Martine Simard | Université Laval (original) (raw)
Papers by Martine Simard
The main goal of this study was to evaluate the impact of a cognitive rehabilitation programme on... more The main goal of this study was to evaluate the impact of a cognitive rehabilitation programme on 12 behavioural and psychological symptoms of dementia (BPSD) in patients with mild to moderate Alzheimer's disease (AD). This sixmonth single-blind block-randomised cross-over controlled study was conducted with 15 mild to moderate AD participants and their caregivers. All participants received a four-week home-based cognitive rehabilitation programme to learn/re-learn an instrumental activity of daily living. They were assessed up until three months following the end of the intervention. The Neuropsychiatric Inventory (NPI-12) was employed to evaluate patients' BPSD at seven assessment points during the course of the study. A general linear mixed model analysis performed on the NPI data revealed that aberrant motor behaviours (AMB) increased significantly more in the treatment condition than in the control condition. In addition, both groups registered a significant reduction of delusional symptoms during the second half of the study. Employing a multisymptom approach to assess participants' BPSD, this cross-over randomised controlled study showed that an individualised cognitive rehabilitation intervention was generally well-tolerated by mild to moderate AD patients. Future cognitive rehabilitation studies conducted with this population should pay attention to AMB symptom changes.
International Journal of Geriatric Psychiatry, 2001
Psychosis has been associated with aggression in dementia, but the nature of this relationship ha... more Psychosis has been associated with aggression in dementia, but the nature of this relationship has been unclear. There has been very little research into the relations between apathy and functional status to psychosis in dementia. The purpose of this study is to investigate the ...
International Journal of Geriatric Psychiatry, 2003
Background Reports of differential impairments on visual-construction tasks in dementia with Lewy... more Background Reports of differential impairments on visual-construction tasks in dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) are sometimes controversial, whereas visual-perceptual data are lacking. The existence of different clinical sub-groups of DLB has been hypothesized to explain the discrepancies among the cognitive results. The goal of this study was to compare the visual-perceptual performance of subjects with DLB with predominant psychosis, DLB with predominant parkinsonian features and AD. Methods This is a cross-sectional neuropsychological study with between diagnostic group comparisons. The Benton Judgement Line Orientation (BJLO) test was administered to four DLB patients with predominant psychosis (DLB-psy), four DLB subjects with predominant parkinsonian features (DLB-PD), and 13 patients with AD. An analysis of error types was applied to the results of the BJLO with QO1, QO2, QO3, QO4 (visual attention) errors, as well as VH, IQO, IQOV, and IQOH (visual-spatial perception) errors. Results A MANOVA showed significant differences between the DLB, and AD groups on the number of VH (F ¼ 6.049, df ¼ 1,19, p ¼ 0.024), IQOH (F ¼ 4.645, df ¼ 1,19, p ¼ 0.044) and QO1 (F ¼ 4.491, df ¼ 1,19, p ¼ 0.047) errors, but no difference on the total score of the BJLO. Another MANOVA and post hoc Student-Newman-Keuls analyses demonstrated that the DLB-psy sub-group made significantly more VH and IQOH errors than AD and the DLB-PD subjects. Conclusions Subjects with DLB and psychosis have more severe visual-perception (VH errors) impairments than subjects with DLB and predominant parkinsonian features, and AD subjects.
Drugs & Aging, 1999
There is an increasing number of cognition-enhancing drugs for Alzheimer's Disease (AD) a... more There is an increasing number of cognition-enhancing drugs for Alzheimer's Disease (AD) and, consequently, drug trials represent a growing field of interest in research. As memory dysfunction is generally the first and most severe cognitive impairment in AD, the choice of memory testing to be used in these studies is of great importance. It should reflect an understanding of memory systems being assessed with neuropsychological tests and the fact that some tests can be more appropriate than others to show benefit with certain classes of cognition-enhancing drugs. Severe deterioration of episodic and semantic memory occurs very early in the AD process while working memory shows a gradual deterioration over time. Some aspects of working and implicit memory can be spared in the mild to moderate stages of AD. Tests of working, episodic, semantic and implicit memory are used as outcomes in trials with acetylcholinesterase inhibitors, drugs with other neurotransmitter strategies, metabolic enhancers and drugs which may impact upon a variety of CNS processes. The clinical scales and observational measures are largely used in trials of cognition-enhancing drugs for AD (46.66% of all the studies reviewed). The Digit Span test, the Rey Auditory Verbal Learning Test, the Buschke Selective Reminding Test and the verbal fluency tasks are the most sensitive memory tests, whereas the most sensitive scales are the Sandoz Clinical Assessment-Geriatric, the Gottfried-Bräne-Steel scale and the Blessed Dementia Scale. Finally, we suggest that future investigations should use sensitive memory tests, together with behavioural and psychiatric scales, rather than general observational evaluations.
Journal of Geriatric Psychiatry and Neurology, 2009
Background: The brain-at-risk stage is the earliest phase of the vascular cognitive impairment co... more Background: The brain-at-risk stage is the earliest phase of the vascular cognitive impairment continuum and includes individuals with vascular risk factors (VRF). However, there is still no clear definition of this concept. The aim of the study is to characterize the neuropsychological profile of elderly individuals by 3 levels of VRF. Methods: This is a cross-sectional analysis of the Canadian Study of Health and Aging baseline data; 577 nondemented elderly individuals 65 years old were divided into 3 groups: reference group (0 VRF; n ¼ 82); intermediate brain-at-risk group (1-2 VRF; n ¼ 360); high brain-at-risk group (3 VRF; n ¼ 135). A principal component analysis (PCA) and univariate/multivariate analyses of variance were performed to examine the relationships between the groups and various cognitive measures. Main findings: The PCA produced a 2-component solution (1) executive/psychomotor functions including measures of abstraction and (2) verbal memory. The high brain-at-risk group performed significantly worse than the reference group on the first component. Conclusions: Elderly individuals presenting with 3 VRF are more impaired on measures of executive functions/ processing speed than participants without any VRF.
International Journal of Methods in Psychiatric Research, 2007
The psychometric properties of the clinician, informant, and self-rated versions of the Apathy Ev... more The psychometric properties of the clinician, informant, and self-rated versions of the Apathy Evaluation Scale (AES-C/I/S) were examined using data on 121 outpatients seen in a behavioral neurology clinic for the assessment of dementia and associated neuropsychiatric disorders. Two factors, apathy and interest, were identified for the AES-C and the AES-I. The AES-S had only an apathy factor. The AES-C was found to have fairly good psychometric properties. However, from a diagnostic point of view, the AES-I provided the greatest sensitivity and the strongest positive and negative predictive values. Generally, the AES-S performed poorly compared with the AES-C and AES-I.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 1999
The authors explored cognitive functioning of a group of elderly subjects with depression. The gr... more The authors explored cognitive functioning of a group of elderly subjects with depression. The group as a whole, and, in particular, the late-onset group (LOD), demonstrated cognitive impairment on the Mattis Dementia Rating Scale (MDRS). Subgroup differences were significant at P=0.004. This between-group difference was not seen when age and level of education were controlled. In the LOD group, 47.5% (vs. 31.5% of the early-onset group [P=0.025]), scored below the cutoff for dementia. Age-at-onset status in a logistic regression model predicted MDRS category, and treatment of the depression had little effect on cognition. Results support the hypothesis that late-life depression, particularly LOD, is associated with cognitive impairment that may represent early AD.
International Journal of Geriatric Psychiatry, 2001
Background. Psychosis has been associated with aggression in dementia, but the nature of this rel... more Background. Psychosis has been associated with aggression in dementia, but the nature of this relationship has been unclear. There has been very little research into the relations between apathy and functional status to psychosis in dementia. The purpose of this study is to investigate the relationship between psychosis and aggression, apathy, and functional status in outpatients with dementia.
Archives of Physical Medicine and Rehabilitation, 2001
Masanic CA, Bayley MT, vanReekum R, Simard M. Open-label study of donepezil in traumatic brain in... more Masanic CA, Bayley MT, vanReekum R, Simard M. Open-label study of donepezil in traumatic brain injury. Arch Phys Med Rehabil 2001;82:896-901.
Alzheimer's & Dementia, 2008
ing to ICD-10. The mean age was 73.1 (range 89/65) years (women 73.4 [89.3/65.3], men 71,1 [81.6/... more ing to ICD-10. The mean age was 73.1 (range 89/65) years (women 73.4 [89.3/65.3], men 71,1 [81.6/62.6]).Co-existing dementia prior to ECT was diagnosed in 10 (23.8%) patients, mild cognitive imparment (MCI) in 7 (16.7%). Advanced vascular or neurodegenerative disease was found in 50% of patients. The affective symtoms were rated with Hamilton Depressions Scale 24 (HAMD 24) before, during and after finishing ECT. All patients achieved complete or partial remission of affective symptoms in HAMD 24. During ECT-treatment, patients with dementia or MCI showed more distinctive cognitive deficits than geriatric participiants without preexisting cognitive deficits in rating MMSE. In patients with cerebrovascular lesions, neurodegeneration or both in cranial MRI transient cognitive impairments were induced faster than in patients without cerebral changes. About 75% of these patients had not achieved baseline levels in cognitive functioning 8 weeks after finishing treatment. In 1/3 MCI or dementia were diagnosed in follow-up. Geriatric patients without cognitive impairment before treatment and no or only mild neuroimaging findings achieved full cognitive functioning during follow-up. Conclusions: Our results show that ECT is effective in refractory geriatric depression. Severe cognitive side-effects occur mainly in patients with pre-diagnosed cognitive impairment or MRI signs of neurodegenerative or vascular disease.
International Journal of Geriatric Psychiatry, 2001
The association between Down's syndrome (DS) and Alzheimer's disease is well esta... more The association between Down's syndrome (DS) and Alzheimer's disease is well established. This paper presents a review of the literature, suggesting a possible association between DS and the more recently recognised dementia with Lewy bodies (DLB). Patients with DLB frequently present with changes in affect and behaviour, and in particular with psychotic symptoms. The literature suggests a possible role for atypical neuroleptics in the management of psychosis in DLB.
We can define photosynthesis as the absorption of photons from electromagnetic radiation, which b... more We can define photosynthesis as the absorption of photons from electromagnetic radiation, which brings about an ionic event. Until today, chlorophyll is accepted to be the only substance widely disseminated in nature that is capable of delivering hydrogen to a plant cell. No other substance has been known in eucaryote cells (in mammals, fish, birds, insects, etc.) that, by capturing photons from electromagnetic radiation, can get the necessary energy to split the water molecule. Results obtained using melanin confirm to us that not only plants carry out photosynthesis, but that mammals can also do so. Indeed, so can any living being that has melanin in its genetic code. In other words, melanin is to the animal kingdom what chlorophyll is to the plant kingdom. Methods: We have estimated that the third of all energy usually available to a human being comes from melanin, light and water. However, this third of all energy is the primordial energy, that is, it is the energy that activates chemical reactions in the human organism. In line with our therapeutic studies (whose results have been extraordinary), life systems are supported by this energy one way or another, or even require chemical energy from melanin derived from photonic energy in order to begin or to sustain life. This is coherent with clinical findings related to the time that a human being can live without water. The pharmacological modulation of photosynthesis in human beings offers major expectations in ailments such as Alzheimer, different types of arthritis, nephropathy, enteropathy, sepsis, etc. Results: Our therapeutic results in Alzheimer patients is extraordinary, in more than two thirds of them; they don't use wrapper anymore, social interactions improve markedly, cook again; and their locomotion abilities is notoriously recuperated. Conclusions: The pharmacological modulation of the photosynthesis in humans is a new possibility in many diseases, and the improvement is in the order of 70-90 %.
Current Aging Sciencee, 2011
The nature of knowledge, i.e. sensory-dependent or abstract, is controversial. Growing evidence s... more The nature of knowledge, i.e. sensory-dependent or abstract, is controversial. Growing evidence supports the existence of sensory-dependent knowledge in young individuals, but this question remains unexplored in elderly individuals. Thus the first objective of this study was to assess sensory-dependent knowledge in normal aging using a cross-modal priming paradigm. The cross-modal priming is a way to verify the nature of knowledge. However, contradictory results are reported about the existence of a cross-modal priming effect in normal aging. One possible explanation for the controversial findings is the priming task difficulty that would require too much executive resources in elderly participants and would prevent them to obtain a priming effect. Therefore, the second objective was to assess the executive involvement in the priming task. The method was based on a cross-modal priming paradigm with familiar bimodal items. First, all the sound primes were presented. For half of them, a visual abstract mask was presented simultaneously. Then, all the visual targets were processed. A battery of neuropsychological tests was administered to assess the involvement of executive functions in the priming paradigm. The results demonstrated a priming effect in the young and elderly participants, but only for the primes presented without the visual mask. The mask interference demonstrated the perceptual nature of the priming effect which supports the sensory-dependent theory of knowledge. The executive functions were correlated with the priming task only in the elderly participants. These results therefore support the task difficulty hypothesis.
American Journal of Geriatric Psychiatry, 2008
The goals of this study were to investigate the prevalence and initial symptoms of the late-onset... more The goals of this study were to investigate the prevalence and initial symptoms of the late-onset schizophrenia (LOS: >40 years) and very-late-onset schizophrenia-like psychosis (VLOSLP: >60 years) nosological groups proposed by the International Late-Onset Schizophrenia Group. This was a retrospective, cross-sectional, chart review study. The study was conducted at Centre Hospitalier Robert-Giffard (CHRG), Quebec City, Canada. The medical records of inpatients from the CHRG who presented with psychotic symptoms were analyzed. Positive and negative symptoms were scored using the SAPS and SANS. Groups' symptoms were compared using chi(2), Fisher's exact tests, t tests, and exact Mann-Whitney tests. An exact conditional logistic regression analysis was performed to determine which clinical characteristics were the most predictive of the groups' classification. Among the 1,767 unique, first-admission medical records reviewed, 23 (1.3%) inpatients developed their first psychotic symptoms at the age of 40-59 years old (LOS), and 13 (0.7%) at the age of 60 years and above (VLOSLP). LOS patients were more apathetic and presented more abnormal psychomotor activity than the VLOSLP. Persecutory delusions, auditory hallucinations, inappropriate social behavior, formal thought disorders and anhedonia were frequent in the two groups. A logistic regression model including psychomotor abnormalities was statistically relevant to predict the belonging to LOS group. LOS and VLOSLP are rare. Abnormal psychomotor activity can properly differentiate VLOSLP and LOS. The nosological model proposed by the International Late-Onset Schizophrenia Group is at least partially supported by the present data.
American Journal of Geriatric Psychiatry, 2010
This systematic literature review addressed the efficacy of 15 cognitive intervention programs th... more This systematic literature review addressed the efficacy of 15 cognitive intervention programs that have been tested in individuals presenting with mild cognitive impairment of the amnestic type (MCI-A) possibly at risk to progress toward dementia. MEDLINE, PsycINFO, and Current Content databases were searched using the following key terms: cognitive training, cognitive stimulation, cognitive rehabilitation, neuropsychological intervention, memory training, memory stimulation, and Mild Cognitive Impairment. The data showed statistically significant improvements at the end of training on 44% of objective measures of memory, when compared with 12% of objective measures of cognition other than memory. Statistically significant improvements after treatment were obtained on 49% of subjective measures of memory, quality of life, or mood. Samples sizes ranged from 1 to 193 patients with MCI-A but were usually Յ30. Five studies were randomized controlled trials, eight were quasiexperimental designs, and two were single-case investigations. Some programs focused only on memory, whereas other programs used multifaceted approaches targeting two or more cognitive functions. Eight were offered in groups, and seven took place on an individual basis. Recommendations to improve cognitive interventions in MCI-A are proposed, such as using large samples and a robust experimental design, as well as the implementation of a standardized cognitive training manual. Well standardized and validated direct and indirect measures of efficacy and noncognitive outcomes are also a crucial issue. A consensus meeting among all the experts working on cognitive training in this population should occur to provide guidelines to improve this treatment option. (Am J Geriatr Psychiatry 2010; 18:281-296)
American Journal of Geriatric Psychiatry, 2013
Objective: The goal of the study was to investigate the effectiveness of a memory rehabilitation ... more Objective: The goal of the study was to investigate the effectiveness of a memory rehabilitation program to re-learn instrumental activities of daily living (IADLs) in patients with Alzheimer disease (AD). Design: This was a 6-month block-randomized cross-over controlled study. Setting: All evaluation and training sessions were performed at each patient's home. Participants: Twenty participants with mild to moderate AD. Intervention: The trained IADL was chosen by the patient and his/her caregiver in order to target the patient's needs and interests. Participants were trained twice a week for 4 weeks with the errorless learning (ELL) and spaced retrieval (SR) cognitive techniques. After training, there were several follow-ups over a period of at least 3 months. Measurements: Performance on the trained IADL was assessed by a Direct Measure of Training (DMT), an observational instrument adapted from a wellvalidated scale. General cognitive function, everyday memory functioning, quality of life, neuropsychiatric symptoms and ADL/IADL of patients, as well as the caregiver's burden were assessed as secondary outcomes. Results: A statistical significant difference was found between the trained and untrained groups on the DMT immediately following the intervention. Improvements were maintained for a 3-month period. The training did not have effects on any other measures. Conclusions: The present study showed that it is possible for AD patients to relearn significant IADLs with the ELL and SR techniques and to maintain these gains during at least 3 months. The findings of this study emphasize the importance to design robust but individualized intervention tailored on patients' particular needs. (Am J Geriatr Psychiatry 2014; 22:1188e1199)
![Research paper thumbnail of [Category-specific deficits in semantic dementia: links between perception and semantic knowledge]](https://attachments.academia-assets.com/43799208/thumbnails/1.jpg)
](Geriatrie et Psychologie Neuropsychiatrie du Vieillissement, 2011
Une question fondamentale concernant l'étude des connaissances en mémoire est de savoir si elles ... more Une question fondamentale concernant l'étude des connaissances en mémoire est de savoir si elles relèvent de différentes natures de connaissances ou si toutes les connaissances sont basées sur des traces sensori-motrices. Cette question porte les liens entre la perception et les connaissances, particulièrement sémantiques, au coeur du débat. Ces liens peuvent s'étudier dans la démence sémantique, maladie touchant essentiellement les connaissances sémantiques, et dans le phénomène d'altérations catégories-spécifiques. En effet, les connaissances ne seraient pas altérées de manière uniforme et présentent le plus souvent un déficit en défaveur des items vivants et concrets. La théorie sensorielle/fonctionnelle (SFT) définit des liens entre les items vivants et les aspects sensoriels afin d'expliquer cette atteinte des items vivants. Cette hypothèse permettrait alors de faire le lien entre la perception et les connaissances sémantiques, liens supposés par les approches fonctionnelles de la mémoire dans lesquelles nos connaissances sont modales (sensori-dépendantes). Cette synthèse critique se propose d'étudier plus avant ces liens entre nos connaissances et le traitement perceptif à travers le prisme de la démence sémantique. Le rôle du cortex périrhinal dans l'intégration visuelle de haut niveau permettrait d'expliquer partiellement ces liens.
Current Psychiatry Reports, 2009
The concept of mild cognitive impairment (MCI) primarily emphasizes changes in individuals' menta... more The concept of mild cognitive impairment (MCI) primarily emphasizes changes in individuals' mental abilities, but it has recently been suggested that neuropsychiatric symptoms should also be considered important factors in age-related neurodegeneration. Psychological distress, defi ned as a reaction of an individual to external and internal stresses, is characterized by a mixture of psychological symptoms. It also may be considered a neuropsychiatric symptom encompassing depression, anxiety, and apathy. This paper reviews and summarizes recent evidence and relevant issues regarding the presence of psychological distress in healthy older adults and MCI patients and its relationship to risk for developing dementia. Results presented in this review show that psychological distress and depressive, anxious, and apathetic symptoms can be present in MCI and may predict progression to dementia. This article also provides suggestions for future research.
The Clinical Neuropsychologist, 2014
Performance on verbal memory tests is generally associated with socio-demographic variables such ... more Performance on verbal memory tests is generally associated with socio-demographic variables such as age, sex, and education level. Performance also varies between different cultural groups. The present study aimed to establish normative data for the Rappel libre/Rappel indicé à 16 items (16-item Free and Cued Recall; RL/RI-16), a French adaptation of the Free and Cued Selective Reminding Test (Buschke, 1984 ; Grober, Buschke, Crystal, Bang, & Dresner, 1988 ). The sample consisted of 566 healthy French-speaking older adults (50-88 years old) from the province of Quebec, Canada. Normative data for the RL/RI-16 were derived from 80% of the total sample (normative sample) and cross-validated using the remaining participants (20%; validation sample). The effects of participants' age, sex, and education level were assessed on different indices of memory performance. Results indicated that these variables were independently associated with performance. Normative data are presented as regression equations with standard deviations (symmetric distributions) and percentiles (asymmetric distributions).
The main goal of this study was to evaluate the impact of a cognitive rehabilitation programme on... more The main goal of this study was to evaluate the impact of a cognitive rehabilitation programme on 12 behavioural and psychological symptoms of dementia (BPSD) in patients with mild to moderate Alzheimer's disease (AD). This sixmonth single-blind block-randomised cross-over controlled study was conducted with 15 mild to moderate AD participants and their caregivers. All participants received a four-week home-based cognitive rehabilitation programme to learn/re-learn an instrumental activity of daily living. They were assessed up until three months following the end of the intervention. The Neuropsychiatric Inventory (NPI-12) was employed to evaluate patients' BPSD at seven assessment points during the course of the study. A general linear mixed model analysis performed on the NPI data revealed that aberrant motor behaviours (AMB) increased significantly more in the treatment condition than in the control condition. In addition, both groups registered a significant reduction of delusional symptoms during the second half of the study. Employing a multisymptom approach to assess participants' BPSD, this cross-over randomised controlled study showed that an individualised cognitive rehabilitation intervention was generally well-tolerated by mild to moderate AD patients. Future cognitive rehabilitation studies conducted with this population should pay attention to AMB symptom changes.
International Journal of Geriatric Psychiatry, 2001
Psychosis has been associated with aggression in dementia, but the nature of this relationship ha... more Psychosis has been associated with aggression in dementia, but the nature of this relationship has been unclear. There has been very little research into the relations between apathy and functional status to psychosis in dementia. The purpose of this study is to investigate the ...
International Journal of Geriatric Psychiatry, 2003
Background Reports of differential impairments on visual-construction tasks in dementia with Lewy... more Background Reports of differential impairments on visual-construction tasks in dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) are sometimes controversial, whereas visual-perceptual data are lacking. The existence of different clinical sub-groups of DLB has been hypothesized to explain the discrepancies among the cognitive results. The goal of this study was to compare the visual-perceptual performance of subjects with DLB with predominant psychosis, DLB with predominant parkinsonian features and AD. Methods This is a cross-sectional neuropsychological study with between diagnostic group comparisons. The Benton Judgement Line Orientation (BJLO) test was administered to four DLB patients with predominant psychosis (DLB-psy), four DLB subjects with predominant parkinsonian features (DLB-PD), and 13 patients with AD. An analysis of error types was applied to the results of the BJLO with QO1, QO2, QO3, QO4 (visual attention) errors, as well as VH, IQO, IQOV, and IQOH (visual-spatial perception) errors. Results A MANOVA showed significant differences between the DLB, and AD groups on the number of VH (F ¼ 6.049, df ¼ 1,19, p ¼ 0.024), IQOH (F ¼ 4.645, df ¼ 1,19, p ¼ 0.044) and QO1 (F ¼ 4.491, df ¼ 1,19, p ¼ 0.047) errors, but no difference on the total score of the BJLO. Another MANOVA and post hoc Student-Newman-Keuls analyses demonstrated that the DLB-psy sub-group made significantly more VH and IQOH errors than AD and the DLB-PD subjects. Conclusions Subjects with DLB and psychosis have more severe visual-perception (VH errors) impairments than subjects with DLB and predominant parkinsonian features, and AD subjects.
Drugs & Aging, 1999
There is an increasing number of cognition-enhancing drugs for Alzheimer's Disease (AD) a... more There is an increasing number of cognition-enhancing drugs for Alzheimer's Disease (AD) and, consequently, drug trials represent a growing field of interest in research. As memory dysfunction is generally the first and most severe cognitive impairment in AD, the choice of memory testing to be used in these studies is of great importance. It should reflect an understanding of memory systems being assessed with neuropsychological tests and the fact that some tests can be more appropriate than others to show benefit with certain classes of cognition-enhancing drugs. Severe deterioration of episodic and semantic memory occurs very early in the AD process while working memory shows a gradual deterioration over time. Some aspects of working and implicit memory can be spared in the mild to moderate stages of AD. Tests of working, episodic, semantic and implicit memory are used as outcomes in trials with acetylcholinesterase inhibitors, drugs with other neurotransmitter strategies, metabolic enhancers and drugs which may impact upon a variety of CNS processes. The clinical scales and observational measures are largely used in trials of cognition-enhancing drugs for AD (46.66% of all the studies reviewed). The Digit Span test, the Rey Auditory Verbal Learning Test, the Buschke Selective Reminding Test and the verbal fluency tasks are the most sensitive memory tests, whereas the most sensitive scales are the Sandoz Clinical Assessment-Geriatric, the Gottfried-Bräne-Steel scale and the Blessed Dementia Scale. Finally, we suggest that future investigations should use sensitive memory tests, together with behavioural and psychiatric scales, rather than general observational evaluations.
Journal of Geriatric Psychiatry and Neurology, 2009
Background: The brain-at-risk stage is the earliest phase of the vascular cognitive impairment co... more Background: The brain-at-risk stage is the earliest phase of the vascular cognitive impairment continuum and includes individuals with vascular risk factors (VRF). However, there is still no clear definition of this concept. The aim of the study is to characterize the neuropsychological profile of elderly individuals by 3 levels of VRF. Methods: This is a cross-sectional analysis of the Canadian Study of Health and Aging baseline data; 577 nondemented elderly individuals 65 years old were divided into 3 groups: reference group (0 VRF; n ¼ 82); intermediate brain-at-risk group (1-2 VRF; n ¼ 360); high brain-at-risk group (3 VRF; n ¼ 135). A principal component analysis (PCA) and univariate/multivariate analyses of variance were performed to examine the relationships between the groups and various cognitive measures. Main findings: The PCA produced a 2-component solution (1) executive/psychomotor functions including measures of abstraction and (2) verbal memory. The high brain-at-risk group performed significantly worse than the reference group on the first component. Conclusions: Elderly individuals presenting with 3 VRF are more impaired on measures of executive functions/ processing speed than participants without any VRF.
International Journal of Methods in Psychiatric Research, 2007
The psychometric properties of the clinician, informant, and self-rated versions of the Apathy Ev... more The psychometric properties of the clinician, informant, and self-rated versions of the Apathy Evaluation Scale (AES-C/I/S) were examined using data on 121 outpatients seen in a behavioral neurology clinic for the assessment of dementia and associated neuropsychiatric disorders. Two factors, apathy and interest, were identified for the AES-C and the AES-I. The AES-S had only an apathy factor. The AES-C was found to have fairly good psychometric properties. However, from a diagnostic point of view, the AES-I provided the greatest sensitivity and the strongest positive and negative predictive values. Generally, the AES-S performed poorly compared with the AES-C and AES-I.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 1999
The authors explored cognitive functioning of a group of elderly subjects with depression. The gr... more The authors explored cognitive functioning of a group of elderly subjects with depression. The group as a whole, and, in particular, the late-onset group (LOD), demonstrated cognitive impairment on the Mattis Dementia Rating Scale (MDRS). Subgroup differences were significant at P=0.004. This between-group difference was not seen when age and level of education were controlled. In the LOD group, 47.5% (vs. 31.5% of the early-onset group [P=0.025]), scored below the cutoff for dementia. Age-at-onset status in a logistic regression model predicted MDRS category, and treatment of the depression had little effect on cognition. Results support the hypothesis that late-life depression, particularly LOD, is associated with cognitive impairment that may represent early AD.
International Journal of Geriatric Psychiatry, 2001
Background. Psychosis has been associated with aggression in dementia, but the nature of this rel... more Background. Psychosis has been associated with aggression in dementia, but the nature of this relationship has been unclear. There has been very little research into the relations between apathy and functional status to psychosis in dementia. The purpose of this study is to investigate the relationship between psychosis and aggression, apathy, and functional status in outpatients with dementia.
Archives of Physical Medicine and Rehabilitation, 2001
Masanic CA, Bayley MT, vanReekum R, Simard M. Open-label study of donepezil in traumatic brain in... more Masanic CA, Bayley MT, vanReekum R, Simard M. Open-label study of donepezil in traumatic brain injury. Arch Phys Med Rehabil 2001;82:896-901.
Alzheimer's & Dementia, 2008
ing to ICD-10. The mean age was 73.1 (range 89/65) years (women 73.4 [89.3/65.3], men 71,1 [81.6/... more ing to ICD-10. The mean age was 73.1 (range 89/65) years (women 73.4 [89.3/65.3], men 71,1 [81.6/62.6]).Co-existing dementia prior to ECT was diagnosed in 10 (23.8%) patients, mild cognitive imparment (MCI) in 7 (16.7%). Advanced vascular or neurodegenerative disease was found in 50% of patients. The affective symtoms were rated with Hamilton Depressions Scale 24 (HAMD 24) before, during and after finishing ECT. All patients achieved complete or partial remission of affective symptoms in HAMD 24. During ECT-treatment, patients with dementia or MCI showed more distinctive cognitive deficits than geriatric participiants without preexisting cognitive deficits in rating MMSE. In patients with cerebrovascular lesions, neurodegeneration or both in cranial MRI transient cognitive impairments were induced faster than in patients without cerebral changes. About 75% of these patients had not achieved baseline levels in cognitive functioning 8 weeks after finishing treatment. In 1/3 MCI or dementia were diagnosed in follow-up. Geriatric patients without cognitive impairment before treatment and no or only mild neuroimaging findings achieved full cognitive functioning during follow-up. Conclusions: Our results show that ECT is effective in refractory geriatric depression. Severe cognitive side-effects occur mainly in patients with pre-diagnosed cognitive impairment or MRI signs of neurodegenerative or vascular disease.
International Journal of Geriatric Psychiatry, 2001
The association between Down's syndrome (DS) and Alzheimer's disease is well esta... more The association between Down's syndrome (DS) and Alzheimer's disease is well established. This paper presents a review of the literature, suggesting a possible association between DS and the more recently recognised dementia with Lewy bodies (DLB). Patients with DLB frequently present with changes in affect and behaviour, and in particular with psychotic symptoms. The literature suggests a possible role for atypical neuroleptics in the management of psychosis in DLB.
We can define photosynthesis as the absorption of photons from electromagnetic radiation, which b... more We can define photosynthesis as the absorption of photons from electromagnetic radiation, which brings about an ionic event. Until today, chlorophyll is accepted to be the only substance widely disseminated in nature that is capable of delivering hydrogen to a plant cell. No other substance has been known in eucaryote cells (in mammals, fish, birds, insects, etc.) that, by capturing photons from electromagnetic radiation, can get the necessary energy to split the water molecule. Results obtained using melanin confirm to us that not only plants carry out photosynthesis, but that mammals can also do so. Indeed, so can any living being that has melanin in its genetic code. In other words, melanin is to the animal kingdom what chlorophyll is to the plant kingdom. Methods: We have estimated that the third of all energy usually available to a human being comes from melanin, light and water. However, this third of all energy is the primordial energy, that is, it is the energy that activates chemical reactions in the human organism. In line with our therapeutic studies (whose results have been extraordinary), life systems are supported by this energy one way or another, or even require chemical energy from melanin derived from photonic energy in order to begin or to sustain life. This is coherent with clinical findings related to the time that a human being can live without water. The pharmacological modulation of photosynthesis in human beings offers major expectations in ailments such as Alzheimer, different types of arthritis, nephropathy, enteropathy, sepsis, etc. Results: Our therapeutic results in Alzheimer patients is extraordinary, in more than two thirds of them; they don't use wrapper anymore, social interactions improve markedly, cook again; and their locomotion abilities is notoriously recuperated. Conclusions: The pharmacological modulation of the photosynthesis in humans is a new possibility in many diseases, and the improvement is in the order of 70-90 %.
Current Aging Sciencee, 2011
The nature of knowledge, i.e. sensory-dependent or abstract, is controversial. Growing evidence s... more The nature of knowledge, i.e. sensory-dependent or abstract, is controversial. Growing evidence supports the existence of sensory-dependent knowledge in young individuals, but this question remains unexplored in elderly individuals. Thus the first objective of this study was to assess sensory-dependent knowledge in normal aging using a cross-modal priming paradigm. The cross-modal priming is a way to verify the nature of knowledge. However, contradictory results are reported about the existence of a cross-modal priming effect in normal aging. One possible explanation for the controversial findings is the priming task difficulty that would require too much executive resources in elderly participants and would prevent them to obtain a priming effect. Therefore, the second objective was to assess the executive involvement in the priming task. The method was based on a cross-modal priming paradigm with familiar bimodal items. First, all the sound primes were presented. For half of them, a visual abstract mask was presented simultaneously. Then, all the visual targets were processed. A battery of neuropsychological tests was administered to assess the involvement of executive functions in the priming paradigm. The results demonstrated a priming effect in the young and elderly participants, but only for the primes presented without the visual mask. The mask interference demonstrated the perceptual nature of the priming effect which supports the sensory-dependent theory of knowledge. The executive functions were correlated with the priming task only in the elderly participants. These results therefore support the task difficulty hypothesis.
American Journal of Geriatric Psychiatry, 2008
The goals of this study were to investigate the prevalence and initial symptoms of the late-onset... more The goals of this study were to investigate the prevalence and initial symptoms of the late-onset schizophrenia (LOS: >40 years) and very-late-onset schizophrenia-like psychosis (VLOSLP: >60 years) nosological groups proposed by the International Late-Onset Schizophrenia Group. This was a retrospective, cross-sectional, chart review study. The study was conducted at Centre Hospitalier Robert-Giffard (CHRG), Quebec City, Canada. The medical records of inpatients from the CHRG who presented with psychotic symptoms were analyzed. Positive and negative symptoms were scored using the SAPS and SANS. Groups' symptoms were compared using chi(2), Fisher's exact tests, t tests, and exact Mann-Whitney tests. An exact conditional logistic regression analysis was performed to determine which clinical characteristics were the most predictive of the groups' classification. Among the 1,767 unique, first-admission medical records reviewed, 23 (1.3%) inpatients developed their first psychotic symptoms at the age of 40-59 years old (LOS), and 13 (0.7%) at the age of 60 years and above (VLOSLP). LOS patients were more apathetic and presented more abnormal psychomotor activity than the VLOSLP. Persecutory delusions, auditory hallucinations, inappropriate social behavior, formal thought disorders and anhedonia were frequent in the two groups. A logistic regression model including psychomotor abnormalities was statistically relevant to predict the belonging to LOS group. LOS and VLOSLP are rare. Abnormal psychomotor activity can properly differentiate VLOSLP and LOS. The nosological model proposed by the International Late-Onset Schizophrenia Group is at least partially supported by the present data.
American Journal of Geriatric Psychiatry, 2010
This systematic literature review addressed the efficacy of 15 cognitive intervention programs th... more This systematic literature review addressed the efficacy of 15 cognitive intervention programs that have been tested in individuals presenting with mild cognitive impairment of the amnestic type (MCI-A) possibly at risk to progress toward dementia. MEDLINE, PsycINFO, and Current Content databases were searched using the following key terms: cognitive training, cognitive stimulation, cognitive rehabilitation, neuropsychological intervention, memory training, memory stimulation, and Mild Cognitive Impairment. The data showed statistically significant improvements at the end of training on 44% of objective measures of memory, when compared with 12% of objective measures of cognition other than memory. Statistically significant improvements after treatment were obtained on 49% of subjective measures of memory, quality of life, or mood. Samples sizes ranged from 1 to 193 patients with MCI-A but were usually Յ30. Five studies were randomized controlled trials, eight were quasiexperimental designs, and two were single-case investigations. Some programs focused only on memory, whereas other programs used multifaceted approaches targeting two or more cognitive functions. Eight were offered in groups, and seven took place on an individual basis. Recommendations to improve cognitive interventions in MCI-A are proposed, such as using large samples and a robust experimental design, as well as the implementation of a standardized cognitive training manual. Well standardized and validated direct and indirect measures of efficacy and noncognitive outcomes are also a crucial issue. A consensus meeting among all the experts working on cognitive training in this population should occur to provide guidelines to improve this treatment option. (Am J Geriatr Psychiatry 2010; 18:281-296)
American Journal of Geriatric Psychiatry, 2013
Objective: The goal of the study was to investigate the effectiveness of a memory rehabilitation ... more Objective: The goal of the study was to investigate the effectiveness of a memory rehabilitation program to re-learn instrumental activities of daily living (IADLs) in patients with Alzheimer disease (AD). Design: This was a 6-month block-randomized cross-over controlled study. Setting: All evaluation and training sessions were performed at each patient's home. Participants: Twenty participants with mild to moderate AD. Intervention: The trained IADL was chosen by the patient and his/her caregiver in order to target the patient's needs and interests. Participants were trained twice a week for 4 weeks with the errorless learning (ELL) and spaced retrieval (SR) cognitive techniques. After training, there were several follow-ups over a period of at least 3 months. Measurements: Performance on the trained IADL was assessed by a Direct Measure of Training (DMT), an observational instrument adapted from a wellvalidated scale. General cognitive function, everyday memory functioning, quality of life, neuropsychiatric symptoms and ADL/IADL of patients, as well as the caregiver's burden were assessed as secondary outcomes. Results: A statistical significant difference was found between the trained and untrained groups on the DMT immediately following the intervention. Improvements were maintained for a 3-month period. The training did not have effects on any other measures. Conclusions: The present study showed that it is possible for AD patients to relearn significant IADLs with the ELL and SR techniques and to maintain these gains during at least 3 months. The findings of this study emphasize the importance to design robust but individualized intervention tailored on patients' particular needs. (Am J Geriatr Psychiatry 2014; 22:1188e1199)
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement, 2011
Une question fondamentale concernant l'étude des connaissances en mémoire est de savoir si elles ... more Une question fondamentale concernant l'étude des connaissances en mémoire est de savoir si elles relèvent de différentes natures de connaissances ou si toutes les connaissances sont basées sur des traces sensori-motrices. Cette question porte les liens entre la perception et les connaissances, particulièrement sémantiques, au coeur du débat. Ces liens peuvent s'étudier dans la démence sémantique, maladie touchant essentiellement les connaissances sémantiques, et dans le phénomène d'altérations catégories-spécifiques. En effet, les connaissances ne seraient pas altérées de manière uniforme et présentent le plus souvent un déficit en défaveur des items vivants et concrets. La théorie sensorielle/fonctionnelle (SFT) définit des liens entre les items vivants et les aspects sensoriels afin d'expliquer cette atteinte des items vivants. Cette hypothèse permettrait alors de faire le lien entre la perception et les connaissances sémantiques, liens supposés par les approches fonctionnelles de la mémoire dans lesquelles nos connaissances sont modales (sensori-dépendantes). Cette synthèse critique se propose d'étudier plus avant ces liens entre nos connaissances et le traitement perceptif à travers le prisme de la démence sémantique. Le rôle du cortex périrhinal dans l'intégration visuelle de haut niveau permettrait d'expliquer partiellement ces liens.
Current Psychiatry Reports, 2009
The concept of mild cognitive impairment (MCI) primarily emphasizes changes in individuals' menta... more The concept of mild cognitive impairment (MCI) primarily emphasizes changes in individuals' mental abilities, but it has recently been suggested that neuropsychiatric symptoms should also be considered important factors in age-related neurodegeneration. Psychological distress, defi ned as a reaction of an individual to external and internal stresses, is characterized by a mixture of psychological symptoms. It also may be considered a neuropsychiatric symptom encompassing depression, anxiety, and apathy. This paper reviews and summarizes recent evidence and relevant issues regarding the presence of psychological distress in healthy older adults and MCI patients and its relationship to risk for developing dementia. Results presented in this review show that psychological distress and depressive, anxious, and apathetic symptoms can be present in MCI and may predict progression to dementia. This article also provides suggestions for future research.
The Clinical Neuropsychologist, 2014
Performance on verbal memory tests is generally associated with socio-demographic variables such ... more Performance on verbal memory tests is generally associated with socio-demographic variables such as age, sex, and education level. Performance also varies between different cultural groups. The present study aimed to establish normative data for the Rappel libre/Rappel indicé à 16 items (16-item Free and Cued Recall; RL/RI-16), a French adaptation of the Free and Cued Selective Reminding Test (Buschke, 1984 ; Grober, Buschke, Crystal, Bang, & Dresner, 1988 ). The sample consisted of 566 healthy French-speaking older adults (50-88 years old) from the province of Quebec, Canada. Normative data for the RL/RI-16 were derived from 80% of the total sample (normative sample) and cross-validated using the remaining participants (20%; validation sample). The effects of participants' age, sex, and education level were assessed on different indices of memory performance. Results indicated that these variables were independently associated with performance. Normative data are presented as regression equations with standard deviations (symmetric distributions) and percentiles (asymmetric distributions).