Gilles Ivaldi
email: gilles.ivaldi@unice.fr

A new course for the French radical-right? The Front National and

This chapter examines the FN in the current French party system. It looks at the extent to which 'dedemonization' has changed the party's strategic and programmatic profile. We ask whether these changes have affected the status of the party across three main aspects as political outsider, niche and radical party, and consider the internal and external stimuli for party modernization. We conclude that, despite the moderation of its rhetoric and the softer packaging of its policies, the FN has not yet shed its populist radical right profile, and that de-demonization is primarily a vote-maximizing strategy. De-demonization is increasingly putting the cordon sanitaire under pressure however, creating new competitive opportunities for the FN.

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This chapter looks at the extent to which 'de-demonization' has altered the party's strategic and programmatic profile. We assess changes in the status of the FN across three main aspects as political outsider, niche and radical party, which all represent strategic features of the populist radical right family. We then look at stimuli for party modernization, both internal and external, and the factors which have induced the new FN trajectory after 2002. We conclude that the party has not yet shed its populist radical right profile despite the moderation of its rhetoric and the softer packaging of its policies, and that de-demonization is primarily a vote-maximizing strategy.

Aspects of party change

This first section looks at the strategic and programmatic changes embedded in 'dedemonization'. It asks whether the FN has become more 'mainstream' over time. Changes are evaluated across three main aspects of niche, radical and outsider party.

For over four decades, the French Front National (FN) has epitomized the populist radical right party in Western Europe (Mudde, 2007: 41). According to [START_REF] Rydgren | Is Extreme Right-Wing Populism Contagious? Explaining the Emergence of a New Party Family[END_REF], the FN has pioneered a new potent 'master frame' combining ethno-nationalist xenophobia with anti-political-establishment populism, which has shaped political mobilization by the European PRR during the 1980s. The electoral development of the FN has been associated with the mobilization of a specific set of issues alongside the 'cultural' dimension of competition [START_REF] Kitschelt | Radical Right in Western Europe. A Comparative Analysis[END_REF]. The FN's focus on immigration and crime has created a niche in the electoral arena, galvanizing radical right voters since the mid-1980s [START_REF] Perrineau | Where do radical right parties stand? Position blurring in multidimensional competition[END_REF]. The FN represents also the archetypal 'political pariah' secluded behind the cordon sanitaire because of its historical legacy of French far right extremism.

Since Marine Le Pen's accession in 2011, however, the FN has claimed to break away from its extreme right status. Changes in the party's strategic and programmatic profile have been embedded in the rhetoric of 'dédiabolisation' (de-demonization). Party normalization emerged immediately after the 2002 presidential election and has been central ever since to the new course set by Marine Le Pen for her party1 . The recent electoral rejuvenation of the FN suggests that de-demonization has allowed the radical right to broaden its support base, setting new historical records in the 2012 presidential and 2014 European elections with 17.9 and 24.9 per cent of the vote, respectively.

Niche

RRPPs parties have emerged as 'niche' parties in West European party systems. According to [START_REF] Meguid | Competition between Unequals: Strategies and Electoral Fortunes in Western Europe[END_REF], niche parties are distinguished from the mainstream by the emphasis they put on certain issues which are neglected by their more established competitors. RRPPs parties compete primarily on a set of cultural issues such as immigration and crime, and they tend on the other hand to 'de-emphasize' economic matters (Rovny 2013).

Whether RRPPs are shedding their niche profile can be measured by the salience they attach to various policy domains. Changes in the salience profile of the FN are examined using the Comparative Manifesto Project (CMP) data for France2 . CMP data provide party specific measures of the relative salience of political issues in party platforms across time (Budge et al. 2001). To assess the niche status of the FN, we measure the deviation from the mean salience of the social-economic and socio-cultural policy domains 3 . According to Meyer and Wagner (2013), a party de/emphasizes an issue more than its competitors if its salience is at least one standard deviation below/above the mean party system salience4 . The economic and sociocultural salience profiles of the FN relative to the other actors in the French party system are summarized in Figure 1. The data reveal that the FN has indeed broadened its programme over time to include a larger set of socio-economic issues. The latter made up 38 per cent of its 2012 manifesto as opposed to 15 per cent in the mid-1990s. Simultaneously, there has been a decrease in socio-cultural salience from 44 down to 24 per cent since 1997. A brief glance at the structure of the 2012 presidential platform confirms this shift in issue emphasis, with household income, the Euro, employment, public debt, pensions and taxes coming before traditional issues of immigration and law-and-order.

In party system terms, the FN continues to differentiate its policy agenda from other competitors on the socio-cultural dimension, while simultaneously pursuing mainstream strategies on socio-economic issues. In 2012, the FN maintained a distinctive niche status on socio-cultural issues compared with the other French parties, with a difference to the mean of about two standard deviations. On economic issues, on the other hand, the party has adopted a more mainstream profile -with a difference in salience smaller than the standard deviation in the French party system-which suggests a move towards officeseeking strategies.

These results corroborate the 'valence' agenda pushed by Marine Le Pen to profile her party as a more credible party of government. Economic issues were already prioritized in the 2007 election5 and party 'technocratization' has been central ever since to Marine Le Pen's agenda of normalization. The greater emphasis put on economic credibility was revealed for instance by the appointment of a former high ranking administrative civil servant, Florian Philippot, as strategic campaign director in October 2011. During the presidential campaign, the FN made every effort to present a credible costing for its socio-economic programme, while simultaneously seeking expert advice on its plan to shed the Euro. Despite significant changes in salience profile, however, the FN has not yet shifted from niche to mainstream status. As public demand for anti-immigration policies grows, there are strong vote-seeking incentives for the FN to maintain its distinctive focus on sociocultural issues. In 2012, the two most important issues reported by Le Pen's supporters were immigration (77 per cent) and crime (54 per cent) (IPSOS-Fiducial exit-poll survey, 22 April 2012). French voters are now even more concerned about immigration, national identity or crime. Polls show high levels of public opinion support for the FN's cultural views (see Table 1 below). The vast majority of the French hold negative opinions of Islam and adhere to the FN's claim that there are too many foreigners in the country. In contrast, the party's economic strategy lacks credibility and is met with strong public skepticism. Claims by the party that it is preparing itself to assume power hardly conceal the flaws in its economic programme and the uncertainty regarding its Euro-exit platform which is rejected by the vast majority of French voters. Looking at the FN's platforms since the mid-1980s, [START_REF] Ivaldi | A new radical right economic agenda? The transformation of the Front National in France[END_REF] suggests also that the party has shifted to the left on the economic axis of competition, endorsing a new domestic economic agenda of state intervention, government spending and public services expansion, while simultaneously accentuating economic nationalism and anti-globalization.

Radical

The French FN epitomizes the populist radical right, which according to [START_REF] Mudde | Populist Radical Right Parties in Europe[END_REF] combines nativism, authoritarianism and populism. Nativism is defined as "an ideology, which holds that states should be inhabited exclusively by members of the native group ('the nation') and that nonnative elements (persons and ideas) are fundamentally threatening to the homogenous nation" (p.19). Nativism is core to the ideological profile of RRPPs and implies welfare chauvinist, ethno-differentialist and Eurosceptic policies. Authoritarianism refers to "the belief in a strictly ordered society, in which infringements of authority are to be punished severely" (p.23). Finally, populism is defined as "a thincentred ideology that considers society to be ultimately separated into two homogeneous and antagonistic groups, 'the pure people' versus 'the corrupt elite'. It argues that politics should be an expression of the volonté générale, i.e. the general will of the people (Mudde 2004).

To what extent has the new political marketing of 'de-demonization' altered the nativist, authoritarian and populist beliefs of the FN? In this section, we examine the content of FN presidential manifestos from 2002 to 2012. Party programmes are analyzed exhaustively in order to extract all policy pledges that form part of the FN's radical agenda, reflecting changes in the specific policy commitments made by the party over time. Although nativist, authoritarian and populist policies are radical 'in essence', they may vary however according to their formulation and the degree to which they challenge constitutional rules or universalist values. Pledges are therefore coded on a 3-point scale to differentiate between extreme (+1), moderate (+.5) and status quo (0) positions. They are then assigned to one of the following categories -nativism, authoritarianism or populism. To improve coding consistency, a unique ID is attributed to each individual policy pledge, which allows also to trace changes in specific issue positions over time.

Let us note here that no liberal, cosmopolitarian or progressive positions were found that would require to consider opposite scores such as those used by Akkerman (2012).

Pledges to maintain the existing status quo were also almost inexistent. The use of unique policy pledge IDs over time allows to track changes in the policy profile of the FN. We distinguish between three main groups of policies. A first group concerns the stable radical right core of the FN. It consists of a total of 59 policies that can be found across the whole 2002-2012 period6 . More than half (54.2 per cent) of those are nativist policies, while authoritarian and populist policies account for another quarter (25.4) and fifth (20.3), respectively. This stable radical right core includes some of the FN's historical policies such as the repatriation of all illegal immigrants and foreign offenders, the end of legal immigration, a drastic reduction in asylum, national preference, opposition to the building of mosques, death penalty and a more severe punishment for offenders and criminals including minors aged 13+, the suppression of family reunion rights for migrants, more powers to the police, the fight against "anti-French racism", an exit from Schengen and ultimately from the EU, a call for discipline and authority in schools, the fight against trade union monopolies and against the politicization of civil servants, or the greater use of the referendum and proportional representation. All policies in this first group exhibit stability in their goals and show also little variation with regards to their degree of 'extremeness': cases where the FN has adopted a more moderate position in 2012 compared with ten years earlier represent about a fifth (22 per cent) of all 59 policies in this stable radical right group, the most notable change being the party's official position now acknowledging abortion rights.

The second group refers to new radical right policies which have emerged in the 2012 party's manifesto and which can be regarded as representative of Marine Le Pen's modernization agenda. This second group has a total of 21 policy pledges of which more than half (57.1 per cent) have a focus on law-and-order issues -in particular repression against violent behavior in schools, more rights for victims in courts, citizen supervision of criminal trials or the suppression of social welfare for repeat offenders. Another third (33.3 per cent) concern nativist policies, mostly articulated around the new secular agenda and the fight against "communautarisme", as well as anti-immigration measures such as a legal ban on undocumented migrant regularization.

The third group contains the FN's old radical right policies abandoned after 2002. In about half (48.9 per cent) of the cases, these concern nativist policies, in particular proposals such as national preference in company layoffs, the dismantling of emergency homes for migrants, sanitary controls at France's borders to fight AIDS, a safety deposit for tourists, the control of naturalization of migrants by municipal councils, extended powers to the police to check migrants or a compulsory medical examination for visa applicants. For another third (34 per cent), these old policies refer to law-and-order issues such as police checks in schools, forced labor camps for offenders and criminals, or restoring high-security quarters in prisons. With regards to the degree of extremeness, it must be noted than this third group shows no statistically significant differences with policies in the former two groups i.e. the stable radical right core and the more recent policies adopted in 2012.

These results suggest that the FN has somewhat de-radicalized over the past ten years.

The party has shed a number of its former extreme nativist and authoritarian policies 7 while simultaneously moderating its social conservative views on issues such as abortion or civil union 8 . From 2007 onwards, the FN has shown a strategic reformulation of its ethnopluralist platform, downplaying national identity issues 9 to focus on the alleged stand-off between Islam and liberal democracy. The 2012 campaign referred to the socalled threats of 'islamization' and 'green fascism' in French society. To evade accusations of racism or xenophobia, the party has endorsed the secular values that are pivotal to the French Republican model of immigrant integration 10 . Finally, other significant behavioral changes include the shedding of anti-Semitism and Holocaust 7 In 2002, the Pour un avenir français presidential programme prioritized the ethno-differentialist arguments laid out in Mégret's 50 propositions on immigration in 1991. Immigration was depicted as a 'deadly threat to France's identity' that 'profoundly alters the very substance of the French people', while the party pledged to 'halt the islamization of France'. 8 Together with Marine Le Pen's personality, this sidelining of traditional and religious issues has helped the party overcome the gender gap inherent in PRR male chauvinistic politics (Mayer 2013). 9 Quite remarkably, the terms 'national identity' would appear only once in 2007, and would be found in the chapter dedicated by the FN to the environment. The party would also limit itself to pointing out the risk of Islamic terrorism for national security and French laicity. Other possibly disorientating policy moves included for instance the release in December 2006 of electoral posters portraying a young black woman wearing low-waisted jeans and a piercing. 10 Such evolution was not entirely novel to the FN. A similar line had temporarily surfaced in the 1999 European elections, in intra-party controversy over 'multi-denominational France'. This realpolitik of immigration and multiculturalism had been abandoned however as the FN confronted ideological competition from the neo-racist islamophobic platform of splinter MNR.

denial which were customary of Jean-Marie Le Pen in the past, without formally condemning such statements. However effective in terms of political marketing, the new policy 'packaging' should not conceal the persistence of a substantial and stable nativist, authoritarian and populist ideology characteristic of the radical right. Moreover, the recent cultural policies adopted by the FN in 2012 show no significant departure from the more established radical right core.

Outsider

Anti-establishment populism is a strategic feature of the PRR. According to [START_REF] Schedler | Anti-Political-Establishment Parties[END_REF], anti-political-establishment parties symbolically construct a double conflict contraposing the political elite against citizens and against themselves. For over four decades, the French FN has operated on this form of radical opposition to the system, vilipending 'decadent' and 'corrupt' elites, opposing the 'gang of four' in reference to the parties of the mainstream, while simultaneously claiming to speak for the ordinary people. The FN represents also the archetypical 'outsider' party, kept out of mainstream politics by the cordon sanitaire, and often being no more than an electoral nuisance for other parties. The FN has never achieved coalition potential at national level and only on rare occasions it has shared power in local or regional governments.

De-demonization aims to shed the FN's pariah status in order to get more public legitimacy and augment its electoral appeal. During most of the 1990s and early 2000s, as a result of its ostracization by the RPR/UDF cartel, the FN pursued mainly adversarial strategies vis-à-vis the mainstream right, although it managed to forge tactical regional alliances in 1998. The party's 'neither left nor right' strategy was epitomized in the 1997 and 2002 elections, which demonstrated also its nuisance against both camps. In 2007, Le Pen only temporarily toned down the FN's traditional anti-political-establishment rhetoric, claiming to be 'centre-right' and explicitly calling for co-operation with Sarkozy's right. In 2012, the party returned to its role as political nuisance. Le Pen's strong anti-UMP campaign had a significant impact, depriving Sarkozy of the votes needed to defeat Hollande in the presidential runoff11 .

Since Marine Le Pen's accession to power, the party has returned to the 'two-tier' competitive strategy that had been briefly endorsed by the party in the late 1990s, and which is characterized by the dominance of anti-political-establishment populism [START_REF] Ivaldi | The Front national vis-à-vis power in France: factors of political isolation and performance assessment of the Extreme Right in municipal office[END_REF]. At national level, the FN persists in its violent attacks against mainstream parties and the so-called 'UMPS caste' 12 . The party claims to represent a third competitive bloc and a political alternative to France's two-bloc polity, while simultaneously ruling out cooperation with other actors in the system. The FN opposes also the existing political status quo -as revealed for instance in its opposition to European integration, while challenging the fundamental pluralist principles. The anti-liberal culture of the FN is exemplified by its critique of intermediary bodies, constitutional courts, checks and balances, parliamentarianism or trade unions. At sub-national level, on the other hand, the FN seeks political désenclavement. It has adopted a more conciliatory approach in the 2012 legislatives, calling for local pacts with the UMP, a position which was reiterated in its 2014 municipal election charter. Vertical differentiation of the party's competitive strategies is corroborated also by the variation in its policy platforms. In the 2014 municipals, the FN has adopted a right-wing agenda combining anti-immigration, lawand-order with tax cuts and the fight against local bureaucracy, which contrasted with its more leftist and statist positions in the national arena.

Significant changes have occurred in the FN's political environment. The electoral revival and softening of the FN's image are certainly putting the cordon sanitaire under strain. Since 2002, the UMP has maintained a strict demarcation from the FN, repeatedly reiterating its exclusionary stance vis-à-vis the radical right. In 2012, however, Sarkozy pushed the political legitimation of the FN one step further by acknowledging the 'democratic nature' of Marine Le Pen's party and its 'compatibility with Republican values'. Recent years have also seen the deterioration of the Front Républicain13 after the mainstream right has adopted a 'neither, nor' strategy. Since 2011, the UMP has maintained its candidates in all three-way contests, urging voters to reject both the FN and the Left. This has created a more favorable structure of opportunity in constituencies with strong FN presence, particularly in the Southern regions.

The FN seems to begin reaping the fruits of these efforts to polish the party's image. Public opinion data point to the increasing normalization of Marine Le Pen's party (see Table 2). In 2014, only 50 per cent of the French said that 'the FN was a threat to democracy' compared with 75 per cent in the mid-1990s. Other indicators of dedemonization include popularity ratings for both the FN and its leader, which have doubled since Marine Le Pen's accession, as well as public support for the FN's ideas which are now shared by over a third (34 per cent) of the French. (1) Annual average of monthly popularity ratings Source: TNS-SOFRES popularities and annual barometer surveys

Conditions for party change

This second section looks briefly at the internal and external stimuli for FN party transformation and the contextual factors which help account for changes that have occurred in the FN's policy and strategic profile. [START_REF] Harmel | An Integrated Theory of Party Goals and Party Change[END_REF] suggest that "party change is normally a result of leadership change, a change of dominant faction within the party and/or an external stimulus for change" (p.262). It is therefore important to look at "the parties' own decision-making processes in effecting organizational change" (p.261). However, agent-based models are not sufficient to explain party change.

We also need to consider the broader political and institutional context in which parties operate.

External stimuli for change

The strategic choices made by the FN must be first situated within the political context of the 2002 'earthquake' presidential election. Jean-Marie Le Pen's progression to the second-round runoff was the paroxysm of the FN as electoral nuisance. Mass anti-FN mobilization between the two rounds demonstrated however strong resistance to the far right and its continuing political exclusion. It helped contain the growth in support for Le Pen in the decisive round, resulting in Chirac's reelection with over 82 per cent of the vote. Le Pen's success in trompe l'oeil suggested that the FN had hit its electoral ceiling, contradicting its claim to represent a viable political alternative. The relatively poor showing by the FN in the subsequent legislatives attested to its lack of support. Finally, the election campaign revealed the low economic credibility of the party.

The 2002 (mis)performance was bitterly disappointing to the party's rank and file, and it acted as a powerful catalyst for party change. The FN entered a period of internal turmoil and intense fractionalization over party strategy, creating opportunities for the 'modernist' factions. Modernization was brought to the agenda of the 2003 party congress by the younger generation of elite around Marine Le Pen -e.g. Olivier Martinelli, Louis Aliot or Jean-François Touzé-, while Marine Le Pen was also appointed as vice-president. In 2007, she was given the strategic direction of the presidential campaign. As noted earlier, significant attempts were made to soften the party's image and to formulate more credible economic policies which were felt to be missing in 2002. Le Pen's family autocratic leadership led to the departure of prominent national cadres such as Jacques Bompard, Carl Lang or Jean-Claude Martinez14 .

Strategic issues resurfaced immediately after the 2007 elections. Despite the FN's poor presidential showing, Marine Le Pen emerged as the most serious contender for taking over the party 15 . Her political momentum profoundly altered the factional balance of power, resulting in the decline of the orthodox wing led by her rival, Bruno Gollnisch, while new 'mariniste' elites rose to all top-level positions 16 . In the wake of their defeat in the 2011 party congress, Gollnisch and his followers stepped down from all official posts, paving the way for the strategic transformation of the party. Marine Le Pen had publicly indicated earlier that she would distance herself from the most radical factions of the French far right, which for some of them had already left the FN in 2007 17 .

Party organization and leadership

A second set of factors concerns party organization and leadership. The rise of Marine Le Pen somewhat reflects the move by the FN towards greater intra-party democracy and its endorsement of a more open procedure of leader selection. In 2011, the decision to hold a competitive membership election for the new leader helped arbitrate between diverging strategic lines. The leadership election participated in Marine Le Pen's momentum, as she took clear advantage of her position of strength in the polls. She won 67.7 per cent of the members' vote in the 2011 party congress in Tours. That the vast majority of the grassroots were inclined towards party modernization contrasted with the previous balance of power in the party's middle level elites 18 . The central committee election in the 2011 congress showed also a rebalancing towards the 'mariniste' camp which won 57 per cent of the seats against 41 per cent for Gollnisch's supporters.

With regards to de-demonization, this suggests continuity rather than significant change in FN personnel over time, as most of Le Pen's close supporters have made their political career within the inner circles of the party. Florian Philippot or Gilbert Collard aside, no significant new entries have occurred and none of Gollnisch's most prominent supporters have left the party since 2011. Changes which have taken place are mostly generational, with the rise of a younger cohort of FN elites, represented by Marine Le Pen herself. At grassroots level, the succession of political controversies regarding racism and anti-Semitism since 2011 attests also to the persistence of the far right legacy.

Strategic considerations of candidate viability were critical in 2011. The internal leadership election served practically as presidential primary and there is little doubt that FN members saw in Marine Le Pen a candidate with stronger presidential prospects. By January 2011, polls were showing a wide gap in the electoral potential of the two contenders as well as a notable variation in their level of attractiveness to the mainstream right electorate 19 .

In policy terms, the FN has maintained a less democratic profile. Marine Le Pen's new leadership shows no significant departure from the past. It features a highly centralized organizational structure in which power is held at the top and in which the leadership is relatively unconstrained in its decisions. The political bureau around Marine Le Pen continues to control policy making and to dominate the internal life of the FN. [START_REF] Kitschelt | The Transformation of European Social Democracy[END_REF] defines this model of hierarchical organization as "'innovation from above', whereby party leaders act autonomously from a party's internal process of interest aggregation" (p.212).

Institutional and party system factors

Finally, we must consider the incentives generated by electoral system features and institutional arrangements. Two important systemic challenges confront the FN. First, the majoritarian system, which forms the electoral backbone of the Fifth Republic, manufactures parliamentary majorities in ways that are primarily detrimental to minor party alternatives. In terms of this system, disproportionality accounts for the FN's inability to win enough seats to achieve coalition potential 20 . Secondly, France's majoritarianism tends to a clustered multiparty system, with two separate party subsystems of the left and the right. This divide is deeply institutionalized, shaping the behavior of parties and voters. It requires that parties within each bloc co-operate to build competitive alliances in order to win a majority, therefore leaving little space to parties outside the two main blocs.

De-demonization seeks to address these challenges. It aims primarily to appeal to a wider cross-section of voters to maximize electoral support. Mainstream politicians might contemplate in the future the implications of the deterioration of Front Républicain.

Runoffs with three or more candidates promote the viability of middle-sized parties and the possibility that the FN will win seats without a clear majority of the votes. Moreover, de-demonization aims to stop political ostracism. The FN's current accommodative position at local level hopes to dislodge the UMP coalition on the ground, while simultaneously putting the cordon sanitaire under strain. National coalitions between the 19 A CSA-Marianne poll revealed for instance that 20 per cent would consider voting for Marine Le Pen in 2012, as opposed to only 7 per cent for Gollnisch. Amongst UMP sympathisers, the comparable figures were 28 and 4 per cent, respectively (Marianne, 14 January 2011). A month earlier, a BVA-Canal+ poll had Marine Le Pen to best represent the FN's ideas against only 3 per cent for Gollnisch: the former would also receive 17 per cent in the presidential election as opposed to 8 per cent for Gollnisch (BVA-Canal+, 10 December 2010). 20 Let us note here that proportional representation would have given the FN up to 76 out of 577 seats in 2012 as opposed to only 2 in the current legislature.

FN and the UMP look unlikely, but the normalization of the FN in the eyes of voters makes it increasingly difficult for the UMP to legitimate political exclusion of their radical challenger21 . As can be seen from Table 3, the radicalization of the mainstream right since 2007 has further decreased the attitudinal distance between the core support of both the conservative UMP and FN with regards to immigration and law-and-order issues. There has also been substantial increase in public support for electoral pacts between the moderate and the radical right: in March 2014, more than half (55 per cent) of UMP voters said they were in favor of local pacts with the FN as opposed to 36 per cent in 199822 .

Conclusion

This chapter offers an account of the current normalization of the French Front National. Since Marine Le Pen's accession, the FN has been seeking a new strategic equilibrium to shed its pariah profile and maximize its political opportunities. Beginning with the 2002 pyrrhic victory, the party leadership has striven to address crucial credibility and identity issues. This evolution attests to the current stage of the FN's development within the French party system, which is that of its entrenchment. [START_REF] Robert | Party leadership and party institutionalization: three phases of development[END_REF] suggest that the final stage of populist party institutionalization targets credibility and cooperation. The FN succession supports their assertion that integration requires a more pragmatic and 'power-seeking' leader.

In this chapter, we asked whether de-demonization has altered the populist radical right features of the FN as niche, radical and outsider party. We found that, despite significant changes in salience profile and the broadening of its economic platform, the FN has not yet shifted from niche to mainstream status. It has accentuated its nationalist antiglobalization stance while endorsing left-wing economic policies. De-demonization has produced only limited amounts of policy moderation and change in the party's antiliberal culture. The FN has primarily filtered its political rhetoric but core radical populist policies have not disappeared. Instead these have been diluted into a narrative of republican secularism employed as a strategic device to elude accusations of racism and xenophobia. Finally, the FN has not varied in its competitive positioning vis-à-vis other actors in the system. Its current position attest to the dominance of populist anti-politicalestablishment strategies juxtaposed with timid efforts of opening the party locally. The FN continues on the other hand to be politically ostracized by its neighbouring competitors of the French right, although de-demonization is certainly increasing the pressure on the cordon sanitaire. The disappearing of the Front Républicain increases the political legitimacy of the FN and might create new opportunities for competition in the more fragmented right pole of French politics in the future.

Reflecting on this persistence of the FN's populist radical right niche status and lack of coalition opportunities, de-demonization can be considered a primarily vote-maximizing strategy and, for that matter, one that has recently been quite successful electorally. As suggested elsewhere in this volume, a vote-seeking strategy is the most realistic option for RRPPs when they are ostracized and stigmatized by their mainstream competitors. The French case corroborates the assumption that majority systems and cordon sanitaire tend to impede RRPPs to choose an office-seeking strategy. Moreover, policy profiles as niche, radical or outsider parties generally go well together with strategies of vote maximization. Policy differentiation and policy radicalism rather than competing for the median voter enhance niche parties' competitiveness in elections (Ezrow 2008).

The FN faces a trade-off between policy and office. On the one hand, the FN must shed its radical right profile to grow its representation or it will otherwise continue to alienate the moderate sectors of the electorate. But normalization strategies may on the other hand be costly in terms of votes. Niche parties risk losing their distinctiveness and support if they move too far beyond their core issues. [START_REF] Adams | Are niche parties fundamentally different from mainstream parties? The causes and the electoral consequences of Western European parties' policy shifts, 1976-1998[END_REF] show that niche parties are punished at the polls when they attempt to moderate their policy positions. Additionally, considering France's current economic and political context, the FN has strong incentives to uphold its 'catch-all' populist anti-political-establishment appeal to mobilize a broad coalition of disenfranchised and protest voters. De-demonization aims therefore to resolve the somewhat antagonistic goals of dislodging the party's radical right status in the eyes of the mass public on the one hand while sustaining its appeal to non-centrist and protest voters on the other hand. Finally, the FN will also need to address political co-operation with the mainstream right and, therefore, its position within France's bipolar system of competition.

Figure 1 .

 1 Figure 1. Changes in the FN's economic and sociocultural salience profile

Figure 2

 2 Figure2below has the size and structure of the FN's radical agenda in presidential elections between 2002 and 2012. The overall size of the FN's radical platform shows a significant decrease in 2007 where the total number of radical policy pledges was halved from 106 in 2002 down to 58, followed by an augmentation up to a total 80 proposals in 2012. The 2002 manifesto stands out also as significantly more radical with regards to the overall number of 'extreme' policies across all three measured dimensions (62 as

Figure 2 .

 2 Figure 2. Size and degree of extremeness in the FN's radical agenda*: 2002-2012

Table 1 . Salience of the FN niche cultural agenda

 1

	Item

Table 2 . Public opinion indicators of de-demonization: 1997-2012

 2

		1997	2002	2007	2014
	Average % FN popularity (1)	13	11	12	23
	Average % leader popularity (1)	15	13	13	27
	Is threat to democracy (%)	75	70	60	50
	Agreement with FN ideas (%)	20	28	26	34

Table 3 . Cultural attitudinal polarization

 3

	Item

% of respondents who agree ; Source: IPSOS-CEVIPOF survey. Les Nouvelles fractures françaises, January 2014 (http://www.ipsos.fr/ipsos-publicaffairs/actualites/2014-01-21-nouvelles-fractures-francaises-resultats-et-analyse-l-enquete-ipsos-steria: retrieved 7 June 2014)

Similar attempts had been made in the past. In the mid-1980s, the strategy of 'notabilization' had materialized in the Rassemblement National (RN), attracting right-wing defectors such as Bruno Mégret. In the 1990s, the rise of Mégret's modernist faction paved the way for tactical pacts with local leaders of the non-Gaullist Right in the 1998 regional elections.

The original CMP dataset is complemented with the coding of all French party manifestos in the 2012 elections -which at the time of writing were still uncoded.

To ensure consistency with the comparative analyses in this volume, the salience of socio-economic issues is calculated by adding up categories per401 till per416, as well as categories per504 till 507. The salience of socio-cultural issues is calculated by adding up issues per601 till per608.

Party system salience is calculated for all parties other than the FN. We use non weighted measures.

These issues topped the agenda of the FN's summer university in Avignon in September 2006, where the party set up thematic committees (Commissions d'Action présidentielle, CAP) to tap a wide range of socioeconomic issues in order to enhance its sectoral expertise.

Of these, 38 are present in all three manifestos, while another 21 are only common to the 2002 and 2012 programmes.

Polls indicated that only half of the FN voters supported Sarkozy, throwing the election to Hollande.

In the 2012 presidential runoff, Marine Le Pen refused to endorse either candidate, while vilipending the 'evil' forces of 'mondialisme' (globalism) i.e. the EU, financial markets, multinational corporations, immigration and France's political 'establishment'.

The Republican Front (Front républicain) consists of ad hoc local alliances of parties across the spectrum wherever and whenever a radical right candidate is likely to win a decisive round.

Jacques Bompard was expelled in September 2005; Carl Lang et Jean-Claude Martinez left the party in November 2008. Other key figures such as Martine Lehideux, Martial Bild, Myriam Baeckeroot, Michel Bayvet and Michel de Rostolan stepped down in January 2009.

Marine Le Pen's ability to survive the legislative debacle in her Northern constituency made her the frontrunner in the succession race to replace her father. Highly publicized local campaigns in the city of Hénin-Beaumont in 2008 and 2009 helped her gain more visibility at national level. She won another

personal success in the 2010 regional elections topping her father's best performance.16 After the 2011 congress, Marine Le Pen's supporters had nearly 70 per cent of the seats in the political bureau. Ironically these included former mégrétistes such as Steeve Briois, Bruno Bilde or Nicolas Bay 17 In December 2010, Marine Le Pen said: "I don't want radical groups, which are a political caricature and an anachronism, to return to the FN. Between traditionalist Catholics, pétainists and those obsessed with the Holocaust, it doesn't seem coherent to me. The FN won't serve as an echo chamber for their obsessions" (http://www.lefigaro.fr/flash-actu/2010/12/07/97001-20101207FILWWW00388-fn-gollnish-s-en-prend-amarin-le-pen.php: retrieved 6 June 2014).18 In the party congress in Bordeaux in November 2007, Bruno Gollnisch had topped the central committee election with 85.2 per cent of the delegates' vote ahead of Marine Le Pen (75.6 per cent).

The mainstream right's growing difficulty maintaining a clear demarcation with the FN was revealed in September 2013 in the controversy by former Prime Minister François Fillon who demanded that his party combat 'sectarism' and abandon the ostracism of the FN.

http://www.atlantico.fr/decryptage/majorite-sympathisants-ump-et-fn-en-faveur-accords-locaux-sondageexclusif-ifop-1020547.html: retrieved 7 June 2014


P H Robert
email: probert@unice.fr

A Konig

S Andrieu

F Bremond

I Chemin

P C Chung

J F Dartigues

B Dubois

G Feutren

R Guillemaud

P A Kenisberg

S Nave

B Vellas

F Verhey

J Yesavage

P Mallea

Philippe H Pr

Robert

Recommendations for ICT use in Alzheimer's Disease assessment: Monaco CTAD expert meeting

Alzheimer disease (AD) and other related dementia represent a major challenge for health care systems within the aging population. It is therefore important to develop better instruments for assessing disease severity and disease progression to optimize patient's care and support to care providers, and also provide better tools for clinical research.

In this area, Information and Communication Technologies (ICT) are of particular interest. Such techniques enable accurate and standardized assessments of patients' performance and actions in real time and real life situations. The aim of this article is to provide basic recommendation concerning the development and the use of ICT for Alzheimer's disease and related disorders.

During he ICT and Mental Health workshop (CTAD meeting held in Monaco on the 30th October 2012) an expert panel was set up to prepare the first recommendations for the use of ICT in dementia research. The expert panel included geriatrician, epidemiologist, neurologist, psychiatrist, psychologist, ICT engineers, representatives from the industry and patient association.

The recommendations are divided into three sections corresponding to 1/ the clinical targets of interest for the use of ICT, 2/ the conditions, the type of sensors and the outputs (scores) that could be used and obtained, 3/ finally the last section concerns specifically the use of ICT within clinical trials.

Alzheimer disease (AD) and other related dementia represent a major challenge for health care systems within the aging population. Today clinician and researchers already used in clinical practice or in clinical trials several robust standardised tools such as the Mini Mental Score Examination (MMSE) for cognitive global assessment [START_REF] Folstein | Mini-mental state". A practical method for grading the cognitive state of patients for the clinician[END_REF], the Alzheimer Disease Assessment Scale (ADAS) to measure the severity changes of the most important cognitive symptoms [START_REF] Rosen | A new rating scale for Alzheimer's disease[END_REF], the Neuropsychiatric Inventory (NPI) interview for Behavioral and psychological symptoms [START_REF] Cummings | The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia[END_REF] and the Clinical Dementia Rating (CDR) to quantify the severity of symptoms of Dementia [START_REF] Morris | The Clinical Dementia Rating (CDR): Current vision and scoring rules[END_REF].

In AD, "dementia" is diagnosed when the disease has reached the stage where cognitive or behavioral (neuropsychiatric) symptoms interfere with social functioning or instrumental activities of daily living [START_REF] Dubois | Revising the definition of Alzheimer's disease: a new lexicon[END_REF] (E). It is also recommended that the core clinical criteria, based on "functional impairment", should be used to diagnose all causes of dementia, including AD, in all clinical settings [START_REF] Mckhann | The diagnosis of dementia due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease[END_REF]

(E).

Dementia is a diagnosis merely based on clinical judgement, for which appropriate assessment instruments are of vital importance. Finding a reliable method to assess functional impairment is of high interest since disease domains other than cognition are increasingly recognized as important outcome measures in clinical practice as well as in clinical trials for anti-dementia drugs. The choice of outcome measures in these trials is often constrained by tradition and availability. Therefore, cognitionbased psychometric measures are usually the preferred option. However, the clinical relevance and « meaningfulness » of such measures has been questioned as they may not adequately identify responders to therapy or address important aspects of outcome [START_REF] Sampaio | Clinical relevance on Alzheimer's disease endpoints[END_REF] (E). One of the main limitations remains that clinical assessments through questionnaires, scales or observations risk bias resulting from the assessor's subjectivity or the usually interviewed caregiver. Due to the time restraint, clinicians have often just limited access to diagnosis relevant information, particularly in cases of patients lacking awareness of their own condition. Neuropsychological tests are generally accused of being artificial and lacking ecological value. Furthermore, test results can show variability depending on many factors such as emotional state and may therefore not always fully reflect a patient's capacities and the complexity of the disease, which can lead to delayed diagnosis.

In this line, Information and communication technology (ICT) may be of great interest because they enable the patients' performances and actions to be captured and accurately evaluated in real time and real life situations. Additionally, ICT is a means to cope with the increasing number of patients with chronic diseases in our aging society. As indicated by [START_REF] Eghdam | Information and communication technology to support self-management of patients with mild acquired cognitive impairments: systematic review[END_REF] [START_REF] Eghdam | Information and communication technology to support self-management of patients with mild acquired cognitive impairments: systematic review[END_REF] for individuals with chronic illness affecting cognitive capacities either directly (eg, dementia) or indirectly (eg, diabetes), ICT has become a fundamental part in their daily lives by providing a wide range of useful services and tools to use at home, work, or anywhere else [START_REF] Meijer | Empowering the patient with ICT-tools: the unfulfilled promise[END_REF].

Over the last few years, research has focused on the development and use of various sensors to monitor activities of the elderly as well as of AD patients. These include cameras and microphones for activity recognition [START_REF] Clarkson | Auditory context awareness via wearable computing[END_REF] embedded sensors [START_REF] Wang | Common sense based joint training of human activity recognizers[END_REF] or sensors placed on the body [START_REF] Foerster | Motion pattern and posture: correctly assessed by calibrated accelerometers[END_REF].

For instance, as part of the EXERCISE-ON study [START_REF] Hooghiemstra | Study protocol: EXERcise and cognition in sedentary adults with early-ONset dementia (EXERCISE-ON)[END_REF] whereas the impact of physical exercise on the progression of dementia symptoms was investigated, an actiwatch was used in order to monitor activity levels over a longer period of time objectively.

Other studies propose the use of such device for the screening of sleep/wake disorders [START_REF] Yesavage | A follow-up study of actigraphic measures in home-residing Alzheimer's disease patients[END_REF], agitation [START_REF] Nagels | Actigraphic measurement of agitated behaviour in dementia[END_REF] or depression [START_REF] Volkers | 24-Hour motor activity after treatment with imipramine or fluvoxamine in major depressive disorder[END_REF]. With the help of infra-red sensors for motion detection, Banerjee et al. [START_REF] Banerjee | Telesurveillance of elderly patients by use of passive infra-red sensors in a 'smart' room[END_REF] developed an automated surveillance system that identifies correctly 89% sequences of movement in comparison with manual analysis. Within a telecare project to help elderly people in France [START_REF] Chan | Assessment of activity of elderly people using a home monitoring system[END_REF], a multisensor home monitoring system has been developed to observe mobility changes that may indicate abnormal events.

European Union also recognizes the confronting issues encountered by the aging populations and has initiated Framework Programme (FP 6 and FP7) to support the research into the development of process for healthy aging, biomedical advances, as well as prevention and disease management. For example, the successful FP6 COGKNOW project (http://www.cogknow.eu/) was strongly user-driven with 42 people with dementia and their informal careers involved throughout the project in specifying and testing functionalities in the four most important areas of unmet needs (memory support, daily activities, social contacts and feeling safe). In the FP7 project CONFIDENCE (http://www.confidence-eu.org/), monitoring of elderly takes place for unusual event detection and setting off the relevant alarms, but there is no direct focus on dementia, with life-logging and the appropriate feedback, such as cognitive exercises, not being offered to the people with dementia. The FP7 Hermes project (http://www.fp7-hermes.eu/) offers memory support for elderly with normal aging-

RECOMMENDATIONS

The recommendations are divided into three sections corresponding to 1/ the clinical targets of interest for the use of ICT, 2/ the conditions, the type of sensors and the outputs (scores) that could be used and obtained, 3/ finally the last section concerns specifically the use of ICT within clinical trials. The first computerized cognitive tests were developed in the 1970s [19].

Computerized testing offers accurate recording of reaction times, electronic capture and processing of data (minimizing human error) and standardization of test administration and automatic scoring (minimizing sources of response bias). Today, they can be used, according to the clinician experience, as an alternative to « paper and pencil tests » in clinical research and practice. The advantage is a better usability but they do not improve ecological validity of the assessment. In fact, for a research study, ecological validity means that methods, material and settings of the study approximate a real-world context that is being examined. Experience sampling methodology (ESM) is a potential way to achieve this goal. ESM refers to a set of empirical methods that are designed to allow respondents to document their thoughts, feelings and actions outside the walls of a laboratory and within the context of everyday life [START_REF] Christensen | A Practical Guide to Experience-sampling Procedures[END_REF] (E). ICT and most particularly wearable smart phones can be of interest for the assessment of cognition. This has been already done for working memory evaluations [START_REF] Kane | Working memory, attention control, and the N-back task: a question of construct validity[END_REF] (E) and could be applied as well to episodic memory tasks.

For instance, as part of the cohort study AMI (Agrica-MSA-ISPED) [ This demonstrates that ICT use could be a source of additional information for the assessment of BPSD.

Other ICT tools can also be used for the assessment and the understanding of motor disturbances. Recently, Robinovitch [START_REF] Robinovitch | Video capture of the circumstances of falls in elderly people residing in long-term care: an observational study[END_REF] (E) demonstrated that Digital video cameras installed in common living areas (dining rooms, lounges, hallways) may provide insight into the sequences of events that most commonly lead to falls and, further to more valid and effective approaches for balance assessment and fall prevention in long-term care.

ACTIVITIES OF DAILY LIVING:

Behavior is not only BPSD but also the ability of a subject to be involved in activities Goal directed behavior (GDB) is another definition presented during the discussion.

GDB is a construct used to operationalize a broad spectrum of purposeful actions and their determinants from the simplest single movement to the most complex patterns behaviors. GDB is a set of related processes (including cognition, emotion, motivation) by which an internal state is translated through action into the attainment of a goal [START_REF] Brown | Negative symptoms: the 'pathology' of motivation and goal-directed behaviour[END_REF] (E). It is important to differentiate the semi directed (prespecified) activities from self initiated GDB activities.

The first one can be directly assessed by proposing a patient to carry out a series of prespecified tasks [START_REF] Shallice | Deficits in strategy application following frontal lobe damage in man[END_REF] (E) and using this strategy it is possible to assess activities in real life time using ICT (Box 1) [START_REF] Sacco | Detection of activities of daily living impairment in Alzheimer's disease and mild cognitive impairment using information and communication technology[END_REF] (E).

The second one can also be tested by giving the patient a complex order (follow a recipe) and assess how he/she deals with the general recommendation in order to test initiation as well as execution. This type of assessment is very difficult to organize and time consuming.

Following these examples the expert panel underlines:

-For the assessment of BPSD objective data covering day and night behavior are needed -BPSD real time assessment must be validated in comparison to the NPI domains.

-ICT devices enable the patients' performances and actions to be captured in real time and real life situations and to be accurately evaluated. This is particularly important for activities of daily living and the semi directed activities -the potential interest of serious games for assessing self initiated goal directed behaviour should be explored

2/ ICT sensors review and description

Table 1 summarizes studies done in elderly subjects with AD and related disorders.

The general recommendations concerning the use of ICT are listed in table 2. The different types of sensors need to be simple and easy to use to avoid a population selection based on their ability to understand device utilization. Various potential sensors exist, and therefore, the choice should be done accordingly to study conditions (in a clinical consultation setting, in Nursing home, at home) and to population groups (patients, family caregiver, professional carer). Technical progress may allow the implementation of one device with multiple sensors (eg actigraphy, body temperature, audio recording). The choice of devices depends on available budget and agreements between clinicians, ICT engineers and end users. In addition the quality of sensor processing often depends on a correct installation / calibration and some sensors have practical issues such as battery life for wearable sensors or data storage/transmission.

Concerning the audio and video recording devices, it is particularly important to employ automatic recording and analysis of the data. This is crucial when long term monitoring is required, such as for the assessment of behavioural disturbances. In order to develop this type of automatic recording, clinicians must describe in full details to the ICT engineers the characteristics of the behavioural sequences that need to be captured.

Use of ICT devices in everyday life raises several issues that must be discussed in each specific situation. However, ICT tools utilization may also have some positive effects, at least for a short-term period, for example by involving more actively the patient or empower the couple patient/ caregiver in the assessment procedure.

The use of video recording devices (wearable or static) is particularly often discussed: "Is there any change in the way of life of the people when there is a camera in the room?" This is mostly depending on the person. However, long term use of such devices seems to indicate a good acceptance. Usually, the person only notices the presence of the video sensor at the beginning of the experimentation but this awareness disappears rapidly [START_REF] Zouba | Monitoring elderly activities at home[END_REF] (E). A very important factor to increase acceptance is the understanding of the reason for installing the sensor.

Furthermore, it is important to provide the subject with systematic feedback about the data that are collected.

In this respect, the experience sampling method using the psymate may be relevant [START_REF] Myin-Germeys | From environment to therapy in psychosis: a real-world momentary assessment approach[END_REF]. The "Psymate" is a small electronic device that momentary assesses daily changes in functioning, emotions, which may contribute to identifying environmental risk factors and symptom patterns, as well as provide sensitive evaluations for treatment. This "PsyMate," was specifically developed to implement momentary assessment in clinical practice. It has been applied in psychotic patients, in whom it was shown that self-monitoring of both positive and negative psychotic symptoms is feasible, provides a much more detailed and fine-grained picture of symptoms, and reveals patterns of behavior that may be relevant for treatment. Furthermore, the PsyMate could be instrumental for real-time and real-world delivery of psychological interventions [START_REF] Wichers | Momentary assessment technology as a tool to help patients with depression help themselves[END_REF]. A trial using the Psymate for patients with dementia, and their caregivers is ongoing.

As these technologies rely on the acquisition of a large number of data collected in the context of the daily life of individuals, there is a need to consider first the respect of privacy and the protection of individual data. It is important to conduct this ethical reflection on a case-by-case basis for each project, as these innovative technologies may elicit specific ethical questions.

Concerning the output coming from the devices used for assessments, the following points have been underlined:

-In everyday clinical practice the output (the clinical score) needs to be simple as possible and easily understandable. The score needs to be obtained automatically or at least be understandable to users without high technical competences.

(patient, caregiver, clinician, researcher).

-Correlation should be established between ICT scores and classical tools scores.

-ICT characteristics allow combining different scores coming from one single domain (cognition) or from different domains (e.g. cognition, motricity, emotion, nutrition).

However, this type of combination needs to be defined and described in a preliminary step between the clinician and the engineers after taking into account the end user point of view [START_REF] Mulin | Functional dementia assessment using a video monitoring system: Proof of concept[END_REF] (E).

/ ICT in outcome measures for clinical trials for Alzheimer's disease

Most of the information indicated in the previous sections can be applied as well to the particular case of clinical research.

It is possible to separate expert suggestions into two parts: the wishes and the requirements.

Wishes;

-In clinical studies, including therapeutic pharmacological and non pharmacological trials, and most particularly cohort follow up studies, one of the major cause for drop outs is that patient are reluctant to return to the center. With the use of ICT, it may be possible to assess cognition, behaviour and/or activities of daily living directly in the patient's home environment and by therefore decrease the number of visit in the center.

-ICT use may be able to help to keep blinding about the evolution of the patient -ICT may help to have a more objective and homogeneous assessment of behavioural disturbances and by reducing variability.

-The use of serious games can be of interest to train the investigator and/or staff members on how to rate or manage certain behavioural problems -The association of ICT and biological data may help to foster new ideas and solve common medical problems (falls, sleep disorders). For example the ICT device can provide researchers with some information on sleep parameters (e.g. apnea, Co2

Level). Having a biological component being part of the discussion process could only aid to the hypothesis generation as well as to the hypothesis testing

Requirements

Before using ICT devices in clinical trials, several steps need to be achieved:

-ICT needs to be accepted by as a valid study endpoint by Health Authorities. In fact, it seems hard to shift from a well establish end point into a surrogate marker. Unless we get this new endpoint to be approved, technologies are interesting but only as investigational technologies for clinical trial. This explains the importance of introducing ICT into clinical practice in a first step before getting it accepted as a validated clinical endpoint by drug regulators.

-It is important to understand the correlation between ICT data and results obtained by classical assessment tools.

-For BPSD, long-term data need to be collected (24h during one month). It is particularly important to assess whether the frequency of the behavior described by the caregiver (using the NPI) is the same as the one recorded by the ICT device.

CONCLUSION

To summarize, special attention should be given to ICT solutions that provide personalized information and more objective assessment that indirectly help people with AD and their caregivers to better understand BPSD and provide help with their daily living activities [START_REF] Lauriks | Review of ICT-based services for identified unmet needs in people with dementia[END_REF].

One of the obvious results of this ICT and Mental Health workshop is to allow the interaction between ICT engineers and health professionals. For clinicians it is important to establish the exact type of indicators that are clinically relevant and that can provide useful information in daily practice. Secondly, for ICT engineers, the challenge is to adapt the constraints of the technology to the needs of the clinician.

The adopted approach tries to emphasize the clinician's user needs. In the next step, more attention should be paid to the user needs from patient / caregiver and to tool designs considering end user perspectives. It is of great importance that patients and caregivers be engaged in the assessment process and be able to give feedback on the feasibility and tolerability of the ICT sensors.

  //www.memorylane.nu/) aima at capturing pictures of the life of people with mild dementia.However these ICT devices are mostly research prototypes which have not been completely validated. Data analysis methods are tested by using simulated physiological data. The detected activities are mostly only to measure simple motion patterns. Furthermore, these devices still need to be validated against clinically accepted standards in a clinical environment. Most of the works done on home sensing previously have been tested with a small number of users in experimental environment or at the researchers' homes and their affiliates. While there has been progress on the algorithms that monitor elderly people's homes and interpret the signals of the sensors, what is acquired is often very limited. Nonetheless, clinical expertise and scientific literature review indicates that ICT are not able today to provide a direct diagnosis of Alzheimer's disease (AD) and related disorders. However, ICT provide information for the assessment of specific domains (behaviour, cognition, activity of daily living) and those indicators contribute with other clinical and biological data to the diagnosis of AD and related disorders. The aim of this article is to provide recommendation concerning the development and the use of ICT for Alzheimer's disease and related disorders. METHOD CoBTek (for Cognition -Behaviour -Technologies) is a Research Unit at Sophia-Antipolis University (UNS) in Nice, France. CoBTek missions are, using Information and Communication Technologies, and most particularly imaging and video analytic techniques: 1/ To improve diagnostic and treatment of behavioural and cognitive symptoms in Alzheimer disease and related disorders 2/ To develop new strategies in order to prevent, help and assist elderly people 3/ To improve autonomy in the elderly. The ICT and Mental Health workshop took place during the CTAD meeting in Monaco on the 30th October 2012. The workshop was organized by the CoBTeK team and the Centre National de Référence Santé à domicile et autonomie. An expert panel was set up to prepare the first recommendations for the use of ICT in dementia research. The expert panel included geriatricians, epidemiologists, neurologists, psychiatrists, psychologists, ICT engineers, and representatives from the industry and patient association. The starting presentation was held by the CoBTeK team as well as the discussion, which was audio recorded. The letter (E) after an article reference number indicates if the reference is related to the expert presentation and discussion directly at the time of the meeting. Two drafts of the recommendations regarding the use of ICT in AD were circulated to experts in December 2012. It includes a literature review, which is summarized in Table 1. about different studies using ICT for monitoring and screening purposes in elderly subjects. For the review research articles and reviews dating from the year 1998 to 2012 were identified in PubMed using the following search terms : « dementia OR alzheimer OR mild cognitive impairment » AND « assessment OR evaluation OR sreening OR monitoring» AND « new methods OR new technologies OR ICT OR (Information and Communication Technologies) OR actigraphy OR infra-red sensors OR assistive technologies OR smart homes OR GPS ». Searches were limited to articles written in English. The experts were encouraged to revise their former comments provided during the meeting in ligh of the 2 drafts.

1 /

 1 What are the Clinical targets ? COGNITION: Cognitive tests are assessments of human cognitive capacities. The administered tests include various forms. Throughout the 20th century, "paper and pencil" cognitive tests were commonly used to measure intelligence, assist with the diagnosis of brain disorders such as Alzheimer's disease, and measure recovery from brain disease or injury.

  22] (E) of 1002 retired farmers, an ancillary project has been developed in which 60 subjects received an MRI with the use of the mobile phone PALM. This phone allowed to collect four times a day during a week (Computerized Ambulatory Monitoring) information regarding the activities of daily living of the subjects as well as their performances in neuropsychological tests of semantic memory and episodic memory.The obtained results of these tests are better associated with the brain imaging data (size of the hippocampus in particular) as with the test results conducted by neuropsychologists.Following these examples the expert panel underlined the interest to develop simple devices with easy and understandable scores, with as added value, in comparison to the present tools, ecological validity, reliability and limitation of the interjudge variability.BEHAVIORS :Behavioral and psychological symptoms of dementia (BPSD) are frequently associated with cognitive deficits during the progression of Alzheimer disease (AD) and other dementia. BPSD assessment is usually based on a structured interview, using subjective input from either the caregiver and/or the patient. For instance apathy, which is the most frequent BPSD,[START_REF] Robert | Proposed diagnostic criteria for apathy in Alzheimer's disease and other neuropsychiatric disorders[END_REF] (E) is usually assessed in clinical practice and research with the Neuropsychiatric Inventory (NPI) apathy domain. It has also been proposed that ICT such as actigraphy could provide an objective assessment.

  of daily living[START_REF] Katz | Studies of Illness in the Aged. The Index of Adl: A Standardized Measure of Biological and Psychosocial Function[END_REF] (E). One of the key clinical features of Alzheimer's disease (AD) is impairment in daily living functioning[START_REF] Lakhan | The Decline in Activities of Daily Living at Discharge (DADLD) Index: Stratifying Patients at Lower and Higher risk[END_REF] (E).The inability to perform Instrumental Activities of Daily Living (ADL)[START_REF] Lawton | Assessment of older people: self-maintaining and instrumental activities of daily living[END_REF] (E) is present from the early stages of cognitive decline[START_REF] Tuokko | Mild cognitive impairment and everyday functioning in older adults[END_REF] (E). As indicated in the recommendations from the NIA-AA[START_REF] Albert | The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease[END_REF] (E) persons with Mild Cognitive Impairment (MCI) commonly have slight problems performing complex tasks[START_REF] De Vriendt | The process of decline in advanced activities of daily living: a qualitative explorative study in mild cognitive impairment[END_REF] (E). Methods to assess IADL comprise self-reported questionnaires, performance-based assessment and informant-based questionnaires. These measurements have some limitations because they do not offer accurate, reproducible, objective and ecological perspectives. Moreover, these assessment batteries and standardized tools rely on quantitative scales, which are often lacking sensitivity. For this reason, information and communication technology (ICT), in particular, techniques involving imaging and video processing are of interest, and may overcome these limitations by reducing the inter/intra rater variability due to human interpretation bias.

Table 1 :

 1 Activities of Daily Living / (NIA-AA) : National Institute on Aging-Alzheimer's Association workgroups / (MCI) Mild Cognitive Impairment / (GDB) Goal directed behavior 79. Demiris, G., Skubic, M, Keller, J, Rantz, MJ, Parker Oliver D, Aud MA, et al., Nurse Participation in the Design of User Interfaces for a Smart Home System., in Proceedings of the International Conference on Smart Homes and Health Telematics, N.I. Belfast, Editor 2006. p. 66-73. Studies using ICT in elderly subjects and patients with AD and related disorders.

	List of abbreviations (order of appearance)
	(AD) Alzheimer disease / (ICT) Information and Communication Technologies / (CoBTek) Cognition -Behaviour -
	Technologies Research unit ; (CTAD) Clinical Trial in Alzheimer Disease congress / (NPS) Neuropsychiatric
	symptoms / (ADL)

Acknowledgments

The ICT and Mental Health workshop was supported by by the Innovation Alzheimer association, The Centre National de Référence Santé à domicile et autonomie (CNR Santé) and grants from the ANR-09-TECS-016-01 -TecSan -SWEET HOME, the FP7 Dem@care project