Showing papers by "Georges Kaltenbach published in 2009"

Health benefits of physical activity in older patients: a review

Abstract: As the number of elderly persons in our country increases, more attention is being given to geriatric healthcare needs and successful ageing is becoming an important topic in medical literature. Concept of successful ageing is in first line on a preventive approach of care for older people. Promotion of regular physical activity is one of the main non-pharmaceutical measures proposed to older subjects as low rate of physical activity is frequently noticed in this age group. Moderate but regular physical activity is associated with a reduction in total mortality among older people, a positive effect on primary prevention of coronary heart disease and a significant benefit on the lipid profile. Improving body composition with a reduction in fat mass, reducing blood pressure and prevention of stroke, as well as type 2 diabetes, are also well established. Prevention of some cancers (especially that of breast and colon), increasing bone density and prevention of falls are also reported. Moreover, some longitudinal studies suggest that physical activity is linked to a reduced risk of developing dementia and Alzheimer's disease in particular.

Homocysteine, vitamin B12, folate and cognitive functions: a systematic and critical review of the literature.

Abstract: Elevated serum homocysteine, decreased folate and low vitamin B(12) serum levels are associated with poor cognitive function, cognitive decline and dementia. Despite evidence of an epidemiological association, randomised controlled trials did not provide any clear evidence so far that supplementation with vitamin B(12) and/or folate improves dementia or slows cognitive decline, even though it might normalise homocysteine levels. In this report, we review the current knowledge on the relationship between homocysteine, folate and vitamin B(12) levels and the way their disruption influences cognitive function in adults.

Impact of short‐term aerobic interval training on maximal exercise in sedentary aged subjects

Abstract: Summary Background: Ageing is known to be associated with a decrease in peak oxygen consumption (VO2peak) and maximal tolerated power (MTP). Regular physical exercise is the most appropriate to improve aerobic capacity, but its effect still remained discussed in old people. Design: The aim of this study was to determine whether a short interval training session would be associated with improvements in exercise efficiency in aged subjects in both genders. Methods: In all, 19 women and 16 men (65.4 ± 4.9 years) performed a cycle incremental exercise test before and after a 9-week period of aerobic interval training (twice a week, 30 min session where 6 × 4-min at the first ventilatory threshold alternated with 1-min at the second ventilatory threshold) with cycle ergometer. Minute ventilation (MV), O2 uptake (VO2) and CO2 output (VCO2) were measured breath-by-breath and by an open-circuit metabolic cart. Results: Before training, maximal values of MV (MMV), VO2peak, heart rate, systolic blood pressure, MTP, blood lactate at MTP recovery and the power at the first (pVT1) and second ventilatory thresholds (pVT2) were higher in men compared with women. Nine weeks of interval training induced a significant increase in MMV, VO2peak, MTP, pVT1 and pVT2 and decrease in systolic blood pressure in the same way in men than in women, without any significant effect on their maximal heart rate values. Conclusions: These findings suggest that the age-related declines in aerobic index are attenuated by a short exercise interval training sessions in women and men.

Syndrome de non-dissociation de la vitamine B12 de ses proteines porteuses ou de maldigestion des cobalamines alimentaires

Abstract: Food-cobalamin malabsorption is a new well-characterized syndrome. In association with pernicious anemia, it is the leading etiology of cobalamin deficiency in adult, especially in elderly patient. Currently, it is an exclusion diagnosis that requires a well-codified clinical strategy for diagnosis. There are several causes of food-cobalamin malabsorption, mainly gastric disorders and drugs (metformin and anti-acid drugs). Current treatment modality includes oral cobalamin administration with lower doses than in pernicious anemia. Studies are in the way to better characterize the food-cobalamin malabsorption in a clinical practice perspective and to validate the usefulness of oral cobalamin therapy.

Analyse de quatorze actions nationales pour le déterminant de santé activités physiques et sportives en France de 2001 à 2006

Abstract: Les activites physiques et sportives sont un des determinants de la sante. L’objectif de cette etude est de faire un bilan des logiques a l’œuvre pour la construction d’une problematique de sante publique pour ce determinant, et sa prise en compte par des actions nationales. La recherche s’est appuyee sur le croisement de donnees issues d’entretiens semi-directifs et de documents concernant la construction, la mise en œuvre et le suivi de ces actions. Cette etude montre que, de 2001 a 2006, quatorze actions nationales ont ete construites et mises en œuvre par 7 promoteurs. Pour les conditions de reussite, les 14 actions ont un score moyen de 175,0 ± 66,9 sur 300 %. Il faut donner aux acteurs plus de possibilite de s’impliquer tout en favorisant les relations avec l’environnement en particulier institutionnel et communautaire. C’est la structuration et le fonctionnement de l’action qui est en general la mieux investie. Six informations fortes en remontent : le dopage considere comme une conduite addictive ; la reconnaissance de la souffrance psychologique des sportifs de haut niveau ; le haut risque pour les jeunes de conduites dopantes ; le concept d’activites physiques et sportives doit prendre en compte un rapport benefice/risques et la necessite de promouvoir la sante. Le partage de nombreuses experiences, du local au regional, a favorise la mise en synergie des experiences au sein d’un continuum depuis la « promotion de la sante par les activites physiques et sportives » jusqu’a la « prevention des conduites dopantes ». Dans ce continuum les professionnels ont pu developper des actions dans les domaines cites et jusque la restes isoles. Des propositions sont faites pour renforcer ces dynamiques. D’autres determinants de sante et d’autres priorites de sante publique pourraient etre investigues selon la meme methodologie.

Update of Food-Cobalamin Malabsorption and Oral Cobalamin Therapy

Abstract: Cobalamin (vitamin B12) deficiency is particularly common in the elderly (>65 years of age), but is often un- recognized because its clinical manifestations are subtle; however, they are also potentially serious, particularly from a neuropsychiatric and hematological perspectives. In the general population, the main causes of cobalamin deficiency are pernicious anemia and food-cobalamin malabsorption. Food-cobalamin malabsorption syndrome, which has only recently been identified, is a disorder characterized by the inability to release cobalamin from food or its binding proteins. This syndrome is usually caused by atrophic gastritis, related or unrelated to Helicobacter pylori infection, and long-term in- gestion of antacids and biguanides. Management of cobalamin deficiency with cobalamin injections is currently well codi- fied, but new routes of cobalamin administration (oral and nasal) are being studied, especially oral cobalamin therapy for food-cobalamin malabsorption.

Effets de la supplémentation orale en vitamine B12 sur les fonctions cognitives de sujets âgés carencés

Abstract: La carence en vitamine B12 est frequente chez les personnes âgees et peut se manifester par des troubles des fonctions cognitives. Une etude prospective a ete realisee, incluant dix personnes âgees ≥ 75 ans, carencees en cobalamine (≤ 0,16 μg/L), presentant des troubles cognitifs (Mini mental state examination [MMSE] entre 10 et 25), afin d’evaluer l’effet de la supplementation orale en cobalamine sur les fonctions cognitives. Ces sujets sont traites par cyanocobalamine orale, a raison de 1 000 μg quotidiennement pendant 6 jours, puis hebdomadairement pendant 3 mois, et enfin mensuellement pendant 3 mois. Les fonctions cognitives sont evaluees avant traitement, a 3 et 6 mois. Les resultats montrent des taux de vitamine B12 augmentes de facon significative (p = 0,004) entre l’inclusion (0,12 ± 0,03 μg/L) et le 6 e mois (0,22 ± 0,15 μg/L). Une augmentation du score au MMSE a la limite de la significativite est mise en evidence a 3 mois (p = 0,06) et a 6 mois (p = 0,07), passant de 20,4 ± 2,9 a l’inclusion a 22,6 ± 3,5 a 3 mois, et a 21,9 ± 3,0 a 6 mois. Ainsi, meme si les effets de la supplementation en cobalamine sur les fonctions cognitives ne sont pas formellement demontres dans cette etude, l’hypovitaminose B12 devrait etre recherchee de principe devant l’existence de troubles cognitifs et meriterait d’etre supplementee selon les donnees actuelles de la litterature.

Effects of oral cobalamin supplementation on cognitive function in elderly persons with vitamin B12 deficiency

Abstract: Vitamin B12 deficiency is common in elderly persons and may be associated with cognitive impairment. However, evidence from trials of the effects of cobalamin supplementation on cognitive function is limited and inconclusive. We conducted an open prospective study to investigate the effects of cobalamin replacement therapy on cognitive function of older people with cognitive impairment and cobalamin deficiency. Ten patients aged ≥ 75 years with cognitive impairment (MMSE score between 10 and 25) and cobalamin deficiency (≤ 0.16 μg/L) were recruited. They were treated by vitamin B12: 1000 μg daily for 6 days, then weekly for 3 months, then monthly for 3 months. Cognitive function was assessed before treatment, 3 and 6 months later by Mini mental state examination (MMSE), verbal fluency test and Frontal assessment battery (FAB). Mean cobalamin serum levels significantly increased from 0.12 ± 0.03 μg/L at baseline to 0.22 ± 0.15 μg/L after 6 months (p = 0.004). Patients showed a statistically non-significant improvement of their mean MMSE scores; 20.4 ± 2.9, 22.6 ± 3.5 (p = 0.06) and 21.9 ± 3.0 (p = 0.07), at baseline, 3 and 6 months after treatment, respectively. Similar improvement was found in their verbal fluency and FAB scores. In spite of the trial's small number of patients, we found a nearly significant improvement in MMSE scores after 3 and 6 months of oral cobalamin supplementation. Previous studies showed that cobalamin supplementation could improve cognitive function in patients having a symptomatic mild dementia for less than 2 years. Therefore, all patients with cognitive impairment should be systematically investigated for cobalamin deficiency.

Les connectivites et la polyarthrite rhumatoïde du sujet âgé : particularités cliniques, diagnostiques et thérapeutiques

Abstract: Le lupus erythemateux systemique, la sclerodermie, les myopathies inflammatoires et la polyarthrite rhumatoide sont des connectivites caracterisees par une presentation clinique polymorphe, un diagnostic positif et differentiel souvent ardus, et une prise en charge therapeutique delicate. Ces difficultes sont particulierement accentuees chez le sujet âge du fait des particularites physiologiques liees au terrain, des comorbidites et du terrain fragilise des patients. L’objectif de cette mise au point est de passer en revue les differents aspects cliniques, diagnostiques et therapeutiques specifiques des connectivites du sujet âge.