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T Luck,
S G Riedel-Heller,
M Luppa,
B Wiese,
C Bachmann, F Jessen,
H Bickel,
S Weyerer,
M Pentzek,
H-H König,
J Prokein,
M Eisele,
M Wagner,
E Mösch,
J Werle,
A Fuchs,
C Brettschneider,
M Scherer,
J C S Breitner,
W Maier
[show abstract]
[hide abstract]
ABSTRACT: OBJECTIVE: Progression from cognitive impairment (CI) to dementia is predicted by several factors, but their relative importance and interaction are unclear. METHOD: We investigated numerous such factors in the AgeCoDe study, a longitudinal study of general practice patients aged 75+. We used recursive partitioning analysis (RPA) to identify hierarchical patterns of baseline covariates that predicted dementia-free survival. RESULTS: Among 784 non-demented patients with CI, 157 (20.0%) developed dementia over a follow-up interval of 4.5 years. RPA showed that more severe cognitive compromise, revealed by a Mini-Mental State Examination (MMSE) score < 27.47, was the strongest predictor of imminent dementia. Dementia-free survival time was shortest (mean 2.4 years) in such low-scoring patients who also had impaired instrumental activities of daily living (iADL) and subjective memory impairment with related worry (SMI-w). Patients with identical characteristics but without SMI-w had an estimated mean dementia-free survival time of 3.8 years, which was still shorter than in patients who had subthreshold MMSE scores but intact iADL (4.2-5.2 years). CONCLUSION: Hierarchical patterns of readily available covariates can predict dementia-free survival in older general practice patients with CI. Although less widely appreciated than other variables, iADL impairment appears to be an especially noteworthy predictor of progression to dementia.
Acta Psychiatrica Scandinavica 03/2013; · 4.22 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Psychische und Verhaltenssymptome bei Demenz stellen eine erhebliche Belastung für Erkrankte und Pflegende dar. Ursächlich
sind krankheitsbedingte neurobiologische Veränderungen, die zu einer erhöhten Vulnerabilität für diese Symptome führen, und
externe Faktoren. Die externen Faktoren (u.a. Kommunikation, Milieu) sind primäres Ziel der Behandlung und der Prävention
von psychischen und Verhaltenssymptomen. Psychosoziale Interventionen zur Modifikation externer Faktoren beziehen sich auf
den Erkrankten oder die Pflegenden. Medikamentöse Therapien werden eingesetzt, wenn psychosoziale Maßnahmen keine ausreichende
Wirkung zeigen oder nur begrenzt angewendet werden können. Pharmakologische Therapien sind bei psychischen und Verhaltenssymptomen
weniger gut untersucht als pharmakologische Therapien zur Behandlung von Kognition und Funktion bei Demenz. Trotzdem können
Empfehlungen gegeben werden. Der folgende Übersichtsartikel orientiert sich an der S3-Leitlinie Demenzen (DGPPN, DGN), die
ein besonderes Gewicht auf psychische und Verhaltenssymptome legt.
Behavioral and psychological symptoms of dementia (BPSD) represent a severe burden for patients and caregivers. The causes
are disease-related neurobiological changes which increase the vulnerability to respond to external triggers with BPSD. Consequently,
external factors (e.g. communication, milieu) are the primary target for treatment and also prevention of BPSD. Psychosocial
interventions with the focus on the patient or on the caregivers are the core elements of BPSD therapy. If psychosocial interventions
are not efficacious or only insufficiently applicable, pharmacological treatment may need to be initiated. Pharmacological
treatment of BPSD has been less intensely investigated as treatment of cognition and function in dementia. However, recommendations
can be given. This review follows the S3 guidelines on dementia published by the German Societies for Psychiatry and Psychotherapy
(DGPPN) and Neurology (DGN) which address BPSD extensively.
SchlüsselwörterPsychische und Verhaltenssymptome bei Demenz-Psychosoziale Interventionen-Pharmakologische Therapie-Leitlinie-Delir
KeywordsBehavioral and psychological symptoms in dementia-Psychosocial interventions-Pharmacological treatment-Guidelines-Delirium
Der Nervenarzt 04/2012; 81(7):815-822. · 0.68 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Die diagnostische Lumbalpunktion (LP) nimmt bei der Abklärung kognitiver Defizite im Alter einen zunehmend wichtigen Platz
ein. In den vergangenen Jahrzehnten wurden LP aufgrund befürchteter postpunktioneller Beschwerden oder Komplikationen nur
selten ambulant durchgeführt. Unter Verwendung eines Fragebogens wurden die postpunktionellen Beschwerden nach ambulanten,
konsekutiv durchgeführten LP von 100Patienten (54–84Jahre alt; Mittelwert: 68,87Jahre; Standardabweichung: 7,9) der Gedächtnissprechstunde
der Psychiatrischen Universitätsklinik Bonn prospektiv erfasst. Von diesen Patienten wurde ein Teil im Rahmen des Früherkennungsprogramms
des Kompetenznetzes Demenzen untersucht. Ein leichtes bis mittelschweres postpunktionelles Syndrom trat bei 9% der Patienten
auf. Mithilfe der logistischen Regression wurde der Einfluss der Faktoren Geschlecht, Alter, kognitiver Status, Vorliegen
einer depressiven Episode als Zusatzdiagnose und Nadeldurchmesser (atraumatische G-20- bzw. G-22-Sprotte-Punktionsnadel) auf
das Auftreten des postpunktionellen Kopfschmerzes untersucht. Als einziger signifikanter Einflussfaktor konnte das Alter der
Patienten identifiziert werden: Je älter die Patienten waren, desto geringer war ihr Risiko für das Auftreten des postpunktionellen
Syndroms [Odd-Ratio (OR)=0,83; Konfidenzintervall (CI)=0,71–0,97 pro Jahr]. Keiner der anderen untersuchten Faktoren beeinflusste
das Risiko signifikant. Bei keinem der Patienten war eine ambulante oder stationäre Nachbehandlung postpunktioneller Folgen
erforderlich.
Lumbar puncture (LP) is growing in relevance for the diagnosis of cognitive impairment in the elderly. Due to the expected
risk of post-lumbar puncture syndrome or other complications LPs have rarely been performed in the outpatient setting. Using
a questionnaire, the post-lumbar puncture symptoms of 100 patients (54–84 years old; mean: 68.87 years; SD: 7.9) have been
prospectively gathered after consecutively performed LPs in the Memory Clinic of the Department of Psychiatry, University
of Bonn. Some of these patients were included in the early diagnosis program of the German Dementia Competence Network. Of
the patients 9% developed a post-lumbar puncture syndrome of mild or middle intensity. The influence of gender, age, cognitive
status, as well as a supplementary diagnosis of depression and needle size (G20 or G22 atraumatic Sprotte needle) on the incidence
of the post-LP syndrome was evaluated by means of logistic regression. Only the patients’ age was identified as a significant
risk factor as with increasing age a diminishing risk of developing a post-lumbar puncture syndrome was found (OR=0.83; CI=0.71–0.97
per year). None of the other factors evaluated proved to be of significant influence. The post-LP symptoms did not necessitate
supplementary consultations in any of the cases.
Der Nervenarzt 04/2012; 78(5):547-551. · 0.68 Impact Factor
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T. Luck,
S.G. Riedel-Heller,
B. Wiese,
J. Stein,
S. Weyerer,
J. Werle,
H. Kaduszkiewicz,
M. Wagner,
E. Mösch,
T. Zimmermann,
W. Maier,
H. Bickel,
H. van den Bussche, F. Jessen,
A. Fuchs,
M. Pentzek,
für die AgeCoDe Study Group
[show abstract]
[hide abstract]
ABSTRACT: Mit der CERAD-NP-Testbatterie liegen gut etablierte Verfahren zur neuropsychologischen Diagnostik charakteristischer kognitiver
Defizite einer Demenz vom Alzheimer-Typ vor. Die Anwendbarkeit neuropsychologischer Verfahren setzt das Vorhandensein zuverlässiger
Normwerte für die zugrunde liegende Population unter Berücksichtigung soziodemographischer Faktoren wie Alter, Bildung und
Geschlecht voraus. In der vorliegenden Arbeit wurden alters- bildungs- und geschlechtsspezifische Normwerte (Prozentränge
und T-Werte bzw. Perzentile) für die Subtests Verbale Flüssigkeit, Wortliste Gedächtnis, Wortliste Abrufen und Wortliste Wiedererkennen sowie den Wortliste-Savings-Score der CERAD-NP-Testbatterie an einer Stichprobe von 2891 älteren (75Jahre und darüber) nichtdementen Hausarztpatienten aus
Deutschland ermittelt. Die Probanden hatten ein Durchschnittsalter von 80,2Jahren (SD=3,6); somit bietet dieser Beitrag zuverlässige
Normwerte für die neuropsychologische Demenzdiagnostik in den höheren Altersgruppen an.
The CERAD-NP battery represents well-established tests for the neuropsychological diagnosis of characteristic cognitive deficits
in Alzheimer’s dementia. However, the use of neuropsychological tests requires reliable standard values for the population
under consideration, taking sociodemographic characteristics like age, education and gender into account. This report presents
age-, education- and gender-specific reference values for the subtests verbal fluency, word list memory, word list recall and word list recognition as well as the word list savings score of the CERAD-NP battery. The study sample consists of 2891 general practitioners’ patients from Germany aged 75years and
older. The study participants had a mean age of 80.2years (SD=3.6); thus, this report provides reliable reference values
for the neuropsychological diagnosis of dementia in older age groups.
SchlüsselwörterCERAD-CERAD-NP-Testbatterie-Neuropsychologische Diagnostik-Normen-Alzheimer-Demenz
KeywordsCERAD-CERAD-NP battery-Neuropsychological assessment-Norms-Alzheimer’s dementia
Zeitschrift für Gerontologie + Geriatrie 04/2012; 42(5):372-384. · 0.61 Impact Factor
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Hanna Kaduszkiewicz,
T. Zimmermann,
H. van Den Bussche,
C. Bachmann,
B. Wiese,
H. Bickel,
E. Mösch,
H. -P. Romberg, F. Jessen,
G. Cvetanovska-Pllashniku,
W. Maier,
S. G. Riedel-Heller,
M. Luppa,
H. Sandholzer,
S. Weyerer,
M. Mayer,
A. Hofmann,
A. Fuchs,
H.-H. Abholz,
M. Pentzek
[show abstract]
[hide abstract]
ABSTRACT: ObjectivesThe need for recognition of mild cognitive impairment (MCI) in primary care is increasingly discussed because MCI is a risk
factor for dementia. General Practitioners (GPs) could play an important role in the detection of MCI since they have regular
and long-term contact with the majority of the elderly population. Thus the objective of this study is to find out how well
GPs recognize persons with MCI in their practice population.
DesignCross-sectional study.
SettingPrimary care chart registry sample.
Participants3,242 non-demented GP patients aged 75–89 years.
MeasurementsGPs assessed the cognitive status of their patients on the Global Deterioration Scale (GDS). Thereafter, trained interviewers
collected psychometric data by interviewing the patients at home. The interview data constitute the basis for the definition
of MCI cases (gold standard).
ResultsThe sensitivity of GPs to detect MCI was very low (11–12%) whereas their specificity amounts to 93–94%. Patients with MCI
with a middle or high level of education more often got a false negative assignment than patients with a low educational level.
The risk of a false positive assignment rose with the patients’ degree of comorbidity. GPs were better at detecting MCI when
memory or two and more MCIdomains were impaired.
ConclusionThe results show that GPs recognise MCI in a very limited number of cases when based on clinical impression only. A further
development of the MCI concept and its operationalisation is necessary. Emphasis should be placed on validated, reliable and
standardised tests for routine use in primary care encompassing other than only cognitive domains and on case finding approaches
rather than on screening. Then a better attention and qualification of GPs with regard to the recognition of MCI might be
achievable.
Key wordsMild cognitive impairment-recognition-primary care-early detection-dementia
The Journal of Nutrition Health and Aging 04/2012; 14(8):697-702. · 2.69 Impact Factor
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M Wagner,
S Wolf,
F M Reischies,
M Daerr,
S Wolfsgruber, F Jessen,
J Popp,
W Maier,
M Hüll,
L Frölich, [......],
R Perneczky,
O Peters,
H Jahn,
C Luckhaus,
H-J Gertz,
J Schröder,
J Pantel,
P Lewczuk,
J Kornhuber,
J Wiltfang
[show abstract]
[hide abstract]
ABSTRACT: To compare cued recall measures with other memory and nonmemory tests regarding their association with a biomarker profile indicative of Alzheimer disease (AD) in CSF among patients with mild cognitive impairment (MCI).
Data were obtained by the German Dementia Competence Network. A total of 185 memory clinic patients fulfilling broad criteria for MCI (1 SD deficit in memory tests or in nonmemory tests) were assessed with an extended neuropsychological battery, which included the Free and Cued Selective Reminding Test (FCSRT), the word list learning task from the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery (CERAD-NP), and the Logical Memory (LM) paragraph recall test from the Wechsler Memory Scale-Revised. CSF was obtained from all patients.
A total of 74 out of 185 subjects with MCI (40%) had a CSF profile consistent with AD (Aβ(1-42)/tau ratio; CSF AD+ group). FCSRT measures reflecting both free and cued recall discriminated best between CSF AD+ and CSF AD- patients, and significantly improved CSF AD classification accuracy, as compared with CERAD delayed recall and LM delayed recall.
Cued recall deficits are most closely associated with CSF biomarkers indicative of AD in subjects with MCI. This novel finding complements results from prospective clinical studies and provides further empirical support for cued recall as a specific indicator of prodromal AD, in line with recently proposed research criteria.
Neurology 02/2012; 78(6):379-86. · 8.31 Impact Factor
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T Zimmermann,
H Kaduszkiewicz,
H vd Bussche,
G Schön,
K Wegscheider,
J Werle,
S Weyerer,
B Wiese,
J Olbrich,
D Weeg,
S Riedel-Heller,
M Luppa, F Jessen,
H H Abholz,
W Maier,
M Pentzek
[show abstract]
[hide abstract]
ABSTRACT: Data on prevalence of chronic diseases are important for planning health care services. Such prevalence data are mostly based on patient self-reports, claims data, or other research data-with limited validity and reliability partially due to their cross-sectional character. Currently, only claims data of statutory health insurance offer longitudinal information. In Germany, these data show a loss of diagnoses of chronic health conditions over time. This study investigated whether there is a similar tendency of loss in the documentation of chronic diseases in data specifically collected for a longitudinal cohort study by general practitioners. In addition, the explanatory power of patient or GP characteristics regarding these losses is investigated.
A total of 3,327 patients aged 75 years and older were recruited for the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). For 1,765 patients, GP diagnoses of four chronic conditions at three time points were available for a total period of 4.5 years. In order to explain the loss of chronic diagnoses, a multilevel mixed-effects logistic regression was performed.
Over the course of 4.5 years, 18.6% of the diagnoses of diabetes mellitus, 34.5% of the diagnoses of coronary heart disease, and 44.9% of the diagnoses of stroke disappeared in the GP documentation for the longitudinal study. The diagnosis of coronary heart disease was less often lost in men than in women. The risk of losing the diagnosis of diabetes was higher in patients who were well known by the GP for a long time. An essential part of the variance of the losses can be explained by practice (owner) effects.
Data on morbidity collected in epidemiological studies and reported by physicians should always be checked for validity and reliability. Appropriate options (e.g., an investigator collecting the data directly in the field or the comparison of the data with health insurance companies' claims data) are presented and discussed.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 02/2012; 55(2):260-9. · 0.66 Impact Factor
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O Peters,
D Lorenz,
A Fesche,
K Schmidtke,
M Hüll,
R Perneczky,
E Rüther,
H-J Möller, F Jessen,
W Maier,
J Kornhuber,
H Jahn,
C Luckhaus,
H-J Gertz,
J Schröder,
J Pantel,
S Teipel,
S Wellek,
L Frölich,
I Heuser
[show abstract]
[hide abstract]
ABSTRACT: Mild cognitive impairment (MCI) is etiologically heterogeneous, and a substantial proportion of MCI subjects will develop different dementia disorders. One subtype of this syndrome, amnestic MCI, occurs preferentially but not exclusively in prodromal AD and is characterized by defined deficits of episodic memory.
For a 2-year, double-blinded, placebo-controlled study MCI patients, presenting with an amnestic syndrome but not necessarily based on presumed prodromal AD were randomized.
Patients received (a) a combination of 16 mg galantamine plus 20 mg memantine, or (b) 16 mg galantamine alone or (c) placebo.
The primary objective was to explore the differential impact of these interventions on the progression to dementia and on cognitive changes as measured by the ADAScog.
After recruitment of 232 subjects, the trial was halted before reaching the planned sample size, because safety concerns arose in other studies with galantamine in MCI. This resulted in a variable treatment duration of 2-52 weeks. The statistical analysis plan was amended for studying cognitive effects of discontinuing the study medication, which was done separately for galantamine and memantine, and under double-blind conditions. There was one death, no unexpected severe adverse events, and no differences of severe adverse events between the treatment arms. The cognitive changes on the ADAScog were not different among the groups. Only for the subgroup of amnestic MCI with presumed AD etiology, a significant improvement of ADAScog score over placebo before the discontinuation of medication was observed, while amnestic MCI presumably due to other etiologies showed no cognitive changes with broad variation. Cognitive improvement was numerically larger in the combination treatment group than under galantamine alone. Patients who received placebo declined as expected. Discontinuation of galantamine, either as part of the combination regimen or as mono treatment, resulted in a transient decline of the ADAScog score in amnestic MCI of presumed AD etiology, while discontinuation of Memantine did not change the cognitive status.
In an interrupted trial with amnestic MCI subjects the combination of galantamine plus memantine were generally well tolerated. In the subgroup of MCI subjects with presumed AD etiology, a cognitive benefit of a short-term combination treatment of galantamine plus memantine was observed, and cognitive decline occurred after discontinuation of galantamine.
The Journal of Nutrition Health and Aging 01/2012; 16(6):544-8. · 2.69 Impact Factor
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Lars Frings,
Stefan Klöppel,
Stefan Teipel,
Oliver Peters,
Lutz Frölich,
Johannes Pantel,
Johannes Schröder,
Hermann-Josef Gertz,
Sönke Arlt,
Isabella Heuser,
Johannes Kornhuber,
Jens Wiltfang,
Wolfgang Maier, Frank Jessen,
Harald Hampel,
Michael Hüll
[show abstract]
[hide abstract]
ABSTRACT: Cognitive decline in degenerative dementia is paralleled by progressive brain atrophy, with the localization of atrophy reflecting specific cognitive impairment. Confrontation naming deficits are frequently observed in dementia across etiologies. In this study we aimed to identify the brain regions underlying this deficit. In patients with clinically diagnosed dementia or mild cognitive impairment (MCI) we investigated the relationship between gray matter volume (GMV) and performance on a standardized confrontation naming test. 268 patients with one of three probable etiologies were included: Alzheimer's Dementia (AD), AD with signs of cerebrovascular pathology, and frontotemporal dementia. Applying voxel-based morphometry using a diffeomorphic registration algorithm we contrasted GMV of patients performing within the normal range with those of patients with pathological performance. Further, differential effects of gray matter atrophy on impaired performance in AD versus MCI of AD type were investigated. Results revealed significantly reduced GMV in the left anterior temporal lobe (ATL) in pathological performers compared to normal performers. The subgroup analysis confined to MCI of AD type and AD patients confirmed this relationship. While left ATL atrophy is known to be implicated in naming deficits in semantic dementia, our data confirm the same in AD and MCI of AD type.
Current Alzheimer research 05/2011; 8(8):893-901. · 4.97 Impact Factor
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T Vanmierlo,
J Popp,
H Kölsch,
S Friedrichs, F Jessen,
B Stoffel-Wagner,
T Bertsch,
T Hartmann,
W Maier,
K von Bergmann,
H Steinbusch,
M Mulder,
D Lütjohann
[show abstract]
[hide abstract]
ABSTRACT: Plant sterols (sitosterol, campesterol, stigmasterol and brassicasterol) are solely dietary-derivable sterols that are structurally very similar to cholesterol. In contrast to peripheral cholesterol, plant sterols can cross the blood-brain barrier and accumulate within mammalian brain. As an impaired function of the cerebrospinal fluid (CSF)-blood barrier is linked to neurodegenerative disorders, i.e. Alzheimer's disease (AD), we investigated whether this results in altered plant sterol concentrations in CSF.
Applying gas chromatography/mass spectrometry analysis, plant sterol concentrations were measured in plasma and CSF of patients with AD (n = 67) and controls (n = 29). Age, gender, plasma-to-CSF albumin ratio, CSF Aβ(42) , CSF pTau, APOE4 genotype, and serum creatinine were applied as covariates in the statistical analysis for individual plant sterols in order to compare plasma and CSF plant sterol concentrations between patients with AD and controls.
Albumin quotient was a consistent predictor in CSF for cholesterol and methyl plant sterols campesterol and brassicasterol. Comparison of lipid parameters per diagnosis based on relevant predictors revealed significantly lower concentrations of brassicasterol (P < 0.001) in CSF of patients with AD. Binary logistic regression analysis revealed that brassicasterol improved the predictive value when added to pTau and Aβ42 in a biomarker model.
Brassicasterol might be a relevant additional biomarker in AD.
Acta Psychiatrica Scandinavica 05/2011; 124(3):184-92. · 4.22 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The apolipoprotein E4 allele (ApoE4) is an established genetic risk factor for Alzheimer's disease (AD). However, its effects on cognitive performance and brain structure in healthy individuals are complex. We investigated the effect of ApoE4 on cognitive performance and medial temporal lobe volumetric measures in cognitively unimpaired young elderly with and without subjective memory impairment (SMI), which is an at-risk condition for dementia.MethodAltogether, 40 individuals with SMI and 62 without were tested on episodic memory and on tasks of speed and executive function. All participants were ApoE genotyped. 21 subjects with SMI and 47 without received additional structural magnetic resonance imaging. Volumetric measures of the hippocampus, the entorhinal cortex and the amygdala were obtained manually.
In the SMI group, ApoE4 carriers performed worse on the episodic memory (p=0.049) and showed smaller left hippocampal volumes (p=0.030). In the individuals without SMI, the ApoE4 carriers performed better on episodic memory (p=0.018) and had larger right hippocampal volumes (p=0.039). The interaction of group (SMI/no SMI) and ApoE genotype was significant for episodic memory (p=0.005) and right and left hippocampal volumes (p=0.042; p=0.035). There were no within-group differences or interaction effects on speed and executive function composite measures or other volumetric measures.
The negative effect of ApoE4 on episodic memory and hippocampal volume in SMI supports SMI as a prodromal condition of AD. The positive effects of ApoE4 in subjects without SMI adds to a number of reports on positive ApoE4 effects in young and very old individuals.
Psychological Medicine 02/2011; 41(9):1997-2006. · 6.16 Impact Factor
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A Papassotiropoulos,
K Henke,
E Stefanova,
A Aerni,
A Müller,
P Demougin,
C Vogler,
J C Sigmund,
L Gschwind,
K-D Huynh, [......],
S Weyerer,
H Bickel,
S Riedel-Heller,
M Pentzek,
B Wiese,
M Dichgans,
M Wagner, F Jessen,
W Maier,
D J-F de Quervain
[show abstract]
[hide abstract]
ABSTRACT: Recent advances in the development of high-throughput genotyping platforms allow for the unbiased identification of genes and genomic sequences related to heritable traits. In this study, we analyzed human short-term memory, which refers to the ability to remember information over a brief period of time and which has been found disturbed in many neuropsychiatric conditions, including schizophrenia and depression. We performed a genome-wide survey at 909 622 polymorphic loci and report six genetic variations significantly associated with human short-term memory performance after genome-wide correction for multiple comparisons. A polymorphism within SCN1A (encoding the α subunit of the type I voltage-gated sodium channel) was replicated in three independent populations of 1699 individuals. Functional magnetic resonance imaging during an n-back working memory task detected SCN1A allele-dependent activation differences in brain regions typically involved in working memory processes. These results suggest an important role for SCN1A in human short-term memory.
Molecular Psychiatry 02/2011; 16(2):184-92. · 13.67 Impact Factor
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Der Nervenarzt 07/2010; 81(7):795. · 0.68 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Behavioral and psychological symptoms of dementia (BPSD) represent a severe burden for patients and caregivers. The causes are disease-related neurobiological changes which increase the vulnerability to respond to external triggers with BPSD. Consequently, external factors (e.g. communication, milieu) are the primary target for treatment and also prevention of BPSD. Psychosocial interventions with the focus on the patient or on the caregivers are the core elements of BPSD therapy. If psychosocial interventions are not efficacious or only insufficiently applicable, pharmacological treatment may need to be initiated. Pharmacological treatment of BPSD has been less intensely investigated as treatment of cognition and function in dementia. However, recommendations can be given. This review follows the S3 guidelines on dementia published by the German Societies for Psychiatry and Psychotherapy (DGPPN) and Neurology (DGN) which address BPSD extensively.
Der Nervenarzt 07/2010; 81(7):815-6, 818-22. · 0.68 Impact Factor
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H Kaduszkiewicz,
T Zimmermann,
H Van den Bussche,
C Bachmann,
B Wiese,
H Bickel,
E Mösch,
H-P Romberg, F Jessen,
G Cvetanovska-Pllashniku,
W Maier,
S G Riedel-Heller,
M Luppa,
H Sandholzer,
S Weyerer,
M Mayer,
A Hofmann,
A Fuchs,
H-H Abholz,
M Pentzek
[show abstract]
[hide abstract]
ABSTRACT: The need for recognition of mild cognitive impairment (MCI) in primary care is increasingly discussed because MCI is a risk factor for dementia. General Practitioners (GPs) could play an important role in the detection of MCI since they have regular and long-term contact with the majority of the elderly population. Thus the objective of this study is to find out how well GPs recognize persons with MCI in their practice population.
Cross-sectional study.
Primary care chart registry sample.
3,242 non-demented GP patients aged 75-89 years.
GPs assessed the cognitive status of their patients on the Global Deterioration Scale (GDS). Thereafter, trained interviewers collected psychometric data by interviewing the patients at home. The interview data constitute the basis for the definition of MCI cases (gold standard).
The sensitivity of GPs to detect MCI was very low (11-12%) whereas their specificity amounts to 93-94%. Patients with MCI with a middle or high level of education more often got a false negative assignment than patients with a low educational level. The risk of a false positive assignment rose with the patients' degree of comorbidity. GPs were better at detecting MCI when memory or two and more MCI-domains were impaired.
The results show that GPs recognise MCI in a very limited number of cases when based on clinical impression only. A further development of the MCI concept and its operationalisation is necessary. Emphasis should be placed on validated, reliable and standardised tests for routine use in primary care encompassing other than only cognitive domains and on case finding approaches rather than on screening. Then a better attention and qualification of GPs with regard to the recognition of MCI might be achievable.
The Journal of Nutrition Health and Aging 01/2010; 14(8):697-702. · 2.69 Impact Factor
-
A Papassotiropoulos,
K Henke,
E Stefanova,
A Aerni,
A M|[uuml]|ller,
P Demougin,
C Vogler,
J C Sigmund,
L Gschwind,
K-D Huynh, [......],
S Weyerer,
H Bickel,
S Riedel-Heller,
M Pentzek,
B Wiese,
M Dichgans,
M Wagner, F Jessen,
W Maier,
D J-F de Quervain
[show abstract]
[hide abstract]
ABSTRACT: Recent advances in the development of high-throughput genotyping platforms allow for the unbiased identification of genes and genomic sequences related to heritable traits. In this study, we analyzed human short-term memory, which refers to the ability to remember information over a brief period of time and which has been found disturbed in many neuropsychiatric conditions, including schizophrenia and depression. We performed a genome-wide survey at 909 622 polymorphic loci and report six genetic variations significantly associated with human short-term memory performance after genome-wide correction for multiple comparisons. A polymorphism within SCN1A (encoding the α subunit of the type I voltage-gated sodium channel) was replicated in three independent populations of 1699 individuals. Functional magnetic resonance imaging during an n-back working memory task detected SCN1A allele-dependent activation differences in brain regions typically involved in working memory processes. These results suggest an important role for SCN1A in human short-term memory.Keywords: SCN1A; sodium channel; memory; functional brain imaging; fMRI; GWAS
Molecular Psychiatry 12/2009; 16(2):184-192. · 13.67 Impact Factor
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T Luck,
S G Riedel-Heller,
B Wiese,
J Stein,
S Weyerer,
J Werle,
H Kaduszkiewicz,
M Wagner,
E Mösch,
T Zimmermann,
W Maier,
H Bickel,
H van den Bussche, F Jessen,
A Fuchs,
M Pentzek
[show abstract]
[hide abstract]
ABSTRACT: The CERAD-NP battery represents well-established tests for the neuropsychological diagnosis of characteristic cognitive deficits in Alzheimer's dementia. However, the use of neuropsychological tests requires reliable standard values for the population under consideration, taking sociodemographic characteristics like age, education and gender into account. This report presents age-, education- and gender-specific reference values for the subtests verbal fluency, word list memory, word list recall and word list recognition as well as the word list savings score of the CERAD-NP battery. The study sample consists of 2891 general practitioners' patients from Germany aged 75 years and older. The study participants had a mean age of 80.2 years (SD=3.6); thus, this report provides reliable reference values for the neuropsychological diagnosis of dementia in older age groups.
Zeitschrift für Gerontologie + Geriatrie 08/2009; 42(5):372-84. · 0.61 Impact Factor
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P Lewczuk,
J Kornhuber,
E Vanmechelen,
O Peters,
I Heuser,
W Maier, F Jessen,
K Bürger,
H Hampel,
L Frölich, [......],
J Schröder,
H Kessler,
J Pantel,
H-J Gertz,
H Vanderstichele,
G de Meyer,
F Shapiro,
S Wolf,
M Bibl,
J Wiltfang
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ABSTRACT: We measured concentrations of Abeta peptides 1-42 and 1-40, and their ratio in plasma of patients carefully categorized clinically and neurochemically as having AD or other dementias with a newly commercially available multiplexing assay, characterized by reasonable laboratory performance (intra-assay imprecision in the range of 1.3-3.8% for Abeta1-42, and 1.8-4.1% for Abeta1-40, inter-assay imprecision for Abeta1-42, Abeta1-40, and Abeta1-42/Abeta1-40 concentration ratio in the range of 2.3-11.5%, 2.2-10.4% and 4.2-9.7%, respectively). Patients with AD or mild cognitive impairment of AD type (MCI-AD) whose clinical diagnosis was supported with CSF biomarkers (n=193) had significantly lower Abeta1-42 plasma concentrations (p<0.007), and Abeta1-42/1-40 ratios (p<0.003) compared to patients with other dementias and MCI of other types (n=64). No significant differences between persons with MCI of AD type and patients with early AD were observed, or between MCI of other types versus patients with early dementia of other types. Our findings reconfirm the hypothesis that alterations of biomarker concentrations occur early in a preclinical AD stage and that these alterations are also reflected in plasma.
Experimental Neurology 08/2009; 223(2):366-70. · 4.70 Impact Factor
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F Jessen,
O Gür,
W Block,
G Ende,
L Frölich,
T Hammen,
J Wiltfang,
T Kucinski,
H Jahn,
R Heun,
W Maier,
H Kölsch,
J Kornhuber,
F Träber
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ABSTRACT: The need for biological markers of Alzheimer disease (AD) is constantly increasing. Proton magnetic resonance spectroscopy ((1)H-MRS) studies have provided consistent evidence for a reduction of the neuronal marker N-acetylaspartate (NAA) in patients with AD. Within the German Competence Network on Dementia, we conducted a (1)H-MRS study in patients with mild dementia and mild cognitive impairment (MCI) at four sites to investigate the multicenter feasibility of (1)H-MRS.
In total, 130 patients with dementia (98 AD, 32 non-AD), 136 subjects with MCI (70 of AD type, 66 of non-AD type), and 45 unimpaired control subjects were included. Single-volume (1)H-MRS of the left medial temporal lobe was performed at long and short echo times. Metabolites were quantified and metabolic ratios were determined.
We found a significant reduction of NAA concentration in patients with AD as compared to healthy volunteers and compared to patients with MCI of AD type. NAA/Cr (creatine/phosphocreatine) was also lower in patients with AD compared to control subjects. NAA, choline compounds, and Cr were lower in patients with AD compared to patients with non-AD dementia.
We demonstrated the multicenter feasibility of proton magnetic resonance spectroscopy ((1)H-MRS) of the medial temporal lobe in mild dementia and mild cognitive impairment, which is a prerequisite for the application of (1)H-MRS in large-scale clinical trials. Since the concentration measures of the metabolites are adjusted for brain tissue volume, these findings are indicators of biochemical pathology beyond brain atrophy.
Neurology 06/2009; 72(20):1735-40. · 8.31 Impact Factor
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ABSTRACT: Cholesteryl ester transfer protein (CETP), a component of the high density lipoprotein (HDL), plays a central role in reverse cholesterol transport. We investigated the association of two putative functional CETP polymorphisms (C-629A and I405V) with the risk of vascular dementia (VD) and tested if this association is influenced by the presence of APOE4 allele. Our study included 163 VD patients (mean age: 74.25 +/- 7.9 years) and 452 cognitively healthy probands (mean age: 70.81 +/- 7.9 years). As a biological correlate, the association of CETP gene variants with white matter lesion (WML) load was investigated. Neither the C-629A (P = 0.169) nor the I405V (P = 0.840) polymorphism was associated with VD risk in the whole sample. However, in non-carriers of the APOE4 allele, homozygote carriers of the CETP C-629A A allele presented with an increased risk of VD (P = 0.01). Whereas in APOE4 carriers, no association of CETP polymorphisms with VD risk was detected. In addition, carriers of the CETP C-629A AA genotype presented with decreased WML load in the frontal brain (P = 0.009). Our results suggest that CETP gene polymorphisms might influence WML load and the risk of VD, the latter in non-carriers of the APOE4 allele.
Acta Neurovegetativa 02/2009; 116(4):467-72. · 2.73 Impact Factor
