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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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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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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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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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[show abstract]
[hide abstract]
ABSTRACT: The effectivity of a disease management programme (DMP) for outpatients suffering from chronic heart insufficiency (CHI) in primary care is presented. The programme is predominantly based on a weekly telephone monitoring by a case manager using a standardised questionnaire that scores CHI-relevant information of the patient. If the score exceeds a predefined limit the patient's general practitioner is alarmed. An observational study including a total of 115 patients indicates a significant decline of the hospital admission rate (p < 0.0001), as the primary outcome measure, whereas the total length of hospitalization remained constant. The findings are compared with other studies' results and the aims of a randomised controlled trial on the efficacy of DMP on patients with chronic heart failure are discussed.
Das Gesundheitswesen 11/2004; 66(10):656-60. · 0.94 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Objective of this systematic review is to determine the level of scientific evidence for the use of Donepezil in Alzheimer's Disease.
Ten randomised controlled double-blind trials testing Donepezil versus Placebo were identified in MEDLINE and EMBASE. All ten trials were included in this systematic review. Following a detailed catalogue of criteria the methodological standard of the ten trials was assessed.
The authors of eight trials postulated statistically significant differences in favour of Donepezil. Unfortunately, the methodological standard of all studies was insufficient. The methodological shortcomings are discussed in detail.
With regard to severe methodological deficiencies the evidence for the use of Donepezil in moderate to severe Alzheimer's Disease is lacking. But even if the trials had been conducted in a methodologically correct way the clinical relevance of the postulated positive results would have to be questioned.
Fortschritte der Neurologie · Psychiatrie 11/2004; 72(10):557-63. · 0.74 Impact Factor
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T Zimmermann,
H Kaduszkiewicz,
H 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: Hintergrund Prävalenzangaben zu chronischen Erkrankungen sind wichtige Daten zur Planung von Versorgungs- und Vergütungsstrukturen. Mit Patienten-Selbstreport-, Abrechnungs- und Studiendokumentationsdaten stehen Angaben zur Verfügung, die meist in Querschnittserhebungen erfasst wurden – mit entsprechenden Einschränkungen von Validität und Reliabilität. Nur in Krankenkassen-Routinedaten werden gegenwärtig dokumentierte Diagnosen im Zeitverlauf abgebildet. Diese zeigen Dokumentationsverluste. In der vorliegenden Arbeit wird untersucht, ob hausärztliche Morbiditätsangaben, die für eine längsschnittliche Kohortenstudie erfasst wurden, ähnliche Dokumentationsverluste aufweisen. Ferner wird analysiert, ob Patienten- und/oder Arzt-Merkmale den Verlust der dokumentierten Diagnosen erklären können. Patienten und Methode In die „German Study on Ageing, Cognition and Dementia in Primary Care Patients“ (AgeCoDe) wurden 3327 Patienten älter als 75 Jahre eingeschlossen. Bei 1765 Patienten wurden hausärztliche Angaben zur Morbidität über 4,5 Jahre erfasst. Dokumentationsverluste wurden mittels einer Multilevel-Mixed-Effects-logistic-Regression analysiert. Ergebnisse 18,6% der dokumentierten Diabetes-Diagnosen, 34,5% der dokumentierten KHK-Diagnosen und 44,9% der dokumentierten Schlaganfalldiagnosen gingen über 4,5 Jahre verloren. Krankheitsspezifisch stellte sich heraus, dass Männer ein geringeres Risiko haben, ihre KHK aus der Dokumentation zu verlieren. Diabetes-Diagnosen gehen eher verloren, wenn der Hausarzt den Patienten gut und lange kennt. Ein erheblicher Teil der Varianz der Verluste lässt sich auf Praxis (Inhaber)-Effekte zurückführen. Schlussfolgerung Im Rahmen epidemiologischer Studien erhobene ärztliche Morbiditätsangaben sollten in Bezug auf ihre Validität und Reliabilität geprüft werden. Maßnahmen, um die Erhebung der Morbidität zu standardisieren (zum Beispiel durch Untersucher vor Ort oder durch den Abgleich mit Routinedaten), werden beschrieben und diskutiert.
Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. 55(2):260-269.
