[Supportive care, cognition and quality of life in brain metastases]

Brain metastases impact on the survival of the patients, but on their quality of life as well. The objective of the management of these patients is then double. Currently, due to medical advances, survivals tend to improve, especially for some tumor subtypes. During the course of the disease, different neurological signs and symptoms can be observed according to the location, the number and the volume of the metastase(s). Patients and caregivers are especially worried about the loss of autonomy and cognitive impairments. A permanent dialogue, during the course of the disease, is mandatory, in order to adapt the management to the objectives determined by the patients and the medical team. These objectives may vary according to the objective response rates of the disease to anticancer therapies, according to the impact of the disease and its management in daily living. Anticancer therapies and supportive care must be appreciated according to their impact on the survival, on the preservation of the functional independence and the quality of life of the patient, on their abilities to preserve the neurological status and delay the apparition of new neurological signs and symptoms, and their adverse events. Supportive care, cognition and quality of life should be regularly evaluated and adapted according to the objectives of the management of brain metastases patients. Different approaches are described in this paper.

[Treatment of arterial hypertension in the elderly with an alpha-blocker: nicergoline (author's transl)]

The tolerance and anti-hypertensive activity of nicergoline, an alpha-adrenoceptor blocking agent, were studied in 28 hypertensive subjects older than 65 years (mean age: 84 years). The trial was conducted double-blind: 14 subjects were given nicergoline 30 mg/day divided into 6 doses ("lyocs"), and 14 subjects received a placebo identical in appearance with the drug. A mean decrease of 34 mm Hg in systolic arterial pressure (p < 0.001) and of 16 mm Hg in diastolic arterial pressure (p < 0.001) was observed in subjects under nicergoline. The corresponding changes in blood pressure (-12 and -7.9 mm Hg respectively) in subjects under placebo were not significant. No side-effect requiring discontinuation of treatment was encountered. The remarkable effectiveness and tolerance of nicergoline make it a highly suitable agent for the treatment of hypertension in elderly people.