasc Dis 2021 Jan 14. Epub 2021 Jan 14.

Pôle de Gériatrie, CHU La Milétrie, 86021 Poitiers, France; CIC 1402, Inserm, centre hospitalier universitaire de Poitiers, université de Poitiers, 86000 Poitiers, France.

The prevalence of heart failure increases with age. In France, the 1-year mortality rate is 35% in subjects aged 80-89 years with heart failure, and 50% after the age of 90 years. In octogenarians, heart failure is associated with high rates of cardiovascular and non-cardiovascular events, and is one of the main causes of hospitalization and disability. The prevalence of frailty increases in elderly subjects with heart failure, and the co-occurrence of heart failure and frailty increases the risk of mortality in patients with heart failure. In the elderly, the presence of frailty must be evaluated using a comprehensive geriatric assessment to manage geriatric syndromes, such as cognitive disorders, malnutrition, falls, depression, polypharmacy, disability and social isolation. The objective of heart failure therapy in octogenarians is to reduce symptoms, mortality and hospitalizations, but also to improve quality of life. In the absence of specific studies involving very old subjects, most recommendations are extrapolated from evidence-based data from younger populations. Overall, the epidemiological studies in patients with heart failure aged>80 years highlight the underprescription of recommended drugs. This underprescription may be related to comorbidity, a fear of side-effects and the lack of specific recommendations for drug prescription in heart failure with preserved ejection fraction, which is common in this very old population. The benefit/risk ratio related to heart failure treatment and comorbidity should be carefully weighed and reassessed on a regular basis. Consideration of disease prognosis according to factors that predict mortality can help to better define the care plan and promote palliative and supportive care when needed.
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http://dx.doi.org/10.1016/j.acvd.2020.12.001DOI Listing
January 2021

Anticoagulant treatment in elderly patients with atrial fibrillation: a position paper.

Geriatr Psychol Neuropsychiatr Vieil 2019 Dec;17(4):341-354

CHU Nantes, Pôle hospitalo-universitaire de gérontologie clinique, France, Gérontopôle Autonomie Longévité Pays de la Loire, France.

Atrial fibrillation (AF) is common in the elderly. The treatment of this condition is based on anticoagulation to prevent stroke and systemic arterial embolism. Vitamin K antagonists (VKAs) have long been the only anticoagulants available for the management of AF. Administration is complex and is one of the main causes of iatrogenic disease in the elderly. In the past 10 years, direct-acting oral anticoagulants (DOACs) have emerged, and large randomised trials (RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE-AF) have demonstrated their superiority over VKAs in the management of AF. These trials were conducted on large numbers of patients (n=71,683), including 27,500 patients aged ≥75 years and nearly 8,000 subjects aged >80 years. Results from 11 recent meta-analyses of randomised trials and observational real-world studies of 660,896 elderly patients indicate that DOACs are more effective than VKA-based prophylaxis in preventing stroke (with a reduction in risk ranging from 13% to 26%), and carry a lower risk of cerebral haemorrhaging (50% reduction in risk). The risk of major haemorrhaging appears to be similar to, or lower than that with DOACs relative to VKAs (depending on the dosage, renal function, haemorrhagic site or type of DOAC). Moreover, improved outcomes with DOACs over VKA therapy have been demonstrated based on subgroup analyses in subjects aged over 75, in patients with renal insufficiency (creatinine clearance: 30-50 mL/min) and in those with a history of falls. Analyses indicate that DOACs are a better choice than VKAs in the elderly because elderly patients are at greatest risk of stroke and cerebral haemorrhaging. In summary, DOACs have a better efficacy/tolerance profile than VKAs, which justifies their first-line use in subjects over 75 years of age.
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http://dx.doi.org/10.1684/pnv.2020.0883DOI Listing
December 2019

[Anticoagulant treatment in elderly patients with atrial fibrillation: position paper].

Geriatr Psychol Neuropsychiatr Vieil 2019 12;17(4):341-355

CHU Nantes, Pôle hospitalo-universitaire de gérontologie clinique, France, Gérontopôle Autonomie Longévité Pays de la Loire, France.

Atrial fibrillation (AF) is common in the elderly. The treatment of this condition is based on anticoagulation in preventing Stroke and systemic arterial embolism. Vitamin K antagonists (VKAs) have long been the only anticoagulants available for the management of AF. Difficulties handling VKAs have made them one of the main causes of iatrogenic disease in the elderly. In the last 10 years, direct-acting oral anticoagulants (DOACs) have emerged and large randomized trials (RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE-AF) have demonstrated their superiority over VKAs in the management of AF. These trials were conducted with large numbers of patients (n=71,683), including 27,500 aged ≥75 years and nearly 8,000 subjects aged >80 years. Results from 11 recent meta-analyses of randomized trials and observational real-world studies of 660,896 elderly patient indicate that DOACs are more effective than VKA-based prophylaxis in preventing stroke (risk reduction ranging from 13% to 26%) and carry a lower risk of cerebral hemorrhage (risk reduction 50%). The risk of major hemorrhage appears to be similar to or lower with DOACs than with VKAs (depending on the dosage, renal function, hemorrhagic site or type of DOACs). Moreover, a greater benefit of DOACs over VKA therapy has been found in subgroup analyses in subjects aged over 75 years, in patients with renal insufficiency (creatinine clearance 30-50 mL/min) and in those with a history of falls. Analyses indicate that DOACs are a better choice than VKAs in the elderly because elderly patients are those with the highest risk of stroke and cerebral hemorrhages. In summary, DOACs have a better efficacy/tolerance profile than VKAs, which justifies their first-line use in subjects over 75 years of age.
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http://dx.doi.org/10.1684/pnv.2019.0834DOI Listing
December 2019

[Challenge of ageing in France: Proposals to let teaching of gerontology be consistent with].

Presse Med 2019 Nov 12;48(11 Pt 1):1213-1215. Epub 2019 Nov 12.

Collège national des enseignants de gériatrie (CNEG).

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http://dx.doi.org/10.1016/j.lpm.2019.09.058DOI Listing
November 2019

Comorbidity Burden in Adults With Autism Spectrum Disorders and Intellectual Disabilities-A Report From the EFAAR (Frailty Assessment in Ageing Adults With Autism Spectrum and Intellectual Disabilities) Study.

Front Psychiatry 2019 19;10:617. Epub 2019 Sep 19.

CESP, INSERM U1178, Centre de recherche en Epidemiologie et Santé des Populations, Paris, France.

Autism spectrum disorder (ASD) is an early-onset and lifelong neurodevelopmental condition frequently associated with intellectual disability (ID). Although emerging studies suggest that ASD is associated with premature ageing and various medical comorbidities, as described for ID, data are scarce. To determine the comorbidity burden and its association with distinct clinical presentation in terms of ASD severity, adaptive skills, level of autonomy, and drug exposure in a well-phenotyped sample of individuals with ASD-ID-the EFAAR (Frailty Assessment in Ageing Adults with Autism Spectrum and Intellectual Disabilities) cohort. A total of 63 adults with ASD-ID, with a mean age of 42.9 ± 15.1 years, were recruited from 2015 to 2017 from nine specialized institutions. They underwent detailed clinical examinations, including screening for comorbidities, ASD severity [Childhood Autism Rating Scale (CARS)], adaptive functioning [Vineland Adaptive Behavior Scale II (VABS-II)], autonomy [activities of daily living (ADLs)], and drug use [polypharmacy and the Drug Burden Index (DBI)]. The comorbidity burden was evaluated using the Cumulative Illness Rating Scale (CIRS-G) and its sub-scores [the severity index (CIRS-SI) and severe comorbidity (CIRS-SC)]. We found a large range of comorbidities, including gastrointestinal disorders and mental and neurological diseases. Overall, 25% of our ASD-ID sample had chronic kidney disease with the associated increased cardiovascular risk factors. The comorbidity burden was high (mean CIRS-G total score of 10.6 ± 4.8), comparable with that observed among patients older than those in our population hospitalized in geriatric departments. Furthermore, the comorbidity burden positively correlated with age, decreased autonomy, and polypharmacy. The severity of the comorbidity burden associated with premature ageing in adults with ASD and ID highlight their crucial need of personalized medical care.
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http://dx.doi.org/10.3389/fpsyt.2019.00617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761800PMC
September 2019

National survey on the management of heart failure in individuals over 80 years of age in French geriatric care units.

BMC Geriatr 2019 08 1;19(1):204. Epub 2019 Aug 1.

Assistance Publique des Hopitaux de Paris, Hopital Broca, 54-56 rue Pascal, 75013, Paris, France.

Background: To evaluate the prevalence and management of heart failure (HF) in very old patients in geriatric settings.

Methods: Members of the French Society of Geriatrics and Gerontology throughout France were invited to participate in a point prevalence survey and to include all patients ≥80 years old, hospitalized in geriatric settings, with HF (stable or decompensated) on June 18, 2012. General characteristics, presence of comorbidities, blood tests and medications were recorded.

Results: Among 7,197 patients in geriatric institution, prevalence of HF was 20.5% (n = 1,478): (27% in acute care, 24.2% in rehabilitation care and 18% in nursing home). Mean age was 88.2 (SD = 5.2) and Charlson co morbidity score was high (8.49 (SD = 2.21)). Left ventricular ejection fraction (LVEF) was available in 770 (52%) patients: 536 (69.6%) had a preserved LVEF (≥ 50%), 120 (15.6%) a reduced LVEF (< 40%), and 114 (14.8%) a midrange LVEF (40-49%). Prescription of recommended HF drugs was low: 42.6% (629) used Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARBs), 48.0% (709) β-blockers, and 21.9% (324) ACEI or ARB with β-blockers, even in reduced LVEF. In multivariate analysis ACEI or ARBs were more often used in patients with myocardial infarction (1.36 (1.04-1.78)), stroke (1.42 (1.06-1.91)), and diabetes (1.54 (1.14-2.06)). β blockers were more likely used in patients with myocardial infarction (2.06 (1.54-2.76)) and atrial fibrillation (1.70 (1.28-2.28)).

Conclusion: In this large very old population, prevalence of HF was high. Recommended HF drugs were underused even in reduced LVEF. These results indicate that management of HF in geriatric settings can still be improved.
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http://dx.doi.org/10.1186/s12877-019-1215-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6670218PMC
August 2019

[Protein supplementation to prevent loss in muscle mass and strength in frail older patients: a review].

Geriatr Psychol Neuropsychiatr Vieil 2019 06;17(2):137-143

Membres du Groupe Expert Nutrition en Gériatrie (GEGN) sous l'égide de la SFGG, Service de médecine gériatrique, Hôpital Bellier, CHU Nantes, France.

Minimum levels of protein intake are essential for the preservation of muscle mass and function, which is a major preventive issue of successful aging. Epidemiological studies suggest strong associations between protein intake and the different elements of sarcopenia, namely maintenance of lean mass and muscle strength. Most often, protein intakes among older patients are below requirements, independently from situations of under nutrition. This opens the path for nutritional interventions to prevent the consequences of sarcopenia in older patients. Isolated amino-acids such as leucine have shown positive effects in the short term only. The positive effects of protein supplementations on muscle strength and function are currently not established in the absence of concomitant exercise training. The highest level of evidence supports interventions combining exercise and nutrition.
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http://dx.doi.org/10.1684/pnv.2019.0804DOI Listing
June 2019

France Will No More Reimburse Available Symptomatic Drugs Against Alzheimer's Disease.

J Alzheimers Dis 2018 ;66(2):425-427

Fédération des Centres Mémoire, Lyon, France.

The French Minister of Health published a decree on May 29th of 2018 removing the drugs used to fight against symptoms due to Alzheimer's disease (donepezil, rivastigmine, galantamine, memantine) from the list of available reimbursed drugs. This follows the advice delivered by the High Authority for Health in 2016 and 2018 stating an "insufficient medical benefit and dangerousness because of significant side effects". The main French scientific and medical societies and professional associations want to state here their deep disagreement regarding this unfair decision. The evidence-based medicine related to these drugs reaches a high level in literature, whereas the clinical relevance of these treatments must be considered with co-prescription of psychosocial interventions and related approaches. As no serious pharmacovigilance signal has been provided by health authorities, the ratio of benefits/risks favors these drugs.
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http://dx.doi.org/10.3233/JAD-180843DOI Listing
October 2019

[Towards a national strategy on the diagnosis of neurocognitive disorders. A shared approach among the French National College of General Practitioners and specialists of neurocognitive disorders].

Presse Med 2018 Jan 26;47(1):75-83. Epub 2017 Dec 26.

Collège de médecine générale, 92200 Neuilly-Sur-Seine, France.

Neurocognitive disorders leading to progressive cognitive, functional and behavioural impairment are often undiagnosed or diagnosed lately. But tailored care and therapeutics help in implementing secondary and tertiary prevention dynamics aiming at preserving quality of life and delaying, anticipating or preventing behavioural crisis and severe stages of dementia. Moreover, the diagnosis of numerous diseases induces specific care and therapeutics, as well access to research and clinical trials. For the first time, the representatives of the National College of General Practitioners, the French Federation of Memory Centres, the French Federation of Gerontology and Geriatrics, the French Federation of Neurology, the French Society of Psychogeriatrics and the national plan on neurodegenerative diseases propose a graduated and tailored diagnosis strategy involving primary care and specialists of neurocognitive disorders. This strategy has been built in the context of the national plan on neurodegenerative diseases, the European Joint Action "Act on dementia", and has been consensually agreed after a seminar animated by the National College of General Practitioners in March 2017.
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http://dx.doi.org/10.1016/j.lpm.2017.10.029DOI Listing
January 2018

Evaluation of prescription along three health-care periods in the elderly.

Geriatr Psychol Neuropsychiatr Vieil 2017 Jun;15(2):153-162

Service de médecine interne gériatrique, CHU Carémeau, Nîmes, France.

Polypharmacy, potentially inappropriate prescriptions and inadequate coordination between prescribers are among main factors explaining the occurrence of adverse drug events in elderly patients. Prospective and descriptive study of medication prescriptions for elderly patients during a continuous period of health-care: entry in an acute geriatric unit (T1), at discharge (T2) and two months after hospitalization (T3). A global iatrogenic risk was defined: presence of poly-pharmacy and/or PPI (Laroche criteria) and/or absence of quality indicators for prescription according to the French health authority. For the 79 patients (mean age 87), mean number of medication decreased from 7.33 (T1) to 6 (T2) (p=0.0018) and 6 (T3). Number of quality indicators for prescription improved from 6.67 (T1) to 6.92 (T2) (p=0.001) then decreased to 6.84 (T3). Number of PPI decreased from 1.16 to 0.42 between T1 and T2 (p=0.001) then increased to 0.59 at T3. The global iatrogenic risk indicator fluctuated from 80% (T1) to 64% (T2) and 75% (T3). Selected interventions were developed to prevent adverse drug events during hospitalization and ambulatory follow-up. If geriatric intervention can enhance quality of prescription, iatrogenic risk remains frequent all along health-care follow-up. A local study of prescriptions can be a first step to develop an adequate program for adverse drug events prevention.
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http://dx.doi.org/10.1684/pnv.2017.0671DOI Listing
June 2017

[Cognitive disorders and the Montessori method].

Rev Infirm 2017 Jan;66(227):23-24

Centre de gérontologie clinique Antonin-Balmès, CHRU Montpellier, 39 avenue Charles Flahaut, 34295 Montpellier, France.

Trained in the Montessori method, a team takes a very positive approach to their patients. The nurses base their practice on patients' remaining capacities, helping them work around their impairments. They seek to offer each person the possibility to pursue a social life through individualised treatments.
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http://dx.doi.org/10.1016/j.revinf.2016.11.006DOI Listing
January 2017

Association between cachexia, chemotherapy and outcomes in older cancer patients: A systematic review.

Clin Nutr 2017 12 18;36(6):1473-1482. Epub 2016 Dec 18.

AP-HP, Henri-Mondor Teaching Hospital, Department of Geriatrics, Geriatric Oncology Clinic, F-94010 Créteil, France; Expert Group on Geriatric Oncology, Société Francophone d'OncoGériatrie (SoFOG), Rheims, France; Expert Group on Nutrition and Geriatrics (GEGN), Société Française de Gériatrie et Gérontologie (SFGG), Paris, France. Electronic address:

Background & Aims: The aims of this systematic review were (i) to determine the prevalence of malnutrition and cachexia in older cancer patients in a chemotherapy setting, and (ii) to report the chemotherapy-related causes of malnutrition and (iii) the consequences of malnutrition on the outcomes of these patients.

Methods: We searched MEDLINE for articles published in English or French between 2005 and 2016 and which reported retrospective or prospective, observational or interventional studies of the prevalence of malnutrition and its consequences in patients 65 years or older with solid tumors and chemotherapy-related causes of malnutrition.

Results And Conclusion: Malnutrition is prevalent up to 83% in older patients with cancer scheduled to receive chemotherapy. One third or more of patients were malnourished before receiving chemotherapy. A weight loss of 10% or more during the past three or six months was reported in 8%-40% of cancer patients, while a body mass index <21 kg/m was found in 10.7%-23%. Malnutrition was more prevalent in digestive (28%-75%) than in non-digestive cancers (8%-46.9%), and also in metastatic cancers (64%-76.5%). During the course of chemotherapy, weight loss was observed in 40%-91.6% of patients, depending on cancer location. The most frequently reported chemotherapy-related digestive symptoms likely to impair nutritional status were dry mouth, nausea, stomach pain, diarrhea and constipation. Low Mini-Nutritional-Assessment score was an independent predictor of early discontinuation of chemotherapy and increased the risk of mortality.
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http://dx.doi.org/10.1016/j.clnu.2016.12.003DOI Listing
December 2017

French law: what about a reasoned reimbursement of serum vitamin D assays?

Authors:
Jean-Claude Souberbielle Claude Laurent Benhamou Bernard Cortet Mickael Rousière Christian Roux Vered Abitbol Cédric Annweiler Maurice Audran Justine Bacchetta Pierre Bataille Olivier Beauchet Rémi Bardet Alexandra Benachi Francis Berenbaum Hubert Blain Françoise Borson-Chazot Véronique Breuil Karine Briot Philippe Brunet Jean-Claude Carel Philippe Caron Olivier Chabre Philippe Chanson Roland Chapurlat Pierre Cochat Régis Coutant Sophie Christin-Maitre Martine Cohen-Solal Christian Combe Catherine Cormier Marie Courbebaisse Grégory Debrus Brigitte Delemer Georges Deschenes Marc Duquenne Guillaume Duval Patrice Fardellone Denis Fouque Gérard Friedlander Jean-Bernard Gauvain Lionel Groussin Pascal Guggenbuhl Pascal Houillier Thierry Hannedouche William Jacot Rose-Marie Javier Guillaume Jean Claude Jeandel Dominique Joly Peter Kamenicky Bertrand Knebelmann Marie-Hélène Lafage-Proust Yves LeBouc Erick Legrand Florence Levy-Weil Agnès Linglart Laurent Machet Emmanuel Maheu Eric Mallet Christian Marcelli Pierre Marès Christophe Mariat Gérard Maruani Yves Maugars France Montagnon Bruno Moulin Philippe Orcel Henri Partouche Virginie Personne Charles Pierrot-Deseilligny Michel Polak Claire Pouteil-Noble Dominique Prié Agathe Raynaud-Simon Yves Rolland Jean-Louis Sadoul Bernard Salle Corinne Sault Anne-Marie Schott Isabelle Sermet-Gaudelus Martin Soubrier Ivan Tack Eric Thervet Isabelle Tostivint Philippe Touraine Florence Tremollières Pablo Urena-Torres Jean-Paul Viard Jean-Louis Wemeau Georges Weryha Norbert Winer Jacques Young Thierry Thomas

Geriatr Psychol Neuropsychiatr Vieil 2016 Dec;14(4):377-382

Service de rhumatologie, CHU de Saint-Etienne, Saint-Etienne, France.

The number of serum 25-hydroxyvitamin D (25OHD) assays has increased tenfold in France in less than 10 years, sometimes for invalidated reasons. In 2013, the French National Authority for Health (Haute autorité de santé, or HAS) limited the indications for serum 25OHD measurements to rickets/osteomalacia, older adults with recurrent falls, monitoring of kidney transplant in adults, and surgical treatment of obesity in adults. Our aim here was to note that other indications for serum 25OHD measurements are supported by previous literature and by a number of national and international recommendations, in particular the following: any situation of bone fragility, any chronic renal failure <45 mL/min/1.73m, any situation of malabsorption, clinical signs consistent with vitamin D deficiency or vitamin D overload, and calcium phosphorus evaluation. We suggest that the measurement of serum 25OHD concentration should remain reimbursed as part of these extended indications.
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http://dx.doi.org/10.1684/pnv.2016.0631DOI Listing
December 2016

Dietary scores at midlife and healthy ageing in a French prospective cohort.

Br J Nutr 2016 08 15;116(4):666-76. Epub 2016 Jun 15.

1Equipe de Recherche en Epidémiologie Nutritionnelle (EREN),Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité,Inserm (U1153),Inra (U1125),Cnam,COMUE Sorbonne Paris Cité,Université Paris 13,F-93017 Bobigny,France.

Although nutrition has been advocated as a major determinant of healthy ageing (HA), studies investigating the link between dietary quality and HA are scarce. We investigated the association between adherence to French food-based and nutrient-based guidelines at midlife, as assessed by three dietary scores, and HA. HA was assessed in 2007-2009, among 2329 participants of the SUpplémentation en Vitamines et Minéraux AntioXydants study aged 45-60 years at baseline (1994-1995) and initially free of diabetes, CVD and cancer. HA was defined as not developing any major chronic disease, good physical and cognitive functioning, no limitations in instrumental activities of daily living, no depressive symptoms, no health-related limitations in social life, good overall self-perceived health and no function-limiting pain. Data from repeated 24-h dietary records provided at baseline permitted the computation of the modified French Programme National Nutrition Santé-Guideline Score (mPNNS-GS), the Probability of Adequate Nutrient Intake Dietary Score (PANDiet) and the Diet Quality Index-International (DQI-I). Associations of these scores with HA were assessed by logistic regression. In 2007-2009, 42 % of men and 36 % of women met our criteria of HA. After adjustment for potential confounders, higher scores of the mPNNS-GS (ORquartile 4 v. quartile 1 1·44; 95 % CI 1·10, 1·87; P trend=0·006) and the PANDiet (1·28; 95 % CI 1·00, 1·64; P trend=0·03) were associated with higher odds of HA. We observed no association between DQI-I and HA. In conclusion, this study suggests a beneficial long-term role of high adherence to both food-based and nutrient-based French dietary guidelines for a HA process.
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http://dx.doi.org/10.1017/S0007114516002233DOI Listing
August 2016

[Immunization schedule in the elderly].

Geriatr Psychol Neuropsychiatr Vieil 2015 Sep;13 Suppl 2:21-6

Service de gérontologie clinique, Centre Antonin Balmès, Montpellier, France.

Elderly people are more likely to develop severe infections diseases. Given the significant increase in the number of the elderly population, reducing the risk of infection by vaccination is a major preventive approach. The immunization schedule for 2014 in France yields, for the first time, vaccination recommendations for patients over 65 years. Tetanus-Diphtheria-Poliomyelitis vaccination is recommended to be given at the age of 65 years and then every 10 years, together with the pertussis vaccine to protect infants less than 6 months. Recommendation for vaccinations against seasonal influenza in autumn is maintained by the High Council for Public Health, which estimates that the population benefit persists despite the lower individual effectiveness in the elderly. The pneumococcal vaccine is recommended only in high-risk populations, and only once after the age 65. Zoster vaccine is recommended between 65 and 74, and the first year of its availability, can be proposed to elderly patients between 75 and 79 years. Vaccination in the elderly must be enhanced, and information about its advantages should be disseminated.
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http://dx.doi.org/10.1684/pnv.2015.0551DOI Listing
September 2015

Healthy Aging 5 Years After a Period of Daily Supplementation With Antioxidant Nutrients: A Post Hoc Analysis of the French Randomized Trial SU.VI.MAX.

Am J Epidemiol 2015 Oct 15;182(8):694-704. Epub 2015 Sep 15.

This study's objective was to investigate healthy aging in older French adults 5 years after a period of daily nutritional-dose supplementation with antioxidant nutrients. The study was based on the double-blind, randomized trial, Supplementation with Antioxidant Vitamins and Minerals (SU.VI.MAX) Study (1994-2002) and the SU.VI.MAX 2 Follow-up Study (2007-2009). During 1994-2002, participants received a daily combination of vitamin C (120 mg), β-carotene (6 mg), vitamin E (30 mg), selenium (100 µg), and zinc (20 mg) or placebo. Healthy aging was assessed in 2007-2009 by using multiple criteria, including the absence of major chronic disease and good physical and cognitive functioning. Data from a subsample of the SU.VI.MAX 2 cohort, initially free of major chronic disease, with a mean age of 65.3 years in 2007-2009 (n = 3,966), were used to calculate relative risks. Supplementation was associated with a greater healthy aging probability among men (relative risk = 1.16, 95% confidence interval: 1.04, 1.29) but not among women (relative risk = 0.98, 95% confidence interval: 0.86, 1.11) or all participants (relative risk = 1.07, 95% confidence interval: 0.99, 1.16). Moreover, exploratory subgroup analyses indicated effect modification by initial serum concentrations of zinc and vitamin C. In conclusion, an adequate supply of antioxidant nutrients (equivalent to quantities provided by a balanced diet rich in fruits and vegetables) may have a beneficial role for healthy aging.
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http://dx.doi.org/10.1093/aje/kwv105DOI Listing
October 2015

[Pleasure and aging in the elderly].

Soins Gerontol 2015 Sep-Oct(115):37-42

Département hospitalo-universitaire de gériatrie, CHU de Montpellier, 191 avenue du Doyen Gaston-Giraud, 34295 Montpellier cedex 5, France.

A survey carried out of people aged 65 and over aimed to provide a clearer picture of the older population's relationship with pleasure. How do they feel as they age? Do they still find pleasure in things? In what ways? If there a certain self-censorship among the older population with regard to the subject? Or, on the contrary, do they make the most out of life without any complexes or limits? A sample of people aged between 15 and 64 were also surveyed for their opinion on the following questions: do they feel that older people still find pleasure in things? How do senior citizens enjoy themselves today?
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http://dx.doi.org/10.1016/j.sger.2015.07.009DOI Listing
December 2015

A Healthy Dietary Pattern at Midlife, Combined with a Regulated Energy Intake, Is Related to Increased Odds for Healthy Aging.

J Nutr 2015 Sep 5;145(9):2139-45. Epub 2015 Aug 5.

University of Paris 13, Nutritional Epidemiology Research Team (EREN), Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité, National Institute of Health and Medical Research (INSERM) U1153, National Institute for Agricultural Research (INRA) U1125, National Conservatory of Arts and Crafts (CNAM), Community of Universities and Establishments (COMUE) Sorbonne Paris Cité, Bobigny, France;

Background: Few studies have investigated the long-term impact of overall dietary patterns (DPs) on healthy aging (HA), and current findings are inconsistent.

Objective: Our study's objective was to investigate the association between empirically derived DPs in midlife and HA after 13 y of follow-up.

Methods: Baseline dietary data from repeated 24-h dietary records (on average, 10 records per participant) of a subsample of the SU.VI.MAX (SUpplémentation en Vitamines et Minéraux AntioXydants) study allowed extraction of 2 DPs with the use of principal components analysis on 37 food groups. HA was assessed in 2007-2009 among 2796 participants of the SU.VI.MAX study aged 45-60 y at baseline (1994-1995), who were initially free of diabetes, cardiovascular disease, and cancer. HA was defined as not developing any major chronic disease, good physical and cognitive functioning, no limitations in instrumental activities of daily living, no depressive symptoms, no health-related limitations in social life, good overall self-perceived health, and no function-limiting pain. The association between DPs (in tertiles) and HA was evaluated by using multivariable logistic regression, and a potential interaction with energy intake was investigated.

Results: A "Western" and a "healthy" DP were identified. After adjustment for a large number of potential confounders, there was no significant association between the Western DP and HA. Moreover, the healthy pattern was not associated with HA among subjects with high (i.e., greater than or equal to the median) energy intake. Among subjects with low (i.e., less than the median) energy intake, on the other hand, higher scores on the healthy DP were related to higher odds of HA (OR for tertile 3 vs. tertile 1: 1.49; 95% CI: 1.11, 2.00; P-trend = 0.01).

Conclusion: Adherence to a healthy diet in midlife that provides micronutrients, fiber, and antioxidants while regulating energy intake may help to promote HA.
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http://dx.doi.org/10.3945/jn.115.210740DOI Listing
September 2015

Physical exercise and weight loss for hip and knee osteoarthritis in very old patients: a systematic review of the literature.

Open Rheumatol J 2014 28;8:89-95. Epub 2014 Nov 28.

Service de Rhumatologie, Rheumatology Department, Medical Office / Hôpital Saint Antoine -A.P-H.P, Paris, France.

Background: Rheumatologic and geriatric scholarly organisations recommendations for the management of hip and knee osteoarthritis, which emphasise the usefulness of non-pharmacological therapies, are not scaled according to patient's age and physical condition. We conducted a systematic review of clinical trials on exercise and weight loss in hip and knee osteoarthritis in very old patients.

Methods: Electronic search in MEDLINE, EMBASE, PASCAL database, systematic search of the Cochrane Reviews, manual search in guidelines, meta-analyses and identified relevant articles.

Results: We identified 83 trials, with only 2 on patients aged ≥ 75 years; we therefore lowered the mean age threshold to 70 years and found 15 trials, mainly performed in knee osteoarthritis and outpatients.

Physical Exercise 8 Trials: was effective on pain and function (4 controlled trials), with a persistent effect only in case of self-rehabilitation.

Aquatic Exercise 5 Trials: was as effective as land-based exercise.

Weight Loss 2 Trials: only patients under diet + exercise had significant improvement on symptoms.

Conclusion: Our systematic review confirms that international recommendations on exercise for knee osteoarthritis also apply to subjects aged 70-80 years. Long-term effectiveness requires a maintenance strategy. Specific trials on very old patients with various comorbidities are mandatory, given that these subjects are more exposed to drug-related iatrogenesis.
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http://dx.doi.org/10.2174/1874312901408010089DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258698PMC
December 2014

FDG-PET in a myocardial tuberculoma.

Age Ageing 2015 Jan 20;44(1):173-4. Epub 2014 Oct 20.

Department of Geriatrics, University Hospital of Montpellier, Montpellier, France.

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http://dx.doi.org/10.1093/ageing/afu147DOI Listing
January 2015

Estimation of age- and comorbidities-adjusted percentiles of high-sensitivity cardiac troponin T levels in the elderly.

Clin Chem Lab Med 2015 Apr;53(5):691-8

Background: Cardiac troponin level measured by high-sensitivity assays (hs-cTn) in the elderly is frequently found higher than the 99th percentile upper reference limit, making the diagnosis of acute coronary syndromes (ACS) difficult. This study aimed at: 1) identifying determinants of hs-cTnT levels in an unselected population of elderly subjects; and 2) assessing the prognosis value of increased hs-cTnT in elderly people free of ACS.

Methods: Hs-cTnT was measured in 591 individuals aged over 65 years without suspicion of ACS. Comorbidities were assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). C-reactive protein, α1-acid glycoprotein, albumin and creatinine were measured. Factors influencing hs-cTnT levels were assessed through linear regression and quantile regression was used to model percentiles of hs-cTnT. Risk of mortality was assessed through Cox regression.

Results: Age, gender, cardiac CIRS-G, estimated glomerular filtration rate (p<0.001 for all), albumin (p<0.028) and α1-acid glycoprotein (p=0.002) were independent predictors of hs-cTnT. After exclusion of outliers, the median was 15 ng/L and 99th percentile was 64 ng/L. After controlling for comorbidities, the 99th percentile increased from 24 ng/L at age 65 to 53 ng/L at age 90 in females and from 33 ng/L to 75 ng/L in males. In multivariate analysis, hs-cTnT level was significantly related to mortality.

Conclusions: Hs-cTnT level is associated with inflammation and renal function in the elderly. Independently of comorbidities, hs-cTnT concentration increases exponentially with age after 65 years. Decision limits adapted to age and sex may be useful to patient management.
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http://dx.doi.org/10.1515/cclm-2014-0121DOI Listing
April 2015

[Weakening osteopathies, chronic kidney disease, malabsorption, biological anomalies of calium/phosphorus metabolism: appropriate indications for a reasoned reimbursment of serum vitamin D measurement].

Authors:
Jean-Claude Souberbielle Claude Laurent Benhamou Bernard Cortet Mickael Rousière Christian Roux Vered Abitbol Cédric Annweiler Maurice Audran Justine Bacchetta Pierre Bataille Olivier Beauchet Rémi Bardet Alexandra Benachi Francis Berenbaum Hubert Blain Françoise Borson-Chazot Véronique Breuil Karine Briot Philippe Brunet Jean-Claude Carel Philippe Caron Olivier Chabre Philippe Chanson Roland Chapurlat Pierre Cochat Régis Coutant Sophie Christin-Maitre Martine Cohen-Solal Christian Combe Catherine Cormier Marie Courbebaisse Grégory Debrus Brigitte Delemer Georges Deschenes Marc Duquenne Patrice Fardellone Denis Fouque Gérard Friedlander Jean-Bernard Gauvain Lionel Groussin Pascal Guggenbuhl Pascal Houillier Thierry Hannedouche William Jacot Rose-Marie Javier Guillaume Jean Claude Jeandel Dominique Joly Peter Kamenicky Bertrand Knebelmann Marie-Hélène Lafage-Proust Yves LeBouc Erick Legrand Florence Levy-Weil Agnès Linglart Laurent Machet Emmanuel Maheu Eric Mallet Christian Marcelli Pierre Marès Christophe Mariat Gérard Maruani Yves Maugars France Montagnon Bruno Moulin Philippe Orcel Henri Partouche Virginie Personne Charles Pierrot-Deseilligny Michel Polak Claire Pouteil-Noble Dominique Prié Agathe Raynaud-Simon Yves Rolland Jean-Louis Sadoul Bernard Salle Corinne Sault Anne-Marie Schott Isabelle Sermet-Gaudelus Martin Soubrier Ivan Tack Éric Thervet Isabelle Tostivint Philippe Touraine Florence Tremollières Pablo Urena-Torres Jean-Paul Viard Jean-Louis Wemeau Georges Weryha Norbert Winer Jacques Young Thierry Thomas

Ann Biol Clin (Paris) 2014 Jul-Aug;72(4):385-9

Service de rhumatologie, CHU de Saint-Etienne, Saint-Etienne, France.

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http://dx.doi.org/10.1684/abc.2014.0972DOI Listing
October 2015

[Comparative study of two on aged care-based occupational (professional) training in medical home for aged and dependent patients with neuropsychiatric behaviors].

Geriatr Psychol Neuropsychiatr Vieil 2014 Jun;12(2):163-79

Service de gériatrie, CHU de Montpellier, France.

Background: Neuropsychiatric behaviours of the elderly is the main issue for caregivers' distress, burn out and high turn-over. This situation will steadily worsen with longer lifetime.

Aim Of The Study: Specialised training of medical staff may decrease their distress: we compare both training programs Humanitude® et Formadep® outcomes.

Methods: A comparative open multicentric non randomised study included 459 elderlies of 9 EHPAD of Korian Company into 3 training groups: Humanitude®, Formadep® and a group control, with 29 weeks follow-up. We studied the scoring NPI-ES (FG and R), BMS-10, ECPA and GIR, medications, caregivers' burn out/absences/turn-over levels. Statistical significance were done by Wilcoxon signed-rank test, Ancova and linear regression.

Results: 320 caregivers and 3 groups of nearly 150 elderlies each, with around 50% dementia. In Formadep® group : lower scoring for a short time of total NPI-R (p<0.05), sustained lower scoring of NPI-FG « agitation/agressivity» (p=0.035) but transitional for its NPI-R (p<0.05), sustained higher scoring of NPI-FG «apathy/indifference» (p=0.002) but transitional for its NPI-R (p=0 .003), sustained lower scoring of NPI-R (p=0.0039) for Motor Aberrant Behaviours (MAB). In Humanitude® group: transitional higher scoring of NPI-R (p=0.025) for MAB et transitional lower scoring NPI-R (p=0.0032) for depression (Alzheimer Disease sub-groupe). No change for other parameters.

Conclusion: Despite high variability of the neuropsychiatric behaviours in elderly, Formadep® training has shown a positive impact on the global distress and on three main challenging behaviours, compared to Humanitude®: this may be depend on their own philosophy. But caregivers' burden in dementia is not a one-factor problem.
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http://dx.doi.org/10.1684/pnv.2014.0477DOI Listing
June 2014

[The French Society of Geriatrics and Gerontology position paper on the concept of integration. Part two].

Geriatr Psychol Neuropsychiatr Vieil 2014 Jun;12(2):123-30

Service de gériatrie, APHP, Hôpital Sainte Périne, Paris, France.

The concept of integrated services delivery, although dating from the 1990s, has only recently appeared in French public health policy. To clarify the concept and its adaptation to the reality of the French systems of healthcare and social services, the French Society of Geriatrics and Gerontology established an interdisciplinary working group. This article reports that group's findings according to three axes: the definition of integration, the objectives of this organizational approach and the means needed to achieve them. Analysis of the literature indicated that integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, finance, interventions and returns on the latter. Indeed, this sharing is the ultimate proof of evolution towards integration. In the second part of the position paper, its authors have developed arguments that could lead professionals and non-professional caregivers to adopt integrated care as an answer to their aspirations. Policy-maker perspectives and politicians are also analyzed. Bearing in mind that integrated care necessarily will always involve a human component which may find expression during individual case-management; relations between integration and case managements are clarified. Finally, lessons learned from national and international experiments are examined. Results suggest that integrated care must to be accompanied by a local pilot. Results of recent experiments have shown that it is possible to initiate a dynamic towards integrated care in France and hence join the international movement towards adapting our healthcare systems to new challenges.
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http://dx.doi.org/10.1684/pnv.2014.0464DOI Listing
June 2014

The French Society of Geriatrics and Gerontology position paper on the concept of integration.

Int J Integr Care 2014 Jan 27;14:e052. Epub 2014 Mar 27.

Université de Versailles-Saint-Quentin, Laboratoire Santé Environnement Vieillissement, EA 2506.

Introduction: The concept of integration, although dating from the 1990s, has only recently appeared in French public health policy. It must be linked with 'coordination', which is the base of most French public policies applied to geriatrics since the 1960s. Herein, we report the French Society of Geriatrics and Gerontology working group's findings according to three axes: definition of integration, objectives of this organisational approach and the means needed to achieve them.

Discussion: Integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, financing, interventions and action-reports on the latter. Integration must be accompanied by a local dedicated professional (the 'pilot'). Results of recent experiments showed that it is possible to implement integrative dynamics in France.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4027931PMC
http://dx.doi.org/10.5334/ijic.1212DOI Listing
January 2014

[The French Society of Geriatrics and Gerontology position paper on the concept of integration, Part One].

Geriatr Psychol Neuropsychiatr Vieil 2014 Mar;12(1):5-12

Service de gériatrie, APHP, Hôpital Sainte Périne, Paris, France.

The concept of integrated services delivery, although dating from the 1990s, has only recently appeared in the French public health policy. To clarify the concept and its adaptation to the reality of the French systems of healthcare and social services, the French Society of Geriatrics and Gerontology established an interdisciplinary working group. This article reports the group's findings according to three axes: the definition of integration, the objectives of this organizational approach and the means needed to achieve them. Analysis of the literature indicated that integration is a process that aims to overcome the fragmentation of services for vulnerable people. This process requires a multilevel approach, particularly concerning how to modify public policies and financing systems. Notably, all relevant levels need to develop shared processes, tools, resources, finance, interventions and feed-back on the latter. Indeed, this sharing is the ultimate proof of evolution towards integration. In this first part of the position paper, its authors analyzed integrated care definitions used in international literature in view of designing the most important components of integrated care. The examination of this concept must be articulated with the idea of "coordination" which has been the cornerstone of the majority of public policies applied to the field of geriatrics and gerontology since the 1960s in France. The components of integrated care highlight that it is an ambitious process leading to real systemic modification. The authors also have proposed to open up a dialogue between citizens' aspirations and integrated care objectives with the aim to verify that the latter respond to the needs as expressed by the targeted group.
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http://dx.doi.org/10.1684/pnv.2013.0440DOI Listing
March 2014

Systems medicine approaches for the definition of complex phenotypes in chronic diseases and ageing. From concept to implementation and policies.

Curr Pharm Des 2014 ;20(38):5928-44

University of Montpellier 1, France.

Chronic diseases are diseases of long duration and slow progression. Major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, rheumatologic diseases and mental health) represent the predominant health problem of the Century. The prevention and control of NCDs are the priority of the World Health Organization 2008 Action Plan, the United Nations 2010 Resolution and the European Union 2010 Council. The novel trend for the management of NCDs is evolving towards integrative, holistic approaches. NCDs are intertwined with ageing. The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has prioritised NCDs. To tackle them in their totality in order to reduce their burden and societal impact, it is proposed that NCDs should be considered as a single expression of disease with different risk factors and entities. An innovative integrated health system built around systems medicine and strategic partnerships is proposed to combat NCDs. It includes (i) understanding the social, economic, environmental, genetic determinants, as well as the molecular and cellular mechanisms underlying NCDs; (ii) primary care and practice-based interprofessional collaboration; (iii) carefully phenotyped patients; (iv) development of unbiased and accurate biomarkers for comorbidities, severity and follow up of patients; (v) socio-economic science; (vi) development of guidelines; (vii) training; and (viii) policy decisions. The results could be applicable to all countries and adapted to local needs, economy and health systems. This paper reviews the complexity of NCDs intertwined with ageing. It gives an overview of the problem and proposes two practical examples of systems medicine (MeDALL) applied to allergy and to NCD co-morbidities (MACVIA-LR, Reference Site of the European Innovation Partnership on Active and Healthy Ageing).
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http://dx.doi.org/10.2174/1381612820666140314115505DOI Listing
June 2015

Use of vitamin K antagonist therapy in geriatrics: a French national survey from the French Society of Geriatrics and Gerontology (SFGG).

Drugs Aging 2013 Dec;30(12):1019-28

French Society of Geriatrics and Gerontology, Suresnes, France,

Objective: We aimed to evaluate the quality and determinants of vitamin K antagonists (VKA) control among very elderly patients in geriatric settings.

Methods: A national cross-sectional survey was conducted among patients aged ≥80 years who were hospitalized in rehabilitation care or institutionalized in a nursing home and who were treated by VKA. Time in therapeutic range (TTR) was computed according to Rosendaal's method.

Results: A total of 2,633 patients were included. Mean [± standard deviation (SD)] age was 87.2 ± 4.4 years and 72.9 % were women. The main indication for VKA therapy was atrial fibrillation (AF; 71.4 %). Mean (±SD) TTR was 57.9 ± 40.4 %. After backward logistic regression, poorer VKA control (TTR <50 vs. ≥50 %) was associated with being hospitalized in rehabilitation care [odds ratio (OR)(rehab. vs. nursing home) = 1.41; 95 % CI 1.11-1.80], the indication for VKA treatment (OR(prosthetic heart valve vs. AF) = 4.76; 95 % CI 2.83-8.02), a recent VKA prescription (OR(<1 vs. >12 months) = 1.70; 95 % CI 1.08-2.67), the type of VKA (OR(fluindione vs. warfarin) = 1.22; 95 % CI 1.00-1.49), a history of international normalized ratio >4.5 (OR = 1.50; 95 % CI 1.21-1.84), a history of major bleeding (OR = 1.88; 95 % CI 1.00-3.53), antibiotic use (OR = 1.83; 95 % CI 1.24-2.70), and falls (OR(≥2 falls during the past year vs. <2) = 1.26; 95 % CI 1.01-1.56).

Conclusion: Overall, VKA control remains insufficient in very old patients. Poorer VKA control was associated with taking VKA for a prosthetic heart valve, a recent VKA prescription, the use of other VKAs than warfarin, a history of overcoagulation and major bleeding, antibiotic use, and falls.
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http://dx.doi.org/10.1007/s40266-013-0127-3DOI Listing
December 2013

Carotenoid-rich dietary patterns during midlife and subsequent cognitive function.

Br J Nutr 2014 Mar 27;111(5):915-23. Epub 2013 Sep 27.

Université Paris 13, Sorbonne Paris Cité Université, UREN (Nutritional Epidemiology Research Unit), Inserm (U557), Inra (U1125), Cnam, SMBH Paris 13, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France.

Carotenoids may help to prevent the ageing of the brain. Previous findings regarding β-carotene alone are not consistent. In the present study, we evaluated the cross-time association between a carotenoid-rich dietary pattern (CDP) and subsequent cognitive performance using a sample of 2983 middle-aged adults participating in the SU.VI.MAX (Supplémentation en Vitamines et Minéraux Antioxydants) study. Cognitive performance was assessed in 2007-9 using six neuropsychological tests, and a composite cognitive score was computed. The cognitive data were related to dietary data obtained by repeated 24 h dietary records (1994-6) and to measurements of baseline plasma concentrations of carotenoids (lutein, zeaxanthin, β-cryptoxanthin, lycopene, α-carotene, trans-β-carotene and cis-β-carotene). DP were extracted using the reduced rank regression method for 381 participants and then extrapolated to the whole sample using plasma carotenoid concentrations as response variables. Associations between a CDP and cognitive function measured 13 years later were estimated with ANCOVA providing mean difference values and 95 % CI across the tertiles of CDP. A correlation between CDP and consumption of orange- and green-coloured fruits and vegetables, vegetable oils and soup was observed. CDP was found to be associated with a higher composite cognitive score (mean difference 1·04, 95 % CI 0·20, 1·87, P for trend 0·02), after adjustment for sociodemographic, lifestyle and health factors. Similar findings were obtained for scores obtained in the cued recall task, backward digit span task, trail making test and semantic fluency task (all P for trend < 0·05). Further studies ought to confirm whether a diet providing sufficient quantity and variety of coloured fruits and vegetables may contribute to the preservation of cognitive function during ageing.
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http://dx.doi.org/10.1017/S0007114513003188DOI Listing
March 2014