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Facteurs pronostiques de patients atteints de démence suivis en centre mémoire de ressource et de recherche : exemple d'utilisation de bases de données médicales à des fins de recherche clinique

Abstract : Dementia is a major public health problem. Prognostic factors of dementia will condition progression of cognitive and executive functions, institutionalisation and survival. When these factors are modifiable, improvement of their knowledge can help implementing actions to reduce the cognitive decline or improve survival. Studies allowing their analysis must be conducted on patients and are part of clinical research. While not always designed for research purpose, medical databases are increasingly being used for research.
The objective of this work is to discuss advantages and limitations in the use of medical databases for research purposes in the clinical study of prognostic factors of dementia. For this, we used the medical database of patients with dementia, followed in the memory centre of Lille – Bailleul.
We confirmed that patients with Alzheimer's disease with a high level of education had a higher cognitive decline, but a similar mortality, compared to the low levels of education. We have described a cognitive decline significantly different, but a similar mortality between Alzheimer's disease, mixed dementia ('MA with CVD') and vascular dementia, patients with 'MA with CVD' having an intermediate decline compared to others. We showed that the risk of developing vascular or mixed dementia increased significantly with the number of subcortical hyperintensities in patients with mild cognitive impairment. This work highlights in particular the difficulty to establish the diagnosis of mixed dementia, the complexity of the analysis of the decline in cognitive functions (taking into account the progression of dementia, lack of monitoring instrument of the cognitive functions both simple to use and sensitive to small changes over time or non-linear decline in cognitive functions), the advantages in terms of cost and time of the use of medical databases, and the selection problems of the population referred to a tertiary care centre.
This work shows the interest for clinical research to use medical data on dementia patients cared in a tertiary care centre. Thus, despite problems of population representativity, populations studied from medical databases do represent the one clinicians are interested in.
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https://tel.archives-ouvertes.fr/tel-00336252
Contributor : Amelie Bruandet <>
Submitted on : Monday, November 3, 2008 - 12:21:12 PM
Last modification on : Friday, October 23, 2020 - 4:36:41 PM
Long-term archiving on: : Monday, June 7, 2010 - 8:09:40 PM

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Amelie Bruandet. Facteurs pronostiques de patients atteints de démence suivis en centre mémoire de ressource et de recherche : exemple d'utilisation de bases de données médicales à des fins de recherche clinique. Sciences du Vivant [q-bio]. Université du Droit et de la Santé - Lille II, 2008. Français. ⟨tel-00336252⟩

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