Innovations : de la recherche fondamentale à la clinique du comportement R.David E Mulin C M2R Nice, 7 Mai 2010
Troubles comportementaux Outils d évaluation actuels La recherche
A longitudinal observational study of 1385 AD patients 60 50 40 % 30 20 10 0 Delusions Hallucinations Sleep Agitation Disinhibition Irritability Aberrant motor behavior Elation/Euphoria Depression Anxiety Apathy Appetite Reynish et al., Neuroepidemiology, 2007 ; Robert et al., JNHA 2007
Troubles comportementaux Outils d évaluation actuels La recherche
Evaluation des SPCD -Echelles Aujourd hui -Jugement du clinicien FUTURE? NOUVELLES TECHNOLOGIES
Echelles d évaluation Scale Neuropsychiatric Inventory (NPI [5]) Brief descrip.on 12 domains, consis-ng of 7 to 9 items within each domain, based on caregiver interview. Frequency and severity over the past month are rated. This scale has limited data regarding responsiveness to change Brief Psychiatric Ra;ng Scale (BPRS [39]) This scale, originally developed to evaluate response to pharmacologic treatment in psychiatric disorders [40], is a 16- item rated on severity assessment method administered to pa-ent. It shows limited u-lity as an outcome measurement scale in drugs trial for AD [3]. AD Assessment Scale- non cogni;ve (ADAS- noncog [41]) This 10- item scale, developed to measure change in AD pa-ents following pharmacologic treatment, doesn t include all behavioral symptoms that can be observed in AD and doesn t appear to be the most appropriate tool to assess accurately behavioral change in clinical trials Behavioral Pathology in AD Ra;ng Scale (BEHAVE- AD [42]) This 26- item scale, based on caregiver interview, is more specific for psycho-c disorders of demented pa-ents and was designed for pharmacologic trials [42, 43]. Rela;ve s Assessment of Global Symptomatology (RAGS [44]) This is a 21- item self administered scale for psychiatric and behavioral symptoms of community dwelling elderly Consor;um to Establish a Registry for AD behavior Ra;ng Scale for Demen;a (C- BRSD) This scale, based on caregiver interview, is designed to assess severity of behavior over the past month (46- or 48- items) [45]. Demen;a Behavior Disturbance Scale (DBD [46]) This 28- item scale, rated by caregiver on frequency over the past week David et al., pharmaceuticals, 2010
Inventaire Neuropsychiatrique - NPI 1 IDEES DELIRANTES 2 HALLUCINATIONS 3 AGITATION / AGRESSIVITE 4 DEPRESSION / DYSPHORIE 5 ANXIETE 6 EXALTATION DE L HUMEUR / EUPHORIE 7 APATHIE / INDIFFERENCE 8 DESINHIBITION 9 IRRITABILITE / INSTABILITE DE L HUMEUR 10 COMPORTEMENT MOTEUR ABERRANT 11 SOMMEIL 12 APPETIT Cummings et al., Neurology, 1994
Version modifiée NPI-C Réalisée à partir revue de 18 échelles existantes Inclut : Nouveaux items 2 Nouveaux domaines Cotation faite par : Accompagnant, Clinicien, Patient Chaque item est coté dans le domaine, afin d évaluer si ce mode de cotation donne plus d infos pour les essais cliniques De Medeiros et al., Int Psychogeriatrics, 2009
Limites outils actuels Peu reproductible peu quantifiable Variabilité inter-cotateur subjectif
Troubles comportementaux Outils d évaluation actuels La recherche
Actigraphie et sommeil, 75 ans MMSE=30
, 77 ans DTA MMSE= 11
Actigraphie et depression Mean half-hour motor activity counts for the 24-h period (from 06:00 h to 06:00 h) of depressed patients before and after treatment with imipramine. Volkers et al., European Neuropsychopharmacology, 2002
Actigraphie et agitation Mahlberg et al., Arch Gerontol and Geriatrics, 2007
Actigraphie et apathie ** David et al., Dementia, in press
Capteurs infra-rouge -Report of activities in the room and duration -89% of the sequences were correctly recognized, in comparison wiith manual analysis -Able to classify all major movements in the room Banerjee et al., Telesurveillance of elderly patients by use of passive infra-red sensors in a smart room. J Telemed Telecare 2003;9:23-9.
Reconnaissance vidéo d évènements Gerhome
Conclusions Apport des nouvelles technologies dans l évaluation des troubles du comportement Dans l évaluation des activités de la vie quotidienne (orientées vers un but) Diversification des sites d expérimentation
Remerciements