  Five years treatment with strontium ranelate reduces vertebral and nonvertebral fractures and increases the number and quality of remaining life-years in women over 80 years of age.; ; et al in BONE (2010), 46(4), 1038-42 INTRODUCTION: Longevity has resulted in a greater proportion of the population entering a time of life when increasing bone fragility and falls predispose to fractures, particularly nonvertebral fractures ... [more ▼] INTRODUCTION: Longevity has resulted in a greater proportion of the population entering a time of life when increasing bone fragility and falls predispose to fractures, particularly nonvertebral fractures. Women over 80 years of age constitute 10% of the population but contribute 30% of all fractures and 60% of all nonvertebral fractures. Despite this, few studies have examined antifracture efficacy of treatments in this high-risk group and none has provided evidence for benefits beyond 3 years. MATERIALS AND METHODS: To determine whether strontium ranelate reduces the risk of vertebral and nonvertebral fractures during 5 years, we analyzed a subgroup of 1489 female patients over 80 years of age (mean 83.5+/-3.0 years) with osteoporosis from the SOTI (spinal osteoporosis therapeutic intervention) and TROPOS (treatment of peripheral osteoporosis) studies randomized to strontium ranelate 2 g/d or placebo. All received a supplement of calcium plus vitamin D. RESULTS: By intention to treat, vertebral fracture risk was reduced by 31% (relative risk, RR=0.69; 95% confidence interval, CI 0.52-0.92), nonvertebral fracture risk by 27% (RR=0.73; 95% CI 0.57-0.95), major nonvertebral fracture risk by 33% (RR=0.67; 95% CI 0.50-0.89) and hip fracture risk by 24% (RR=0.76; 95% CI 0.50-1.15, not significant). Treatment was cost-saving as it decreased cost and increased QALYs and life-years. DISCUSSION: Strontium ranelate safely produced a significant reduction in vertebral and nonvertebral fracture risk during 5 years in postmenopausal women over 80 years of age and was cost saving. [less ▲] Detailed reference viewed: 11 (1 ULg)Does cognitive impairment influence burden in caregivers of patients with Alzheimer’s disease?Germain, Sophie  ; Adam, Stéphane ; Olivier, Catherine et alin Journal of Alzheimer's Disease [=JAD] (2009), 17(1), 105-114 Alzheimer's disease is characterized by a progressive deterioration of various cognitive and behavioral abilities and it also has a health impact on the patients’ caregiver. Our aim was to determine the ... [more ▼] Alzheimer's disease is characterized by a progressive deterioration of various cognitive and behavioral abilities and it also has a health impact on the patients’ caregiver. Our aim was to determine the patient (and to a lesser extent the caregiver’s) characteristics that contribute most to the caregiver burden. We used the baseline data from the ICTUS study, a European longitudinal cohort of patients with mild to moderate AD. Data from 1091 patients and their caregivers has been used for analysis. Three principal components analyses were performed on variables from the domains of cognition, neuropsychiatric symptoms and daily function using MMSE plus ADAS-Cog, NPI and IADL subscores respectively. These were followed by a stepwise logistic regression to identify patient characteristics which best predict caregiver burden. The regression model (R2 = 0.35, p < .001) shows that the best explanatory variables are (1) neuropsychiatric symptoms (NPI), (2) difficulties in the IADL, (3) time taken by caregiving, (4) demographic variables such as caregiver’s age and patient sex and (5) severity of cognitive impairment. In conclusion, our results demonstrate that although the strongest determinant of the caregiver burden is behavioral disturbance, the impact of the degree of cognitive impairment on burden is also significant. [less ▲] Detailed reference viewed: 110 (28 ULg)Methodological issues in primary prevention trials for neurodegenerative dementia.; ; et al in Journal of Alzheimer's Disease [=JAD] (2009), 16(2), 235-70 The prevention of neurodegenerative dementias, such as Alzheimer's disease, is a public health priority. Due to the large numbers of affected patients, even interventions bringing about a relatively small ... [more ▼] The prevention of neurodegenerative dementias, such as Alzheimer's disease, is a public health priority. Due to the large numbers of affected patients, even interventions bringing about a relatively small delay in disease onset could have large public health effects. Randomized controlled trials (RCTs) are required to demonstrate the effectiveness of preventive interventions, but such trials raise specific methodological questions because they are new in the field of neurodegenerative diseases, and require large numbers of elderly subjects and lengthy follow-up periods. We performed a literature search to identify primary prevention RCTs for neurodegenerative dementia. The methodology of the trials was summarized and discussed during two expert meetings. Overall, 39 trials were identified that assessed dementia incidence or cognitive decline as a primary or secondary study outcome. Age was the most common selection criteria for target populations. Follow-up periods ranged from one month to nine years and were longest in studies measuring dementia incidence as an outcome. Results of RCTs have so far been generally negative and conflicting with those of observational studies, perhaps due to methodological issues. Future trials must therefore carefully consider the target population, outcomes and duration of follow-up to be used, and should assess the problem of attrition. [less ▲] Detailed reference viewed: 53 (2 ULg)Consistency of Neuropsychiatric Syndromes across Dementias: Results from the European Alzheimer Disease Consortium; ; et al in Dementia & Geriatric Cognitive Disorders (2008), 25(1), 1-8 Background/Aims: The aim of this study was to determine the consistency of neuropsychiatric subsyndromes of the Neuropsychiatric Inventory across several clinical and demographic subgroups ( e. g ... [more ▼] Background/Aims: The aim of this study was to determine the consistency of neuropsychiatric subsyndromes of the Neuropsychiatric Inventory across several clinical and demographic subgroups ( e. g. dementia subtypes, dementia severity, medication use, age and gender) in a large sample of outpatients with dementia. Methods: Cross-sectional data of 2,808 patients with dementia from 12 centres from the European Alzheimer's Disease Consortium were collected. Principal component analysis was used for factor analysis. Subanalyses were performed for dementia subtypes, dementia severity, medication use, age and gender. Results: The results showed the relatively consistent presence of the 4 neuropsychiatric subsyndromes `hyperactivity', `psychosis', `affective symptoms' and `apathy' across the subanalyses. The factor structure was not dependent on dementia subtypes, age and gender but was dependent on dementia severity and cholinesterase use. The factors hyperactivity and affective symptoms were present in all subanalyses, but the presence of the factors apathy and psychosis was dependent on use of cholinesterase inhibitors and dementia severity, respectively. Conclusion: The present study provided evidence of the relative consistency of neuropsychiatric subsyndromes across dementia subtypes, age and gender, thereby stressing the importance of thinking about neuropsychiatric subsyndromes instead of separate symptoms. However, the subsyndromes apathy and psychosis were dependent on use of cholinesterase inhibitors and dementia severity. Copyright (c) 2007 S. Karger AG, Basel. [less ▲] Detailed reference viewed: 36 (5 ULg)L’accompagnement au quotidien d’une personne atteinte de maladie d’Alzheimer : étude de la qualité de vie et du sentiment de fardeau chez l’accompagnantGermain, Sophie ; ; et alPoster (2007, June 21) Detailed reference viewed: 6 (2 ULg)Neuropsychiatric syndromes in dementia - Results from the European Alzheimer Disease Consortium: Part I; ; et al in Dementia & Geriatric Cognitive Disorders (2007), 24(6), 457-463 Background/Aims: The aim of this study was to identify neuropsychiatric subsyndromes of the Neuropsychiatric Inventory in a large sample of outpatients with Alzheimer's disease (AD). Methods: Cross ... [more ▼] Background/Aims: The aim of this study was to identify neuropsychiatric subsyndromes of the Neuropsychiatric Inventory in a large sample of outpatients with Alzheimer's disease (AD). Methods: Cross-sectional data of 2,354 patients with AD from 12 centres from the European Alzheimer's Disease Consortium were collected. Principal component analysis was used for factor analysis. Results: The results showed the presence of 4 neuropsychiatric subsyndromes: hyperactivity, psychosis, affective symptoms and apathy. The subsyndrome apathy was the most common, occurring in almost 65% of the patients. Conclusion: This large study has provided additional robust evidence for the existence of neuropsychiatric subsyndromes in AD. Copyright (c) 2007 S. Karger AG, Basel. [less ▲] Detailed reference viewed: 59 (11 ULg) |
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