Publications by authors named "Pierre Pfitzenmeyer"

37 Publications

Factors associated with caregivers' underestimation of quality of life in patients with Alzheimer's disease.

Dement Geriatr Cogn Disord 2012 22;33(1):11-7. Epub 2012 Feb 22.

University of Reims Champagne-Ardenne, Reims, France.

Objective: The aim of this study was to identify the factors associated with differences between how Alzheimer's disease (AD) patients and their caregivers rate the patient's health-related quality of life (QoL).

Methods: Cross-sectional, multicentre study. Patients were 65 years or more, suffering from mild to moderate AD, native French speakers, with a main caregiver. Interrater agreement of the QoL-AD was assessed using the intraclass coefficient. A generalised linear model was used to identify factors related to the difference in health-related QoL scores between patients and their caregivers.

Results: The 122 patients of the study were 82 ± 6 years old and mainly women (69%). Independent factors related to the difference between patients and caregivers were: Mini Mental State Exam score (β = 0.32; 95% CI = 0.05-0.59); instrumental activities of daily living score (β = -0.61; 95% CI = -1.14 to -0.07); total Neuropsychiatric Inventory score (β = 0.10; 95% CI = 0.05-0.59), and Zarit's burden score (β = 0.09; 95% CI = 0.01-0.17).

Conclusion: Practitioners must take into account the trend towards underestimation when health-related QoL is rated by caregivers or proxies.
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http://dx.doi.org/10.1159/000333070DOI Listing
July 2012

Assessment of the use of hypolipidemic agents (HAs), mainly statins, in elderly subjects aged 80 years and more in Burgundy: analysis of 13,211 patients.

Arch Gerontol Geriatr 2012 Jul-Aug;55(1):101-5. Epub 2011 Aug 25.

Service de Médecine Interne Gériatrie, Hôpital de Champmaillot, CHU, 2 rue Jules Violle, F-21079 Dijon Cedex, France.

Only few studies have investigated the use of HA in elderly subjects and there are no data in very elderly subjects. We assessed the prescription of HA and analyzed the relationship between such prescriptions and frailty markers among persons aged 80 and more in an observational study. We recorded the prescriptions for 13,211 patients aged 80-109 years and affiliated to the "Mutualité-Sociale-Agricole (MSA)" of Burgundy over a 1-month period. The prescription of a HA among all included patients, and the existence of serious long-term disease(s) (LTD), polypharmacy or a prescription of cardiovascular drugs among patients receiving a HA were recorder. Among the 13,211 patients, 3412 aged 80-98 years were treated with an HA. The main HA were statins (70.4%), and fibrates were used in 27.3% of cases. Of these 3412 patients, 2250 had one or several LTD mainly coronaropathy, hypertension, diabetes mellitus or peripheral artery disease. The mean number of drugs per prescription was 6.37. Among subjects treated with HA, 40% also received antiplatelets, 35.6% β-blockers and 30% inhibitors of the renin-angiotensin system. For 99% of the patients, the prescription of HA was a renewal. Prescribers were mainly general practitioners (96.8%). Statins are the most widely prescribed HA even among very elderly subjects. However, after 80 years the prescription of HA, mainly statins, decreases with aging. This could be explained by polypathology, polypharmacy and the deterioration in metabolic functions which are markers of frailty. This study should encourage research into the use of statins in very elderly subjects.
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http://dx.doi.org/10.1016/j.archger.2011.06.025DOI Listing
September 2012

[Geriatric investigation in front of a balance disorders in the older elderly].

Rev Prat 2011 Jun;61(6):823-4

Service de médecine interne gériatrie, CHU de Dijon, hôpital de Champmaillot, 21079 Dijon Cedex.

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June 2011

Feasibility and safety of weekly sequential epirubicin-paclitaxel as adjuvant treatment for operable breast cancer patients older than 70 years.

Clin Breast Cancer 2011 Aug 7;11(4):235-40. Epub 2011 Jul 7.

Department of Medical Oncology, Georges François Leclerc Center, Centrede Recherche INSERM 866, Faculté de Médecine, 7 Boulevard Jeanne d’Arc, Dijon, France.

Background: There are currently no internationally agreed recommendations for the management of adjuvant chemotherapy in women aged >70 years with high-risk breast cancer. The purpose of this study was to assess the feasibility and the tolerance of adjuvant weekly sequential epirubicin-paclitaxel combination in this setting.

Patients And Methods: From 2005 to 2009, 59 women over 70 years of age with operable breast cancer and who required adjuvant chemotherapy were proposed weekly sequential epirubicin-paclitaxel chemotherapy schedule, and were prospectively registered. Compliance and treatment tolerance were studied. We also report preliminary results of disease-free survival (DFS) and overall survival (OS).

Results: Weekly sequential epirubicin-paclitaxel was well tolerated. No grade 4 adverse event occurred. No secondary malignancy was observed. Compliance with chemotherapy was good: 95% of patients received the six planned cycles. After a median follow-up of 24 months, median DFS and OS were not reached, there were only three relapses, and two cancer-related deaths were reported.

Conclusion: This study conducted in patients over 70 years of age demonstrates the feasibility of weekly adjuvant chemotherapy including anthracyclines and taxanes in a sequential schedule. This regimen is safe in terms of hematologic, nonhematologic, and cardiac toxicities, and showed encouraging efficacy, justifying further studies in geriatric patients.
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http://dx.doi.org/10.1016/j.clbc.2011.06.002DOI Listing
August 2011

A case of meningitis due to Achromobacter xylosoxidans denitrificans 60 years after a cranial trauma.

Med Sci Monit 2011 Jun;17(6):CS63-5

Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France.

Background: Achromobacter xylosoxidans (AX) is a non-fermentative aerobic gram-negative bacillus. It is an opportunistic pathogen and the causative agent of various infections. We report an original case of late posttraumatic meningitis due to AX denitrificans.

Case Report: An 83-year-old man was hospitalized for acute headache, nausea and vomiting. The emergency brain computer tomography (CT) scan did not reveal any anomaly. In his medical history, there was an auditory injury due to a cranial trauma incurred in a skiing accident 60 years earlier. Cytobiochemical analysis of the cerebrospinal fluid (CSF) revealed increased levels of neutrophils and proteins. The CSF bacterial culture was positive: the Gram stain showed a gram-negative bacillus, oxidase + and catalase +, and the biochemical pattern using the API 20 NE strip revealed AX dentrificans. Late posttraumatic meningitis on a possible osteomeningeal breach was diagnosed even though the breach was not confirmed because the patient declined a second brain CT scan. The patient was successfully treated with meropenem.

Conclusions: This report demonstrates the importance of searching for unusual or atypical organisms when the clinician encounters meningitis in a particular context, as well as the importance of adequate follow-up of craniofacial traumas.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539539PMC
http://dx.doi.org/10.12659/msm.881796DOI Listing
June 2011

"Card sorting": a tool for research in ethics on treatment decision-making at the end of life in Alzheimer patients with a life threatening complication.

BMC Palliat Care 2011 Mar 3;10. Epub 2011 Mar 3.

Clinical Investigation Centre, Inserm CIT 808, Besançon University Hospital, 2, Place St Jacques, 25030 Besançon, France.

Background: End stage dementia is a particularly difficult aspect of care for patients with Alzheimer's disease and related dementias. In care institutions, caregivers and family are concerned by treatment decision-making for an acute life threatening complication occurring in Alzheimer patients at the end of life. How should the best treatment pathway be decided: to treat or not to treat? Which arguments are used for decision-making? These are mainly ethical questions which are currently difficult to express and investigate.

Methods/design: Cross sectional multicentre study of clinical cases involving 67 health centres (university hospitals, general hospitals, local hospitals and homes for the elderly) in the east of France. The method was based on the "card sorting" technique, with a set of 36 cards, each labelled with a different item relating to arguments for treatment decision-making. For each clinical case, medical staff and carers expressed in a meeting the pieces of information which they believed had been taken into account in the decision. Each participant received a card game, selected fewer than ten and ranked them according to the importance they attached to each one. All selected cards were then put on the table anonymously for participants, respecting the order of importance of the cards in each pile. Lastly, all games were photographed together in order to analyse occurrence and order frequencies. The cards were then classified on the table by frequency to open the discussion. Discussion time, which was conducted by the head carer of the department, concerned the clinical situation of the patient based on the shared responses.

Discussion: During team meetings, the "card sorting" method was quickly adopted by professionals as a tool to assist with discussion beyond the context of the study. The participants were not compelled to mention their feelings in relation to a case, and it is significant that the anonymity which we tried to maintain so that each person felt "listened to" without value judgement was very often discarded by the individuals themselves.
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http://dx.doi.org/10.1186/1472-684X-10-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056822PMC
March 2011

Churg-Strauss syndrome: retrospective study in Burgundian population in France in past 10 years.

Rheumatol Int 2011 May 29;31(5):587-93. Epub 2009 Dec 29.

Department of Internal Medicine and Systemic Diseases, General Hospital, University Hospital, Dijon Cedex, France.

Churg-Strauss Syndrome (SCS) is a systemic vasculitis associated with asthma and eosinophilia. The aim of our work is to describe this pathology in the Burgundian population in France. We counted from the hospitalisation data-processing summaries, the whole of the SCS hospitalised in Burgundy between 1998 and 2008. During the follow-up, the clinical and paraclinical characteristics of every patient were collected. The average prevalence is of 11.3 per million inhabitants and the incidence is of 1.2 new cases per million inhabitants per annum. There exists however, a great prevalence disparity and incidence amongst the various departments of the area. The patient's average follow-up is of 7.7 years. In 23% of the cases one finds a starting factor for vasculitis. The delay between the first signs and the diagnostic is an average of 61 months. The ANCA are positive in 26% of cases and of anti-myeloperoxidase specificity in 83% of cases (P < 0.001). The most profitable biopsies are essentially cutaneous and neuromuscular. At the diagnostic, two-third of the patients have had a treatment adapted according to the current recommendations based on the Five Factor Score. The remission rate within a 1-year period is of 77%. The remission is strongly correlated to the therapeutic protocol associating corticoids and cyclophosphamide (P < 0.05). In conclusion, the prevalence of SCS in our area is similar to that observed in other European regions. However, this vasculitis remains a difficult and often a tardive diagnostic pathology.
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http://dx.doi.org/10.1007/s00296-009-1275-yDOI Listing
May 2011

Aging affects the mental simulation/planning of the "rising from the floor" sequence.

Arch Gerontol Geriatr 2010 Nov-Dec;51(3):e41-5. Epub 2009 Dec 9.

INSERM U887 Motricité-Plasticité, Université de Bourgogne, Campus Universitaire Montmuzard, BP 27 877, 21078 Dijon Cedex, France.

We investigated the effect of aging on the ability to mentally simulate/plan a complex sequential action of the whole body, namely "rising from the floor". Forty-four non-demented elderly people (mean age: 85.2±5.5 years) and 20 young people (mean age: 26.6±4.9 years) were included in the study. They were required to put in order six images representing the main movements necessary to get up from a sitting position on the floor. We showed that older subjects had poorer performance-both in terms of proportion of success and response time-than their younger counterparts. These results are in line with previous findings showing age-related alterations in action simulation/action planning processes, and highlight the fact that elderly people have particular difficulties when the action to mentally simulate is complex.
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http://dx.doi.org/10.1016/j.archger.2009.11.010DOI Listing
March 2011

Stroke in the very old: incidence, risk factors, clinical features, outcomes and access to resources--a 22-year population-based study.

Cerebrovasc Dis 2010 Jan 1;29(2):111-21. Epub 2009 Dec 1.

Stroke Registry of Dijon (INSERM et Institut de Veille Sanitaire), EA4184, University Hospital and Faculty of Medicine and Department of Neurology, Dijon, France. ybejot @ yahoo.fr

Background: For several years, the burden of stroke in very old patients has been increasing in western countries. Nevertheless, we have little information about this new challenge in individuals >or=80.

Methods: We ascertained all first-ever strokes in the population of Dijon, France (150,000 inhabitants), from 1985 to 2006. The incidence of stroke, risk factors, clinical presentation, resource mobilization and 1-month outcome were evaluated in individuals >or=80 and compared to the data obtained in younger patients.

Results: We collected 1,410 first-ever strokes in people >or=80 years (39%) versus 2,130 in those <80 years. The incidence was 997/100,000, and 68/100,000, respectively. Over the 22 years, the incidence of stroke in individuals >or=80 years rose significantly. A lower prevalence of diabetes, hypercholesterolemia and alcohol intake, as well as a higher prevalence of hypertension, atrial fibrillation, previous myocardial infarction and use of prestroke antiplatelet agents were noted in patients >or=80 years. The clinical presentation was severer and the 1-month outcome in terms of case fatality and handicap was worse, despite improvements observed over time. Finally, in patients >or=80 years, the use of CT scan, MRI, cervical Doppler, angiography and carotid surgery were significantly lower than for younger patients. Length of stay >30 days was more frequent, and discharge to prestroke residence was less common. However, all these improved between the first and the last study periods.

Conclusions: Our findings have important implications not only for clinical management but also for initiating preventive strategies and health policy.
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http://dx.doi.org/10.1159/000262306DOI Listing
January 2010

Prognostic factors in stage D heart failure in the very elderly.

Gerontology 2009 10;55(6):719-26. Epub 2009 Sep 10.

Service de Médecine Interne Gériatrique, Centre Gérontologique de Champmaillot, Dijon, France.

Background: The clinical characteristics of frail older patients with advanced heart failure have scarcely been studied.

Objective: To describe this population and to identify some prognostic factors of mortality.

Methods: 104 patients aged 75 years and older hospitalized with refractory heart failure were enrolled in a prospective multicentric study.

Results: Mean age was 87.2 +/- 5.3 years. Dyspnea (79.8%), crepitant rales (76.9%) and peripheral edema (73.1%) were particularly frequent. Signs of low cardiac output such as renal insufficiency (46.9%), cutaneous low flow (40.4%), and systolic hypotension (< or =100 mm Hg) (24.3%) were observed less often. Signs of cognitive impairment including anxiety (55.4%), sleep disorders (43.7%) and delirium (35.5%) were frequent. Asthenia and chronic pain were noted in 92.3 and 37.5% of cases, respectively. Mortality rates were 32.7, 59.6 and 71.2% during hospitalization, at 6 months and at 12 months, respectively. According to the multivariate Cox model, six significant factors suggesting a poor prognosis were observed: chronic renal insufficiency, past neuropsychological pathology, long-term treatment with nitrates, presence of edema, low cutaneous flow, and pain. The ability to sit on a chair was the only significant factor associated with a good prognosis.

Conclusion: Our study identified some clinical and prognostic factors which had been observed in very old patients with refractory heart failure. Pain management has to be a priority in these patients in order to improve their quality of life.
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http://dx.doi.org/10.1159/000237872DOI Listing
January 2010

Analysis of postural control in elderly subjects suffering from Psychomotor Disadaptation Syndrome (PDS).

Arch Gerontol Geriatr 2010 Jul-Aug;51(1):e19-23. Epub 2009 Aug 8.

INSERM/U887 Motricité-Plasticité: Performance, Dysfonctionnement, Vieillissement et Technologies d'optimisation, Université de Bourgogne, Faculté des Sciences du Sport, Dijon Cedex, France.

PDS is a geriatric affliction, described in 1999, characterized by postural impairments, including backward disequilibrium, freezing, a deterioration in the ability to anticipate postural adjustments, anxiety and fear of falling, inducing loss of autonomy. This study compared 10 subjects suffering from PDS, aged 87.3+/-4.9 years, with 10 control subjects, aged 85.4+/-7.9 years concerning postural control (body sway amplitude). In all participants, postural control was assessed using the SwayStar system in natural (spontaneous) and standardized stances, eyes open and eyes closed over a period of 40 s. It was found that: (1) with eyes open, subjects with PDS showed greater body sway amplitude than did controls whatever the position (natural or standardized) and the plane (sagittal or frontal) considered (F(1,16)=6.05; p=0.026), (2) with eyes closed, subjects with PDS showed greater body sway amplitude than did controls in the natural stance whatever the plane (F(1,18)=7.65; p=0.013). In conclusion, PDS has a negative effect on postural control. This data must be taken into account during the rehabilitation of patients with this syndrome.
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http://dx.doi.org/10.1016/j.archger.2009.07.003DOI Listing
September 2010

Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management. Retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis.

BMC Infect Dis 2008 Jan 30;8:12. Epub 2008 Jan 30.

Infectious and Tropical Diseases department, and Groupe de Recherche sur les Antimicrobiens (GRAM-EA2656), Rouen University Hospital, Rouen, F-76031, France.

Background: There is currently a lack of consensus for the diagnosis, investigations and treatments of acute bacterial prostatitis (AP).

Methods: The symptoms, investigations and treatments of 371 inpatients diagnosed with AP were analyzed through a retrospective study conducted in four departments - Urology (U), Infectious Diseases (ID), Internal Medicine (IM), Geriatrics (G) - of two French university hospitals.

Results: The cause of admission, symptoms, investigations and treatments depended markedly on the department of admission but not on the hospital. In U, patients commonly presented with a bladder outlet obstruction, they had a large imaging and functional check-up, and received alpha-blockers and anti-inflammatory drugs. In ID, patients were febrile and received longer and more appropriate antibiotic treatments. In G, patients presented with cognitive disorders and commonly had post-void urine volume measurements. In IM, patients presented with a wide range of symptoms, and had very diverse investigations and antibiotic regimen.Overall, a 3:1 ratio of community-acquired AP (CA-AP) to nosocomial AP (N-AP) was observed. Urine culture isolated mainly E. coli (58% of AP, 68% of CA-AP), with venereal agents constituting less than 1%. The probabilistic antibiotic treatments were similar for N-AP and CA-AP (58% bi-therapy; 63% fluoroquinolone-based regimen). For N-AP, these treatments were more likely to be inadequate (42% vs. 8%, p < 0.001) and had a higher rate of bacteriological failure (48% vs. 19%, p < 0.001). Clinical failure at follow-up was more common than bacteriological failure (75% versus 24%, p < 0.001). Patients older than 49 had more underlying urinary tract disorders and a higher rate of clinical failure (30% versus 10%, p < 0.0001).

Conclusion: This study highlights the difficulties encountered on a daily basis by the physicians regarding the diagnosis and management of acute prostatitis.
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http://dx.doi.org/10.1186/1471-2334-8-12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2254416PMC
January 2008

Assessment of cardiac autonomic nervous activity in frail elderly people with postural abnormalities and in control subjects.

Arch Gerontol Geriatr 2009 Jan-Feb;48(1):121-4. Epub 2008 Jan 4.

Service de Médecine Interne-Gériatrie, Centre Gériatrique de Champmaillot, 2 rue Jules Violle, BP 87 909 CHRU, 21079 Dijon Cedex, France.

Heart rate variability (HRV), which is considered to reflect the activity of the autonomic nervous system (ANS), has been shown to decline with age. The aim of the present study was to explore cardiac ANS in older patients showing frontal-subcortical dysfunction with "Psychomotor Disadaptation Syndrome" (PDS), through the 24-h HRV. We enrolled 14 patients with PDS (mean age: 84.5+/-6.9 years), they were compared to 13 frail control subjects (mean age: 80.6+/-6.7 years). Cardiac ANS activity was assessed by 24-h ECG recordings from three leads with a Holter digital monitor. The decrease in cardiac ANS activity observed in PDS subjects was greater than the alteration found in normally aging subjects. The abnormalities of ANS that aggravate the effects of aging can be seen as a type of physical deconditioning. Such patients could benefit from particular attention in physical training.
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http://dx.doi.org/10.1016/j.archger.2007.11.004DOI Listing
April 2009

Backward disequilibrium in elderly subjects.

Clin Interv Aging 2008 ;3(4):667-72

Department of Internal Medicine and Geriatrics, University Hospital, Dijon, France.

Backward disequilibrium is observed frequently in daily clinical practice. However, there are no epidemiological data concerning this postural disorder. Defined by a posterior position of the centre of mass with respect to the base of support, backward disequilibrium is abnormal postural behavior, usually characterized by a posterior trunk tilt in standing and sitting positions, which predisposes subjects to backward falls. Many afflictions whether they are somatic (degenerative, ischemic and traumatic brain lesions), psychosomatic (psychomotor disadaptation syndrome, confinement to bed, nonuse situations) or psychological (depression) can cause backward disequilibrium. A vicious circle of falls, and loss of autonomy can arise and this is the main consequence of backward disequilibrium. Thus, in this paper, we review backward disequilibrium in elderly subjects with regard to the causes, consequences, assessment, and management.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2682399PMC
http://dx.doi.org/10.2147/cia.s3811DOI Listing
April 2009

Clinical determinants of failure in balance tests in elderly subjects.

Arch Gerontol Geriatr 2008 Sep-Oct;47(2):217-28. Epub 2007 Sep 25.

Département de Médecine Interne, Centre de Gériatrie et Médecine Interne, Hôpital de Brabois CHU de Nancy, Rue de Morvan, 54511 Vandoeuvre-lès-Nancy, France.

We assessed the role of clinical and biological parameters on performance in four balance tests in elderly subjects. An observational study was conducted in the Center for Preventive Medicine of Nancy (France) in 2368 community-living elderly subjects aged 60 and older. Body mass index (BMI), Mini-Mental State Examination (MMSE), clock test, "Health score" and use of psychotropic drugs (UPD) were assessed. Participants performed four balance tests: "one-leg-stand" (OLS), "timed-up-and-go" (TUG), "rise-from-the-floor" (RFF) and "sit-to-stand" (STS). The statistical analysis showed that women were almost twice as likely to fail balance tests as men. In both women and men, the following determinant factors of the performance in balance tests were found: for OLS: age, BMI and health score; for TUG: age, BMI, clock test and health score; for RFF: BMI and health score. In addition, in women other determinant factors were: MMSE for OLS, UPD for TUG, age and clock test for RFF. In men, the clock test and the UPD were also significant determinant factors for OLS. Similar results were found for STS. In conclusion, female sex, overweight, low cognitive status, low self-perception of health and UPD were associated with a higher risk of failure in balance tests.
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http://dx.doi.org/10.1016/j.archger.2007.07.011DOI Listing
October 2008

Is backward disequilibrium in the elderly caused by an abnormal perception of verticality? A pilot study.

Clin Neurophysiol 2007 Apr 20;118(4):786-93. Epub 2007 Feb 20.

INSERM/ERIT-M 0207 Motricité-Plasticité, Université de Bourgogne, Dijon, France.

Objective: We hypothesised that backward disequilibrium (BD), defined by a posterior position of the centre of mass with respect to the base of support, could be caused by a backward tilt in the perception of verticality.

Methods: The relationship between BD, the perception of verticality, and the history of falls in 25 subjects aged 84.5+/-7.4 years was analysed. An original ordinal scale, the BD scale (BDS), was used to quantify BD. Postural (PV) and haptic verticals (HV) were measured in sagittal plane.

Results: BDS scores closely correlated with the number of falls (r = 0.81, p =10(-5)). The more the PV was tilted backward, the greater the BDS scores (r = -0.95, p<10(-6)), with a huge backward tilt of about 15 degrees in 4 subjects with severe BD. In these subjects, the tilt in perception of verticality was transmodal since a severe backward HV tilt was also found.

Conclusions: This transmodality suggested high-order cognitive disruption in the construction of the subjective vertical used in postural control by subjects showing BD, which confirmed our hypothesis.

Significance: This study clearly shows that perception and action with respect to gravity are closely related and brings a new insight about fall mechanisms in the elderly.
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http://dx.doi.org/10.1016/j.clinph.2006.11.274DOI Listing
April 2007

A new formula for correction of total calcium level into ionized serum calcium values in very elderly hospitalized patients.

Arch Gerontol Geriatr 2007 Sep-Oct;45(2):151-7. Epub 2006 Dec 4.

Service de Médecine Gériatrique, Centre Hospitalier Régional, Université de Dijon, Centre de Champmaillot, 2, rue Jules Violle, BP 87 909, 21078 Dijon Cédex, France.

Ionized calcium (Ca(2+)) seems to be the best measure of active serum calcium but, in France, numerous laboratories do not have Ca(2+) analyzers so that numerous clinicians use Payne's formula to obtain adjusted calcium (Ca(Ad)) values. In frail very elderly patients with protein/energetic malnutrition and very low concentrations of albumin, "correction" with Payne's formula usually gives false hypercalcemic results, so that hypocalcemia may be seriously underdiagnosed. Two hundred and ninety-four patients of 80 years and older with serum albumin level < 35 g/l were included in four French hospitals for elderly people. Biological measurements were standardized in order to determine Ca(2+) and total calcium (Ca(T)) in accordance with approved guidelines. Ca(Ad) was calculated with Payne's formula whereas the dependence of Ca(2+) with serum protein, albumin and Ca(Ad) was investigated by linear regression, the goodness-of-fit of each equation with the measure of Ca(2+) being studied. Taking into account serum protein and albumin levels, multiple linear regression gave the equation: Ca(2+) (mmol/l)=0.188-0.00469 protein (g/l)+0.0110 albumin (g/l)+0.401 Ca(Ad) with r(2)=0.442. The relative difference between the measure and the value given by the equation did not depend upon the center, and the correlation between measured and computed values of Ca(2+) was better, for any group, with our formula than with Payne's formula. When Ca(2+) was expressed with Ca(T) instead of Ca(Ad), albumin term was no longer significant and the new equation was: Ca(2+) (mmol/l)=0.592-0.00449 protein (g/l)+0.410 total calcium (mmol/l) with r(2)=0.438. We propose an alternative to direct measurement of Ca(2+) with a simple formula usable in geriatric units, which are often deprived of high-performance equipment.
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http://dx.doi.org/10.1016/j.archger.2006.10.006DOI Listing
October 2007

Multidisciplinary management in geriatric day-hospital is beneficial for elderly fallers: a prospective study of 28 cases.

Arch Gerontol Geriatr 2007 Jan-Feb;44(1):61-70. Epub 2006 May 11.

Service de Médecine Interne Gériatrique Hôpital de Champmaillot CHU, BP 87 909, 2, rue Jules Violle, F-21 079 Dijon Cedex, France.

We determined whether management including medical, psychological, and physiotherapeutic approaches, over a period of 6 weeks, has a beneficial effect on motor abilities, psychological status, and independence of elderly fallers with psychomotor disadaptation syndrome (PDS). We included 28 subjects (mean age 81.4 years). They were assessed from a medical, motor, and psychological point of view at both the inclusion and the end of the multidisciplinary intervention. A follow-up was conducted with multidisciplinary assessment at 6 and 9 months after the beginning of the study in order to evaluate duration of benefits of the management. The statistical analysis concerned only subjects who took part in the total multidisciplinary program, i.e., 14 subjects. The multidisciplinary intervention had an overall positive impact on motor abilities as shown by the increase in the mini-motor test scores, the rate of success in rising from the floor and decrease of time for the dual task. This study also showed a reduction in the fear of falling and a decrease in the rate of fallers. This positive effect on motor abilities, fear of falling and rate of fallers was sustained until 9 months after the beginning of the multidisciplinary management. This study shows the importance of a multidisciplinary management of elderly fallers with PDS.
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http://dx.doi.org/10.1016/j.archger.2006.02.004DOI Listing
February 2007

Factors affecting the management of outcome in elderly patients with acute myocardial infarction particularly with regard to reperfusion. Data from the French regional RICO survey.

Gerontology 2005 Nov-Dec;51(6):409-15

Service de Gériatrie, CHU Bocage, Dijon, France.

Background: Acute myocardial infarction (AMI) in elderly patients is often unrecognized and associated with poor prognosis.

Objectives: To investigate management and efficacy of reperfusion therapy to the elderly patients with AMI.

Methods: From the January 1, 2001 to October 31, 2002, 964 patients with AMI were included in the French regional RICO survey. The patients were divided into three groups: younger (<70 years old), elderly (70-79 years old) and very elderly (>or=80 years old).

Results: Distribution of groups was 56, 27, and 16%, respectively. The longest time delay to first request for medical attention was found in the very elderly group (30 and 55 vs. 90 min, respectively, p < 0.05). Rate of lysis fell significantly with increasing age (35, 22 and 9%, respectively, p < 0.001) but the time delay to lysis was similar for the 3 groups. The proportion of patients who benefited from primary percutaneaous transluminal coronary angioplasty decreased with age (21, 15, 11%, respectively, p < 0.001), but time delay to balloon angioplasty was similar and no difference in mortality rate was observed between the three groups after reperfusion. The incidence of in-hospital cardiovascular events (cardiogenic shock and recurrent myocardial infarction/ischemia) and in-hospital mortality increased with age (5, 13, 17%, respectively, p < 0.001). Moreover, multivariate analysis showed that only ejection fraction and Killip >1 were independent predictive factors for in-hospital cardiovascular mortality, respectively (OR 5.15, 95% CI 2.08-12.74, p < 0.0001 and OR 3.81, 95% CI 1.90-7.65, p < 0.0001), whereas age, sex, diabetes and anterior location were not significant.

Conclusion: Our data in an unselected population indicate that very elderly patients were characterized by increased pre-hospital delays and less frequent utilization of reperfusion therapy, although no difference in the mortality in reperfused patients could be observed between the three age groups.
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http://dx.doi.org/10.1159/000088706DOI Listing
February 2006

Impact of cognitive task on the posture of elderly subjects with Alzheimer's disease compared to healthy elderly subjects.

Mov Disord 2006 Feb;21(2):236-41

Service de Médecine Interne Gériatrique Hôpital de Champmaillot Centre Hospitalier Universitaire, Université de Bourgogne Faculté des Sciences du Sport, Dijon, France.

The aims of this study were to analyze the effects of cognitive task on static posture in Alzheimer's disease (AD) and in healthy elderly (HE) subjects and to evaluate whether those effects were greater in AD subjects than in HE subjects. We performed a posturographic analysis on 13 subjects with mild AD (mean age, 79.7+/-5.1 years, Mini-Mental State Examination scores between 18 and 23) and on 17 HE subjects (mean age, 78.5+/-4.4 years). After watching a video sequence, the subjects were asked to maintain a stable upright posture while standing on a force platform. Then, the postural sway was measured during the following two conditions: (1) quiet standing and (2) both standing and answering questions about the video sequence. We were interested in the center of pressure (CoP) area and path. For each group, the single task was compared to the dual task for the CoP area and path. We also compared the variability of both CoP area (variation of the CoP area between the single and the dual task) and path (variation of the CoP path between the single and the dual task) between the two groups. We showed that there was no significant difference between the single and the dual task in HE subjects concerning the CoP area and path, in contrast to the AD group, and that variability of both the CoP area and path were significantly greater in the AD subjects than in the HE subjects. This finding may contribute to the risk of falls in AD patients.
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http://dx.doi.org/10.1002/mds.20649DOI Listing
February 2006

[Specificity of stroke in the elderly: clinical characteristics and impact on care].

Psychol Neuropsychiatr Vieil 2005 Sep;3(3):147-55

Service de neurologie, Hôpital général, CHU Dijon.

Stroke in the elderly differs from stroke in younger adults in several points. It represents the most frequent consequence of atherothrombotic disease associated with hypertension, diabetes and hypercholesterolemia. It is also the main complication of cardiac arrhythmia. From a clinical point of view, epileptic seizure is frequently observed at the onset, and prognosis is darkened by a high risk of dementia occurrence (20%). Management of stroke in acute phase requires intensive care, which has been shown to decrease mortality and handicap by 20% in Stroke Units. Fibrinolysis with rt-PA can be carried out till 80 years. Primary and secondary prevention are still very efficacious in old patients and decrease not only the risk of stroke, but also the risk of dementia. Moreover, influenzae vaccination has been shown to decrease the risk of stroke in the following year in subjects over 65 years.
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September 2005

Energy cost and cardiorespiratory adaptation in the "Get-Up-and-Go" test in frail elderly women with postural abnormalities and in controls.

J Gerontol A Biol Sci Med Sci 2005 Jan;60(1):98-103

Centre Européen des Sciences du Goût, UMR CNRS 5170, Dijon Cedex, France.

Background: This study investigated the hypothesis that postural abnormalities might increase energy expenditure during a clinical functional test in frail elderly persons.

Methods: Two groups of hospitalized women (aged 73 to 100 years) were recruited. Women who showed postural and gait abnormalities as described in the psychomotor disadaptation syndrome (PDS) were compared with control participants. The authors measured energy expenditure during the timed "up and go" test. For each participant, oxygen uptake, carbon dioxide output, expiratory minute ventilation, breathing frequency, heart rate, and alveolar ventilation were recorded 10 minutes before, during, and 10 minutes after exercise. The arterial pressure of carbon dioxide was estimated from expired gases.

Results: The mean oxygen uptake values were significantly higher in women with PDS than in the control group during exercise and recovery periods (4.89 +/- 1.68 vs 3.75 +/- 1.25 ml . kg(-1) . min(-1) and 4.69 +/- 1.45 vs 3.76 +/- 0.97 ml . kg(-1) . min(-1), respectively [p <.05]). Expiratory minute ventilation was always higher in women with PDS than in controls regardless of the period of the test (p <.05), and alveolar ventilation was higher in women with PDS only during the exercise period (p <.05). The estimated arterial pressure of carbon dioxide did not change significantly between the different phases of the test but was always lower (p <.05) in women with PDS compared with the control group.

Conclusions: The significant increase in oxygen uptake during the exercise and recovery periods in women with PDS compared with controls suggests that postural abnormalities that characterize PDS may be associated with an increase in energy expenditure. In clinical practice, the low capacity to tolerate even moderate exercise must be considered when specific rehabilitation programs are offered to women with PDS.
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http://dx.doi.org/10.1093/gerona/60.1.98DOI Listing
January 2005

Mini motor test: a clinical test for rehabilitation of patients showing psychomotor disadaptation syndrome (PDS).

Arch Gerontol Geriatr 2005 Mar-Apr;40(2):201-11

Service de Médecine Gériatrique, Centre Hospitalier Régional, Université de Dijon, Centre de Champmaillot, 2 rue Jules Violle BP 87909, 21079 Dijon Cédex, France.

Direct observation of postural and motor abilities appears as very important in assessment of patients showing psychomotor disadaptation syndrome (PDS). We examine feasibility and reliability of mini motor test (MMT) which has been developed in order to establish rehabilitation goals in this population. MMT is a 20-item score which assesses abilities in bed, quality of sitting position, abilities in the standing position, and quality of gait. MMT has been conducted by two different independent investigators, a physiotherapist and a physician, in four different geriatric centers. One hundred and one subjects (mean age: 84.9 +/- 6.0 years) were included in the study. The agreement between the two investigators was highly satisfying for both MMT total score and each item of MMT. Redundancy between items appeared very limited. The difference between investigators for MMT total score did not vary significantly with score of the mini-mental-state examination (MMSE). The correlation between MMT and the Katz index was found significantly negative. MMT is an easy direct-observation test which may be particularly useful in patients who present with severe postural and gait impairment. This test can be used in clinical practice by different professional actors in order to allow an interdisciplinary approach for a common rehabilitation goal in the PDS patients.
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http://dx.doi.org/10.1016/j.archger.2004.08.004DOI Listing
July 2005

A 4-year follow-up of very old patients presenting with frontal-subcortical dysfunction compared with Alzheimer's disease patients.

Gerontology 2005 Jan-Feb;51(1):62-5

Service de Médecine Gériatrique, Centre de Champmaillot, Dijon, France.

Background: Frontal-subcortical clinical syndrome (FSCS) is frequently described in elderly patients and consists of specific alterations in cognition and motor functions. This clinical picture may be associated with a high level of dependence and a high mortality risk.

Objective: We report the risks of institutionalization and death during a follow-up of 4 years in patients showing FSCS.

Methods: The study was initiated in 1998 to compare FSCS patients showing postural and gait abnormalities with Alzheimer's disease (AD) patients. Follow-up was conducted by means of telephone interviews with the patient's general practitioner over a 4-year period (1998-2002).

Results: Both institutionalization and mortality rates were significantly higher (p < 0.05) in the FSCS group compared to the AD group.

Conclusions: The high risk of disability and death in FSCS patients suggests that they might require specific care programs that include stimulation in daily living activities in order to reduce the risk of institutionalization and to improve quality of life.
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http://dx.doi.org/10.1159/000081437DOI Listing
May 2005

Falls and depression in older people.

Gerontology 2004 Sep-Oct;50(5):303-8

Service de Gériatrie, Hôpital de Champmaillot, Centre Hospitalier Universitaire, Dijon, France.

Background: Depression is one of the most common risk factors for falls, but links between falls and depression are still unclear. Few studies have examined the relationship between depression and gait alteration, which may increase the risk of fall.

Objective: This study aims to assess a possible relationship between depression, postural and gait abnormalities, and falls.

Methods: We conducted a 1-year prospective study on patients >/=70 years who were admitted to a geriatric unit for 'spontaneous' unexplained falls. Patients were tested for depression using the 30-item Geriatric Depression Scale (GDS). Their motor performances were assessed using the Mini Motor Test (MMT), which is an easy direct-observation test, validated in France, for assessment of frail old people who present with severe postural and gait impairment. This scale is composed of 4 categories of items: (1) abilities in bed; (2) quality of the sitting position; (3) abilities in the standing position, and (4) quality of gait.

Results: Sixty-nine patients were included. Depression was found in 46 patients (66.7%). The MMT score was higher in the non-depressed fallers (NDF) group (GDS 10; p < 0.05). The 2 groups were compared for each of the 4 items of the MMT: the difference between the DF and NDF groups was mainly explained by the impairment of postural abilities in the standing position.

Conclusions: Our results support the idea that depression is associated with postural abnormalities in the standing position, which may predispose to falls. In clinical practice, more attention should be given to old fallers concerning diagnosis and treatment of associated depression.
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http://dx.doi.org/10.1159/000079128DOI Listing
April 2005