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Master Thesis

Étiologies et caractéristiques cliniques des troubles neurocognitifs majeurs compliquant les pathologies bipolaires : étude d’une cohorte rétrospective mono centrique de 31 patients

Abstract : We present the results of a monocentric retrospective study of 62 patients with bipolar disorder referred by their psychiatrist for suspected major neurocognitive disorder conducted at the Institut des Maladies Neurodégénératives de Bordeaux between january 2015 and april 2019. Out of 62 patients, 31 had a major neurocognitive disorder after a median follow-up of 2 years, 27 patients had a minor neurocognitive disorder, and 4 patients had no cognitive impairment. Among the 31 patients, 15 had dementia criteria whose etiologies were: 5 probable or possible Alzheimer's diseases (AD), 2 mixed dementias, 2 vascular parkinsonians, 1 Parkinson's disease dementia, 4 Lewy body dementias and 1 fronto temporal dementia. Sixteen patients remained undiagnosed. The existence of behavioural disorder, temporo-spatial disorientation, apathy, extrapyramidal syndrome and anosognosia were significantly associated with dementia, with no difference between known dementias and dementias without etiology. Dementia patients without diagnosis had a dysexecutive profile, MMS around 23 (4-30), but a significant functional dependency and a loss of autonomy in the foreground . The paraclinical assessment did not find any abnormalities in the biomarkers of AD, but showed diffuse atrophy and mild leukopathy in cerebral MRI. PET scans revealed diffuse temporal hypometabolisms associated with either frontal or parietal hypometabolism. Dementia patients without etiological diagnosis were significantly more likely to be bipolar type 1 (31%) with disabling bipolar disease (37%), neuroleptic (87.5%) and/or anticholinergic (93.7%). Course of neurocognitive disorders showed relatively stable MMS , but a degraded functional autonomy. Patients with bipolar disorders who develop major cognitive disorders with atypical presentations, but with common characteristics, may present neurodegradation secondary to bipolar disorder whose underlying pathophysiologies are still unknown.
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Chloé Grégoire. Étiologies et caractéristiques cliniques des troubles neurocognitifs majeurs compliquant les pathologies bipolaires : étude d’une cohorte rétrospective mono centrique de 31 patients. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02492732⟩

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