Maternal-fetal transfer of fluoride in pregnant women

Gas chromatography was used to measure the maternal and fetal plasma inorganic fluoride values at term in 91 women. They were assigned to one of four groups: group A were untreated controls; group B received a single daily dose of 1.5 mg of fluoride (as calcium fluoride) during the final trimester of pregnancy; group C was given a single dose of 1.5 mg of fluoride (as sodium fluoride) and group D was given 2 daily doses of fluoride (as sodium fluoride) totaling 1.5 mg. There was a significant difference between the cord plasma fluoride levels of the newborns in the untreated group (mean: 27.8 micrograms/l) and that of the combined supplemented groups B, C and D (mean: 58.3 micrograms/l). There was no difference between the average fluoride levels in the three supplemented groups. There was no significant effect of maternal age, infant birth weight, gestation or diet during pregnancy on the cord plasma fluoride level. These results indicate that fluoride supplementation during the final trimester of pregnancy will significantly elevate cord plasma fluoride concentrations.     

Role of behavioural disturbance in the loss of autonomy for activities of daily living in Alzheimer patients

BACKGROUND: Cognitive impairment is associated with functional impairment in patients with Alzheimer's disease (AD). Behavioural disturbance is very common in these patients. Nevertheless, there has been very little research into the relations between behavioural disturbance and functional status in AD. The purpose of this study is to investigate the relationship between behavioural disturbance and functional status after taking account of cognitive impairment. MATERIAL AND METHODS: 579 patients were prospectively evaluated at 16 French hospitals, all referents for AD, and were diagnosed with possible or probable AD. These patients were assessed with NeuroPsychiatric Inventory (NPI), cognitive subscales of the Alzheimer's Disease Assessment Scale (ADAS-cog), Clinical Dementia Rating scale (CDR) and Instrumental Activities of Daily Living scale (IADL). RESULTS: The number of men with available data for IADL total score was too small to make any analysis. 'Group A' gathered 256 women for whom the relation between autonomy for Activities of Daily Living (ADL) and the other variables were determined. 'Group B', pooled 85 women for whom relations found were verified. Linear regression was used for the analysis. With age, cognitive impairment allows us to explain best (38%) the loss of autonomy for ADL. CONCLUSION: The role of behavioural disturbances in the loss of autonomy for ADL was not determinant in our study, whereas cognitive impairment and age were better able to determine the loss of autonomy for ADL. Further study is needed to explain the decline of functional status in AD patients.     

The cognitive efficiency profile: Description and validation in patients with Alzheimer's disease

The rigorous diagnosis of dementia, especially in the early stages, requires clinical observation and neuropsychological tests. This article shows how a short strategy-oriented neuropsychological battery, the Cognitive Efficiency Profile (CEP), can contribute to the early diagnosis of Alheimer's disease. The CEP was given to 56 subjects who had been independently diagnosed as being cognitively unimpaired (N = 16), as having probable AD with mild dementia (N = 32) or as having “borderline” deterioration (N = 8). One-year follow-up showed that all the latter patients developed unequivocal dementia. There was a clear-cut separation in the test results between the controls and the probable AD cases when the scores were corrected for age and education. There was some overlap between the borderline cases and the probable AD patients but, in all cases, the corrected scores fell below those of normal controls. The usefulness of the CEP rests on the fact that it assesses the efficiency or the failure of strategies applied to a number of abilities related to cognitive efficiency. Coupled with clinical data, a good or a poor performance on the CEP strongly corroborates the diagnosis of normal cognitive functioning or of dementia in the elderly.     

Cognitive stimulation of patients with dementia: Preliminary results

We present the first results of a cognitive stimulation programme for patients with dementia. Fifty-six subjects entered a study involving two parallel, randomized groups. Assessment was blind for the main criteria (neuropsychological tests). Twenty-nine patients were stimulated and were compared to 27 non-stimulated patients. The stimulated group attended 10 stimulation sessions over 5 weeks. Each group was assessed on the first and seventh week. Following stimulation, there was significant improvement of Mini-Mental State (MMS) scores (p < 0.01) and increased performance for the Word List Memory Test (one-tailed p = 0.09) in the Consortium to establish a Registry for Alzheimer's Disease (CERAD) battery. Verbal fluency remained unchanged. Stimulation tended to improve items of an additional battery (one-tailed p < 0.01). The composite sum of test scores showed a significant difference in favour of the stimulated group. These results were positively correlated with the initial MMS scores and negatively with education. The Activities of Daily Living (ADL) scale did not show a significant change. We concluded that global stimulation of cognitive functions improves certain parameters among demented outpatients.     

Determination of regimen fluindione needed for anticoagulation in the elderly

INTRODUCTION: There is no validated method to predict the daily maintenance dosage of oral anticoagulation treatment by fluindione in the elderly patients. The aim of our prospective study was to look for a relation between INR at day 2 after a fixed dosage of fluindione and the daily maintenance dosage of fluindione necessary to obtain an INR value between 2 and 3. PATIENTS AND METHODS: Ten milligrams of fluindione were administered on first and second day of treatment. INR was determined the third day. RESULTS: From this value, we were able to determine the daily dosage of fluindione (+/- 5mg) that maintained a steady state INR value between 2 and 3. CONCLUSION: In these very elderly patients, there was a relation between INR at the third day after a fixed dosage of fluindione and the daily maintenance dosage of fluindione necessary to obtain an INR value between 2 and 3.     

Predictive factors of rate of loss of autonomy in Alzheimer's disease patients. A prospective study of the REAL.FR Cohort

Alzheimer's disease is characterised by a progressive loss of autonomy in activities of daily living. Many patients lose this autonomy rapidly with dramatic consequences for the patients and their relatives, and for health and social services. The aim of this study was to determine, in a large French cohort of community-living Alzheimer patients (REAL.FR), the factors underpinning different rates of loss of autonomy. Six hundred and eighty seven patients were recruited to this French cohort. Autonomy in activities of daily living was estimated with the IADL scale (Lawton). Patients were divided into three groups according to loss of autonomy during the first one-year follow-up period. Patients with a decrease in the IADL score had worse ADAS-cog score (Alzheimer's Disease Assessment Scale, cognitive subscale), Mini-Mental State Examination (MMSE), and Clinical Dementia Rating Scale scores. Up to a point, a marked decrease in the IADL score was less frequent among patients with a better ADAS-cog score (p < 0.10, bilateral test). At one-year evaluation, patients with a marked decline in autonomy were characterised by a greater decrease in Mini-Mental State score, faster progression of behavioural disturbance, and more hospitalisations. Further prospective studies, using established models, are needed to isolate the factors associated with a high rate of loss of autonomy in activities of daily living in Alzheimer patients.