The decrease with age of the adrenal-secreted dehydroepiandrosterone sulfate (DHEAS) in serum has suggested that it may be causally related to longevity. For the PAQUID [People (Personnes) Aged (Agé es) About What (Quid, in Latin)] cohort of elderly subjects, we have previously reported higher DHEAS in men than in women, a decrease with age and, among men, a negative correlation between the DHEAS level and mortality at 2 and 4 years. Here, with an 8-year followup in 290 subjects, we show a global decrease of 2.3% per year for men and 3.9% per year for women. However, in approximately 30% of cases, there was an increase of DHEAS. We observed no relationship between the evolution of DHEAS level and functional, psychological, and mental status, possibly because of selection by death. In women, no association was found between mortality and DHEAS level. In men, the relative risk (RR) of death was higher for the lowest levels of DHEAS (RR ‫؍‬ 1.9, P ‫؍‬ 0.007), with RR ‫؍‬ 6.5, P ‫؍‬ 0.003 for those under 70 years old, a result indicating heterogeneity of the population. There was an effect of subjective health on mortality that disappeared after adjustment of DHEAS levels, suggesting its relation with these DHEAS levels. Death RR was much higher in smokers with a low DHEAS level than in nonsmokers with high DHEAS (RR ‫؍‬ 6.7, P ‫؍‬ 0.001). We submit that the involvement of DHEAS is possibly different according to gender, that association between low DHEAS level and mortality only for men under 70 years old possibly reflects heterogeneity of the population, and that DHEAS level is a reliable predictor of death in male smokers. I n human beings, dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) are secreted adrenal steroids whose role is still poorly understood. Except in the nervous system, no receptor for those steroids has been described, and they likely operate in part by a transformation into androgens and estrogens (1-5) and probably also directly as neuroactive steroids (6). Furthermore, DHEAS concentration declines with age (7, 8) and remains 10-20% higher in men than in women (9), despite an important interindividual range.The decline of DHEAS concentrations with aging has led to the suggestion that DHEAS could play a role in itself and be implicated in longevity. Thus, DHEAS has been studied with controversial results in several processes that occur during aging (10, 11). In particular with reference to the mortality issue studied in this paper, we note that DHEAS has been inversely related to cardiovascular diseases in men (12-16), but this relation was not found in women (17).To clarify the role of DHEAS, our strategy within the PAQUID ʈ program (a prospective cohort study of elderly subjects from the southwest of France) was to relate DHEAS level with several health parameters and mortality. Among the 3,777 elderly subjects of this cohort, 622 volunteers agreed to have blood sampling after 1 year of followup. The measurement of DHEAS concentrations at this time allowed us to confirm the already known ...

Background: Knowledge of functional evolution in dementia is crucial for the patients and their families as well as the clinician. Objective: This review identifies scales and outcomes used to describe the natural history of functional decline and describes the natural history of functional decline in a representative clinical population sample of published studies of patients with Alzheimer's disease (AD). Methods: A search of three relevant databases was conducted and limited to articles published in English and French between 1998 to March 2012, using the keywords "Dementia", "Activities of Daily Living", "Instrumental Activities of Daily Living", "Functional Impairment", "Prognosis", and "Disease Progression". Results: The search strategy displayed 683 articles, 20 of which were found to be related to the functional evolution of AD. In these studies, different scales were used to describe the evolution of the functional decline, except for the decline of instrumental activities, for which the Lawton scale was used in all studies. Thus, it is difficult to represent the evolution of the functional decline from a clinical point of view. Conclusion: Relatively little data are available to estimate the functional evolution of AD. A consensus with broadened thought is required to know if the progression of the incapacities in these scales is additive or hierarchical.

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