Klaus Schmidtke

Ortenau Klinikum Offenburg, Dept. of Neurogeriatrics, and Rehabilitation Hospital, Nordrach

Objectives In memory clinics, patients with significant memory complaints without objective neuropsychological findings are common. They are classified as subjective cognitive decline (SCD) and, as a group, face a heightened risk for future dementia. However, the SCD group is heterogeneous and comprises patients suffering from a somatoform conditio...

Zusammenfassung Exekutive Leistungen, visuell-räumliches Denken und Verhaltenskontrolle sind für das sichere Autofahren wesentliche geistige Leistungen. Bei Demenz und Leichter Kognitiver Störung treten Defizite dieser Leistungen auf, die sich zu altersbedingten Defiziten addieren. Sie können durch eine angepasste Fahrweise nicht immer ausreichend...

Zusammenfassung Hintergrund Vaskuläre kognitive Beeinträchtigung (engl. Vascular Cognitive Impairment, VCI) umfasst das gesamte Spektrum von einer milden vaskulär bedingten kognitiven Beeinträchtigung (Mild Cognitive Impairment, MCI) bis hin zur vaskulären Demenz und beinhaltet neben rein vaskulären Pathologien auch gemischte Fälle von vaskulärer u...

Background: The recently proposed latent variable δ is a new tool for dementia case finding. It is built in a structural equation modeling framework of cognitive and functional data and constitutes a novel endophenotype for Alzheimer's disease (AD) research and clinical trials. Objective: To investigate the association of δ with AD biomarkers an...

Background Several studies have tested the N-methyl-D-aspartate–receptor antagonist memantine as an add-on to pre-existing treatment with acetylcholinesterase inhibitors. Objective To evaluate the efficacy and safety of a combined memantine and galantamine-CR de novo regimen compared with galantamine-CR only treatment in never treated patients w...

To test whether, in individuals with mild cognitive impairment (MCI), different measures of subjective cognitive decline (SCD) in the memory domain predict abnormal CSF biomarkers of Alzheimer disease (AD). We analyzed the multicenter baseline (cross-sectional) data of 245 patients with MCI. SCD was measured quantitatively with the Subjective Memor...

Speech disorders already occur in the early phases of Alzheimer's disease (AD). As a possible cause, problems of executive processes are discussed. Cognitive slowing is also repeatedly addressed. Are there any connections between cognitive slowing and speech disorders in AD? And is there a relationship between cognitive slowing and executive proces...

Background Concerns about worsening memory (“memory concerns”; MC) and impairment in memory performance are both predictors of Alzheimer's dementia (AD). The relationship of both in dementia prediction at the pre-dementia disease stage, however, is not well explored. Refined understanding of the contribution of both MC and memory performance in dem...

Many studies have shown that not only pharmacological treatment but also cognitive stimulation in the early stages of Alzheimer's disease (AD) improves language processing and (other) cognitive functions, stabilizes Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL) functions and increases the subjective quality of...

Kognitive Störungen, vor allem des Gedächtnisses und der Konzentration, ohne fassbare organische Ursache sind ein wichtiges und häufiges Beschwerdebild in Gedächtnissprechstunden und Nervenarztpraxen. Bei Patienten mit psychiatrischen Erkrankungen sind ausgeprägte kognitive Defizite die Regel, z. B. bei Depression, Psychosen, dissoziativen Störunge...

Zusammenfassung Eine kausale Therapie der Alzheimer-Demenz (AD) existiert bisher nicht. Memantine, ein Modulator der glutamatergen Neurotransmission, und die drei Cholinesterasehemmer (ChEH) zeigen eine mäßige, jedoch mit hohem Evidenzgrad unterlegte Wirkung. Ziel der symptomatischen antidementiven Therapie ist eine Besserung und Stabilisierung der...

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, place...

A causal therapy of Alzheimer's disease (AD) does not yet exist. Memantine, a modulator of glutamatergic neurotransmission, and the three cholinesterase inhibitors (ChEI) show effects that are moderate but were demonstrated with a high degree of evidence. The aim of the symptomatic antidementive treatment is an improvement and stabilisation of the...

Our purpose was to measure Abeta(1-42), T-tau and P-tau(181) in the cerebrospinal fluid (CSF) of patients with posterior cortical atrophy (PCA), a presenile dementia likely to represent a variant of Alzheimer's disease (AD). CSF samples from 34 subjects including 9 patients with PCA, 11 age-matched patients with AD and 14 age-matched cognitively he...

Magnetic resonance imaging (MRI)-based volumetry of medial temporal lobe regions is among the best established biomarker candidates of Alzheimer's disease (AD) to date. This study assessed the effect of multicentre variability of MRI-based hippocampus and amygdala volumetry on the discrimination between patients with Alzheimer's disease (AD) and mi...

Fragestellung: Die funktionelle Gedächtnis- und Konzentrationsstörung (FGK) ist häufig bei Patienten psychosomatischer Kliniken und in Gedächtnissprechstunden anzutreffen. Ziel der vorliegenden Studie war die Evaluation einer neu konzipierten Gruppentherapie für FGK in einer randomisierten kontrollierten Studie. Methode: 40 FGK-Patienten wurden der...

The Tower of Hanoi is a classical puzzle applied in the psychology of problem solving and skill learning. In the standard wooden version, it consists of three vertical pegs and a variable number of disks, usually three to five, with increasing diameter. The disks have a hole in the middle and are stacked on the left peg in the order of the diameter...

Functional memory disorder (FMD) is an acquired nonorganic condition characterized by significant deficits of memory and concentration that occur in daily living and are thought to be caused by psychosocial burden and distress. FMD is an important differential diagnosis to organic mild cognitive impairment. Although frequent, FMD is under-researche...

Mutations of the progranulin gene lead to progranulin haploinsufficiency and to frontotemporal lobar degeneration (FTD) with TDP-43 positive inclusions. It is assumed that unknown genetic, epigenetic and environmental factors are responsible for the observed marked degree of phenotypic variability among mutation carriers. This is the first publishe...

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...

Memory complaints are a common finding in outpatients, especially in psychosomatic and neurological practice. In a substantial group of patients persistent memory complaints are found in the absence of abnormal neuropsychology. Different labels such as "functional memory complaint" have been suggested for this phenomenon. We characterise a group of...

The German Dementia Competence Network (DCN) has established procedures for standardized multicenter acquisition of clinical, biological and imaging data, for centralized data management, and for the evaluation of new treatments. A longitudinal cohort study was set up for patients with mild cognitive impairment (MCI), patients with mild dementia an...

Functional Memory and Attention Disorder (FMD) is regularly seen in patients presenting in psychosomatic or memory clinics. The aim of this study was the evaluation of a novel group therapy for FMD in a randomized controlled trial. 40 FMD patients were randomly assigned to either the experimental (EG) or the wait-list control group (CG). Out of the...

The ‘multiple chemical sensitivity syndrome’ (MCS) is defined descriptively as a (1) chronic condition (2) with symptoms that recur reproducibly (3) in multiple organ systems (4) in response to low levels of exposures (5) to multiple unrelated chemicals and which (6) improve or are resolved when incitants are removed. Patients' symptom profiles ind...

Nonorganic, functional memory disorder (FMD) is frequent in memory clinic patients, and is an important differential diagnosis to prodromal dementia. The authors propose a definition of FMD as an acquired medical and psychological condition that is closely related to psychosocial burden and distress. Prospective follow-up study, aimed to evaluate t...

A large proportion of patients with amnestic mild cognitive impairment (MCI) progress to Alzheimer's disease (AD), but the rate of conversion is highly variable, depending on selection and inclusion criteria. In the present prospective study, amnestic MCI criteria were applied in order to enrich the study population with prodromal AD patients. A co...

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The 12-item Clock Reading Test (CRT) allows a fine-graded assessment of clock-reading ability. It has a strong focus on visuo-spatial processing and requires no executive processing. This study evaluated the reliability, validity, sensitivity and specificity of the CRT for the diagnosis of dementia and visuo-spatial dysfunction. The CRT, the Clock...

Functional, non-organic disturbances of memory and attention (FDMC) are frequent and highly disturbing for affected patients. The stereotyped presentation of FDMC justifies defining it as a syndrome in its own right, which is nosologically related to the somatoform disorders. We postulate chronic psychsocial distress to be essential in the etiology...

A neuropsychological examination should be the first step when a dementing illness is suspected. It encompasses history taking, psychological assessment and testing. Screening tests like the Mini-MentalStarus-Examination are mainly useful for the staging of established dementias, while the work-up of early and unclear cases requires a more elaborat...

Zusammenfassung Eine neuropsychologische Untersuchung sollte das erste Diagnoseverfahren bei Verdacht auf eine beginnende demenzielle Erkrankung sein. Sie umfasst Anamnese, psychischen Befund und Testuntersuchung. Kurzverfahren wie der Mini- Mental-Test dienen vor allem zur Schweregradbestimmung einer bereits deutlicheren demenziellen Symptomatik,...

Zusammenfassung: Ein ambulantes Behandlungskonzept für Demenzpatienten und ihre Angehörigen wurde in der Memory-Ambulanz des Universitätsklinikums Freiburg entwickelt. In zwölf Terminen in zweiwöchentlichen Abständen werden Patienten und Angehörige zeitgleich, aber in getrennten Räumen betreut. Die Angehörigen nehmen an einem Informations- und Bera...

Small vessel disease (SVD), or microangiopathy, of the cerebral white and central grey matter is an important subtype of vascular dementia (VD). SVD-dementia is characterised by a "dysexecutive" type of cognitive impairment, neurological deficits including imbalance and voiding dysfunction, and emotional disturbances. SVD is also frequent among cli...

To validate and extend the US case definition for the Multiple Chemical Sensitivity Syndrome (MCS) from 1999 by a systematic literature-review. MEDLINE-research from 1997 to August 2003, research in the Cochrane-Library in August 2003, earlier reviews since 1997. Headings and abstracts were screened by one reviewer. All references dealing with mult...

Nine patients with posterior cortical atrophy (PCA), a rare degenerative brain disease of unclear etiology and nosology, were followed over a mean time of 7.4 years. The mean age at onset was low (56.2 years). At onset, eight patients had visuo-spatial and eight had memory impairment. A minority showed early signs of occipital lobe involvement with...

The term "vascular dementia" is used for a broad spectrum of different vascular pathologies that can lead to dementia. Clinico-pathological studies have shown poor correlations between clinical criteria for vascular dementia and neuropathology. Subcortical small vessel dementia is difficult to differentiate from mixed small vessel Alzheimer's demen...

Zusammenfassung Unter dem Begriff »vaskuläre Demenz« verbergen sich heterogene Demenzformen mit unterschiedlichen vaskulären Pathomechanismen. Die bisherigen klinischen Kriterien müssen im Licht aktueller neuropathologischer Studien als ungenügend betrachtet werden. Vor allem die subkortikale vaskuläre Demenz lässt sich differenzialdiagnostisch nic...

We performed a retrospective analysis of 79 patients with cerebral sinus venous thrombosis, who were treated with a fixed regimen of dose-adjusted intravenous heparin, to determine predictors of a fatal course. The parameters investigated were the state of consciousness and the presence of intracranial haemorrhage (ICH) at the start of heparin trea...

This study examined the neuropsychological profile of probable Alzheimer's disease (AD, n=72), vascular dementia due to diffuse subcortical small vessel disease (SVD, n=18) and mixed dementia (AD+SVD, n=18). Five simple tests were analysed, i.e. verbal recall and recognition memory, object naming, word fluency and clock reading. Pairwise discrimina...

Previous studies on the role of prefronto-striatal loop systems for cognitive procedural learning (PL) brought inconsistent results. To examine whether the integrity of the dorsolateral prefrontal loop is indispensable for normal cognitive PL, we examined the acquisition of cognitive skills in 35 patients with focal prefrontal lesions, focal caudat...

We present the case of a 71-year-old woman with an 11-year history of slowly progressive decline of motor speech. Normal clinical investigations including routine magnetic resonance imaging (MRI) at 7, 8 and 10 years after the onset of speech dysfunction led to the suggestion of a psychogenic disorder. Extensive clinical, neuropsychological and neu...

The neural correlates of procedural learning were studied using functional magnetic resonance imaging (fMRI) and the mirror reading paradigm. The aim of the study was to investigate a presumed learning-related change of activation in cortical areas that are involved in the performance of a nonmotor skill. Changes in cortical blood oxygenation contr...

Transient global amnesia (TGA) represents a transient benign self- limiting cerebral dysfunction of unknown aetiology. It manifests as a sudden failure of anterograde and retrograde memory lasting for several hours and subsiding gradually. Prompted by the findings of previous positron emission tomography and single-photon emission computed tomograp...

Einleitung: Die transiente globale Amnesie (TGA) ist eine vorübergehende, ätiologisch bislang nicht geklärte Funktionsstörung des Gehirns. Sie manifestiert sich als plötzlich einsetzender, mehrere Stunden anhaltender, reversibler Ausfall des Neugedächtnisses, begleitet von unterschiedlich ausgeprägten Altgedächtnisstörungen. Ausgehend von PET-und S...

Zusammenfassung: Der Beruhmte-Personen-Test ist ein deutschsprachiges Verfahren zur Evaluation des Altgedachtnisses fur offentliche Daten. Er deckt den Zeitraum von 1961 bis 1995 in sieben Jahrfunft-Schritten ab. Ein Testteil pruft semantisiertes Wissen, ein weiterer Detailwissen zu den Personen. Zur Item-Auswahl wurde eine Validierungsstudie mit 6...

Die transiente globale Amnesie ist eine eindrucksvolle, ätiologisch bisher ungeklärte Funktionsstörung des Gehirns. Sie manifestiert sich als plötzlich einsetzender, mehrere Stunden anhaltender uns sich dann wieder zurückbildender Ausfall des Neugedächtnisses, begleitet von unterscheidlich ausgeprägten reversiblen Altgedächtnisstörungen. Obwohl gut...

Memory is comprised of diverse capacities, which are of central importance to most kinds of mental activities. Firstly, procedural and declarative memory have to be differentiated, i.e. memory for skills and for knowledge. Declarative memory, in turn, is composed of two components: long term memory and retrograde memory, i.e. the capacities to lear...

Autobiographical Memory Interview and the Semantic Memory Test Abstract: Two instruments for the evaluation of retrograde memory deficits are presented. The autobiographic memory test assesses childhood memories, as well as episodic and semantic memories of the most recent five-year-period. The semantic memory test assesses facts, i. e. general kno...

This study examined the putative association of transient global amnesia (TGA) and migraine. 57 TGA patients were compared to a double-size control group of normal subjects. TGA patients who also had migraine were additionally compared to those without migraine and to a second control group of outpatients with migraine only. The prevalence of migra...

Mutations in the presenilin-1 gene (PS-1 gene) on chromosome 14 have recently been identified as a cause of familial early-onset Alzheimer’s disease (EOAD). To our knowledge, only two German EOAD patients with mutations in the PS-1 gene have been identified thus far. Herein we report the case of a German EOAD patient with a family history of dement...

There is evidence that dysfunction within associative frontostriatal circuits represents a feature of obsessive-compulsive disorder (OCD). Previous neuropsychologic studies have yielded diverging results, which may in part be explained by differences in the selection of subjects and methods. The present study focused on the question of cognitive fr...

The aim of this study was to investigate the pattern of regional cerebral blood flow changes associated with transient global amnesia (TGA). HMPAO SPECT was performed in six consecutive patients during the acute phase of TGA. A follow-up SPECT was performed 3-20 wk later in four of the six patients. Semiquantitative analysis of 14 regions of intere...

Sixty-three patients with tick-borne encephalitis were studied for sequelae up to 5 years after the acute illness (median: 12 months, range: 1-44 months). Patients were examined clinically, by neuropsychological testing and by electroencephalography. The clinical presentation during the acute stage was as follows: Meningitis (M,n = 12), Meningoence...

This group study of 24 amnesic patients and 40 control subjects examined the hypothesis that retrograde memory deficits result from a combination of two impairment mechanisms: (1) a deficit in the retrieval of contents that is related to dysfunctioning of the hippocampal anterograde memory system, and (2) a deficit in the storage and/or retrieval o...

Sixty-three patients with tick-borne encephalitis were studied for sequelae up to 5 years after the acute illness (median: 12 months, range: 1–44 months). Patients were examined clinically, by neuropsychological testing and by electroencephalography. The clinical presentation during the acute stage was as follows: Meningitis (M, n=12), Meningoencep...

Hemiparesis has rarely been observed in frontal lobe degeneration (FLD). We describe the clinical, neuropsychological and neuroimaging findings of a patient in whom a slowly evolving hemiparesis was the principal symptom of FLD, and of 2 demented patients in whom hemiparesis was an early and prominent symptom. The occurrence of central motor defici...

This group study examined the role of residual declarative memory and task-specific cognitive abilities for cognitive procedural learning in amnesia. 20 amnesic patients and 40 control subjects were studied, using four new cognitive tasks, as well as the Tower of Hanoi and a Mirror Reading task. On the cognitive tasks, but not on Mirror Reading, th...

Twenty-five patients without relevant organic disease were examined who complained of long-standing memory disturbance, but were free of relevant organic disease and exhibited a test performance that was normal, or reduced by not more than two standard deviations. Cases of amnesia in the context of dissociative reactions were not considered. Sympto...