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Master Thesis

Diagnostic et caractérisation de la démence dans une cohorte de patients schizophrènes d'âge moyen

Abstract : a Cognitive dysfunction is a well-known feature of schizophrenia. Its evolution during aging has been studied with heterogeneous methods. Cognitive decline could be more frequent in middle-aged or older schizophrenic patients than in the general population. Although numerous studies have assessed cognitive dysfunctions in patients with schizophrenia, very few have focused on the diagnosis of dementia. The different types and causes of dementias remain poorly studied in this context. The objectives of this study were to accurately diagnose dementia in a cohort of middle-aged schizophrenic patients, and to assess the type of dementia. Methods: ninety-six schizophrenic patients (46 inpatients and 50 outpatients), aged 50 to 70 years, underwent a psychiatric, neurological, and neuropsychological evaluation at baseline and after a 20-month follow-up. We established a 3-step procedure: (1) diagnose dementia: according to the DSM-IV criteria, dementia was diagnosed in patients showing Mattis Dementia Rating Scale and Activities of Daily Living scores declining between the two evaluations. (2) characterize dementia: this step was addressed using brain imaging, brain perfusion by 99mTc-ECD-SPECT and laboratory tests including Alzheimer disease cerebrospinal fluid biomarkers. (3) search for genetic determinants specific genetic analyses adapted to the type of dementia were performed. Results: Fourteen patients were diagnosed with dementia. Four were diagnosed with behavioral-variant frontotemporal dementia (bvFTD: three probable, one possible), two with probable Alzheimer disease (including one with anAPOE44, genotype), two with probable vascular dementia, including one due to Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), and one with CNS inflammatory disease. Discussion and conclusion: The diagnosis of dementia in middle-aged schizophrenic patients is challenging but possible, using a multistep procedure. Several cases are likely incidental findings, as with Alzheimer disease associated with APOE44 genotype, or CADASIL. Vascular dementia due to vascular risk factors could be related to the course of schizophrenia or to its treatment. CNS inflammatory disease could be causal for both schizophrenia and dementia. The most frequent condition, bvF'TD, could reflect the presence of an evolutive neurodegenerative process in some schizophrenic patients.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-00758418
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Submitted on : Wednesday, November 28, 2012 - 4:53:57 PM
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  • HAL Id : dumas-00758418, version 1

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Gaël Nicolas. Diagnostic et caractérisation de la démence dans une cohorte de patients schizophrènes d'âge moyen. Médecine humaine et pathologie. 2012. ⟨dumas-00758418⟩

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