Families caring for a patient with dementia are prone to significant physical, psychological and social stress. It is now well established that the caregiver burden does not only negatively affect ...the caregiver's physical and mental health, but is also associated with an increase in behavioural and psychiatric symptoms of dementia. Burden determinants include the quality of the relationship between the patient and caregiver; patient variables, such as the need to manage the behavioural and psychological symptoms of dementia; and also caregiver variables, such as the satisfaction of caring, demographic characteristics and societal roles. The standardised assessment of interventions for caregivers in dementia care remains a difficult task. In recent years, family interventions that focus on the process of burden itself in relation to the caregiver's subjective experience of personal growth and enrichment have been proposed. This new approach is based on the identification of tasks and challenges faced by family members throughout the different stages of the disease. In this context, brief crisis interventions transform periods of disorganisation experienced by the family into opportunities for change, whereas rehabilitation interventions developed by professional caring networks offer a continuous assessment and advice to the family. This article provides a critical review of the consequences and determinants of caregiver burden in dementia care with special reference to the emerging notion of the caregiver's subjective experience in the context of family processes.
Families caring for a patient with dementia are prone to significant physical, psychological and social stress. It is now well established that the caregiver burden does not only negatively affect ...the caregiver's physical and mental health, but is also associated with an increase in behavioural and psychiatric symptoms of dementia. Burden determinants include the quality of the relationship between the patient and caregiver; patient variables, such as the need to manage the behavioural and psychological symptoms of dementia; and also caregiver variables, such as the satisfaction of caring, demographic characteristics and societal roles. The standardised assessment of interventions for caregivers in dementia care remains a difficult task. In recent years, family interventions that focus on the process of burden itself in relation to the caregiver's subjective experience of personal growth and enrichment have been proposed. This new approach is based on the identification of tasks and challenges faced by family members throughout the different stages of the disease. In this context, brief crisis interventions transform periods of disorganisation experienced by the family into opportunities for change, whereas rehabilitation interventions developed by professional caring networks offer a continuous assessment and advice to the family. This article provides a critical review of the consequences and determinants of caregiver burden in dementia care with special reference to the emerging notion of the caregiver's subjective experience in the context of family processes.PUBLICATION ABSTRACT
Introduction Au cours des dégénérescences lobaires fronto-temporales (DFT), et en particulier dans certaines formes génétiques, la présence d’hypersignaux flair de la substance blanche il a été ...rapporté dans les zones d’atrophie. Cependant, l’incidence et la spécificité de ces anomalies ne sont pas connues. L’objectif de ce travail était d’étudier le volume et la répartition topographique des hypersignaux flair de la substance blanche dans différentes pathologies neurodégénératives et de corréler ces anomalies aux données cliniques et aux patterns d’atrophie. Matériel et méthodes Nous avons étudié 125 patients issus d’une cohorte rétrospective monocentrique, présentant un diagnostic de pathologie neurodégénérative (maladie d’Alzheimer, forme comportementale de DFT, démence sémantique, atrophie corticale postérieure, dégénérescence cortico-basale) ou de dépression. Tous les patients avaient eu une IRM cérébrale comprenant une acquisition 3DT1 et une séquence flair. Nous avons recueilli pour ces patients les données cliniques avec en particulier les facteurs de risques cardiovasculaires et le résultat des dosages des biomarqueurs de la maladie d’Alzheimer dans le liquide cérébrospinal. Le volume des hypersignaux de la substance blanche a été mesuré pour chaque patient sur la séquence flair à l’aide d’un algorithme de segmentation automatique (WHASA). Les volumes des différents lobes cérébraux ont été mesurés pour chaque patient à partir de la séquence 3DT1 par le logiciel Neuroreader (Horsens, Denmark). Résultats et conclusion Les hypersignaux flair de la substance blanche dans les régions atrophiques ne sont pas spécifiques aux DFT, ils peuvent également être observés au cours des démences sémantiques et des atrophies corticales postérieures. Il est important de connaître ces anomalies, car elles ne doivent pas être prises à tort pour des séquelles vasculaires.
Subtle cognitive impairments without dementia are common in the elderly population and numerous nosological entities have been proposed for their classification. The concept of mild cognitive ...impairment has become increasingly popular both in clinical practice and in research. It has been developed to describe a transitional zone between the cognitive changes of normal aging and early Alzheimer's disease or other forms of dementia. Its interest lies mainly in early identification of individuals who might be at risk of developing rapid cognitive decline. But the further one tends towards the early detection, the greater is the risk to lose in specificity. A number of other factors such as depression, metabolic or nutritional disorders, medication use, may cause cognitive dysfunctions and are reversible. The concept of mild cognitive impairment arouses a debate about its heterogeneity,limits, and relevance in clinical practice and research.
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