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Denise Harold,
Richard Abraham,
Paul Hollingworth,
Rebecca Sims,
Amy Gerrish,
Marian L Hamshere,
Jaspreet Singh Pahwa,
Valentina Moskvina,
Kimberley Dowzell,
Amy Williams, [......],
Karl-Heinz Jöckel,
Norman Klopp,
H-Erich Wichmann,
Minerva M Carrasquillo,
V Shane Pankratz,
Steven G Younkin,
Peter A Holmans,
Michael O'Donovan,
Michael J Owen,
Julie Williams
Nature Genetics 05/2013; 45(6):712. · 35.53 Impact Factor
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ABSTRACT: Dementia patients suffering from behavioral and psychological symptoms (BPSD) are often treated with antipsychotics. Trial results document an increased risk for serious adverse events and mortality in dementia patients taking these agents. Furthermore, the efficacy of treating BPSD with antipsychotics seems to be only modest. Using data of a German statutory health insurance company, we examined prescription trends of antipsychotics in prevalent dementia patients in the context of official warnings. The study period is 2004-2009. We studied trends in demographics, age and sex, as well as need of care and the intake of typical and atypical antipsychotics. Seeking for linear trends adjusted for age, sex and level of care between 2004 and 2009, we obtained p-values from a multivariate logistic regression. Prescription volumes were calculated by number of packages as well as defined daily doses (DDDs) using multiple linear regressions for trends in prescriptions amount. We included 3460-8042 patients per year (mean age 80 years). The prescription prevalence of antipsychotics decreased from 35.5% in 2004 to 32.5% in 2009 (multivariate analysis for linear trend: p=0.1645). Overall prescriptions for typical antipsychotics decreased (from 27.2% in 2004 to 23.0% in 2009, p<0.0001) and prescriptions for atypical antipsychotics increased from 17.1% to 18.9% (p<0.0001). The mean DDD per treated patient increased from 80.5 to 91.2 (2004-2009; p=0.0047). Our findings imply that warnings of international drug authorities and manufacturers against adverse drug events in dementia patients receiving antipsychotics did not impact overall prescription behavior.
European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 03/2013; · 3.68 Impact Factor
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Hendrik van den Bussche,
Ingmar Schäfer,
Birgitt Wiese,
Anne Dahlhaus,
Angela Fuchs,
Jochen Gensichen,
Susanne Höfels,
Heike Hansen,
Hanna Leicht,
Daniela Koller,
Melanie Luppa,
Anna Nützel,
Jochen Werle,
Martin Scherer,
Karl Wegscheider,
Gerd Glaeske,
Gerhard Schön
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ABSTRACT: We investigated the degree of comparability of the prevalence of chronic diseases and disease combinations in the elderly in two databases comparable with regard to diseases included, sex and age of the patients (65-85 years), and cutoff score for case definition.
One study is based on chart-supported interviews with the primary care physicians within a cohort study of 3,189 multimorbid elderly patients. The second study analyzed claims data from ambulatory care delivered to the multimorbid members of one German Health Insurance (n = 70,031). Multimorbidity was defined by the presence of three or more chronic conditions from an identical list of 46 diseases.
The difference of the median number of chronic conditions was 1 (mean 6.7 vs. 5.7). The prevalences of individual conditions were approximately one-third lower in the claims data, but the relative rank order corresponded well between the two databases. These relatively small prevalence differences cumulate when combinations of chronic conditions are investigated, for example, the prevalence differences between the two databases increased to nearly 100% for triadic combinations and nearly 170% for quartets.
The study shows that conclusions regarding the prevalence of combinations of diseases should be drawn with caution when based on a single database.
Journal of clinical epidemiology 02/2013; 66(2):209-17. · 2.96 Impact Factor
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Frank Jessen,
Steffen Wolfsgruber,
Birgitt Wiese,
Horst Bickel,
Edelgard Mösch,
Hanna Kaduszkiewicz,
Michael Pentzek,
Steffi G Riedel-Heller,
Tobias Luck,
Angela Fuchs,
Siegfried Weyerer,
Jochen Werle, Hendrik van den Bussche,
Martin Scherer,
Wolfgang Maier,
Michael Wagner
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ABSTRACT: OBJECTIVE: To compare the risk of developing Alzheimer's disease (AD) dementia in late mild cognitive impairment (LMCI), early MCI (EMCI), and subjective memory impairment (SMI) with normal test performance. METHODS: The baseline sample (n = 2892) of the prospective cohort study in nondemented individuals (German Study on Aging, Cognition and Dementia in Primary Care Patients) was divided into LMCI, EMCI, SMI, and control subjects by delayed recall performance. These groups were subdivided by the presence of self-reported concerns associated with experienced memory impairment. AD dementia risk was assessed over 6 years. RESULTS: Across all groups, risk of AD dementia was greatest in LMCI. In those with self-reported concerns regarding their memory impairment, SMI and EMCI were associated with a similarly increased risk of AD dementia. In those subgroups without concerns, SMI was not associated with increased risk of AD dementia, but EMCI remained an at-risk condition. CONCLUSIONS: SMI and EMCI with self-reported concerns were associated with the same risk of AD dementia, suggesting that pre-LMCI risk conditions should be extended to SMI with concerns.
Alzheimer's & dementia: the journal of the Alzheimer's Association 01/2013; · 5.90 Impact Factor
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Attila Altiner,
Ingmar Schäfer,
Christine Mellert,
Christin Löffler,
Achim Mortsiefer,
Annette Ernst,
Carl-Otto Stolzenbach,
Birgitt Wiese,
Martin Scherer, Hendrik van den Bussche,
Hanna Kaduszkiewicz
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ABSTRACT: BACKGROUND: This study investigates the efficacy of a complex multifaceted intervention aiming at increasing the quality of care of GPs for patients with multimorbidity. In its core, the intervention aims at enhancing the doctor-patient-dialogue and identifying the patient's agenda and needs. Also, a medication check is embedded. Our primary hypothesis is that a more patient-centred communication will reduce the number of active pharmaceuticals taken without impairing the patients' quality of life. Secondary hypotheses include a better knowledge of GPs about their patients' medication, a higher patient satisfaction and a more effective and/or efficient health care utilization.Methods/designMulti-center, parallel group, cluster randomized controlled clinical trial in GP surgeries. Inclusion criteria: Patients aged 65--84 years with at least 3 chronic conditions. Intervention: GPs allocated to this group will receive a multifaceted educational intervention on performing a narrative doctor-patient dialogue reflecting treatment targets and priorities of the patient and on performing a narrative patient-centred medication review. During the one year intervention GPs will have a total of three conversations a 30 minutes with the enrolled patients. Control: Care as usual. Follow-up per patient: 14 months after baseline interview. Primary efficacy endpoints: Differences in medication intake and health related quality of life between baseline and follow-up in the intervention compared to the control group. Randomization: Computer-generated by an independent institute. It will be performed successively when patient recruitment in the respective surgery is finished. Blinding: Participants (GPs and patients) will not be blinded to their assignment but will be unaware of the study hypotheses or outcome measures. DISCUSSION: There is growing evidence that the phenomenon of polypharmacy and low quality of drug use is substantially due to mis-communication (or non-communication) in the doctor patient interaction. We assume that the number of pharmaceutical agents taken can be reduced by a communicational intervention and that this will not impair the patients' health-related quality of life. Improving communication is a core issue of future interventions, especially for patients with multimorbidity.Trial registration: Current Controlled Trials ISRCTN46272088.
BMC Family Practice 12/2012; 13(1):118. · 1.80 Impact Factor
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ABSTRACT: BACKGROUND: Social integration seems to be associated with depression in late life. But the measurement of social integration still lacks a strong consensus. To date in most studies the different domains of social integration have been examined separately. AIMS: In order to improve comparability among studies, we used the social integration index (SII), which covers all domains of social integration, to examine the association of social integration and depression in non-demented primary care patients aged 75 years and older. METHOD: Data were derived from the longitudinal German study on Aging, Cognition and Dementia in primary care patients. Included in the cross-sectional survey were 1028 non-demented subjects aged 75 years and older. The GDS-15 Geriatric Depression Scale was used to measure depression with a threshold of ≥6. Associations of the SII and further potential risk factors and depression were analysed using multivariate logistic regression models. RESULTS: The SII was significantly associated with depression in the elderly. After full adjustment for all variables, odds of depression were significantly higher for lower levels of the SII, having a care level, impaired vision and mobility and subjective memory complaints. CONCLUSION: Because the social integration index covers several aspects of social integration, the results seem to be more significant than considering only one of these domains alone. Further research is needed to prove the practicability of the social integration index and to supply the literature with consistent results regarding the association of social integration and depression. Elderly with depression could benefit from increased social networks and enhanced social integration, which points to the development of social programs and social policies that maximize the engagement of older adults in social activities and volunteer roles.
Journal of affective disorders 08/2012; · 3.76 Impact Factor
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Melanie Luppa,
Steffi G Riedel-Heller,
Janine Stein,
Hanna Leicht,
Hans-Helmut König, Hendrik van den Bussche,
Wolfgang Maier,
Martin Scherer,
Horst Bickel,
Edelgard Mösch,
Jochen Werle,
Michael Pentzek,
Angela Fuchs,
Marion Eisele,
Frank Jessen,
Franziska Tebarth,
Birgitt Wiese,
Siegfried Weyerer
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ABSTRACT: In the past few decades, a number of studies investigated risk factors of nursing home placement (NHP) in dementia patients. The aim of the study was to investigate risk factors of NHP in incident dementia cases, considering characteristics at the time of the dementia diagnosis.
254 incident dementia cases from a German general practice sample aged 75 years and older which were assessed every 1.5 years over 4 waves were included. A Cox proportional hazard regression model was used to determine predictors of NHP. Kaplan-Meier survival curves were used to evaluate the time until NHP.
Of the 254 incident dementia cases, 77 (30%) were institutionalised over the study course. The mean time until NHP was 4.1 years. Significant characteristics of NHP at the time of the dementia diagnosis were marital status (being single or widowed), higher severity of cognitive impairment and mobility impairment.
Marital status seems to play a decisive role in NHP. Early initiation of support of sufferers may ensure remaining in the familiar surroundings as long as possible.
Dementia and Geriatric Cognitive Disorders 07/2012; 33(4):282-8. · 2.14 Impact Factor
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ABSTRACT: To provide information about occurrence and patterns of geriatric morbidity and need for long-term care in patients newly diagnosed with dementia compared to controls without dementia.
An analysis of administrative data was conducted to compare the geriatric outpatient diagnoses and the patterns of care dependency of 1,848 incident dementia patients and 7,385 matched non-dementia controls older than 65 years in the incidence year.
In most cases the geriatric characteristics show an increased (partly statistically significant) prevalence in the group with dementia as compared to controls. Moreover, dementia patients show a higher number of geriatric comorbidities in contrast to non-dementia controls. Furthermore, the percentage of persons with need for long-term care in the dementia-group is significantly higher than for controls (44.4 vs. 12.9 %).
Prevention, early recognition or treatment of attendant symptoms are very important in daily clinical and nursing care in patients with dementia to ameliorate the progression of the disease and to improve the patients' quality of life.
Psychiatrische Praxis 07/2012; 39(5):222-7. · 1.64 Impact Factor
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Tobias Luck,
Melanie Luppa,
Birgit Wiese,
Wolfgang Maier, Hendrik van den Bussche,
Marion Eisele,
Frank Jessen,
Dagmar Weeg,
Siegfried Weyerer,
Michael Pentzek,
Hanna Leicht,
Mirjam Koehler,
Franziska Tebarth,
Julia Olbrich,
Sandra Eifflaender-Gorfer,
Angela Fuchs,
Hans-Helmut Koenig,
Steffi G Riedel-Heller
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ABSTRACT: OBJECTIVES:: There is an increasing call for a stronger consideration of impairment in instrumental activities of daily living (IADL) in the diagnostic criteria of Mild Cognitive Impairment (MCI) to improve the prediction of dementia. Thus, the aim of the study was to determine the predictive capability of MCI and IADL impairment for incident dementia. DESIGN:: Longitudinal cohort study with four assessments at 1.5-year intervals over a period of 4.5 years. SETTING:: Primary care medical record registry sample. PARTICIPANTS:: As part of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients, a sample of 3,327 patients from general practitioners, aged 75 years and older, was assessed. MEASUREMENTS:: The predictive capability of MCI and IADL impairment for incident dementia was analysed using receiver operating characteristics, Kaplan-Meier survival analyses, and Cox proportional hazards models. RESULTS:: MCI and IADL impairment were found to be significantly associated with higher conversion to, shorter time to, and better predictive power for future dementia. Regarding IADL, a significant impact was particularly found for impairment in responsibility for one's own medication, shopping, and housekeeping, and in the ability to use public transport. CONCLUSIONS:: Combining MCI with IADL impairment significantly improves the prediction of future dementia. Even though information on a set of risk factors is required to achieve a predictive accuracy for dementia in subjects with MCI being clinically useful, IADL impairment should be a very important element of such a risk factor set.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 06/2012; 20(11):943-954. · 3.35 Impact Factor
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ABSTRACT: Eine wesentliche Ursache der Versorgungsprobleme von Demenzkranken ist die Tabuisierung der Krankheit und die Stigmatisierung
der Kranken auch seitens der professionellen Dienstleister, der Ärzte und der professionell Pflegenden. Ziel des Projekts
war die Prüfung der Frage, ob Hausärzte und ambulante Pflegedienste mittels einer Fortbildungsmaßnahme in die Lage versetzt
werden können, besser mit Patienten und Angehörigen über das Tabuthema Demenz zu kommunizieren. Das interdisziplinär entwickelte
Programm für Hausärzte wurde 8-mal mit insgesamt 53 Hausärzten durchgeführt. Das Programm für Pflegedienste wurde mit zwei
kompletten Pflegeteams (54 Teilnehmenden) getestet.
Die Evaluation wurde als Vorher-nachher-Erhebung mittels eines 39-Item-Fragebogens durchgeführt. Um die Stabilität von etwaigen
Einstellungsveränderungen zu erfassen, wurde derselbe Fragebogen bei den Hausärzten ein Jahr nach der Fortbildung, bei den
Pflegediensten zwei Monate danach erneut administriert.
Die Prozessqualität der Fortbildungen wurde sehr positiv beurteilt. Die Auswertung bezüglich der Einstellungen der Hausärzte
zeigte statistisch signifikante positive Veränderungen. Bemerkenswert war vor allem, dass die Mehrzahl dieser Veränderungen
auch nach einem Jahr noch nachweisbar waren. Dies war z. B. der Fall für die Grundhaltung gegenüber der Versorgung von Demenzpatienten,
die Einschätzung der therapeutischen Möglichkeiten, die Unterstützungsmöglichkeiten der Angehörigen sowie für die Bereitschaft,
den Angehörigen Beratungsangebote der Alzheimer-Gesellschaft und die Teilnahme an Selbsthilfegruppen zu empfehlen. Die Ergebnisse
der Befragung der Pflegedienste weisen in die gleiche Richtung. Demgegenüber war in der Frage der Diagnoseübermittlung und
Aufklärung des Patienten ein Effekt der Fortbildung nicht nachweisbar.
One of the main reasons for deficits in the care of patients with dementia is the taboo on the disease and the stigma of the
people suffering from the disease, also from the side of the professional caregivers. The aim of the project was to find out
whether a continuing education program for GPs and for nurses in ambulatory care was able to increase the skills of professionals
to better communicate with patients and relatives on the taboo topic of dementia. The program was developed with a multi-professional
team and tested with 53 GPs and 54 nurses in ambulatory care.
The evaluation was performed with a 39-item questionnaire administered before and after the training. Also, to test the stability
of the outcomes, the same questionnaire was administered to the GPs after one year and after two months for the nurses. The
process quality of the training was evaluated very positively in both groups. Outcome quality was also very positive. Many
attitudes of the GPs changed in a positive way and this change was still present after one year. This was the case for their
general attitude towards caring for people with dementia, their view on therapeutic possibilities, their willingness to support
relatives, to refer them to the Alzheimer Society and to suggest to them participation in a self-help group. Results for the
nurses pointed in the same direction. However, with regard to diagnosis disclosure and informing the patient, no effect of
the training could be shown in the GP sample.
SchlüsselwörterDemenz-Stigmatisierung-Fortbildung-Hausärzte-ambulante Pflege
Key wordsdementia-stigma-education-primary care-general practice-nursing
Zeitschrift für Gerontologie + Geriatrie 04/2012; 42(2):155-162. · 0.61 Impact Factor
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Ingmar Schäfer,
Heike Hansen,
Gerhard Schön,
Susanne Höfels,
Attila Altiner,
Anne Dahlhaus,
Jochen Gensichen,
Steffi Riedel-Heller,
Siegfried Weyerer,
Wolfgang A Blank,
Hans-Helmut König,
Olaf von dem Knesebeck,
Karl Wegscheider,
Martin Scherer, Hendrik van den Bussche,
Birgitt Wiese
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ABSTRACT: Multimorbidity is a phenomenon with high burden and high prevalence in the elderly. Our previous research has shown that multimorbidity can be divided into the multimorbidity patterns of 1) anxiety, depression, somatoform disorders (ADS) and pain, and 2) cardiovascular and metabolic disorders. However, it is not yet known, how these patterns are influenced by patient characteristics. The objective of this paper is to analyze the association of socio-demographic variables, and especially socio-economic status with multimorbidity in general and with each multimorbidity pattern.
The MultiCare Cohort Study is a multicentre, prospective, observational cohort study of 3.189 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Missing values have been imputed by hot deck imputation based on Gower distance in morbidity and other variables. The association of patient characteristics with the number of chronic conditions is analysed by multilevel mixed-effects linear regression analyses.
Multimorbidity in general is associated with age (+0.07 chronic conditions per year), gender (-0.27 conditions for female), education (-0.26 conditions for medium and -0.29 conditions for high level vs. low level) and income (-0.27 conditions per logarithmic unit). The pattern of cardiovascular and metabolic disorders shows comparable associations with a higher coefficient for gender (-1.29 conditions for female), while multimorbidity within the pattern of ADS and pain correlates with gender (+0.79 conditions for female), but not with age or socioeconomic status.
Our study confirms that the morbidity load of multimorbid patients is associated with age, gender and the socioeconomic status of the patients, but there were no effects of living arrangements and marital status. We could also show that the influence of patient characteristics is dependent on the multimorbidity pattern concerned, i.e. there seem to be at least two types of elderly multimorbid patients. First, there are patients with mainly cardiovascular and metabolic disorders, who are more often male, have an older age and a lower socio-economic status. Second, there are patients mainly with ADS and pain-related morbidity, who are more often female and equally distributed across age and socio-economic groups.
ISRCTN89818205.
BMC Health Services Research 04/2012; 12:89. · 1.66 Impact Factor
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ABSTRACT: Dementia is an important disease in older age. Existing studies on dementia mortality face limitations. For instance, they are based on prevalent, small, or geographically limited samples or do not include controls. We aimed to study survival after the first diagnosis of dementia compared with a control group.
We analyzed claims data of a German health insurance company, including 1,818 incident dementia cases and 7,235 age- and sex-matched non-dementia controls (53% male; mean age 78.8 years). The follow-up was five years. We assessed survival with the Kaplan-Meier curves and performed Cox proportional hazard regression, also including nursing care dependency and comorbidities.
The cumulative five-year mortality was 53.5% in the dementia cases and 31.1% in the control group (hazard ratio: 2.1). Even after adjusting for comorbidities and nursing care, the mortality risk was 1.5 times higher for patients with incident dementia than for controls. Nursing care dependency showed high influence on mortality, likewise in dementia patients and controls.
Although some factors, such as education or the type and severity of dementia, could not be included in the analyses, our study shows a clear influence of dementia on mortality irrespective of age, sex, care dependency, and comorbidities. The strongest influence on mortality was found for dementia patients with nursing care dependency. Taking into account their mortality of around 70% in care level 1 and up to 80% in care levels 2 and 3, healthcare delivery to these patient groups should strongly consider elements of palliative care focusing on the quality of life.
International Psychogeriatrics 03/2012; 24(9):1522-30. · 2.24 Impact Factor
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ABSTRACT: Primary care practices provide a gate-keeping function in many health care systems. Since depressive disorders are highly prevalent in primary care settings, reliable detection and diagnoses are a first step to enhance depression care for patients. Provider training is a self-evident approach to enhance detection, diagnoses and treatment options and might even lead to improved patient outcomes.
A systematic literature search was conducted reviewing research studies providing training of general practitioners, published from 1999 until May 2011, available on the electronic databases Medline, Web of Science, PsycINFO and the Cochrane Library as well as national guidelines and health technology assessments (HTA).
108 articles were fully assessed and 11 articles met the inclusion criteria and were included. Training of providers alone (even in a specific interventional method) did not result in improved patient outcomes. The additional implementation of guidelines and the use of more complex interventions in primary care yield a significant reduction in depressive symptomatology. The number of studies examining sole provider training is limited, and studies include different patient samples (new on-set cases vs. chronically depressed patients), which reduce comparability.
This is the first overview of randomized controlled trials introducing GP training for depression care. Provider training by itself does not seem to improve depression care; however, if combined with additional guidelines implementation, results are promising for new-onset depression patient samples. Additional organizational structure changes in form of collaborative care models are more likely to show effects on depression care.
BMC Health Services Research 01/2012; 12:10. · 1.66 Impact Factor
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Amy Gerrish,
Giancarlo Russo,
Alexander Richards,
Valentina Moskvina,
Dobril Ivanov,
Denise Harold,
Rebecca Sims,
Richard Abraham,
Paul Hollingworth,
Jade Chapman, [......],
Norman Klopp,
H-Erich Wichmann,
Minerva M Carrasquillo,
V Shane Pankratz,
Steven G Younkin,
Lesley Jones,
Peter A Holmans,
Michael C O'Donovan,
Michael J Owen,
Julie Williams
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ABSTRACT: Rare mutations in AβPP, PSEN1, and PSEN2 cause uncommon early onset forms of Alzheimer's disease (AD), and common variants in MAPT are associated with risk of other neurodegenerative disorders. We sought to establish whether common genetic variation in these genes confer risk to the common form of AD which occurs later in life (>65 years). We therefore tested single-nucleotide polymorphisms at these loci for association with late-onset AD (LOAD) in a large case-control sample consisting of 3,940 cases and 13,373 controls. Single-marker analysis did not identify any variants that reached genome-wide significance, a result which is supported by other recent genome-wide association studies. However, we did observe a significant association at the MAPT locus using a gene-wide approach (p = 0.009). We also observed suggestive association between AD and the marker rs9468, which defines the H1 haplotype, an extended haplotype that spans the MAPT gene and has previously been implicated in other neurodegenerative disorders including Parkinson's disease, progressive supranuclear palsy, and corticobasal degeneration. In summary common variants at AβPP, PSEN1, and PSEN2 and MAPT are unlikely to make strong contributions to susceptibility for LOAD. However, the gene-wide effect observed at MAPT indicates a possible contribution to disease risk which requires further study.
Journal of Alzheimer's disease: JAD 01/2012; 28(2):377-87. · 3.74 Impact Factor
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Janine Stein,
Melanie Luppa,
Tobias Luck,
Wolfgang Maier,
Michael Wagner,
Moritz Daerr, Hendrik van den Bussche,
Thomas Zimmermann,
Mirjam Köhler,
Horst Bickel,
Edelgard Mösch,
Siegfried Weyerer,
Teresa Kaufeler,
Michael Pentzek,
Birgitt Wiese,
Anja Wollny,
Hans-Helmut König,
Steffi G Riedel-Heller
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ABSTRACT: The Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological (CERAD-NP) battery represents a commonly used neuropsychological instrument to measure cognitive functioning in the elderly. This study provides normative data for changes in cognitive function that normally occur in cognitively healthy individuals to interpret changes in CERAD-NP test scores over longer time periods.
Longitudinal cohort study with three assessments at 1.5-year intervals over a period of 3 years.
: Primary care medical record registry sample.
As part of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients, a sample of 1,450 cognitively healthy general practitioner patients, age 75 years and older, was assessed.
Age-, education-, and gender-specific Reliable Change Indices (RCIs) were computed for a 90% confidence interval for selected subtests of the CERAD-NP battery.
Across different age, education, and gender subgroups, changes from at least six to nine points in Verbal Fluency, four to eight points in Word List Memory, two to four points in Word List Recall, and one to four points in Word List Recognition indicated significant (i.e. reliable) changes in CERAD-NP test scores at the 90% confidence level. Furthermore, the calculation of RCIs for individual patients is demonstrated.
Smaller changes in CERAD-NP test scores can be interpreted with only high uncertainty because of probable measurement error, practice effects, and normal age-related cognitive decline. This study, for the first time, provides age-, education-, and gender-specific CERAD-NP reference values on the basis of RCI methods for the interpretation of cognitive changes in older-age groups.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 01/2012; 20(1):84-97. · 3.35 Impact Factor
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Amy Gerrish,
Giancarlo Russo,
Alexander Richards,
Valentina Moskvina,
Dobril Ivanov,
Denise Harold,
Rebecca Sims,
Richard Abraham,
Paul Hollingworth,
Jade Chapman, [......],
Norman Klopp,
H-Erich Wichmann,
Minerva M Carrasquillo,
Shane Pankratz,
Steven G Younkin,
Lesley Jones,
Peter A Holmans,
Michael C O 'donovan,
Michael J Owen,
Julie Williams
Journal of Alzheimer's disease: JAD 01/2012; 28:377-387. · 3.74 Impact Factor
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ABSTRACT: Although most guidelines recommend the use of cholinesterase inhibitors (ChEIs) for mild to moderate Alzheimer's Disease, only a small proportion of affected patients receive these drugs. We aimed to study if geriatric comorbidity and polypharmacy influence the prescription of ChEIs in patients with dementia in Germany.
We used claims data of 1,848 incident patients with dementia aged 65 years and older. Inclusion criteria were first outpatient diagnoses for dementia in at least three of four consecutive quarters (incidence year). Our dependent variable was the prescription of at least one ChEI in the incidence year. Main independent variables were polypharmacy (defined as the number of prescribed medications categorized into quartiles) and measures of geriatric comorbidity (levels of care dependency and 14 symptom complexes characterizing geriatric patients). Data were analyzed by multivariate logistic regression.
On average, patients were 78.7 years old (47.6% female) and received 9.7 different medications (interquartile range: 6-13). 44.4% were assigned to one of three care levels and virtually all patients (92.0%) had at least one symptom complex characterizing geriatric patients. 13.0% received at least one ChEI within the incidence year. Patients not assigned to the highest care level were more likely to receive a prescription (e.g., no level of care dependency vs. level 3: adjusted Odds Ratio [OR]: 5.35; 95% CI: 1.61-17.81). The chance decreased with increasing numbers of symptoms characterizing geriatric patients (e.g., 0 vs. 5+ geriatric complexes: OR: 4.23; 95% CI: 2.06-8.69). The overall number of prescribed medications had no influence on ChEI prescription and a significant effect of age could only be found in the univariate analysis. Living in a rural compared to an urban environment and contacts to neurologists or psychiatrists were associated with a significant increase in the likelihood of receiving ChEIs in the multivariate analysis.
It seems that not age as such but the overall clinical condition of a patient including care dependency and geriatric comorbidities influences the process of decision making on prescription of ChEIs.
BMC Psychiatry 12/2011; 11:190. · 2.55 Impact Factor
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Elisabeth M C Schrijvers,
Britta Schürmann,
Peter J Koudstaal, Hendrik van den Bussche,
Cornelia M Van Duijn,
Frank Hentschel,
Reinhard Heun,
Albert Hofman,
Frank Jessen,
Heike Kölsch, [......],
Oliver Peters,
Fernando Rivadeneira,
Eckart Rüther,
André G Uitterlinden,
Steffi Riedel-Heller,
Martin Dichgans,
Jens Wiltfang,
Wolfgang Maier,
Monique M B Breteler,
M Arfan Ikram
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ABSTRACT: Most studies investigating the genetics of dementia have focused on Alzheimer disease, but little is known about the genetics of vascular dementia. The aim of our study was to identify new loci associated with vascular dementia.
We performed a genome-wide association study in the Rotterdam Study, a large prospective population-based cohort study in the Netherlands. We sought to replicate genome-wide significant loci in 2 independent replication samples.
In the discovery analysis of 5700 dementia-free individuals, 67 patients developed incident vascular dementia over a mean follow-up time of 9.3 ± 3.2 years. We showed genome-wide significance for rs12007229, which is located on the X chromosome near the androgen receptor gene (OR, 3.7; 95% CI, 2.3-5.8, per copy of the minor allele; P=1.3 × 10(-8)). This association was further confirmed in 2 independent populations (probability value of combined replication samples=0.024).
Our study shows a novel genetic locus for vascular dementia on the X chromosome. Further replication of this finding is required.
Stroke 11/2011; 43(2):315-9. · 5.73 Impact Factor
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ABSTRACT: In order to estimate the future demands for health services, the analysis of current utilization patterns of the elderly is crucial. The aim of this study is to analyze ambulatory medical care utilization by elderly patients in relation to age, gender, number of chronic conditions, patterns of multimorbidity, and nursing dependency in Germany.
Claims data of the year 2004 from 123,224 patients aged 65 years and over which are members of one nationwide operating statutory insurance company in Germany were studied. Multimorbidity was defined as the presence of 3 or more chronic conditions of a list of 46 most prevalent chronic conditions based on ICD 10 diagnoses. Utilization was analyzed by the number of contacts with practices of physicians working in the ambulatory medical care sector and by the number of different physicians contacted for every single chronic condition and their most frequent triadic combinations. Main statistical analyses were multidimensional frequency counts with standard deviations and confidence intervals, and multivariable linear regression analyses.
Multimorbid patients had more than twice as many contacts per year with physicians than those without multimorbidity (36 vs. 16). These contact frequencies were associated with visits to 5.7 different physicians per year in case of multimorbidity vs. 3.5 when multimorbidity was not present. The number of contacts and of physicians contacted increased steadily with the number of chronic conditions. The number of contacts varied between 35 and 54 per year and the number of contacted physicians varied between 5 to 7, depending on the presence of individual chronic diseases and/or their triadic combinations. The influence of gender or age on utilization was small and clinically almost irrelevant. The most important factor influencing physician contact was the presence of nursing dependency due to disability.
In absolute terms, we found a very high rate of utilization of ambulatory medical care by the elderly in Germany, when multimorbidity and especially nursing dependency were present. The extent of utilization by the elderly was related both to the number of chronic conditions and to the individual multimorbidity patterns, but not to gender and almost not to age.
BMC Geriatrics 09/2011; 11:54. · 2.34 Impact Factor
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Simon Forstmeier,
Andreas Maercker,
Wolfgang Maier, Hendrik van den Bussche,
Steffi Riedel-Heller,
Hanna Kaduszkiewicz,
Michael Pentzek,
Siegfried Weyerer,
Horst Bickel,
Franziska Tebarth,
Melanie Luppa,
Anja Wollny,
Birgitt Wiese,
Michael Wagner
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ABSTRACT: Midlife motivational abilities, that is, skills to initiate and persevere in the implementation of goals, have been related to mental and physical health, but their association with risk of mild cognitive impairment (MCI) and Alzheimer's disease (AD) has not yet been directly investigated. This relation was examined with data from the German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe). A total of 3,327 nondemented participants (50.3% of a randomly selected sample) aged 75-89 years were recruited in primary care and followed up twice (after 1.5 and 3 years). Motivation-related occupational abilities were estimated on the basis of the main occupation (assessed at follow-up II) using the Occupational Information Network (O* NET) database, which provides detailed information on worker characteristics and abilities. Cox proportional hazards models were used to evaluate the relative risk of developing MCI and AD in relation to motivation-related occupational abilities, adjusting for various covariates. Over the 3 years of follow-up, 15.2% participants developed MCI and 3.0% developed AD. In a fully adjusted model, motivation-related occupational abilities were found to be associated with a reduced risk of MCI (HR: 0.77; 95% CI: 0.64-0.92). Motivation-related occupational abilities were associated with reduced risk of AD in ApoE ε4 carriers (HR: 0.48; CI: 0.25-0.91), but not in noncarriers (HR: 0.99; CI: 0.65-1.53). These results suggest that midlife motivational abilities are associated with reduced risk of MCI in general and with reduced risk of AD in ApoE ε4 carriers. Revealing the mechanisms underlying this association may inform novel prevention strategies for decelerating cognitive decline in old age.
Psychology and Aging 08/2011; 27(2):353-63. · 2.73 Impact Factor
