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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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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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H Leicht,
S Heinrich,
D Heider, C Bachmann,
H Bickel,
H van den Bussche,
A Fuchs,
M Luppa,
W Maier,
E Mösch,
M Pentzek,
S G Rieder-Heller,
F Tebarth,
J Werle,
S Weyerer,
B Wiese,
T Zimmermann,
H-H König
[show abstract]
[hide abstract]
ABSTRACT: To estimate net costs of dementia by degree of severity from a societal perspective, including a detailed assessment of costs of formal and informal nursing care.
In a cross-sectional study, costs of illness were analysed in 176 dementia patients and 173 matched non-demented control subjects. Healthcare resource use and costs were assessed retrospectively by means of a questionnaire. Dementia patients were classified into three disease stages, and linear regression models were applied to estimate net costs of dementia by degree of severity.
Annual net costs of dementia by stage were approximately €15 000 (mild), €32 000 (moderate) and €42 000 (severe), corresponding to US-$21 450, 45 760 and 60 060 respectively. Across disease stages, nursing care accounted for approximately three-quarters of total costs, of which half resulted from informal care. In sensitivity analyses using different valuation methods for nursing care, total costs decreased or increased by more than 20%.
Net costs more than double across stages of dementia. Informal care accounts for a considerable share of nursing care costs, and the approach to valuation of informal care has a large impact on cost-of-illness estimates.
Acta Psychiatrica Scandinavica 08/2011; 124(5):384-95. · 4.22 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
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[show abstract]
[hide abstract]
ABSTRACT: In this paper, oxidation of d-glucose on RuCl2(azpy)2 (azpy = 2-phenylazopyridine), as electrochemical mediator is studied. The complexes RuCl2(azpy)2 were prepared according to literature procedures with some modifications. Two isomers (E–Z or γ-RuCl2(azpy)2 and E–E or δ-RuCl2(azpy)2) were isolated. Each isomer and the crude were investigated electrochemically by immobilizing them with a Nafion/water solution on carbon Toray (CT) as supporting electrode. The voltammetric investigations were in fact used to determine the optimized oxidation potentials, which were helpful to carry out long-term electrolyses of glucose in carbonate buffer. High value products such as 2-ketogluconic and gluconic acids were obtained. The comparison of the results between the crude complex and the two isomers showed that γ-RuCl2(azpy)2 was the most active catalyst.
Electrochimica Acta 04/2005; 50:3341-3346. · 3.83 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The present situation of neonatal mass screening for metabolic disorders in eleven European countries is presented. The only disease screened for on a population wide basis in almost all countries is phenylketonuria. Screening for congenital hypothyroidism has been started in most countries or is under active consideration. A priority list of disorders that should be screened for routinely in all newborns comprises congenital hypothyroidism, hyperphenylalaninaemia, galactosaemia and maple syrup urine disease. Other disorders, like adrenogenital syndrome, cystic fibrosis. Duchenne's muscular dystrophy, histidinaemia, or tyrosinaemia cannot be recommended for mass screening at present because of an unsatisfactory test procedure or lack of effective treatment.
European Journal of Pediatrics 09/1981; 137(2):133-139. · 1.88 Impact Factor
