Optimization of the inclusion of Alzheimer's disease patients in international multicenter randomized trials: results of a national survey conducted in memory research centers in france

INTRODUCTION

Since 2002, with the creation of Centers of Memory Resources and Research (CMRR), considerable progress has been made in France regarding the administrative and institutional framework within which Alzheimer's disease (AD) is managed. In this study, we explore three approaches that can help optimize the inclusion of patients in clinical trials related to AD. They are as follows: to assess communication concerning clinical trials on AD in French CMRR, to analyze the internal organization of these centers concerning the dynamics of inclusion, and to evaluate screening tools used.

METHODS

A national, descriptive, cross-sectional survey was conducted in all CMRR in France between May 1 and July 31, 2011, using a self-administered questionnaire. All investigators, subinvestigators and the relevant CMRR personnel were involved.

RESULTS

A total of 75% of the CMRR participated, and about 30% of the physicians contacted responded positively to the survey. Only 50% reported having communicated with health care professionals at least once in the previous 3 months, and less than 50% had communicated occasionally with the general public. A total of 75% of those surveyed had a research group but only half of the groups were active, 50% of the physicians did not have a consultation time dedicated to study recruitment, and 75% of the respondents had a screening tool in their CMRR but over half of them were not satisfied with it.

CONCLUSION

This investigation provides a basis for improving the screening of patients by both internal organizational development and adaptation of tools already available. Improvement requires promoting regular communication that is appropriate and targeted to health care professionals, smaller memory centers, associations and the public, and therefore, familiarizing the whole population with clinical research on AD.

[Epidemiology of dementia in elderly living in the 3rd borough of Bangui (Central African Republic)]

Given the gradual improvement of living conditions and aging, dementia and related syndromes are becoming serious problems in the developing countries. A cross-sectional door to door type study in neighbourhood, was conducted from October 2008 to January 2009, in the general population in Bangui, order to help get a better understanding of the prevalence and risk factors of dementia among people over 65 living in the Central African capital. Of the 496 elderly respondents, 188 had cognitive disorders. After a neuropsychological examination, 40 of these subjects were diagnosed with dementia. The prevalence of dementia was 8.1% (IC 95% = [5.7-10.5]). The average age of subjects with dementia, ranging from 65 to 90 years, was 76.0 ± 7.1 years. There was a significant risk of developing dementia for an increase of ten years old (OR = 2.6, 95% CI [1.5 to 4.5]). The sex-ratio was 6/34. 82.5% of the demented had never attended school. 70.0% showed a state of malnutrition (BMI ≤ 18,5 kg/m(2)), significantly associated with dementia (OR = 3.3; IC 95% = [1.5-7.3]). The blood pressure was high in 67.5% of demented which is significantly associated with dementia (OR = 2.4; IC 95% = [1.1-5.4]). A recent change in financial status was a factor significantly associated with dementia (OR = 6.4; IC 95% = [1.8-22.5]). These results support the existence of dementia in urban Africa. The observed prevalence is close to those found in high-income countries. Further studies should be conducted which includes both the rural and urban Africa, to better understand the problem and solutions consider to comprehensive care and prevention axes adapted to our context.

[Two cases of cryptococcal meningitis revealed by an ischemic stroke]

The usual clinical expression of neuromeningeal cryptococcosis is a meningoencephalitis. We report two cases of neurocryptococcosis which have been revealed by an unusual clinical aspect: an ischemic stroke with a vasculitis mechanism. The two patients had a positive reaction for the HIV and we discussed the responsibility of the HIV or the Cryptococcus in the occurrence of the cerebral infarct.

Le test des 5 mots : validité dans la détection de la maladie d’Alzheimer dans la population générale

INTRODUCTION

In general medicine lack of time impairs screening for Alzheimer's disease (AD). The five word test (FWT) enables rapid assessment of verbal episodic memory in accordance with Grober and Buschke neuropsychological concept. The main steps of the FWT are: induce specific semantic processing, control of encoding to avoid attention deficits, free and cued recall. Cued recall helps to distinguish a recall impairment from storage impairment which is evocative of AD.

OBJECTIVE

Evaluate FWT total score (sum of free and cued recalls), FWT total weighed score which give a higher coefficient for free recalls than cued recalls and present the ability of these two scores for AD screening.

METHOD

Evaluation performed with 4116 subjects (of whom 73 MA) aged from 65 years and more, randomly selected in two French towns for the "Three Cities" Study, a population-based cohort.

RESULTS

The total score was more specific than sensitive with a maximal sensitivity (Se) at 63 percent with specificity (Sp) at 91.1 percent. The total weighed score significantly increased Se (83.6 percent) with control of specificity (84.9 percent) and positive predictive value (9.1 percent).

CONCLUSION

The FWT allows quick screening of patients for whom further neuropsychological evaluation is needed to diagnose AD. The ability of is simple test to screen for AD is improved by a simple weighting procedure: the total weighted score.

Diagnostic et traitement de la tuberculose vertébrale étendue

Tuberculous spondylodiscitis called Pott's disease is the most common presentation of vertebral tuberculosis. Atypical presentation is rare and its diagnosis also difficult. We report a retrospective analysis of 7 immunocompetent patients treated for extensive vertebral tuberculosis. Five men and two women, between 5 and 39 Years. The median age was 24 Years. Clinical features were incomplete tetraplegia (4 cases), complete paraplegia (1 case) incomplete paraplegia (1 cases), and lumbocruralgia (1 case). Spinal X-ray revealed spondylodiscitis. Both CT Scan and MRI are very useful to determine the extent of the lesions. Bacteriological and histological diagnosis can be deficient. For this reason, we insist on a the contribution of antituberculous treatment to diagnosis. But the appearance of drug-resistance can limit the role of antituberculous chemotherapy in achieving diagnosis.

[Venous vascularization of the heart in the African. Tributary veins of the coronary sinus]

This anatomic study realized on 40 African adults hearts, studies the veins related to the coronary sinus. By using injection of the coronary arteries and corrosion of the myocardium, this study discovers certain particularities of the small coronary vein and of the posterior descending interventricular vein in Africans.

[Sinus node vascularization in the black African]

The aim of this study is to identify in 43 adults African hearts the different arteries of the sinus node. The method used is the injection corrosion technic of the coronary vessels. This study conclude that the right coronary system is the principal way of irrigation of sinus node in Africans (46.6% of cases).

[Coronary veins and coronary sinus tributary veins in Africans]

This anatomical study carried out on 40 African adults hearts studied branches of the coronary sinus. By using of injection of the coronary arteries and corrosion of the myocardium, the study identified certain peculiarities of the small coronary vein and the posterior descending interventricular vein in Africans.

[Vascularization of the sinus node in the Black African]

The aim of this study is to identify in 43 adults african hearts the different arteries of the sinus node. The method used is the injection corrosion technique of the coronary vessels. The study concludes that the right coronary system is the principal way of irrigation of sinus node in Africans (46.6% of cases).