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Authors: Godefroy, Olivier | Bakchine, Serge | Verny, Marc | Delabrousse-Mayoux, Jean-Philippe | Roussel, Martine | Pere, Jean-Jacques | REFLEX study group:

Collaborators: Larrieu, JL | Kubler, C | Filippi, M | Gaida, P | Abdulnayef, A | Nachar, H | Benoit, C | Galletti, P | Stehlin, P | Malkoun, I | Chanel Soulier, MP | Augustin, J | Rigal, B | Boge, T | Balasoiu, R | Lubeau, M | Haddad, V | Fromager, G | Kerouanton, A | Cufi, MN | Dussaux, P | Doury, E | Zai, L | Saad, S | Delamarre Damier, F | Michel, J | Dami, M | Mousnier Lompre, A | Le Fevre, G | Rahioui Sidki, L | Benhabib Benelhadj, H | Liagre, A | Kinugawa Bourron, K | Berrani, D | Gire Couret, P | Anguenot, A | Trefouret, S | Gaida Rostane, T | Jammes, JF | Desclaux, F | Abied, R | Chatot-Henry, C | Senechal, O | Pujol, JF | Huvent Grelle, D | David, JP | Chekroud, H | Gallice, I | Rochefort, N | Denis, B | Paquot Chaudron, C | Angibaud, G | Maillet Vioud, M | Cervantes, C | Ollier, J | David, R | Mechkour, A | Ghiba, B | Castelnovo, G | Le Bras, F | Delfiner, B | Defontaines, B | Volpe Gillot, L | Bailbe, M | Richard Harston, S | Durantay, F | Diraison, P | Vaillant, S | Gugenheim, M | Hinault, P | Hadjout, K | Bautrant, T | Hemet Francois, C | Schmidt, N | Beaudout Agbo, C | Seiller, N | Edouard, T | Sophoclis, C | Badr, A | Saudreau Furgier, C | Del Mazo, F | Pin, JC | Moreau Perrein, F | Deyrolle, AM | Baudin, V | Crauser, C | Gallopin, V | Pariente, J | Gallouj, K | Awad, R | Renard, P | Schott Geisert, C | Hascar, T | Burlaud Laumond, A | Guichardon, M

Article Type: Research Article

Abstract: Background: Executive dysfunctions in Alzheimer’s disease (AD) have been assessed using variable batteries and/or in selected populations. Objective: The primary objective of this observational study was to determine the prevalence and severity of executive dysfunction in AD patients using a previously validated battery. The secondary objective was to determine the characteristics including treatment outcomes of AD patients with severe executive dysfunction. Methods: The study included AD patients with mild-to-moderate dementia aged 60 or over, consulting in various clinical settings including memory clinics and requiring the introduction of an antidementia drug. Executive dysfunction was examined using a validated, shortened executive battery. …Results: 381 patients were included. Executive dysfunctions were observed in 88.2% of the patients (95% CI: 84.9–91.4) and were severe (defined as ≥2/3 impaired scores) in 80.4% (95% CI: 76.9–84.8). Global hypoactivity with apathy was more frequent (p  = 0.0001) than impairment in executive function tests. The 308 patients with severe executive dysfunction were older (p  = 0.003) and had more severe dementia (p  = 0.0001). Similarly, in the subset of 257 patients with mild dementia, individuals with severe executive dysfunction were older (p  = 0.003) and had more severe dementia. Global hypoactivity was independently associated with difficulties in IADL and a higher caregiver burden (p  = 0.0001 for both). The severity of executive dysfunction did not significantly influence the patients’ outcomes at 6 months. Conclusions: Executive dysfunction is a very common disorder in a representative population of patients with mild-to-moderate AD. It was independently correlated with impaired autonomy and increased caregiver burden but did not significantly influence treatment outcomes. Show more

Keywords: Alzheimer’s disease, apathy, cognitive disorders, control function, executive function, treatment

DOI: 10.3233/JAD-150971

Citation: Journal of Alzheimer's Disease, vol. 51, no. 3, pp. 815-825, 2016

Authors: Godefroy, Olivier | Martinaud, Olivier | Verny, Marc | Mosca, Chrystèle | Lenoir, Hermine | Bretault, Eric | Roussel, Martine | GREFEX Study Group

Article Type: Research Article

Abstract: Background: Dysexecutive disorders are common in early-stage Alzheimer’s disease (AD) but have yet to be characterized in detail. Objective: The objectives of the present study based on validated diagnostic criteria were to determine the frequency and characterize the profile of behavioral and cognitive dysexecutive disorders in AD. Methods: 102 patients with AD (mild: n = 92; moderate: n = 10; mean MMSE score: 23.2) were examined with the GREFEX battery. Neuropsychological data were interpreted within a validated framework based on the performance levels of 780 control participants from the GREFEX study. Results: Dysexecutive syndrome was observed in 87.5% (95%CI: 79–96) …of the AD patients (p = 0.0001). The dysexecutive disorder profile was characterized by prominent impairments of planning, inhibition flexibility and generation in the cognitive domain (p = 0.0001 as compared to controls for all) and global hypoactivity in the behavioral domain (p = 0.0001 as compared to controls). Conclusions: Dysexecutive syndrome is observed in over 80% of AD patients and has a distinct profile. Show more

Keywords: Alzheimer disease, attention, dementia, executive function, mild cognitive impairment

DOI: 10.3233/JAD-140585

Citation: Journal of Alzheimer's Disease, vol. 42, no. 4, pp. 1203-1208, 2014

Authors: Zerah, Lorene | Cohen-Bittan, Judith | Raux, Mathieu | Meziere, Anthony | Tourette, Cendrine | Neri, Christian | Verny, Marc | Riou, Bruno | Khiami, Frederic | Boddaert, Jacques

Article Type: Research Article

Abstract: Background: Dementia is associated with a worse prognosis of hip fracture, but the impact of a dedicated geriatric care pathway on the prognosis of these patients has not been evaluated. Objective: According to the cognitive status before surgery, our main objective was to compare mortality rate at 6 months; secondary outcomes were to compare in-hospital complications, the risk of new institutionalization, and the ability to walk at 6 months. Methods: Between 2009 and 2015, all patients (>70 years) admitted after hip fracture surgery into a dedicated unit of peri-operative geriatric care were included: patients with dementia (DP), without dementia (NDP), …and with cognitive status not determined (CSND). Data are expressed as hazard ratio (HR) for multivariate cox analysis or odds ratio (OR) for multivariate logistic regression analysis and their 95% confidence interval (CI). Results: We included 650 patients (86±6 years): 168 DP, 400 NDP, and 82 CSND. After adjustment for age, sex, comorbidities, polypharmacy, pre-fracture autonomy, time-to-surgery, and delirium, there were no significant differences for 6-month mortality (DP versus NDP: HR = 0.7[0.4–1.2], DP versus CSND: HR = 0.6[0.3–1.4], CSND versus NDP: HR = 0.8[0.4–1.7]); but DP and CSND were more likely to be newly institutionalized after 6 months compared to NDP (OR DP = 2.6[1.4–4.9], p  = 0.003, OR CSND = 2.9[1.4–6.1], p  = 0.004). 92% of population was walking after 6 months (63% with assistance): no difference was found between the three groups. Conclusion: In a dedicated geriatric care pathway, DP and CSND undergoing hip surgery have the same 6-month mortality and walking ability as NDP. Show more

Keywords: Dementia, elderly, hip fracture, unit of peri-operative geriatric care

DOI: 10.3233/JAD-160655

Citation: Journal of Alzheimer's Disease, vol. 56, no. 1, pp. 145-156, 2017