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Cardiovascular characteristics and cerebral CT findings in elderly subjects with psychomotor disadaptation syndrome

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Abstract

Background and aims: In previous studies, we described a clinical picture typically observed in frail old people, called “Psychomotor Disadaptation Syndrome” (PDS), but we have never studied etiopathogenic data. The aim of this study was to complete the clinical picture, record cardiovascular risk factors and provide cerebral CT scan findings in patients with PDS. Methods: 73 patients with PDS were recruited in the Geriatric Medicine departments of the University Hospitals of Dijon (Burgundy, France) and Strasbourg (Alsace, France); this group included prospectively all hospitalized patients showing postural and gait abnormalities according to the following criteria: trend towards backward falling and gait pattern alteration characterized by hesitancy in initiation, small steps, and increase in the double support durations. General characteristics, neurological and cardiovascular information were collected for each patient. For the detection of white matter changes (WMC), we used a third-generation CT scanner (GE CT HSA) evaluating a section of 7 mm at each interval of 8 mm. Results: Neurological examination showed that “reactional hypertonia” was observed in more than 90% of the patients, and that no patient showed normal reactive postural responses. Prior history of hypertension was noted in 49% of the patients, while a current antihypertensive treatment was taken by 13% of the patients. Orthostatic hypotension was observed in 44% of patients. Severe or moderate periventricular lucencies on CT scan were found in 67% of the patients, and severe ventricular enlargement in 50.5% of the patients. Conclusions: We advance that PDS might be associated with WMC, and that hypotension might be an important etiologic factor of WMC in causing reduction of the cerebral blood flow in subcortical areas.

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References

  1. Rockwood K, Hogan DB, MacKnight C. Conceptualisation and measurement of frailty in elderly people. Drugs Aging 2000; 17: 295–302.

    Article  PubMed  CAS  Google Scholar 

  2. Cohen HJ. In search of the underlying mechanisms of frailty. J Gerontol 2000; 55A: M706–8.

    Google Scholar 

  3. Nourhashémi F, Andrieu S, Gillette-Guyonnet S, Vellas B, Albarède JL, Grandjean H. Instrumental activities of daily living as a potential marker of frailty: a study of 7346 communitydwelling elderly women (the EPIDOS study). J Gerontol 2001; 56A: M448–53.

    Google Scholar 

  4. Pfitzenmeyer P, Mourey F, Tavernier-Vidal B, Camus A. Psychomotor Disadaptation Syndrome. Arch Gerontol Geriatr 1999; 28: 217–25.

    Article  PubMed  CAS  Google Scholar 

  5. Mourey F, Camus A, Tavernier B, Pfitzenmeyer P. Le syndrome de régression psychomotrice, 10 ans après. L’année gérontologique 1998; 12: 111–8.

    Google Scholar 

  6. Alexander NB. Gait disorders in older adults. J Am Geriatr Soc 1996; 44: 434–51.

    PubMed  CAS  Google Scholar 

  7. Masdeu J, Wolfson L, Lantos G, et al. Brain white-matter changes in the elderly prone to falling. Arch Neurol 1989; 46: 1292–6.

    Article  PubMed  CAS  Google Scholar 

  8. Briley DP, Wasay M, Sergent S, Thomas S. Cerebral white matter changes (leukoaraiosis), stroke, and gait disturbance. J Am Geriatr Soc 1997; 45: 1434–8.

    PubMed  CAS  Google Scholar 

  9. Camicioli R, Moore MM, Sexton G, Howieson DB, Kaye JA. Age-related brain changes associated with motor function in healthy older people. J Am Geriatr Soc 1999; 47: 330–4.

    PubMed  CAS  Google Scholar 

  10. DeCarli C, Murphy DGM, Tranh M, et al. The effect of white matter hyperintensity volume on brain structure, cognitive performance, and cerebral metabolism of glucose in 51 healthy adults. Neurology 1995; 45: 2077–84.

    Article  PubMed  CAS  Google Scholar 

  11. Schmidt R, Fazekas F, Koch M, et al. Magnetic resonance imaging cerebral abnormalities and neuropsychologic test performance in elderly hypertensive subjects. Arch Neurol 1995; 52: 905–10.

    Article  PubMed  CAS  Google Scholar 

  12. Fazekas F, Kleinert R, Offenbacher H, et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 1993; 43: 1683–9.

    Article  PubMed  CAS  Google Scholar 

  13. Chimowitz MI, Estes ML, Furlan AJ, Awad IA. Further observations on the pathology of subcortical lesions identified on magnetic resonance imaging. Arch Neurol 1992; 49: 747–52. 14. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. revised. Washington, DC: American Psychiatric Association, 1994.

    Article  PubMed  CAS  Google Scholar 

  14. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW, Cleveland MA. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185: 914–9.

    CAS  Google Scholar 

  15. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.

    CAS  Google Scholar 

  16. Consensus Statement: The definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. J Auton Nervous Syst 1996; 58: 123–4.

    Article  Google Scholar 

  17. Horak F, Henry S, Shumway-Cook A. Postural perturbations: new insights for treatment of balance disorders. Phys Ther 1997; 77: 517–33.

    PubMed  CAS  Google Scholar 

  18. Fazekas F, Chawluk JB, Alavi A, Hurting HI, Zimmerman RA. MR signal abnormalities at 1.5T in Alzheimer’s dementia and normal aging. Am J Neuroradiol 1987; 8: 416–21.

    Google Scholar 

  19. Fazekas F. Magnetic resonance signal abnormalities in asymptomatic individuals: their incidence and functional correlates. Eur Neurol 1989; 29: 164–8.

    Article  PubMed  CAS  Google Scholar 

  20. Kawamura J, Stirling Meyer J, Terayama Y, Weathers S. Leukoaraiosis correlates with cerebral hypoperfusion in vascular dementia. Stroke 1991; 22: 609–14.

    Article  PubMed  CAS  Google Scholar 

  21. Kobari M, Stirling Meyer J, Ichijo M. Leukoaraiosis, cerebral atrophy, and cerebral perfusion in normal aging. Arch Neurol 1990; 47: 161–5.

    Article  PubMed  CAS  Google Scholar 

  22. George AE, de Leon MJ, Gentes CI, et al. Leukoencephalopathy in normal and pathologie aging: 1. CT of brain lucencies. AJNR 1986; 7: 561–6.

    CAS  Google Scholar 

  23. Guo X, Skoog I, Matousek M, et al. A population-based study on motor performance and white matter lesions in older women. J Am Geriatr Soc 2000; 48: 967–70.

    PubMed  CAS  Google Scholar 

  24. Inzitari D, Carlucci G, Pantoni L. White matter changes: the clinical consequences in the aging population. J Neural Transm (Suppl.) 2000; 59: 1–8.

    CAS  Google Scholar 

  25. Kerber KA, Enrietto JA, Jacobson BA, Baloh RW. Disequilibrium in older people: a prospective study. Neurology 1998; 51: 574–80.

    Article  PubMed  CAS  Google Scholar 

  26. Whitman GT, DiPatre PL, Lopez IA, et al. Neuropatholgy in older people with disequilibrium of unknown cause. Neurology 1999; 53: 375–82.

    Article  PubMed  CAS  Google Scholar 

  27. Hendrie HC, Farlow MR, Austrom MG, Edward MK, Williams MA. Foci of increased T2 signal intensity on brain MR scans of healthy elderly subjects. Am J Neuroradiol 1989; 10: 703–7.

    PubMed  CAS  Google Scholar 

  28. London E, de Leon MJ, George AE, Englund E, Ferris S, Reisberg B. Periventricular lucencies in the CT scans of aged and demented patients. Biol Psychiatry 1986; 21: 960–2.

    Article  PubMed  CAS  Google Scholar 

  29. Cadelo M, Inzitari D, Pracucci G, Maschalchi M. Predictors of leukoaraiosis in elderly neurological patients. Cerebrovasc Dis 1991; 1: 345–51.

    Article  Google Scholar 

  30. Curran T, Lang AE. Parkinsonian syndromes associated with hydrocephalus: case reports, a review of the literature, and pathophysiological hypotheses. Mood Disord 1994; 9: 508–20.

    Article  CAS  Google Scholar 

  31. Baloh RW, Yue Q, Socotch TM, Jacobson KM. White matter lesions and disequilibrium in older people. Arch Neurol 1995; 52: 970–4.

    Article  PubMed  CAS  Google Scholar 

  32. Pantoni L, Garcia JH. Pathogenesis of leukoaraiosis: a review. Stroke 1997; 28: 652–9.

    Article  PubMed  CAS  Google Scholar 

  33. Breteler MMB, van Swieten JC, Bots ML, et al. Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study: the Rotterdam study. Neurology 1994; 44: 1246–52.

    Article  PubMed  CAS  Google Scholar 

  34. Bonanno MR, Russo MS, Leonardo M, et al. Leukoaraiosis, cognitively and affectively in elderly patients: on the lack of correlation between neurodiagnostic and psychometric findings. Arch Gerontol Geriatr 2000; 30: 101–8.

    Article  PubMed  CAS  Google Scholar 

  35. Gersh BJ. Epidemiology of atrial fibrillation and atrial flutter. In DiMarco JP, Prystowsky EN, Eds. Atrial arrhythmias: state of the art. New York: Armonk: Futura Publishing Company, 1996: 1–22.

    Google Scholar 

  36. Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J 1991; 121: 951–7.

    Article  PubMed  CAS  Google Scholar 

  37. Rautaharju PM, Manolio TA, Furberg CD, et al. Ischémic episodes in 24-h ambulatory electrocardiograms of elderly persons: The Cardiovascular Health Study. Int J Cardiol 1995; 51: 165–75.

    Article  PubMed  CAS  Google Scholar 

  38. Bulpitt C, Fletcher A, Amery A, et al. The Hypertension in the Very Elderly Trial (HYVET). J Hum Hypertens 1994; 8: 631–2.

    PubMed  CAS  Google Scholar 

  39. Harris MJ. Undiagnosed NIDDM: clinical and public health issues. Diabetes Care 1993; 16: 642–52.

    PubMed  CAS  Google Scholar 

  40. Vanhanen H, Thijs L, Birkenhäger W, et al. Prevalence and persistency of orthostatic blood pressure fall in older patients with isolated systolic hypertension. J Hum Hypertens 1996; 10: 607–12.

    PubMed  CAS  Google Scholar 

  41. Hatazawa J, Shimosegawa E, Satoh T, Toyoshima H, Okudera T. Subcortical hypoperfusion associated with asymptomatic white matter lesions on magnetic resonance imaging. Stroke 1997; 28: 1944–7.

    Article  PubMed  CAS  Google Scholar 

  42. Matssushita K, Kuriyama Y, Nagatsuka K, Nakurama M, Sawada T, Omae T. Periventricular white matter lucency and cerebral blood flow autoregulation in hypertensives patients. Hypertension 1994; 23: 565–8.

    Article  Google Scholar 

  43. De Leeuw FE, de Groot JC, Oudkerk M, et al. Aortic atherosclerosis at middle age predicts cerebral white matter lesions in the elderly. Stroke 2000; 31: 425–9.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Service de Médecine Gériatrique, Centre Hospitalier Régional et Université de Dijon, Dijon

    Pierre Pfitzenmeyer M.D., France Mourey & Christelle Mischis-Troussard

  2. Service de Médecine Interne-Gériatrie, Centre Hospitalier Régional et Université de Strasbourg, Strasbourg

    Catherine Martin-Hunyadi

  3. Service de Biostatistique et d’Informatique Médicale, Centre Hospitalier Régional et Université de Dijon, Dijon

    Philippe d’Athis

  4. Service d’Imagerie Médicale, Centre Hospitalier Régional et Université de Dijon, Dijon, France

    Nathalie Baudouin

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  1. Pierre Pfitzenmeyer M.D.
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  2. Catherine Martin-Hunyadi
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Correspondence to Pierre Pfitzenmeyer M.D..

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Pfitzenmeyer, P., Martin-Hunyadi, C., Mourey, F. et al. Cardiovascular characteristics and cerebral CT findings in elderly subjects with psychomotor disadaptation syndrome. Aging Clin Exp Res 14, 100–107 (2002). https://doi.org/10.1007/BF03324423

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  • DOI: https://doi.org/10.1007/BF03324423

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