Background/Aims: To analyze the prevalence of dementia by severity and to describe the sociodemographic characteristics of people with dementia in the community, as well as the consequences of this disease in terms of disability and institutionalization. Methods: This study was based on the PAQUID community-based cohort study of 1,461 subjects aged 75 years or over. Severity of dementia was assessed using the Mini-Mental State Examination (MMSE). Results: The prevalence of dementia was estimated to be 17.8%, with about 43% at a moderately severe or more severe stage of the disease (MMSE ≤ 15). About 39% of the people with dementia lived in an institution. Among the institutionalized residents, 71.6% were diagnosed as demented. About 57% of the people with dementia were ADL disabled. In this over-75 population, people with dementia accounted for 74% of the ADL-disabled subjects. The consequences of dementia were particularly frequent among the subjects who were at least at a moderately severe stage of dementia, with 59.6% of them living in institution and 87.2% being ADL disabled. Conclusion: These results confirm the high prevalence of dementia in subjects aged over 75 and illustrate the devastating consequences of this disease in terms of disability and institutionalization.

In naive HIV-1 infected patients who start a highly active antiretroviral therapy (HAART), the relationship between time-updated CD4+ cell count, HIV RNA, and clinical progression (new AIDS-defining event or death) is incompletely understood. A 2-step statistical approach was adopted: first, modeling the evolution of the 2 markers taking into account left-censoring of HIV RNA and, second, studying their respective effect on clinical progression. The study sample consisted in 551 previously untreated patients of the Aquitaine Cohort who started their first HAART regimen between 1996 and 2000. During a median follow-up of 33 months, 46 patients experienced a new AIDS-defining diagnosis and 23 died. In multivariate survival analysis, time-updated CD4+ cell count (hazard ratio [HR] = 1.92 for 100 cells/mm3 lower, P < 10(-4) and HIV RNA (HR = 1.30 for 1 log(10) copies/mL higher, P = 0.04) on continuous scale were associated with clinical progression. When analyzing the effect of updated biomarkers using usual thresholds, the association with clinical progression was weaker for CD4+ but still significant (P = 0.007) whereas it remained only significant for updated HIV RNA above 4 log(10) copies/mL (P = 0.01). The prognostic information of updated HIV RNA adjusted on updated CD4+ is significant but depends on how the markers are taken into account. Clinical decisions and interpretation of clinical trial results must weigh the signification of each of these 2 biomarkers.

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