In Alzheimer patients with a solid musical background, isolated case-reports have reported the maintenance of remarkable musical abilities despite clear difficulties in their verbal memory and linguistic functions. These reports have encouraged a number of scientists to undertake more systematic studies which would allow a rigorous approach to the analysis of musical memory in Alzheimer patients with no formal musical background. Although restricted in number, the latest data are controversial regarding preserved musical capacities in Alzheimer patients. Our current review of the literature addresses this topic and advances the hypothesis that the processes of musical memory are function of illness progression. In the earlier stages, the majority of evaluations concerned musical episodic memory and suggested a dysfunction of this memory whereas in the moderate and severe stages, musical semantic memory and implicit learning are the majority of investigations and seemed more resistant to Alzheimer disease. In summary, our current review bring to understand the memory circuits involved and highlight the necessity to adapted the investigational tools employed to conform with the severity of the signs and symptoms of progressive Alzheimer disease in order to demonstrate the preserved musical capacities.

Primary progressive aphasia is a neurodegenerative condition characterised by a progressive and isolated disorder of expressive language, associated with atrophy of the left posterior frontoinsular region (nonfluent/agrammatic variant) or with atrophy of the left temporoparietal junction area (logopenic variant). This literature review reports studies about language therapies for these two variants of primary progressive aphasia. More precisely, the review presents the behavioral interventions and the augmentative/alternative communication tools reported in the literature to improve language performances or to compensate for language difficulties. Most of these studies reported that interventions are efficient. However, inconsistent results are found regarding maintenance of improvement and generalization to untreated language abilities. Other studies are still required to establish the clinical relevance of interventions for language and communication disorders in primary progressive aphasia. In these studies, the use of more ecological interventions focusing on the specific needs of people living with this disease should be specifically addressed.

Memory is most often negatively associated with aging. This perception partially arises from the research literature as well as from subjective complaints by older adults, which have mainly focused on performance levels. More recently, however, there is a growing number of researchers and clinicians interested in the role of reminiscing in older adults. The goal of this synthesis is to introduce the reader to the different functions of reminiscence and their adaptive values in aging. Three narrative methods based on personal memories are presented (life review, reminiscence therapy guided autobiography) in the context of current theories of memory and developmental psychology. A brief review of empirical data regarding the efficiency of narrative methods in the well being of healthy older adults and individuals with dementia is presented.

The concept of quality of life appears to be easy to understand but, actually, is very complex when it comes to define it. Several notions are synonymous and often used indiscriminately such as happiness, life satisfaction and well-being. However, quality of life is dependant on several factors that, according to their presence or their absence, can change its perceptions and evaluation. Besides the difficulties of definition, methodological difficulties are added for its evaluation: how to measure a multi-factor concept whose definition is complex and non-consensual? What about its assessment in the elderly? Are the difficulties of definition and evaluation the same in studies involving elderly dementia patients? Starting from the historical context of quality of life we particularly discuss its definition and assessment in elderly patients with dementia.

The name of Parkinson is universally famous because of the eponymous disease. But as a man, James Parkinson (1755-1824), is poorly known. He was born, married and passed away in his St-Leonard parish in Shoreditch (London). After having studied Latin, Greek, natural philosophy, and stenography (shorthand), which he considered as the basic tools of any doctor, he studied for six months at the London Hospital Medical College, and served his apprenticeship as an apothecary-surgeon with his father for six years. Then he was qualified as a surgeon in 1784 at the age of 29 years. His activity has been deployed in three areas: 1) medicine, 2) political activism and social reformism, 3) paleontology and oryctology. As a physician, Parkinson has published several books, the most important concerned paralysis agitans (future Parkinson's disease), gout, complications of lightning (future Lichtenberg figures and keraunoparalysis), acute appendicitis (with his son John Parkinson) and hernias (diagnosis, development, dangers of hernia ruptures, and design of a simple truss). Its ideological and political commitment was manifested by joining two secret societies and publishing numerous pamphlets, many of which are signed by the pseudonym Old Hubert; he campaigned for a better representation of the people in Parliament, for greater social justice, for the defense and recognition of the rights of the poor, the insane, the children, and against children abuse. He published a small compendium of chemistry, he was one of the thirteen members who create the British Geological Society and is recognized as one of the founders of paleontology; as was Georges Cuvier (1769-1832), he remained a strong supporter of creationism and catastrophism. Distinguished oryctologist, he gave his name to several fossils, mainly molluscs.

Growing evidence suggests that age impacts on interhemispheric representation of language. Dichotic listening test allows assessing language lateralization for spoken language and it generally reveals right-ear/left-hemisphere (LH) predominance for language in young adult subjects. According to reported results, elderly would display increasing LH predominance in some studies or stable LH language lateralization for language in others ones. The aim of this study was to depict the main pattern of results in respect with the effect of normal aging on the hemisphere specialization for language by using dichotic listening test. A meta-analysis based on 11 studies has been performed. The inter-hemisphere asymmetry does not seem to increase according to age. A supplementary qualitative analysis suggests that right-ear advantage seems to increase between 40 and 49 y old and becomes stable or decreases after 55 y old, suggesting right-ear/LH decline.

Refusal of care and support in these patients with Alzheimer's disease and related illnesses at home is a cause of accelerated loss of autonomy and increases the risk of a crisis with early institutionalization. Factors contributing to the denial of care are poorly understood and very few epidemiological data exist. Materials and methods: we compared age, diagnosis, level of severity of the disease, the type of behavioral, family status of 101 patients living in denial of care and support as seen by a mobile home (group UPEPc) to 136 control patients seen at the memory clinic (group CM). Patients living in denial of care appear to significantly low age [82/80.5, p<0.0001], with more advanced disease [average MMSE 18/22, p<0.0001], the presence family conflicts and behavioral disorders [delirious - hallucination, agitation - aggression, depression, apathy, p<0.05].

Conclusion:

the profile of patients refusing home care is specific and it is important to educate GPs conditions that favor an obstacle to medicalization. The advantage of a mobile extramural to analyze risk factors for refusal of care and propose alternatives should be further investigated.

In France, only a third of demented patients have an established diagnostic of dementia. Hospitalization is often an opportunity to perform a diagnostic of dementia. Real benefits for patients of such a diagnostic process are unknown. The objective of the study was to observe prognosis of elderly patients hospitalized in geriatric courses in terms of mortality, hospitalization rate and entry into an institution. This was a monocentric prospective study with a one-year follow-up of 90 patients hospitalized in an acute geriatric ward with either dementia known by general practitioner, either diagnosed during the hospitalization according to DSM IV criteria. A one year follow-up by phone has been conducted. From a consecutive set of 159 inpatients for 18 weeks, we included in this study 49 patients with a known dementia (group 1, mean age 85.7±4.6 years, mean Mini-mental state examination (MMSE) score 12.4±6.2) and 41 patients with dementia diagnosed during hospitalization (group 2, mean age 88.4±6.4 years, mean MMSE score 16.1±6.5). Differences between the two groups were significant for age (p <0.03) and MMSE score (p <0.02). One-year mortality rate was near 30% in the 2 groups. Rate of institutionalization was 33% in group 1 and 49% in group 2 (not statistically significant). There was a significant difference in number of days spent at home between group 1 and group 2, respectively 190.9±159.9 days vs 111.1±148.1 days (p <0.03). Demented patients previously diagnosed lived longer at home at one year than patients newly diagnosed. These results tend to support the diagnosis of dementia in very elderly patients with multiple comorbidities. Conditions of living at home, in particular the quality of life, should be the object of further studies.

Background:

alcohol use disorders in the elderly are often underdiagnosed in spite of their effects worsened by age-related physiological changes, comorbidities and frequent polymedication.

Objective:

the aim of this study was to assess the prevalence of alcohol use in a geriatric acute care unit. Subjects and methods: a prospective and descriptive study was carried out in an acute care geriatric unit in France, from November 2011 to March 2012. It included inpatients aged 75 and older. We gathered medical data from medical records and conducted one-to-one interviews assessing the inpatients' weekly alcohol intake and personal history of alcohol use. We screened alcohol abuse and dependence by using parts of the MINI (Mini international neuropsychiatric interview). We also assessed benzodiazepine and tobacco consumption. Comprehensive geriatric assessment was conducted using the CIRS-G (cumulative illness scale in geriatrics), the MMSE (Mini mental state evaluation), the MNA (Mini nutritional assessment), the mini GDS (mini Geriatric depression scale) and the 4-IADL (4-Instrumental activities of daily living). Patients were dispatched in five groups according the DSM-IV-TR classification.

Results:

the study included consicutively 100 inpatients (53 women and 47 men), with a mean age of 84.8±5.4 years. Forty-four percent had alcohol use disorders (29% at-risk users, 11% harmful users and 4% dependent). Very few inpatients with alcohol use disorders had been asked in the past about their alcohol consumption. They used benzodiazepine more often than the others. We did not find any differences in geriatric assessment when comparing the two sub-groups.

Conclusion:

alcohol use disorders are very common in elderly inpatients of acute geriatric care units, especially when considering the group of at-risk users. Alcohol use should thus be screened for every elderly inpatient.