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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
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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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K Heser,
F Tebarth,
B Wiese, M Eisele,
H Bickel,
M Köhler,
E Mösch,
S Weyerer,
J Werle,
H-H König,
H Leicht,
M Pentzek,
A Fuchs,
S G Riedel-Heller,
M Luppa,
J Prokein,
M Scherer,
W Maier,
M Wagner
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ABSTRACT: BACKGROUND: Whether late-onset depression is a risk factor for or a prodrome of dementia remains unclear. We investigated the impact of depressive symptoms and early- v. late-onset depression on subsequent dementia in a cohort of elderly general-practitioner patients (n = 2663, mean age = 81.2 years). Method Risk for subsequent dementia was estimated over three follow-ups (each 18 months apart) depending on history of depression, particularly age of depression onset, and current depressive symptoms using proportional hazard models. We also examined the additive prediction of incident dementia by depression beyond cognitive impairment. RESULTS: An increase of dementia risk for higher age cut-offs of late-onset depression was found. In analyses controlling for age, sex, education, and apolipoprotein E4 genotype, we found that very late-onset depression (aged ⩾70 years) and current depressive symptoms separately predicted all-cause dementia. Combined very late-onset depression with current depressive symptoms was specifically predictive for later Alzheimer's disease (AD; adjusted hazard ratio 5.48, 95% confidence interval 2.41-12.46, p < 0.001). This association was still significant after controlling for cognitive measures, but further analyses suggested that it was mediated by subjective memory impairment with worries. CONCLUSIONS: Depression might be a prodrome of AD but not of dementia of other aetiology as very late-onset depression in combination with current depressive symptoms, possibly emerging as a consequence of subjectively perceived worrisome cognitive deterioration, was most predictive. As depression parameters and subjective memory impairment predicted AD independently of objective cognition, clinicians should take this into account.
Psychological Medicine 11/2012; · 6.16 Impact Factor
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T. Luck,
S. G. Riedel-Heller,
M. Luppa,
B. Wiese,
A. Wollny,
M. Wagner,
H. Bickel,
S. Weyerer,
M. Pentzek,
F. Haller,
E. Moesch,
J. Werle, M. Eisele,
W. Maier,
H. Van Den Bussche,
H. Kaduszkiewicz,
for the AgeCoDe Study Group
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ABSTRACT: Luck T, Riedel-Heller SG, Luppa M, Wiese B, Wollny A, Wagner M, Bickel H, Weyerer S, Pentzek M, Haller F, Moesch E, Werle J, Eisele M, Maier W, van den Bussche H, Kaduszkiewicz H for the AgeCoDe Study Group. Risk factors for incident mild cognitive impairment – results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe).Objectives: To provide age- and gender-specific incidence rates of MCI among elderly general practitioner (GP) patients (75+ years) and to identify risk factors for incident MCI.Method: Data were derived from the longitudinal German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Incidence was calculated according to the ‘person-years-at-risk’ method. Risk factors were analysed using multivariate logistic regression models.Results: During the 3-year follow-up period, 350 (15.0%) of the 2331 patients whose data were included in the calculation of incidence developed MCI [person-years (PY) = 6198.20]. The overall incidence of MCI was 56.5 (95% confidence interval = 50.7–62.7) per 1000 PY. Older age, vascular diseases, the apoE ε4 allele and subjective memory complaints were identified as significant risk factors for future MCI.Conclusion: Mild cognitive impairment is frequent in older GP patients. Subjective memory complaints predict incident MCI. Especially vascular risk factors provide the opportunity of preventive approaches.
Acta Psychiatrica Scandinavica 03/2010; 121(4):260 - 272. · 4.22 Impact Factor
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ABSTRACT: Stroke is the archetype of a chronic disease, with a considerable burden on ambulatory care. After discharge from hospital or inpatient rehabilitation, stroke patients are attended primarily by general practitioners (GPs). Little is known about the quality of outpatient care for stroke patients, so this study focused on the views of professionals involved in outpatient care.
A postal survey of 443 general practitioners from Hamburg, Germany was undertaken. Results were compared with a parallel survey carried out with physiotherapists and occupational therapists.
89 questionnaires were analysed. Based on a response rate of 28% the results cannot be seen as representative, but they do provide important information. As it seems, problems in ambulatory care do not start after discharge from hospital, but are partly caused by inpatient care. GPs see therapeutic benefits in ambulatory care for only half of their chronic stroke patients. They assess their own therapeutic efforts as effective in terms of medication, but they are less successful in changing their patients' behaviour with regard to lifestyle. Estimations of the prevalence of post-stroke depression vary substantially, with a mean of 47%. With regard to their daily practice, 60% of GPs do not find guidelines to be helpful. All in all, respondents describe the situation of chronic stroke patients and their families to be complex and difficult to manage. In addition to their professional performance, GPs carry out duties related to case management - as do the therapists.
The care of stroke patients is not only the responsibility of a single group of professionals, but is a rather complex task involving different health-care professionals. The rehabilitation process and the interdisciplinary cooperation need to be further analysed to ensure a good cooperation between health-care professionals and to improve the quality of ambulatory care for stroke patients.
Das Gesundheitswesen 04/2008; 70(3):170-6. · 0.94 Impact Factor
