Stefan Kreisel

Evangelisches Klinikum Bethel · Division of Geriatric Psychiatry

BACKGROUND In face of an increasing treatment need of persons with dementia, effective and efficient interventions with a focus on quality of life need to be established. In this context, Serious Games have received increasing attention. However, there is a lack of applications specifically designed for people with dementia. OBJECTIVE In the curre...

Zusammenfassung Ziel Ziel ist die Analyse pandemiebedingter Auswirkungen auf den Alltag und die psychosoziale Gesundheit der bislang wenig untersuchten vulnerablen Gruppe zu Hause lebender, kognitiv beeinträchtigter älterer Menschen. Methodik Mittels strukturierter Telefoninterviews 2020 (n+=+141) und 2021 (n+=+107) wurden über 65-Jährige mit kogni...

Around 1.8 million people in Germany live with dementia. Ascending trend. Discharging people with cognitive impairment from the hospital and transitioning them to outpatient care brings special challenges and presents the health care system with a new and increasingly important task. In Germany there are legal efforts (§39 paragraph 1a, SGB V) to c...

Background There is a need to examine whether evidence based collaborative care management can be beneficial to people with cognitive impairment transitioning from hospital to primary care. Method We conducted a longitudinal multisite randomized controlled trial with two arms (care as usual and care as usual + intersectoral care management) and tw...

Objectives: Older drivers often show less precise self-ratings with a tendency to overestimate themselves. It is unclear, however, how overestimators differ from underestimators or drivers with adequate self-ratings. Methods: 59 healthy older drivers participated in this on-road study. Besides standardized on-road driving assessment, the study prot...

Objectives: Persons with Alzheimer's disease dementia (ADD) often show impaired orientation particularly in unknown environments. Signs may offer an opportunity to compensate for these deficits and thus improve participation. Method: We assessed 30 persons with ADD and 36 healthy controls by using a Sign Comprehension Paradigm (SCP) in a real-li...

What does it mean to be a (female) child in the city of Baku, Azerbaijan? How can we critically interpret the girls' understandings of well-being considering different forms of compliance with unequal social orders? What conclusions may be drawn from understandings of well-being about the nature of welfare state structures and therein children's sp...

Objective Attention is the cardinal feature of delirium, but attentional domains may also be affected by dementia and its severity. It is, therefore, of interest to study the correlation between the severity of cognitive impairment in non-delirious patients and different measurements of attentional performance, to identify attention subdomains less...

Objective: Patients with Alzheimer disease dementia (ADD) often show impaired orientation and navigation. Signage offers an opportunity to compensate for these deficits, communicate information efficiently and facilitate wayfinding. Certain properties of signs such as colors and contrasts may beneficially affect the uptake and processing of inform...

Background Cognitive impairment is an important determinant in health care. In the acute hospital setting cognition has a strong impact on treatment and care. Cognitive impairment can negatively affect diagnostics and treatment success. However, little is known about the individual situation and specific risks of people with cognitive impairments d...

Zusammenfassung Hintergrund Da ältere Menschen ein erhöhtes Risiko für schwere und letale Verläufe einer SARS-CoV-2-Infektion aufweisen, erfahren sie besondere Aufmerksamkeit, die sich jedoch häufig einseitig auf ihre Schutzbedürftigkeit bezieht. Erforderlich ist eine Auseinandersetzung, die ihren subjektiven Wirklichkeiten Rechnung trägt und nebe...

Background In the healthcare system in Germany, different institutions and actors play specific roles in the discharge and transition of patients from hospitals into primary care (Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen, Wettbewerb an der Schnittstelle zwischen ambulanter und stationärer Gesundheitsversorgung, 2012)...

Background Assistive technologies for people with dementia and their relatives have the potential to ensure, improve, and facilitate home care and thereby enhance the health of the people caring or being cared for. The number and diversity of technologies and research have continuously increased over the past few decades. As a result, the research...

Background: Cognitive impairment is an important determinant in health care. In the acute hospital setting cognition has a strong impact on treatment and care. Cognitive impairment can negatively affect diagnostics and treatment success. However, little is known about the individual situation and specific risks of patients with cognitive impairment...

Objectives : Due to demographic change, the number of older drivers with impaired driving skills will increase in the next decades. The current study aimed at the validation and extension of the screening tool Safety Advice For Elderly drivers (SAFE) that allows a cost-efficient assessment of driving-related risk factors in older drivers. Method :...

Background The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of healt...

The sizeable number of population-based cohort studies of aging in Germany have provided highly valuable contributions for the specification of risk factors and predictors for frequent mental disorders in old age, especially dementia and depression. The results from these cohort studies enable the specification of mechanisms for the development of...

BACKGROUND Assistive technologies for people with dementia and their relatives have the potential to ensure, improve, and facilitate home care and thereby enhance the health of the people caring or being cared for. The number and diversity of technologies and research have continuously increased over the past few decades. As a result, the research...

Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of heal...

Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of heal...

Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of heal...

Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. The aim of this study is to analyze a) knowledge about, and feelings related to the Corona-pandemic. Describe b) loneliness, depression and anxiety and, c) the perceived, immediate impact of the lockdown on frequency of social contacts and quality of heal...

Background: The outbreak of the Corona virus is a challenge for health care systems worldwide. Elderly people with comorbidities are at a higher risk and the different levels of government in Germany reacted jointly to the challenge with social distancing and a lockdown. Little empirical evidence exists about the psychosocial situation of elderly p...

Zusammenfassung Im Fallbericht werden die Vorteile multiprofessioneller Kooperation von BehandlerInnen bei der gerontopsychiatrischen Arbeit in einer Psychiatrischen Institutsambulanz (PIA) dargestellt. Psychologin und Psychiater arbeiten parallel auch stationär fallverantwortlich und können auf die dortige Behandlungsexpertise zurückgreifen. So ge...

Background In German hospitals approximately 40% of all patients over the age of 65 years are cognitively impaired (MmkB). After discharge from hospital it is particularly important for MmkB that the transition to domestic life is organized as seamlessly and as well-coordinated as possible.Objective The aim of the study was to determine the existin...

Ageing is associated with changes in cognitive functions that affect fitness to drive. However, little is known about age effects on traffic sign comprehension (TSC). In this study, we assessed 37 older and 29 younger healthy drivers with a standardised traffic sign test and a comprehensive neuropsychological test battery. Older drivers showed lowe...

Introduction: Previous research suggests that specific symbol features attenuate symbol comprehension deficits in seniors suffering from Alzheimer disease dementia (ADD). However, it remains unclear whether these findings also apply to other disorders associated with cognitive dysfunctions. Methods: Ninety healthy controls, 30 patients with majo...

Background: The sectorization of health-care systems leads to inefficient treatment, especially for elderly people with cognitive impairment. The transition from hospital care to primary care is insufficiently coordinated, and communication between health-care providers is often lacking. Consequences include a further deterioration of health, high...

Background Sectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rate...

Background Sectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rate...

Background Sectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rate...

Objectives: The aim of the current work was to investigate the relationship between avoidance of specific driving situations and on-road driving skills in older drivers considering factors found to be related to both avoidance behavior and driving skills. Method: Seventy-two older drivers (M = 76 years) from the general population were included...

Diagnosing delirium superimposed on dementia (DSD) remains challenging because of a lack of specific tools, though motor dysfunction in delirium has been relatively under-explored. This study aimed to use dysfunction in balance and mobility (with the Hierarchical Assessment of Balance And Mobility: HABAM) to identify DSD. This is a cross-sectional...

Background Causal experimental evidence that physical activity prevents disability in older people is sparse. Being physically active has nonetheless been shown to be associated with disability-free survival in observational studies. Observational studies are, however, prone to bias introduced by time-dependent confounding. Time-dependent confoundi...

Background Detecting delirium superimposed on dementia (DSD) can be challenging because assessment partly relies on cognitive tests that may be abnormal in both conditions. We hypothesized that a combined arousal and attention testing procedure would accurately detect DSD. Methods Patients aged ≥70 years were recruited from five hospitals across E...

Objectives: To determine whether sleep disruption at home or in hospital is an independent risk factor for postoperative delirium in older adults undergoing elective surgery. Design: Prospective cohort study. Setting: German teaching hospital. Participants: Individuals aged 65 and older undergoing elective arthroplasty (N = 101). Measuremen...

Delirium occurring in patients with dementia is referred to as delirium superimposed on dementia (DSD). People who are older with dementia and who are institutionalized are at increased risk of developing delirium when hospitalized. In addition, their prior cognitive impairment makes detecting their delirium a challenge. The Diagnostic and Statisti...

Background: Average serum matrix metalloproteinase (MMP) concentrations in patients with acute stroke have shown to be varying across studies. Possibly, next to true effects, other factors may influence MMP levels. The aim of this study was to investigate the dynamics of these enzymes in repeated measurements in the acute post-stroke period, in re...

We report on a 75-year-old female who consulted our Memory Clinic because of subjective memory complaints that she first recognized three months previously. Next to the standard detailed patient history, neuropsychological assessment, psychopathological status, the patient’s driving history played an important role in the diagnostic process. In thi...

Due to rather unspecific statutory regulations in Germany, particularly for patients with neurodegenerative disorders, many seniors still drive despite severe driving-related cognitive deficits. An accurate assessment of driving fitness requires immense financial, personnel and temporal resources which go beyond daily clinical routines. In cooperat...

Objectives: Memory and executive deficits are important cognitive markers of Alzheimer's disease (AD). Moreover, in the past decade, cerebrospinal fluid (CSF) biomarkers have been increasingly utilized in clinical practice. Both cognitive and CSF markers can be used to differentiate between AD patients and healthy seniors with high diagnostic accu...

Background: The Guillain-Barré syndrome (GBS) occurs after infections and as an adverse reaction to vaccines. No detailed information on incidence rates (IRs) in Germany is available. Methods: This retrospective cohort study estimated age- and sex-specific IRs of GBS in Germany in the years 2007-2009 based on electronic healthcare data from the...

Borderline personality disorder (BPD) may be associated with smaller hippocampi in comparison to hippocampal size in controls. However, specific pathology in hippocampal substructures (i.e., head, body and tail) has not been sufficiently investigated. To address hippocampal structure in greater detail, we studied 39 psychiatric inpatients and outpa...

Das Thema Fahrtauglichkeit wird von Patienten mit kognitiven Einschränkungen und den behandelnden Ärzten gemieden, um die therapeutische Beziehung nicht zu belasten. Vielen Ärzten fehlt die Erfahrung im Bereich der Verkehrsmedizin und die Sicherheit in der Wertung neuropsychologischer und medizinischer Befunde, vor allem bei beginnenden kognitiven...

Background The Diagnostic and Statistical Manual fifth edition (DSM-5) provides new criteria for delirium diagnosis. We examined delirium diagnosis using these new criteria compared with the Diagnostic and Statistical Manual fourth edition (DSM-IV) in a large dataset of patients assessed for delirium and related presentations.Methods Patient data (...

Delirium is a common and serious problem among acutely unwell persons. Alhough linked to higher rates of mortality, institutionalisation and dementia, it remains underdiagnosed. Careful consideration of its phenomenology is warranted to improve detection and therefore mitigate some of its clinical impact. The publication of the fifth edition of the...

Results of MRI volumetry in Borderline Personality Disorder (BPD) are inconsistent. Some, but not all, studies reported decreased hippocampus, amygdala, and/or prefrontal volumes. In the current study, we used rater-independent voxel-based morphometry (VBM) in 33 female BPD patients and 33 healthy women. We measured gray matter (GM) volumes of the...

Background: There are still substantial uncertainties over best practice in delirium care. The European Delirium Association (EDA) conducted a survey of its members and other interested parties on various aspects of delirium care. Methods: The invitation to participate in the online survey was distributed among the EDA membership. The survey cover...

Delirium is a serious and common acute neuropsychiatric syndrome that is associated with short- and long-term adverse health outcomes. However, relatively little delirium research has been conducted in unselected populations. Epidemiologic research in such populations has the potential to resolve several questions of clinical significance in deliri...

Background: Cross-sectional studies have shown an association between the severity of age-related white matter change (ARWMC) and lower body motor function. However, the association between prevalent ARWMC and incident deterioration of balance and gait remains insufficiently investigated. This study investigates if the degree of prevalent ARWMC ha...

Subarachnoid hemorrhage (SAH) accounts for <7% of all strokes, but is an enormous individual and societal burden. We investigated the risk of SAH associated with prior use of antithrombotic drugs and their influence on 30-day case fatality. We conducted a nested case-control study in a cohort of 13.4 million members of the German Pharmacoepidemiolo...

Matrix metalloproteinases (MMP) have a prominent role in the pathophysiology of stroke. We investigated potential differences in MMP-2 concentrations with respect to acute stroke etiology. For another MMP family member, MMP-9, significant degradation over time has been found even when stored at -80°C, so we measured temporal degradation of MMP-2 an...

To compare performance characteristics of the Confusion Assessment Method (CAM) algorithm for screening and delirium diagnosis with criteria for delirium from the International Classification of Diseases, Tenth Revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) in high-risk individuals. Prospective...

Delirium, a frequently occurring, devastating disease, is often underdiagnosed, especially in dementia. Serum anticholinergic activity (SAA) was proposed as a disease marker as it may reflect delirium's important pathogenetic mechanism, cholinergic deficiency. We assessed the association of serum anticholinergic activity with delirium and its risk...

Hemorrhagic transformation (HT) after acute ischemic stroke is frequently detected using magnetic resonance imaging (MRI), in particular in patients treated with tissue plasminogen activator (tPA). Knowledge about causes and early clinical consequences of HT mostly arises from computed tomography-based studies. We analyzed potential predictors and...

The frontal hypothesis of aging predicts an age-related decline in cognitive functions requiring inhibitory or attentional regulation. In Alzheimer’s disease, preattentive gating out of redundant information is impaired. Our study aimed to examine changes associated with physiological aging in both pre- and early attentive inhibition of recurrent a...

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Fragestellung: Patienten mit einer zugrunde liegenden Demenz haben ein deutlich erhohtes Risiko ein Delir zu entwickeln mit z.T. erheblichen Konsequenzen i.S. einer weiteren Verschlechterung kognitiver wie funktioneller Defizite. Zwar ist die Entstehung des Delirs multifaktoriell, jedoch wird angenommen, dass eine gemeinsame „Endstrecke“ i.S. einer...

Emotional dysregulation is a key feature of borderline personality disorder (BPD) with altered inhibitory functions having suggested as being crucial. The anterior cingulate cortex and further prefrontal brain regions are crucial for response inhibition. The regulation of emotions is ensured via inhibitory control over the amygdala. The present stu...

In patients with acute ischaemic stroke, hyperglycaemia has been retrospectively associated with negative outcome. There is an ongoing discussion as to which treatment algorithm, if any, provides the most effective prospective intervention. Here we test the safety and feasibility of an intravenous insulin-only infusion protocol designed for pragmat...

Stem cell therapy seems promising in reducing deficits after focal cerebral ischemia. As stroke may result from intracerebral hemorrhage (ICH) in up to 20% we investigated whether human processed lipoaspirate mesenchymal stem cells (PLA-MSC) influence the functional outcome, migration behavior and the activation of endogenous progenitor cells. Expe...

Cognitive inhibition processes were found to be deficient early in the clinical course of Alzheimer's disease (AD). The inhibition of redundant information is a precondition for efficient cognitive processing and presumably modulated by prefrontal attentional networks. Deficits in the suppression of the evoked potential P50 response to paired click...

Combined 2-MHz ultrasound (US) and second-generation, sulfur hexafluoride microbubbles (MB) treatment (US+MB) was performed in a permanent middle cerebral artery (MCA) occlusion model in rats to evaluate possible effects on the ischemic cascade. We used 16 Wistar rats and the MCA occlusion model for stroke induction. Glutamate, pyruvate, lactate an...

Even though the disruption of motor activity and function caused by stroke is at times severe, recovery is often highly dynamic. Recuperation reflects the ability of the neuronal network to adapt. Next to an unmasking of latent network representations, other adaptive processes, such as excitatory metabolic stress, an imbalance in activating and inh...

Microbubble-enhanced sonothrombolysis (MEST) may be an alternative therapeutic option in ischemic stroke. Clinical study of the efficacy of MEST as an adjunct stroke therapy, before imaging with CT or MRI, requires experimental data on the safety of this approach in the presence of hemorrhagic stroke. We, therefore, investigated the effect of diagn...

Stroke almost always causes an impairment of motor activity and function. Clinical recovery, though usually incomplete, is often highly dynamic and reflects the ability of the neuronal network to adapt. Mechanisms that underlie neuro-functional plasticity are now beginning to be understood. Albeit the enormous efforts undertaken to support the natu...

The purpose of this study was to define a standardized multiplanar approach for transcranial ultrasound (US) imaging of brain parenchyma based on matched data from 3-D US and 3-D magnetic resonance imaging (MRI). The potential and limitations of multiple insonation planes in transverse and coronal orientation were evaluated for the visualization of...

Mutations in the X-linked deafness-dystonia peptide 1 (DDP1) gene cause Mohr-Tranebjaerg syndrome (MTS), a rare form of deafness associated with dystonia. In the patient presented here, improvement of dystonic symptoms upon treatment with alcohol and GABAergic substances is demonstrated for the first time.

The Mohr-Tranebjaerg syndrome (MTS) is a rare neurodegenerative disorder characterized by early-onset deafness, dystonia and further neurological abnormalities such as cortical blindness, spasticity, dementia and mental retardation. Causative mutations were identified within the deafness-dystonia peptide (DDP1/TIMM8a) gene on the X-chromosome. The...

An inflammatory host response in the ischemically injured brain is well documented. However, its pathophysiological relevance is uncertain. We investigated whether inflammatory leukocyte response in the ischemic brain alters infarct size. The cellular inflammatory response to cerebral ischemia in Wistar-derived rats induced by the transient occlusi...

Subarachnoidal release of inflammatory cytokines (interleukin (IL)-1beta, IL-6, and tumour necrosis factor (TNF)-alpha) was characterised in 35 patients with subarachnoid haemorrhage (SAH) and control subjects and compared with development of complicating haemodynamic abnormalities in basal cerebral arteries and clinical outcome. Serial analysis al...