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Laurence Lacoste Ph. D, Paris, France

4th Int’l Conference on NEUROLOGY & THERAPEUTICS Rome, Italy , July 27-29, 2015 INTEREST AND LIMITS IN EVALUATION OF COGNITIVE DISORDERS FOR THE ELDERLY. Laurence Lacoste Ph. D, Paris, France. Introduction : Why ?.

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Laurence Lacoste Ph. D, Paris, France

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  1. 4th Int’lConference on NEUROLOGY & THERAPEUTICS Rome, Italy, July 27-29, 2015 INTEREST AND LIMITS IN EVALUATION OF COGNITIVE DISORDERS FOR THE ELDERLY Laurence Lacoste Ph. D, Paris, France

  2. Introduction: Why ? • Population’s Ageing is a Public Health issue and dementia for the Elderly a reality • Examination of cognitive disorders for the Elderly are done to help them to have the better ageing possible in spite of Alzheimer disease and related disorders, Parkinson disease, psychiatric and/or addictive disorders, and also to reassure people with no cognitive troubles to prevent pathological ageing. • But the way to do it is what is the most important, taking care of each subject in his own history.

  3. Who is requesting it ? It can be : • Either a subject who comes by himself • Or a family which is in difficulties with an old relative • Or a general practitioner or a hospital MD • Or a care provider in institution for the elderly

  4. How is it done ? • With first interview using MMSE or MOCA tests with a Doctor qualified in Gerontology and Neuropsychology who works with a Neuropsychologistto have an idea of the complaint. • And history of the patient (Medical and Psychological with questions of the person’s biography)

  5. Which data are required ? • Patients and care givers ’ self-questionnaires if someone of the familyispresent • Imaging (MRI scan, functional MRI) • Cerebrospinalfluid markers • Neuropsychologyassessment : memory, language, executivesfunctions, troubles of behaviour… • Depression state using DSM V or ICD 10’s criteria

  6. Specificity of consultations in institutions • Firstly, it’snecessary to provide a preliminary training of nurses The question is : whyis the assessmentrequired ? • Thenweprocess to clinical interviews of the elderlypersons and to an assessmentusing simple standardized tests • Liaison with the main care provider*

  7. Evaluations for Research in Epidemiology • First, weneed the opinion of practitioners to eliminatecontraindications • Then, wewrite a letter to inform the elderlypersontaking part in the research and his informant explainingwhy the studyiscarried out. • Finally, a cognitive assessmentisdonethatcanbelinked to factors of risk and protection.

  8. Decisionaltreewith MMSE • If MMSE > 17 : completebattery of tests • If MMSE isbetween 10 and 17 : simple standardized tests • If MMSE < 10 : no more tests (case of severeDementia)

  9. Management goals for patients with cognitive complaint* For all patients with cognitive complaint, we have 3 mains goals : 1/ Mainteningfunction and independence 2/ Preventingfurther cognitive decline 3/ Ensuringquality of life

  10. Subjective cognitive impairment For this patients, the goals are : • Reassurance • Optimizing management of comorbidities • Promoting a healthylifestyle However, theyshouldbemonitoredcarefully for anysigns of progression predictive of future MCI.

  11. Mild Cognitive Impairment (MCI) (1) An important goal to achieveisaccepting the uncertaintysurroundingthisdiagnosisgiven the possibility of either progression, or stability, or evenimprovement. Other goals to consider as well are :

  12. Mild Cognitive Impairment (MCI) (2) • Optimizing management of comorbidities and especiallytreatvascularriskfactors • Minimizingmedicationsaffecting cognitive functions • Promotingphysical and mental health • Building a partenershipwith patient and caregiver to establish a safety net and advance care planning.

  13. Dementia • Caregiver support becomesincreasingly important as disease progresses and dependanceincreases • Vigilance and early intervention for neuropsychiatricsymptoms, sleepdisturbance and incontinence… • Meeting patient’s goals for end-of-life care.

  14. *NonpharmacologicStrategies • To date, no nonpharmacologic interventions have been shown to preventfurtherdecline in patients witheither subjective cognitive impairment or MCI. • On the other hand, numerousnonpharmacologic interventions targeting patients withdementia, theircaregiver or the patient-caregiverdyad have been investigated.

  15. Physicalexercises Possible mechanisms by whichexercisemayimprove or maintain cognitive functioninclude : • Improving central adiposity and insulinresistance • Decreasing oxydative stress • Improvingvascularfunction • Increasingcerebralblood flow

  16. Cognitive stimulation • Cognitive stimulation uses enjoyableactivities to engage memory and concentration in a social setting. • Two of the largerstudiesusingthisapproachreportedimprovements in cognitive functions and quality of life, but not in functionalstatus, mood, or behavioralsymptoms.

  17. Cognitive training • To date « brain training » programs have not providedstrongevidence of benefit on cognition, function or mood in patients withmild to moderatedementia. • Patients and caregiversshouldbecautionedagainstexpensive programs that promise to prevent or reverse dementia.

  18. Cognitive reframing for carers • It’s a component of Cognitive BehavioralTherapy (CBT) • It focuses on caregiver’smaladaptative, self defeating or distressing cognition about their relative behavior • It focusesalso on theirown performance in the caringrole

  19. Conclusion • Neuropsychologicalevaluationisveryuseful to help doingdiagnosis as precisely as possible in Alzheimer disease and relateddisorders • But to date, there are too few studies to show how to treat patients with MCI diagnosis and subjective cognitive impairment. So, preventing Alzheimer disease and relateddisordersisalmost impossible.

  20. Acknowledgements • F. Petitjean, Psychiatrist, PsychiatricHospital Center of Ainay-Le-Château, France. • C. Trivalle Geriatrician Paul Brousse Hospital, South Paris

  21. THANK YOU VERY MUCH FOR YOUR ATTENTION…

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