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Prise en charge des complications de la maladie d’Alzheimer: mise au point

Improvement of care-provision with respect to complications of Alzheimer’s disease

  • Thérapeutique / Therapeutics
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Résumé

Les complications de la maladie d’Alzheimer, parmi lesquelles les symptômes psychocomportementaux (SPCD), la perte de poids, les troubles de la mobilité et la perte d’autonomie fonctionnelle, sont responsables d’une altération de la qualité de vie du patient. Les SPCD représentent la principale complication de la maladie. Il est important de les dépister, de les prévenir et de les traiter précocement. Leur prise en charge doit comprendre, en première intention, les mesures non pharmacologiques associées ou non aux mesures pharmacologiques. La perte de poids, quant à elle, est associée à une augmentation du risque d’hospitalisation et d’entrée en institution. Elle pourra être surveillée par le suivi de la courbe pondérale et le MNA. Les troubles de la mobilité, responsables de chutes et les symptômes moteurs sont également les complications fréquemment rencontrées. Enfin, l’épuisement de l’aidant doit évidemment être considéré comme une conséquence de la maladie et un élément important de sa prise en charge. Ces complications et leur conséquences doivent être identifiées et, dans la mesure du possible, évitées grâce à un plan de soin d’aide et de suivi spécifique.

Abstract

Complications in Alzheimer’s disease such as functional decline, weight loss, gait and balance disturbances and behavioral and psychological symptoms in dementia (BPSD) have a negative impact on quality of life. It is therefore important to identify these complications at an early stage. BPSD are major features of Alzheimer’s disease and related disorders. They represent half of admissions to special care units with, in order of frequency, agitation and agressivity. The non pharmacological approach must be implemented first and linked to a pharmacological approach. Weight loss is of complex physiopathology. It can be monitored by observation of the weight curve and use of the Mini Nutritional Assessment (MNA). Weight loss may be responsible for an increased risk of institutionalization and mortality. Gait and balance disturbances are also a prevalent complication of the illness and lead to an increased risk of falls and injuries. Neurological complications take the form of seizures and motor symptoms. Amongst these complications the burden of the caregiver must also be assessed. These complications and their consequences must be identified and, wherever possible, prevented with a specific care plan.

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Authors and Affiliations

  1. Service de médecine interne et gérontologie clinique, CHU Purpan-Casselardit, place du Docteur-Baylac, F-31059, Toulouse cedex 09, France

    H. Villars, M. -E. Soto, F. Nourhashemi, C. Arbus, C. Hein, A. -S. Gillioz & B. Vellas

  2. Unité Inserm 558, faculté de médecine de Toulose, 37, allées Jules-Guesde, F-31073, Toulouse cedex, France

    F. Nourhashemi & B. Vellas

  3. Centre mémoire de ressources et de recherche, hôpital Pasteur, 30, avenue de la Voie-Romaine, F-06002, Nice, France

    M. Benoît

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  1. H. Villars
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Villars, H., Soto, M.E., Nourhashemi, F. et al. Prise en charge des complications de la maladie d’Alzheimer: mise au point. Psychiatr Sci Hum Neurosci 6, 91–98 (2008). https://doi.org/10.1007/s11836-008-0061-3

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