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18 results on '"Weckbecker, Klaus"'

1. [Addressing Issues of Living Will and Power of Attorney in Patients With Dementia - A Cross-Sectional Study Among German General Practitioners].

Author

Tillmann J, Schnakenberg R, Weckbecker K, Just J, Weltermann B, and Münster E

Subjects
Attitude of Health Personnel, Cross-Sectional Studies, Germany, Humans, Surveys and Questionnaires, Dementia, General Practitioners, Living Wills, Proxy
Abstract

Objectives: Issues of living will and power of attorney must be addressed as early as possible in dementia patients because of their decreasing independence and ability to act for themselves. The aim of this study was to investigate whether general practitioners (GPs), who usually have long-standing and regular contact with this group of patients, address these precautionary measures and if there is any association between this approach and further communication and educational behaviour of doctors., Methods: A cross-sectional survey, using standardized, written questionnaires, was conducted in a random sample of 982 GPs in North Rhine-Westphalia in western Germany between October 2017 and January 2018. Descriptive statistical as well as logistic regression analyses were carried out using IBM SPSS Statistics, version 24., Results: A total of 339 GPs responded to the survey questionnaire (response rate: 34.5%). A majority of GPs (70.1%) agreed totally or partially that it was necessary to address their dementia patients on living will and power of attorney; GPs who were more confident in communicating a dementia diagnosis reported addressing the issue of documents for the end of life more frequently (aOR: 1.97; 95%-CI: 1.17-3.33). Older GPs with greater knowledge of regional services for dementia patients also tended to address this topic more frequently., Conclusions: General practitioners make a major contribution to help dementia patients and their relatives to plan ahead at an early stage of the disease. It can be concluded from our results that GPs' knowledge and experiences about dementia and local services, as well as how to deal with those affected should be improved in order to optimise communication on living will and power of attorney as precautionary measures., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Published
2020
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2. Challenges in diagnosing dementia in patients with a migrant background - a cross-sectional study among German general practitioners.

Author

Tillmann J, Just J, Schnakenberg R, Weckbecker K, Weltermann B, and Münster E

Subjects
Attitude to Health, Cross-Sectional Studies, Female, Germany, Humans, Logistic Models, Male, Middle Aged, Shame, Surveys and Questionnaires, Attitude of Health Personnel, Communication Barriers, Culture, Dementia diagnosis, Emigrants and Immigrants, General Practitioners
Abstract

Background: Diagnosing dementia, a syndrome affecting 35.6 million people worldwide, can be challenging, especially in patients with a migrant background. Language barriers and language-based diagnostic tools, cultural differences in the perception of the syndrome as well as restricted access to healthcare can influence medical care. For the first time in Germany, this study investigates whether German general practitioners (GPs) feel prepared to meet the diagnostic needs of these patient groups and whether there are challenges and support needs., Methods: A cross-sectional study among a random sample of 982 general practitioners in Germany was conducted from October 2017 to January 2018 (response rate: 34.5%). A self-developed, written, standardised questionnaire was used. Descriptive statistics as well as multiple logistic regression analyses were performed using data of 326 GPs., Results: Ninety-six percent of GPs reported having experienced barriers at least once. Uncertainties in diagnosing dementia in patients with a migrant background were indicated by 70.9%. There was no significant association between uncertainties in diagnosing dementia and GPs' sociodemographic characteristics. The most frequently reported barriers were language barriers that affected or prevented diagnostics (89.3%) and information deficits in patients with a migrant background (59.2%). Shameful interaction or lack of acceptance of the syndrome was also common (55.5%). A demand for more information about the topic was expressed by 70.6% of GPs., Conclusions: Public health measures supporting GPs in their interaction with patients with a migrant background as well as information and services for dementia patients are needed. Efforts to facilitate access to interpreting services and to focus on people with a migrant background in healthcare are necessary., Trial Registration: German Clinical Trials Register: DRKS00012503 , date of registration: 05/09/2017 (German Institute of Medical Documentation and Information. German Clinical Trials Register (DRKS) 2017). Clinical register of the study coordination office of the University hospital of Bonn: ID530, date of registration: 05/09/2017 (Universitätsklinikum Bonn. Studienzentrum. UKB-Studienregister 2017).

Published
2019
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3. Barriers in general practitioners' dementia diagnostics among people with a migration background in Germany (BaDeMi) - study protocol for a cross-sectional survey.

Author

Tillmann J, Schnakenberg R, Puth MT, Weckbecker K, Just J, and Münster E

Subjects
Cross-Sectional Studies, General Practice methods, General Practice standards, Germany, Humans, Primary Health Care methods, Primary Health Care standards, Research Design standards, Surveys and Questionnaires, Transients and Migrants statistics & numerical data, Dementia diagnosis, General Practice statistics & numerical data, General Practitioners, Primary Health Care statistics & numerical data
Abstract

Background: Considering the targeted general practitioner-centred healthcare in Germany, general practitioners (GPs) are in the best possible position to increase awareness of all sorts of dementia, an age-related syndrome with rising relevance in the future. In Germany, a doubling of the number of cases from 1.55 million up to 3 million in 2050 is predicted. Diagnostics can be challenging, especially among patients with a migration background. Complicating factors include: Language-based diagnostic tools, cultural differences in handling the syndrome and its underlying diseases as well as a differing use of the healthcare system. Because of missing research in this field in Germany, the type, frequency and intensity of barriers as well as the way GPs cope with them is unknown. That is why it's crucial to focus research on diagnostics in total and especially among this population group., Methods: A cross-sectional study among a random sample of 1000 general practitioners in Germany is conducted in October 2017. A self-administered standardized questionnaire was developed, evaluated and send to the GP practices. A response rate of 30% is expected with one reminder letter. Descriptive statistics as well as, depending on the results, multivariable analyses will be executed. Based on these results and the stated needs, a cluster-randomized intervention study will be constructed to improve healthcare., Discussion: This study is the first in Germany focusing on how dementia diagnostics in general practice is performed, what problems occur, especially because of a migration background of patients, and how GPs cope with them. Depending on the results, it should emphasize the necessity of dementia diagnostics to be adjusted to the needs of the rising amount of people with a migration background (22.5% in Germany, 2016) like concluded from international studies., Trial Registration: German Clinical Trials Register: DRKS00012503 , date of registration: 05.09.2017. Clinical register of the study coordination office of the University hospital of Bonn: ID530 , date of registration: 05.09.2017.

Published
2018
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4. Hyperuricemia and dementia - a case-control study.

Author

Engel B, Gomm W, Broich K, Maier W, Weckbecker K, and Haenisch B

Subjects
Aged, Case-Control Studies, Female, Gout epidemiology, Humans, Male, Middle Aged, Odds Ratio, Risk, Uric Acid blood, Dementia epidemiology, Hyperuricemia epidemiology
Abstract

Background: There is evidence that uric acid may have antioxidant and neuroprotective effects and might therefore alter the risk for neurodegenerative diseases such as dementia. So far, the relation between serum uric acid (SUA) levels or hyperuricemia and dementia remains elusive. Most studies focused on the disease or SUA levels. Effects of anti-hyperuricemic treatment have not been considered yet. This study investigated the association between hyperuricemia and dementia taking into account anti-hyperuricemic treatment., Methods: We used longitudinal German public health insurance data and analyzed the association between hyperuricemia with and without different treatment options and dementia in a case-control design. Applying logistic regression the analysis was adjusted for several potential confounders including various comorbidities and polypharmacy., Results: We identified 27,528 cases and 110,112 matched controls of which 22% had a diagnosis of hyperuricemia or gout and 17% received anti-hyperuricemic drugs. For patients with a diagnosis of hyperuricemia we found a slightly reduced risk for dementia (adjusted odds ratio [OR] 0.94, 95% confidence interval [CI] 0.89 to 0.98). The risk reduction was more pronounced for patients treated with anti-hyperuricemic drugs (adjusted OR 0.89, 95% CI 0.85 to 0.94, for regular treatment)., Conclusions: Our results showed a slight reduction for dementia risk in patients with hyperuricemia, both with and without anti-hyperuricemic treatment.

Published
2018
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5. Regular Benzodiazepine and Z-Substance Use and Risk of Dementia: An Analysis of German Claims Data.

Author

Gomm W, von Holt K, Thomé F, Broich K, Maier W, Weckbecker K, Fink A, Doblhammer G, and Haenisch B

Subjects
Aged, Aged, 80 and over, Benzodiazepines chemistry, Case-Control Studies, Dementia diagnosis, Drug Utilization statistics & numerical data, Female, Follow-Up Studies, Germany epidemiology, Humans, Insurance Claim Reporting statistics & numerical data, Longitudinal Studies, Male, Middle Aged, Risk Factors, Benzodiazepines adverse effects, Dementia chemically induced, Dementia epidemiology, Drug Utilization trends, Insurance Claim Reporting trends
Abstract

Background: While acute detrimental effects of benzodiazepine (BDZ), and BDZ and related z-substance (BDZR) use on cognition and memory are known, the association of BDZR use and risk of dementia in the elderly is controversially discussed. Previous studies on cohort or claims data mostly show an increased risk for dementia with the use of BDZs or BDZRs. For Germany, analyses on large population-based data sets are missing., Objective: To evaluate the association between regular BDZR use and incident any dementia in a large German claims data set., Methods: Using longitudinal German public health insurance data from 2004 to 2011 we analyzed the association between regular BDZR use (versus no BDZR use) and incident dementia in a case-control design. We examined patient samples aged≥60 years that were free of dementia at baseline. To address potential protopathic bias we introduced a lag time between BDZR prescription and dementia diagnosis. Odds ratios were calculated applying conditional logistic regression, adjusted for potential confounding factors such as comorbidities and polypharmacy., Results: The regular use of BDZRs was associated with a significant increased risk of incident dementia for patients aged≥60 years (adjusted odds ratio [OR] 1.21, 95% confidence interval [CI] 1.13-1.29). The association was slightly stronger for long-acting substances than for short-acting ones. A trend for increased risk for dementia with higher exposure was observed., Conclusion: The restricted use of BDZRs may contribute to dementia prevention in the elderly.

Published
2016
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6. The value of the GP’s clinical judgement in predicting dementia: a multicentre prospective cohort study among patients in general practice

Author

Pentzek, Michael, Wagner, Michael, Maier, Wolfgang, Koppara, Alexander, Group, AgeCoDe Study, Scherer, Martin, van den Bussche, Hendrik, Abholz, Heinz-Harald, Brettschneider, Christian, Bachmann, Cadja, Bickel, Horst, Blank, Wolfgang, Eifflaender-Gorfer, Sandra, Eisele, Marion, Ernst, Annette, Fuchs, Angela, Heser, Kathrin, Jessen, Frank, Kaduszkiewicz, Hanna, Kaufeler, Teresa, Köhler, Mirjam, König, Hans-Helmut, Lange, Carolin, Lubisch, Diana, Luck, Tobias, Lühmann, Dagmar, Luppa, Melanie, Mayer, Manfred, Mösch, Edelgard, Posselt, Tina, Prokein, Jana, Riedel-Heller, Steffi, Röhr, Susanne, Schumacher, Anna, Stein, Janine, Steinmann, Susanne, Tebarth, Franziska, Wiese, Birgitt, Weckbecker, Klaus, Weeg, Dagmar, Werle, Jochen, Weyerer, Siegfried, Wolfsgruber, Steffen, Zimmermann, Thomas, and Riedel-Heller, Steffi G

Subjects
Male, medicine.medical_specialty, Clinical Decision-Making, General Practice, epidemiology [Germany], Judgment, 03 medical and health sciences, 0302 clinical medicine, General Practitioners, Germany, Internal medicine, Humans, Medicine, Dementia, ddc:610, Prospective Studies, 030212 general & internal medicine, Cognitive decline, statistics & numerical data [Referral and Consultation], Prospective cohort study, Referral and Consultation, Aged, Physician-Patient Relations, business.industry, Proportional hazards model, Research, standards [General Practitioners], Odds ratio, medicine.disease, Confidence interval, diagnosis [Dementia], Cognitive test, Log-rank test, Evidence-Based Practice, Female, Family Practice, business, 030217 neurology & neurosurgery
Abstract

BackgroundClinical judgement is intrinsic to diagnostic strategies in general practice; however, empirical evidence for its validity is sparse.AimTo ascertain whether a GP’s global clinical judgement of future cognitive status has an added value for predicting a patient’s likelihood of experiencing dementia.Design and settingMulticentre prospective cohort study among patients in German general practice that took place from January 2003 to October 2016.MethodPatients without baseline dementia were assessed with neuropsychological interviews over 12 years; 138 GPs rated the future cognitive decline of their participating patients. Associations of baseline predictors with follow-up incident dementia were analysed with mixed-effects logistic and Cox regression.ResultsA total of 3201 patients were analysed over the study period (mean age = 79.6 years, 65.3% females, 6.7% incident dementia in 3 years, 22.1% incident dementia in 12 years). Descriptive analyses and comparison with other cohorts identified the participants as having frequent and long-lasting doctor–patient relationships and being well known to their GPs. The GP baseline rating of future cognitive decline had significant value for 3-year dementia prediction, independent of cognitive test scores and patient’s memory complaints (GP ratings of very mild (odds ratio [OR] 1.97, 95% confidence intervals [95% CI] = 1.28 to 3.04); mild (OR 3.00, 95% CI = 1.90 to 4.76); and moderate/severe decline (OR 5.66, 95% CI = 3.29 to 9.73)). GPs’ baseline judgements were significantly associated with patients’ 12-year dementia-free survival rates (Mantel–Cox log rank testPConclusionIn this sample of patients in familiar doctor–patient relationships, the GP’s clinical judgement holds additional value for predicting dementia, complementing test performance and patients’ self-reports. Existing and emerging primary care-based dementia risk models should consider the GP’s judgement as one predictor. Results underline the importance of the GP-patient relationship.

Published
2019
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8. Mortality in Incident Cognitive Impairment: Results of the Prospective AgeCoDe Study

Author

Luck, Tobias, Riedel-Heller, Steffi G, Mamone, Silke, Mallon, Tina, Wolfsgruber, Steffen, Weeg, Dagmar, Fuchs, Angela, Brettschneider, Christian, Scherer, Martin, Maier, Wolfgang, Weyerer, Siegfried, group, AgeCoDe study, Roehr, Susanne, van den Bussche, Hendrik, Abholz, Heinz-Harald, Bachmann, Cadja, Blank, Wolfgang, Eifflaender-Gorfer, Sandra, Eisele, Marion, Ernst, Annette, Jessen, Frank, Kaduszkiewicz, Hanna, Kaufeler, Teresa, Wiese, Birgitt, Köhler, Mirjam, Koppara, Alexander, Lubisch, Diana, Lühmann, Dagmar, Luppa, Melanie, Mayer, Manfred, Mösch, Edelgard, Prokein, Jana, Schumacher, Anna, Stein, Janine, van der Leeden, Carolin, Steinmann, Susanne, Tebarth, Franziska, Wagner, Michael, Weckbecker, Klaus, Zimmermann, Thomas, Heser, Kathrin, Bickel, Horst, Pentzek, Michael, König, Hans-Helmut, and Werle, Jochen

Subjects
Male, Pediatrics, medicine.medical_specialty, epidemiology [Germany], Kaplan-Meier Estimate, Interviews as Topic, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Germany, Mean Survival Time, Medicine, Dementia, Humans, 030212 general & internal medicine, ddc:610, Prospective Studies, Prospective cohort study, Cognitive impairment, Aged, mortality [Cognition Disorders], Proportional hazards model, business.industry, Incidence, Cognition, medicine.disease, Increased risk, Ageing, Female, Geriatrics and Gerontology, Cognition Disorders, business, 030217 neurology & neurosurgery
Abstract

Objectives To investigate mortality risk and survival time in new-incident cases of cognitive impairment (CI) in old age. Design Prospective cohort study in six German cities. Setting German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe). Participants Two thousand eighty-nine nondemented GP patients aged 75+. Measurements Every 18 months, trained psychologists and physicians conducted structured clinical interviews at the participants’ homes. Dates of death were obtained from relatives, general practitioner (GP), or the local registry offices. We used the Kaplan–Meier survival method to estimate survival times of individuals with and without incident CI and multivariable Cox proportional hazards regressions to assess the association between CI and mortality risk, controlled for covariates. Results Out of the 2,089 included patients at follow-up I, 859 (41.1%) died during the subsequent mean observation period of 8.0 years. Patients with incident CI at follow-up I showed a significantly higher case-fatality rate per 1,000 person-years (74.2, 95% CI = 64.2–84.2 vs 47.8, 95% CI = 44.6–51.0) and a significantly shorter mean survival time in the observation period than those without (7.8 vs 9.1 years; P < .001). The association between incident CI and mortality remained significant in the multivariable Cox analyses–incident CI was associated with a 42% increased, incident severe CI with a 75% increased mortality risk. Conclusion Our findings suggest an elevated mortality risk in newly acquired cognitive deficits in old age. Even though further studies are required to analyze potential underlying mechanisms, our findings support the notion that such cognitive deficits should be taken seriously in clinical practice not only for an increased risk of developing dementia but also for a broader range of possible adverse health outcomes.

Published
2017
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9. Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe)

Author

Heser, K., Tebarth, F., Leicht, H., Bohnau, Harald, Pinsdorf, Ursula, Busch, Thomas, Keller, Gisela, Fuchs-Romer, Susanne, Beisel, Wolfgang, Richter-Polynice, Birgitt, Cupsa, Florinela, Unkelbach, Roland Matthias, Schiller, Gerhard, Pentzek, M., Damanakis, Barbara, Frenkel, Michael, Ebeling, Klaus-Wolfgang, Berger, Pauline, Gillhausen, Kurt, Hellmessen, Uwe, Hummerich, Helga, Heede, Hans-Christian, Kormann, Boguslaw-Marian, Peters, Josef, Fuchs, A., Schott, Ulrich, Matzies, Dirk, Schumacher, Andre, Oliver Flettner, Tim, Thraen, Winfried, Siegmund, Harald, Levacher, Claus, Blankenstein, Tim, Lamborelle, Eliane, Hollstein, Ralf, Riedel-Heller, S. G., Hoffmann, Edna, Ghane, Ingeborg, Claß, Regine, Meier, Stefan-Wolfgang, Moers, Leo W, Wundram, Udo, Schmitt, Klaus, Missghian, Rastin, Spallek, Karin, Schlosser, Christiane, Luppa, M., Groß, Kathrin, Bouche, Winfried, Linn, Ursula, Bormann, Gundula, Schulze, Gerhard, Stelter, Klaus, Gatermann, Heike, Fischer-Radizi, Doris, Witt, Peter, Kavka, Stefanie, Prokein, J., Klotzl, Gunther, Baumho, Michael, Oberlander, Maren, Schiewe, Cornelia, Hufnagel, Jorg, Kressel, Marei, Kebschull, Michael, Wagner, Christine, Burkhardt, Fridolin, Hase, Martina, Scherer, M., Houcken, Karl-Heinz, Zebidi, Christiane, Brohan, Johann, Russ, Christiane, Bethge, Frank, Rughase-Block, Gisela, Lorenzen, Margret, Elsen, Arne, Korte, Daniela, Jedicke, Ursula, Group, Age CoDe Study, Zoras, Constantin, Pfeil-Woltmann, Gabriele, Kaiser, Martin, Bruns, Johannes, Homann, Joachim, Gorgon, Georg, Middendorf, Niklas, Menschke, Kay, Bayer, Hans H, Maier, Wolfgang, Jesse, Nadine, Dahlke, Marcus, Lipp, Thomas, Amm, Martina, Bauer, Horst, Rauchmaul, Gabriele, Ebert, Hans Jochen, Gabriel-Mu, Angelika, Taut, Hans-Christian, Voß, Hella, Scherer, Martin, Schmidt, Holger, Hager, Eva, Tunze, Bettina, Paschke, Thomas, Assmann, Heinz-Michael, Rahnefeld, Uwe, Striegler, Petra, Gierth, Marga, Boehm, Margret, Harnisch, Dagmar, Wiese, B., van den Bussche, Hendrik, Kornisch-Koch, Simone, Hambsch, Frank, Herzig, Cornelia, Georgi, Astrid, Schwarzmann, Erhard, Schinagl, Gerd, Pehnke, Ulrike, Dayab, Mohammed, Brosig, Michael, Sperling, Volkmar, Abholz, Heinz-Harald, Lebuser, Frank, Hagert, Detlef, Arnold, Gerhard, Bauer, Viet-Harold, Becker, Hartwig, Becker, Hermine, Besier, Werner, Grella, Hartmut, Grimm, Hans Heinrich, Heck, Petra, Bachmann, Cadja, Hemler, Werner, Henn, Eric, Mayer, Manfred, Orlovius, Gerhard, Renz, Helmut, Scheer, Georg, Schilp, Michael, Schmid, Angela, Schneider, Matthias, Uhle, Christian, Bickel, Horst, Weinga, Brigitte, Wochele, Eberhard, Wolfram, Bernhard, Hofmann, Andreas, Allwein, Eugen, Ruile, Helmut, Koeppel, Andreas, Dick, Peter, Holtz, Friedrich, Schmidt, Gabriel, Blank, Wolfgang, Fischer, Lutz-Ingo, Thaller, Johann, Bloß, Guntram, Kreuzer, Franz, Holthausen, Gunther, Ludwig Maier, Karl, Krebs, Walter, Mohr, Christoph, Koschine, Heinz, Ellersdorfer, Richard, Speth, Michael, Kleinhans, Maria, Koutsouva-Sack, Panagiota, Staudinger, Gabriele, Eiber, Johann, Thiel, Stephan, Gold, Cornelia, Nalbach, Andrea, Reichert, Kai, Neef, Martin, Eifflaender-Gorfer, Sandra, Fleischmann, Viktor, Mayer, Natalija, Spiegl, Andreas, Renner, Fritz, Weishappel-Ketisch, Eva, Kochems, Thomas, Hunger, Hartmut, Hofbeck, Marianne, Neumeier, Alfred, Goldhofer, Elfriede, Eisele, Marion, Bommer, Thomas, Vollmuth, Reinhold, Lanzinger, Klaus, Pauli, Ramona, Lindner, Jutta, Brandt, Gerlinde, Hohentanner, Otto, Porz, Peter, Zimmerhackl, Bernd, Hallwachs, Alexander, Ernst, Annette, Haseke, Claudia, Ploch, Andreas, Swobodnik, Monika, Jost, Detlev, Narr, Renate, Nehmann, Gabriele, Eder, Christiane, Pillin, Helmut, Loth, Frank, Fritz, Nicola, Fuchs, Angela, Rafferzeder, Michael, Zirpel, Dietmar, Romberg, Heinz-Peter, Liese, Hanna, Burfent, Inge, von Aswege, Johann, Honig, Wolf-Dietrich, Schu, Heribert, Marx, Manfred, Straimer, Annemarie, Eisele, M., Heser, Kathrin, Uhlenbrock, Arndt, Werner, Michael, Gobel-Schlatholt, Maria, Prechtel, Eberhard, Kaschell, Hans-Jurgen, Weckbecker, Klaus, Alfen, Theodor, Eimers-Kleene, Jorg, Fischer, Klaus, Weisbach, Wolf-Rudiger, Jessen, Frank, Tschoke, Martin, Fliedner, Michael, Hodgson, Binjamin, Hamkens, Werner, Ackermann, Angela, Kaduszkiewicz, Hanna, Kirsch, Michael, Miasnikov, Vladimir, Kormann, Marian, Kaufeler, Teresa, Lu, Dieter, Wirtz, Clemens, Kohler, Mirjam, Krug, Bernd-Uwe, Hutter, Petra, Lau, Dietrich, Schroder-Hoch, Ursula, Herzog, Wolfgang, Weidner, Klaus, Witt, Otto-Peter, Konig, Hans-Helmut, Titova, Ljudmila, Moritz, Andrea, Lipp, Ina, Koppara, Alexander, Muhlmann, Ute, Bra, Barbara, Ziehbold, Sabine, Lange, Carolin, Schmalbruch, Ina, Ka, Gunter, Bo, Hanna, Ludwig, Ingrid, Noky, Adolf, Leicht, Hanna, Perleberg, Helmut, Rieder, Carsten, Rosen, Michael, Kunzendorf, Gerhard, Wachter, Jurgen, Weingartner, Brigitte, Luck, Tobias, Willhauck, Hans-Georg, Herbst, Helga, Friedrich, Peter, Kirchner, Hans-Georg, Kirchner, Elke, Knauer, Luitpold, Bickel, H., Luppa, Melanie, Holtz, Karl-Friedrich, Schmid, Elmar, Kahmann, Ulf, nther Holthausen, Gu, Mosch, Edelgard, Reich, Paul, Stahl, Eberhard, Lunow, Reinhold, Undritz, Klaus, Voss, Bernd, Spreer, Achim, Brenig, Oliver, Eich, Ralf, Vossel, Angelika, Leggewie, Dieter, Olbrich, Julia, Schmidt, Angelika, Aghdai-Heuser, Nahid, Witten, Lutz, Igel, Michael, Hodgson, Benjamin, Hoff, Bernhard, Pentzek, Michael, Luttringhaus, Dieter, Opitz, Rolf, Bausch, Jurgen, Mecking, Dirk, Ganßauge, Friederike, Peters, Elmar, Wester, Alfons, Petersen, Werner, Prokein, Jana, Daase, Martin, Rusing, Martin, von Sethe, Christoph, Borngra, Wilmhard, Colling-Pook, Brigitte, Weidner, Ullrich, Rieger, Peter, Witte, Lutz, Busch, Hans-Wilhelm, Unger, Jurgen, Schumacher, Anna, Preis, Angela, Mann, Michael, Haeberle, Ernst, Kohler, Horst, Sliwiok, Helmut, Deest, Harald, Ackermann-Korner, Margret, Reinstorff, Dieter, Schluter, Christamaria, Heinrichs, Henrik, Riedel-Heller, Steffi, Dankwarth, Ole, Bose, Michael, Ryll, Ulricke, Bauer, Reinhard, Schnakenbeck, Sven, Beckmann, Karin, Callsen, Annegret, Schiewe, Ewa, Gehm, Holger, Lambert, Volker, Stein, Janine, Hinkel-Reineke, Karin, Stolzenbach, Carl-Otto, Berdin, Peter, Windler, Friedhelm, Weidnitzer, Sabine, Rosenkranz, Erika, Letzien, Norbert, Klossek, Doris, Liebsch, Martin, Steinmann, Susanne, Zwicker, Andrea, Hantel, Ulrike, Pilz, Monika, Kirschner, Volker, Arnold, Rainer, Poser, Ulrich, Barthel, Wolfgang, Blechinger, Fritz, Fritz, Reiner Walter, Junemann, Susanne, Köhler, M., Tebarth, Franziska, Kirsch, Gabriele, Kulinna, Jurgen, Legner-Gorke, Andreas, Lehr, Christa, Meer, Wolfgang, Panzer, Christina, Raabe, Achim, Schmidt-Back, Helga, Wagner, Michael, Gunter Stieglitz, Hans, von der Heide, Marie-Luise, Kirchner, Georg, Kastner, Jorg, Janssen, Ulrike, Standl, Albert, Gottl, Clemens, Franze, Marianne, Moser, Gerhard, Blumm, Almut, Weber, Petra, Poetsch, Wolfgang, Puppe, Heinrich, Weeg, Dagmar, Specht, Gerd, Badmann, Leonard, Leveringhaus, May, Posern, Michael, Potkowski, Ralph, Schwandner, Michael, Weigert, Rudolf, Huber, Christoph, Werle, Jochen, Weyerer, Siegfried, Wiese, Birgitt, Wolfsgruber, Steffen, Zimmermann, Thomas, Adrian, Claudia, Mösch, E., Gulle, Peter, Schutzendorf, Heribert, Benz, Elisabeth, Werner, Klaus-Michael, Weyerer, S., Stahlschmidt, Markus, Dorn, Jurgen, Menke, Helmut, Werle, J., Sievert, Erik, Krockert, Ulrich, Salingre, Gabriele, Morchen, Christian, Raab, Peter, Baszenski, Angela, Loth, Clarli, Knaak, Christian, Hotte, Peter, Pieper, Jorg, König, H-H, Wassermann, Dirk, Leyendecker, Hans Josef, Gohde, Gerhard, Simons, Barbara, Brunger, Achim, Petersen, Uwe, Wahl, Heike, Tewes, Rainer, Junghans-Kullmann, Doris, and Grimm-Kraft, Angela

Subjects
Male, Risk, epidemiology [Cognition Disorders], Aging, medicine.medical_specialty, epidemiology [Alzheimer Disease], etiology [Alzheimer Disease], epidemiology [Depressive Disorder, Major], epidemiology [Germany], epidemiology [Dementia], Prodrome, Alzheimer Disease, Germany, medicine, History of depression, psychology [Aging], Humans, Dementia, ddc:610, Age of Onset, Risk factor, Psychiatry, Applied Psychology, Depression (differential diagnoses), Aged, Aged, 80 and over, epidemiology [Depression], Depressive Disorder, Major, Primary Health Care, Depression, business.industry, Hazard ratio, Cognition, Middle Aged, medicine.disease, Psychiatry and Mental health, Female, etiology [Dementia], Age of onset, Cognition Disorders, business, Follow-Up Studies
Abstract

BackgroundWhether 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).MethodRisk 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.ResultsAn 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 ConclusionsDepression 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.

Published
2012
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10. Incident Subjective Cognitive Decline Does Not Predict Mortality in the Elderly--Results from the Longitudinal German Study on Ageing, Cognition, and Dementia (AgeCoDe)

Author

Roehr, Susanne, Luck, Tobias, Pentzek, Michael, Lange, Carolin, Prokein, Jana, Weyerer, Siegfried, Mösch, Edelgard, König, Hans-Helmut, Maier, Wolfgang, Scherer, Martin, Jessen, Frank, Riedel-Heller, Steffi G, Heser, Kathrin, Group, AgeCoDe Study, Abholz, Heinz-Harald, Bachmann, Cadja, Bickel, Horst, Blank, Wolfgang, van den Bussche, Hendrik, Eifflaender-Gorfer, Sandra, Eisele, Marion, Ernst, Annette, Fuchs, Angela, Kaduszkiewicz, Hanna, Kaufeler, Teresa, Köhler, Mirjam, Leicht, Hanna, Luppa, Melanie, Mayer, Manfred, Olbrich, Julia, Posselt, Tina, Schumacher, Anna, Riedel-Heller, Steffi, Röhr, Susanne, Stein, Janine, Steinmann, Susanne, Wiese, Birgitt, Tebarth, Franziska, Weckbecker, Klaus, Weeg, Dagmar, Werle, Jochen, Wolfsgruber, Steffen, Zimmermann, Thomas, Brettschneider, Christian, and Koppara, Alexander

Subjects
Male, congenital, hereditary, and neonatal diseases and abnormalities, Aging, epidemiology [Cognitive Dysfunction], psychology [Dementia], lcsh:Medicine, Kaplan-Meier Estimate, epidemiology [Dementia], Cognition, hemic and lymphatic diseases, Prevalence, psychology [Aging], Humans, Cognitive Dysfunction, ddc:610, Longitudinal Studies, Prospective Studies, Mortality, lcsh:Science, Aged, Aged, 80 and over, lcsh:R, Age Factors, Socioeconomic Factors, lcsh:Q, Dementia, Female, psychology [Cognitive Dysfunction], etiology [Dementia], Research Article
Abstract

OBJECTIVE:Subjective cognitive decline (SCD) might represent the first symptomatic representation of Alzheimer's disease (AD), which is associated with increased mortality. Only few studies, however, have analyzed the association of SCD and mortality, and if so, based on prevalent cases. Thus, we investigated incident SCD in memory and mortality. METHODS:Data were derived from the German AgeCoDe study, a prospective longitudinal study on the epidemiology of mild cognitive impairment (MCI) and dementia in primary care patients over 75 years covering an observation period of 7.5 years. We used univariate and multivariate Cox regression analyses to examine the relationship of SCD and mortality. Further, we estimated survival times by the Kaplan Meier method and case-fatality rates with regard to SCD. RESULTS:Among 971 individuals without objective cognitive impairment, 233 (24.0%) incidentally expressed SCD at follow-up I. Incident SCD was not significantly associated with increased mortality in the univariate (HR = 1.0, 95% confidence interval = 0.8-1.3, p = .90) as well as in the multivariate analysis (HR = 0.9, 95% confidence interval = 0.7-1.2, p = .40). The same applied for SCD in relation to concerns. Mean survival time with SCD was 8.0 years (SD = 0.1) after onset. CONCLUSION:Incident SCD in memory in individuals with unimpaired cognitive performance does not predict mortality. The main reason might be that SCD does not ultimately lead into future cognitive decline in any case. However, as prevalence studies suggest, subjectively perceived decline in non-memory cognitive domains might be associated with increased mortality. Future studies may address mortality in such other cognitive domains of SCD in incident cases.

Published
2015
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11. Longitudinal Predictors of Institutionalization in Old Age

Author

Hajek, André, Brettschneider, Christian, Stein, Janine, Luck, Tobias, Bickel, Horst, Mösch, Edelgard, Wagner, Michael, Jessen, Frank, Maier, Wolfgang, Scherer, Martin, Riedel-Heller, Steffi G, König, Hans-Helmut, Lange, Carolin, Group, AgeCoDe Study, Abholz, Heinz-Harald, Bachmann, Cadja, Blank, Wolfgang, van den Bussche, Hendrik, Eifflaender-Gorfer, Sandra, Eisele, Marion, Ernst, Annette, Posselt, Tina, Fuchs, Angela, Heser, Kathrin, Kaduszkiewicz, Hanna, Kaufeler, Teresa, Köhler, Mirjam, Koppara, Alexander, Leicht, Hanna, Wiese, Birgitt, Luppa, Melanie, Mayer, Manfred, Olbrich, Julia, Pentzek, Michael, Prokein, Jana, Schumacher, Anna, Riedel-Heller, Steffi, Steinmann, Susanne, Tebarth, Franziska, Weckbecker, Klaus, Weeg, Dagmar, Werle, Jochen, Weyerer, Siegfried, Wolfsgruber, Steffen, and Zimmermann, Thomas

Subjects
Male, Gerontology, Activities of daily living, physiopathology [Depression], lcsh:Medicine, statistics & numerical data [Homes for the Aged], Personality Assessment, Logistic regression, Germany, Activities of Daily Living, Homes for the Aged, Longitudinal Studies, diagnosis [Hearing Loss], lcsh:Science, Depression (differential diagnoses), Aged, 80 and over, education.field_of_study, Multidisciplinary, Depression, Institutionalization, physiopathology [Dementia], physiopathology [Hearing Loss], statistics & numerical data [Nursing Homes], ddc, Spouse, Marital status, Female, Personality Assessment Inventory, statistics & numerical data [Marital Status], Psychology, Research Article, Population, diagnosis [Depression], medicine, Humans, Dementia, statistics & numerical data [Institutionalization], ddc:610, Mobility Limitation, Hearing Loss, education, Aged, Probability, Marital Status, lcsh:R, medicine.disease, Nursing Homes, diagnosis [Dementia], Logistic Models, lcsh:Q
Abstract

Objective To investigate time-dependent predictors of institutionalization in old age using a longitudinal approach. Methods In a representative survey of the German general population aged 75 years and older predictors of institutionalization were observed every 1.5 years over six waves. Conditional fixed-effects logistic regressions (with 201 individuals and 960 observations) were performed to estimate the effects of marital status, depression, dementia, and physical impairments (mobility, hearing and visual impairments) on the risk of admission to old-age home or nursing home. By exploiting the longitudinal data structure using panel econometric models, we were able to control for unobserved heterogeneity such as genetic predisposition and personality traits. Results The probability of institutionalization increased significantly with occurrence of widowhood, depression, dementia, as well as walking and hearing impairments. In particular, the occurrence of widowhood (OR = 78.3), dementia (OR = 154.1) and substantial mobility impairment (OR = 36.7) were strongly associated with institutionalization. Conclusion Findings underline the strong influence of loss of spouse as well as dementia on institutionalization. This is relevant as the number of old people (a) living alone and (b) suffering from dementia is expected to increase rapidly in the next decades. Consequently, it is supposed that the demand for institutionalization among the elderly will increase considerably. Practitioners as well as policy makers should be aware of these upcoming challenges.

Published
2015
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12. Mortality in incident dementia - results from the German Study on Aging, Cognition, and Dementia in Primary Care Patients

Author

Roehr, S., Luck, T., Pentzek, M., Steinmann, S., Weyerer, S., Werle, J., Wiese, B., Scherer, M., Maier, W., Riedel-Heller, S. G., Group, AgeCoDe Study, Scherer, Martin, Bickel, H., Abholz, Heinz-Harald, Bachmann, Cadja, Bickel, Horst, Blank, Wolfgang, van den Bussche, Hendrik, Eifflaender-Gorfer, Sandra, Eisele, Marion, Ernst, Annette, Fuchs, Angela, Heser, Kathrin, Brettschneider, C., Kaduszkiewicz, Hanna, Kaufeler, Teresa, Köhler, Mirjam, König, Hans-Helmut, Koppara, Alexander, Lange, Carolin, Leicht, Hanna, Luck, Tobias, Luppa, Melanie, Mayer, Manfred, Ernst, A., Mösch, Edelgard, Olbrich, Julia, Pentzek, Michael, Prokein, Jana, Schumacher, Anna, Riedel-Heller, Steffi, Stein, Janine, Steinmann, Susanne, Tebarth, Franziska, Weckbecker, Klaus, Fuchs, A., Weeg, Dagmar, Werle, Jochen, Weyerer, Siegfried, Wiese, Birgitt, Wolfsgruber, Steffen, Zimmermann, Thomas, König, H-H, Jessen, F., Lange, C., and Mösch, E.

Subjects
Gerontology, Male, psychology [Dementia], epidemiology [Germany], Primary care, Subjective memory, German, Cognition, German population, Risk Factors, Germany, medicine, Dementia, Humans, ddc:610, Longitudinal Studies, Prospective Studies, Aged, Demography, Proportional Hazards Models, Aged, 80 and over, Proportional hazards model, Age Factors, physiology [Cognition], mortality [Dementia], medicine.disease, Prognosis, language.human_language, Sociological Factors, diagnosis [Dementia], Psychiatry and Mental health, Life expectancy, language, Female, Psychology, Follow-Up Studies
Abstract

Objective Dementia is known to increase mortality, but the relative loss of life years and contributing factors are not well established. Thus, we aimed to investigate mortality in incident dementia from disease onset. Method Data were derived from the prospective longitudinal German AgeCoDe study. We used proportional hazards models to assess the impact of sociodemographic and health characteristics on mortality after dementia onset, Kaplan–Meier method for median survival times. Results Of 3214 subjects at risk, 523 (16.3%) developed incident dementia during a 9-year follow-up period. Median survival time after onset was 3.2 years (95% CI = 2.8–3.7) at a mean age of 85.0 (SD = 4.0) years (≥2.6 life years lost compared with the general German population). Survival was shorter in older age, males other dementias than Alzheimer's, and in the absence of subjective memory complaints (SMC). Conclusion Our findings emphasize that dementia substantially shortens life expectancy. Future studies should further investigate the potential impact of SMC on mortality in dementia.

Published
2015
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13. Elevated HbA1c is associated with increased risk of incident dementia in primary care patients

Author

Ramirez, Alfredo, Wolfsgruber, Steffen, Mösch, Edelgard, Bickel, Horst, Wiese, Birgitt, Prokein, Jana, König, Hans-Helmut, Brettschneider, Christian, Breteler, Monique M, Maier, Wolfgang, Jessen, Frank, Scherer, Martin, Lange, Carolin, Group, AgeCoDe Study, Abholz, Heinz-Harald, Bachmann, Cadja, van den Bussche, Hendrik, Eifflaender-Gorfer, Sandra, Eisele, Marion, Ernst, Annette, Heser, Kathrin, Kaufeler, Teresa, Köhler, Mirjam, Kaduszkiewicz, Hanna, Koppara, Alexander, Luppa, Melanie, Mayer, Manfred, Schumacher, Anna, Stein, Janine, Tebarth, Franziska, Wagner, Michael, Weckbecker, Klaus, Weeg, Dagmar, Zimmermann, Thomas, Weyerer, Siegfried, Werle, Jochen, Pentzek, Michael, Fuchs, Angela, Riedel-Heller, Steffi G, and Luck, Tobias

Subjects
Male, medicine.medical_specialty, Glycated Hemoglobin A, endocrine system diseases, metabolism [Glycated Hemoglobin A], blood [Diabetes Mellitus, Type 2], Comorbidity, epidemiology [Dementia], Internal medicine, Epidemiology, metabolism [Glycated Hemoglobin], medicine, Dementia, Humans, ddc:610, Risk factor, Psychiatry, Aged, Retrospective Studies, Aged, 80 and over, Glycated Hemoglobin, Primary Health Care, business.industry, General Neuroscience, Incidence (epidemiology), epidemiology [Diabetes Mellitus, Type 2], Incidence, nutritional and metabolic diseases, Type 2 Diabetes Mellitus, Retrospective cohort study, General Medicine, medicine.disease, blood [Dementia], Psychiatry and Mental health, Clinical Psychology, Diabetes Mellitus, Type 2, Cohort, statistics & numerical data [Primary Health Care], Female, hemoglobin A1c protein, human, Geriatrics and Gerontology, business, Mental Status Schedule
Abstract

Type 2 diabetes mellitus (T2DM) is a risk factor of dementia. The effect of T2DM treatment quality on dementia risk, however, is unclear. 1,342 elderly individuals recruited via general practitioner registries (AgeCoDe cohort) were analyzed. This study analyzed the association between HbA1c level and the incidence of all-cause dementia (ACD) and of Alzheimer's disease dementia (referred to here as AD). HbA1c levels ≥6.5% were associated with 2.8-fold increased risk of incident ACD (p = 0.027) and for AD (p = 0.047). HbA1c levels ≥7% were associated with a five-fold increased risk of incident ACD (p = 0.001) and 4.7-fold increased risk of incident AD (p = 0.004). The T2DM diagnosis per se did not increase the risk of either ACD or AD. Higher levels of HbA1c are associated with increased risk of ACD and AD in an elderly population. T2DM diagnosis was not associated with increased risk if HbA1c levels were below 7%.

Published
2014
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14. The costs of dementia from the societal perspective: is care provided in the community really cheaper than nursing home care?

Author

König, Hans-Helmut, Leicht, Hanna, Pentzek, Michael, Bouché, Winfried, Linn, Ursula, Bormann, Gundula, Schulze, Gerhard, Stelter, Klaus, Gatermann, Heike, Fischer-Radizi, Doris, Witt, Otto-Peter, Kavka, Stefanie, Klötzl, Günther, Werle, Jochen, Münter, Karl-Christian, Baumhöfener, Michael, Oberländer, Maren, Schiewe, Cornelia, Hufnagel, Jörg, Kressel, Anne-Marei, Kebschull, Michael, Wagner, Christine, Burkhardt, Fridolin, Hase, Martina, Weyerer, Siegfried, Büttner, Matthias, Houcken, Karl-Heinz, Zebidi, Christiane, Bröhan, Johann, Russ, Christiane, Bethge, Frank, Rughase-Block, Gisela, Lorenzen, Margret, Elsen, Arne, Stiller, Lerke, Wiese, Birgitt, Giovanopoulos, Angelika, Korte, Daniela, Jedicke, Ursula, Müller-Mette, Rosemarie, Richter, Andrea, Rauhala-Parrey, Sanna, Zoras, Constantin, Pfeil-Woltmann, Gabriele, Knöppel-Frenz, Annett, Kaiser, Martin, Scherer, Martin, Bruns, Johannes, Homann, Joachim, Gorgon, Georg, Middendorf, Niklas, Menschke, Kay, Stöver, Hans Heiner, Bayer, Hans H, Quandt, Rüdiger, Köllner, Hans-Michael, Maier, Wolfgang, Strohbehn, Enno, Haller, Thomas, Jesse, Nadine, Domsch, Martin, Dahlke, Marcus, Lipp, Thomas, Lipp, Ina, Amm, Martina, Bauer, Horst, Rauchmaul, Gabriele, Riedel-Heller, Steffi G, Ebert, Hans Jochen, Gabriel-Müller, Angelika, Taut, Hans-Christian, Voß, Hella, Mühlmann, Ute, Schmidt, Holger, Müller, Gabi, Hager, Eva, Tunze, Bettina, Bräutigam, Barbara, Group, AgeCoDe Study, Paschke, Thomas, Assmann, Heinz-Michael, Schmalbruch, Ina, Kässner, Gunter, Pförtzsch, Iris, Ernst-Brennecke, Brigitte, Rahnefeld, Uwe, Striegler, Petra, Gierth, Marga, Krügel, Anselm, Adrian, Claudia, Boehm, Margret, Harnisch, Dagmar, Kornisch-Koch, Simone, Höne, Birgit, Schönherr, Lutz, Hambsch, Frank, Meitsch, Katrin, Krägelin-Nobahar, Britta, Herzig, Cornelia, Georgi, Astrid, Liese, Hanna, Schwarzmann, Erhard, Schinagl, Gerd, Pehnke, Ulrike, Dayab, Mohammed, Müller, Sabine, Onnasch, Jörg-Friedrich, Brosig, Michael, Frydetzki, Dorothea, Abschke, Uwe, Sperling, Volkmar, Brettschneider, Christian, Bürfent, Inge, Gläser, Ulrich, Lebuser, Frank, Hagert, Detlef, Arnold, Gerhard, Bauer, Viet-Harold, Becker, Hartwig, Becker, Hermine, Besier, Werner, Böttcher-Schmidt, Hanna, Füllgraf-Horst, Susanne, von Aswege, Johann, Göry, Enikö, Grella, Hartmut, Grimm, Hans Heinrich, Heck, Petra, Hemler, Werner, Henn, Eric, Löb, Violetta, Maaßen-Kalweit, Grid, Mayer, Manfred, Mühlig, Hubertus, Honig, Wolf-Dietrich, Müller, Arndt, Orlovius, Gerhard, Perleberg, Helmut, Radon, Brigitte, Renz, Helmut, Rieder, Carsten, Rosen, Michael, Scheer, Georg, Schilp, Michael, Schmid, Angela, Gülle, Peter, Schneider, Matthias, Schneider, Christian, Stahl, Rüdiger, Uhle, Christian, Wachter, Jürgen, Weihs, Necla, Weingärtner, Brigitte, Werner, Monika, Willhauck, Hans-Georg, Wochele, Eberhard, Schützendorf, Heribert, Wolfram, Bernhard, Hofmann, Andreas, Allwein, Eugen, Ruile, Helmut, Koeppel, Andreas, Dick, Peter, Holtz, Karl-Friedrich, Schmidt, Gabriel, Fischer, Lutz-Ingo, Thaller, Johann, Benz, Elisabeth, Bloß, Guntram, Kreuzer, Franz, Holthausen, Günther, Maier, Karl Ludwig, Krebs, Walter, Mohr, Christoph, Koschine, Heinz, Ellersdorfer, Richard, Speth, Michael, Kleinhans, Maria, Straimer, Annemarie, Koutsouva-Sack, Panagiota, Staudinger, Gabriele, Eiber, Johann, Thiel, Stephan, Gold, Cornelia, Nalbach, Andrea, Reichert, Kai, Rückgauer, Markus, Neef, Martin, Fleischmann, Viktor, Uhlenbrock, Arndt, Mayer, Natalija, Spiegl, Andreas, Renner, Fritz, Weishappel-Ketisch, Eva, Kochems, Thomas, Hunger, Hartmut, Hofbeck, Marianne, Neumeier, Alfred, Goldhofer, Elfriede, Bommer, Thomas, Werner, Klaus-Michael, Vollmuth, Reinhold, Lanzinger, Klaus, Bustami-Löber, Simone, Pauli, Ramona, Lindner, Jutta, Brandt, Gerlinde, Hohentanner, Otto, Urban-Hüttner, Rosita, Porz, Peter, Zimmerhackl, Bernd, Göbel-Schlatholt, Maria, Naumann, Barbara, Vach, Margarete, Hallwachs, Alexander, Haseke, Claudia, Ploch, Andreas, Bürkle-Grasse, Paula, Swobodnik, Monika, Tröger, Corina, Jost, Detlev, Steinhuber, Roman, Bachmann, Cadja, Kaschell, Hans-Jürgen, Narr, Renate, Nehmann-Hörwick, Gabriele, Eder, Christiane, Pillin, Helmut, Loth, Frank, Rücker, Beate, Fritz, Nicola, Rafferzeder, Michael, Zirpel, Dietmar, Romberg, Heinz-Peter, Weckbecker, Klaus, Marx, Manfred, Alfen, Theodor, Prechtel, Eberhard, Eimers-Kleene, Jörg, Fischer, Klaus, Weisbach, Wolf-Rüdiger, Tschoke, Martin, Richter-Polynice, Birgitt, Stahlschmidt, Markus, Fliedner, Michael, Hodgson, Binjamin, Cupsa, Florinela, Hamkens, Werner, Unkelbach, Roland Matthias, Schiller, Gerhard, Damanakis, Barbara, Ackermann, Angela, Frenkel, Michael, Ebeling, Klaus-Wolfgang, Hoff, Bernhard, Kirsch, Michael, Miasnikov, Vladimir, Berger, Pauline, Gillhausen, Kurt, Hellmessen, Uwe, Hümmerich, Helga, Heede, Hans-Christian, Kormann, Boguslaw-Marian, Lüttringhaus, Dieter, Peters, Wolfgang Josef, Schott, Ulrich, Matzies, Dirk, Schumacher, Andre, Flettner, Tim Oliver, Thraen, Winfried, Wirtz, Clemens, Siegmund, Harald, Groß, Kathrin, Krug, Bernd-Uwe, Hütter, Petra, Lau, Dietrich, Schröder-Höch, Ursula, Herzog, Wolfgang, Weidner, Klaus, Dorn, Jürgen, Titova, Ljudmila, Moritz, Andrea, Menke, Helmut, Ziehbold, Sabine, Sievert, Erik, Ludwig, Ingrid, Noky, Adolf, Bickel, Horst, Kröckert, Ulrich, Kunzendorf, Gerhard, Willhauck, Georg, Herbst, Helga, Salingré, Gabriele, Friedrich, Peter, Kirchner, Hans-Georg, Kirchner, Elke, Knauer, Luitpold, Mörchen, Christian, Schmid, Elmar, Kahmann, Ulf, Raab, Peter, Reich, Paul, Stahl, Eberhard, Baszenski, Angela, Lunow, Reinhold, Undritz, Klaus, Voss, Bernd, Spreer, Achim, Brenig, Oliver, Müller, Bernhard G, Eich, Ralf, Vossel, Angelika, Leggewie, Dieter, Schmidt, Angelika, Loth, Clärli, Aghdai-Heuser, Nahid, Witten, Lutz, Igel, Michael, Hodgson, Benjamin, Knaak, Christian, Opitz, Rolf, Bausch, Jürgen, Mecking, Dirk, Ganßauge, Friederike, Peters, Elmar, Wester, Alfons, Petersen, Werner, Daase, Martin, Hötte, Peter, Rüsing, Martin, von Sethe, Christoph, Borngräber, Wilmhard, Colling-Pook, Brigitte, Weidner, Ullrich, Rieger, Peter, Witte, Lutz, Busch, Hans-Wilhelm, Unger, Jürgen, Preis, Angela, Pieper, Jörg, Mann, Michael, Haeberle, Ernst, Köhler, Horst, Schäfer, Ruth, Sliwiok, Helmut, Brühl, Volker L, Stöver, Hans-Heiner, Deest, Harald, Ackermann-Körner, Margret, Reinstorff, Dieter, Wassermann, Dirk, Schlüter, Christamaria, Heinrichs, Henrik, Dankwarth, Ole, Böse, Michael, Ryll, Ulricke, Bauer, Reinhard, Möltgen, Dieter, Schnakenbeck, Sven, Beckmann, Karin, Callsen, Annegret, Fuchs, Angela, Leyendecker, Hans Josef, Schiewe, Ewa, Gehm, Holger, Lambert, Volker, Hinkel-Reineke, Karin, Stolzenbach, Carl-Otto, Berdin, Peter, Windler, Friedhelm, Weidnitzer, Sabine, Rosenkranz, Erika, Gohde, Gerhard, Letzien, Norbert, Klossek, Doris, Liebsch, Martin, Zwicker, Andrea, Hantel, Ulrike, Pilz, Monika, Kirschner, Volker, Arnold, Rainer, Poser, Ulrich, Barthel, Wolfgang, Simons, Barbara, Blechinger, Fritz, Fähnle, Marcus, Fritz, Reiner Walter, Jünemann, Susanne, Kirsch, Gabriele, Kulinna, Jürgen, Legner-Görke, Andreas, Lehr, Christa, Meer, Wolfgang, Brünger, Achim, Panzer, Christina, Raabe, Achim, Schmidt-Back, Helga, Schürmann, Ralf, Stieglitz, Hans-Günter, von der Heide, Marie-Luise, Petersen, Uwe, Kastner, Jörg, Janssen, Ulrike, Standl, Albert, Göttl, Clemens, Franze, Marianne, Moser, Gerhard, Wahl, Heike, Blümm, Almut, Weber, Petra, Poetsch, Wolfgang, Puppe, Heinrich, Specht, Gerd, Badmann, Leonard, Leveringhaus, May, Posern, Michael, Tewes, Rainer, Potkowski, Ralph, Schwandner, Michael, Weigert, Rudolf, Huber, Christoph, Junghans-Kullmann, Doris, Grimm-Kraft, Angela, Bohnau, Harald, Jessen, Frank, Pinsdorf, Ursula, Busch, Thomas, Keller, Gisela, Fuchs-Römer, Susanne, Beisel, Wolfgang, Köhler, Mirjam, Kormann, Marian, Luppa, Melanie, Levacher, Claus, Blankenstein, Tim, Lamborelle, Eliane, Hollstein, Ralf, Hoffmann, Edna, Mösch, Edelgard, Ghane, Ingeborg, Claß, Regine, Meier, Stefan-Wolfgang, Moers, Leo W, Wundram, Udo, Schmitt, Klaus, Missghian, Rastin, Spallek und Chriatiane, Karin, and Schlösser, Christiane

Subjects
Male, medicine.medical_specialty, Activities of daily living, economics [Caregivers], Total cost, economics [Home Care Services], epidemiology [Germany], epidemiology [Dementia], economics [Nursing Homes], statistics & numerical data [Ambulatory Care], Severity of Illness Index, Nursing care, Disability Evaluation, Germany, Intervention (counseling), Activities of Daily Living, Ambulatory Care, medicine, Dementia, Humans, ddc:610, General Nursing, Primary nursing, Aged, statistics & numerical data [Hospitalization], Aged, 80 and over, business.industry, Health Policy, General Medicine, medicine.disease, Home Care Services, Comorbidity, Nursing Homes, economics [Hospitalization], Hospitalization, statistics & numerical data [Home Care Services], Long-term care, Cross-Sectional Studies, Caregivers, Family medicine, economics [Dementia], Regression Analysis, Female, Geriatrics and Gerontology, business, economics [Ambulatory Care]
Abstract

Objective To compare the costs of care for community-dwelling dementia patients with the costs of care for dementia patients living in nursing homes from the societal perspective. Design Cross-sectional bottom-up cost of illness study nested within the multicenter German AgeCoDe-cohort. Setting Community and nursing homes. Participants One hundred twenty-eight community-dwelling dementia patients and 48 dementia patients living in nursing homes. Intervention None. Measurements Utilization and costs of medical care and long term care, including formal and informal social and nursing care based on proxy interviews. Informal care was valued using the replacement cost method. Results Unadjusted mean annual total costs including informal care were €29,930 ($43,997) for community-dwelling patients and €33,482 ($49,218) for patients living in nursing homes. However, multiple regression analysis controlling for age, sex, deficits in basic and instrumental activities of daily living and comorbidity showed that living in the community significantly increased total costs by €11,344 ($16,676; P P Conclusion From the societal perspective care for dementia patients living in the community tends to cost more than care in nursing homes when functional impairment is controlled for.

Published
2014
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15. The CERAD neuropsychological assessment battery total score detects and predicts Alzheimer disease dementia with high diagnostic accuracy

Author

Wolfsgruber, Steffen, Jessen, Frank, Köhler, Mirjam, Bachmann, Cadja, Riedel-Heller, Steffi G, Scherer, Martin, Maier, Wolfgang, Wagner, Michael, Group, AgeCoDe Study, Abholz, Heinz-Harald, Wiese, Birgitt, Bickel, Horst, Blank, Wolfgang, van den Bussche, Hendrik, Eifflaender-Gorfer, Sandra, Eisele, Marion, Ernst, Annette, Fuchs, Angela, Kaduszkiewicz, Hanna, Kaufeler, Teresa, Stein, Janine, König, Hans-Helmut, Lange, Carolin, Leicht, Hanna, Luck, Tobias, Luppa, Melanie, Mayer, Manfred, Mösch, Edelgard, Olbrich, Julia, Pentzek, Michael, Prokein, Jana, Schumacher, Anna, Riedel-Heller, Steffi, Steinmann, Susanne, Tebarth, Franziska, Weckbecker, Klaus, Weeg, Dagmar, Werle, Jochen, Weyerer, Siegfried, and Zimmermann, Thomas

Subjects
Male, medicine.medical_specialty, Diagnostic accuracy, Neuropsychological Tests, Logistic regression, Alzheimer Disease, Predictive Value of Tests, Germany, mental disorders, medicine, Dementia, Humans, Neuropsychological assessment, ddc:610, Longitudinal Studies, Psychiatry, Aged, Aged, 80 and over, medicine.diagnostic_test, Medical record, Area under the curve, diagnosis [Alzheimer Disease], Cognition, standards [Neuropsychological Tests], medicine.disease, Psychiatry and Mental health, Cross-Sectional Studies, ROC Curve, Physical therapy, Regression Analysis, Female, Geriatrics and Gerontology, Alzheimer's disease, Psychology
Abstract

Objectives To establish the diagnostic accuracy of the Total Score of the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological assessment battery (CERAD-NP) both for cross-sectional discrimination of Alzheimer disease (AD) dementia and short-term prediction of incident AD dementia. Design Longitudinal cohort study with two assessments at a 1.5-year interval. Setting Primary care sample randomly recruited via medical record registries. Participants As part of the German Study on Ageing, Cognition, and Dementia (AgeCoDe), a sample of elderly individuals (N = 1,606; mean age: 84 years) was assessed. Measurements Subjects were assessed with the CERAD-NP and followed up for 18 months (97.6% follow-up rate). Logistic regression and receiver-operating-characteristic (ROC) curve analysis were used to compare the diagnostic accuracy of the CERAD-NP Total Score (CTS) with that of single CERAD-NP scores and the Mini-Mental-State-Examination (MMSE) score. Results ROC curve analysis resulted in excellent (area under the curve [AUC]: 0.97) cross-sectional discrimination between non-AD and AD dementia subjects. Prediction of incident AD dementia with the CTS was also very good (AUC: 0.89), and was significantly better than prediction based on the MMSE. Conclusions The cross-sectional results confirm that the CTS is a highly accurate diagnostic tool for detecting AD dementia in elderly primary care patients. In addition, we provide evidence that the CTS is also accurate for the prediction of incident AD dementia. These findings further support the validity of the CTS as an index of overall cognitive functioning for detection and prediction of AD dementia.

Published
2014
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16. AD dementia risk in late MCI, in early MCI, and in subjective memory impairment

Author

Jessen, Frank, Wolfsgruber, Steffen, Weyerer, Siegfried, Werle, Jochen, van den Bussche, Hendrik, Scherer, Martin, Maier, Wolfgang, Wagner, Michael, German Study on Aging, Cognition and Dementia in Primary Care Patients, Abholz, Heinz-Harald, Bachmann, Cadja, Blank, Wolfgang, Wiese, Birgitt, Eifflaender-Gorfer, Sandra, Eisele, Marion, Ernst, Annette, Heser, Kathrin, Kaufeler, Teresa, Köhler, Mirjam, König, Hans-Helmut, Koppara, Alexander, Lange, Carolin, Leicht, Hanna, Bickel, Horst, Luppa, Melanie, Mayer, Manfred, Olbrich, Julia, Prokein, Jana, Schumacher, Anna, Stein, Janine, Steinmann, Susanne, Tebarth, Franziska, Weckbecker, Klaus, Weeg, Dagmar, Mösch, Edelgard, Zimmermann, Thomas, Kaduszkiewicz, Hanna, Pentzek, Michael, Riedel-Heller, Steffi G, Luck, Tobias, and Fuchs, Angela

Subjects
Male, Risk, medicine.medical_specialty, psychology [Alzheimer Disease], epidemiology [Cognitive Dysfunction], Epidemiology, epidemiology [Alzheimer Disease], Apolipoprotein E4, Disease, Subjective memory, Primary care, Neuropsychological Tests, Cohort Studies, Cellular and Molecular Neuroscience, Developmental Neuroscience, Alzheimer Disease, mental disorders, medicine, Memory impairment, Dementia, Humans, Cognitive Dysfunction, ddc:610, Psychiatry, Prospective cohort study, epidemiology [Memory Disorders], genetics [Apolipoprotein E4], Aged, Aged, 80 and over, Psychiatric Status Rating Scales, Memory Disorders, Health Policy, diagnosis [Alzheimer Disease], Cognition, medicine.disease, Survival Analysis, Psychiatry and Mental health, diagnosis [Cognitive Dysfunction], mortality [Alzheimer Disease], Test performance, Female, Neurology (clinical), Geriatrics and Gerontology, diagnosis [Memory Disorders], Psychology, mortality [Cognitive Dysfunction]
Abstract

Objective To compare the risk of developing Alzheimer's disease (AD) dementia in late mild cognitive impairment (LMCI), early MCI (EMCI), and subjective memory impairment (SMI) with normal test performance. Methods The baseline sample (n = 2892) of the prospective cohort study in nondemented individuals (German Study on Aging, Cognition and Dementia in Primary Care Patients) was divided into LMCI, EMCI, SMI, and control subjects by delayed recall performance. These groups were subdivided by the presence of self-reported concerns associated with experienced memory impairment. AD dementia risk was assessed over 6 years. Results Across all groups, risk of AD dementia was greatest in LMCI. In those with self-reported concerns regarding their memory impairment, SMI and EMCI were associated with a similarly increased risk of AD dementia. In those subgroups without concerns, SMI was not associated with increased risk of AD dementia, but EMCI remained an at-risk condition. Conclusions SMI and EMCI with self-reported concerns were associated with the same risk of AD dementia, suggesting that pre-LMCI risk conditions should be extended to SMI with concerns.

Published
2012
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17. Influence of social support on cognitive change and mortality in old age: results from the prospective multicentre cohort study AgeCoDe

Author

Eisele, Marion, Zimmermann, Thomas, Weyerer, Siegfried, Schumacher, Andre, Flettner, Tim Oliver, Thraen, Winfried, Siegmund, Harald, Levacher, Claus, Blankenstein, Tim, Lamborelle, Eliane, Hollstein, Ralf, Hoffmann, Edna, Ghane, Ingeborg, Werle, Jochen, Claß, Regine, Meier, Stefan-Wolfgang, Moers, Leo W, Wundram, Udo, Schmitt, Klaus, Missghian, Rastin, Spallek, Karin, Schlösser, Christiane, Groß, Kathrin, Bouché, Winfried, Leicht, Hanna, Linn, Ursula, Bormann, Gundula, Schulze, Gerhard, Stelter, Klaus, Gatermann, Heike, Fischer-Radizi, Doris, Witt, Otto-Peter, Kavka, Stefanie, Klötzl, Günther, Münter, Karl-Christian, König, Hans-Helmut, Baumhöfener, Michael, Oberländer, Maren, Schiewe, Cornelia, Hufnagel, Jörg, Kressel, Anne-Marei, Kebschull, Michael, Wagner, Christine, Burkhardt, Fridolin, Hase, Martina, Büttner, Matthias, Luppa, Melanie, Houcken, Karl-Heinz, Zebidi, Christiane, Bröhan, Johann, Russ, Christiane, Bethge, Frank, Lorenzen, Margret, Elsen, Arne, Stiller, Lerke, Giovanopoulos, Angelika, Korte, Daniela, Maier, Wolfgang, Jedicke, Ursula, Müller-Mette, Rosemarie, Richter, Andrea, Rauhala-Parrey, Sanna, Zoras, Constantin, Pfeil-Woltmann, Gabriele, Knöppel-Frenz, Annett, Kaiser, Martin, Bruns, Johannes, Homann, Joachim, Scherer, Martin, Gorgon, Georg, Middendorf, Niklas, Menschke, Kay, Stöver, Hans Heiner, Bayer, Hans H, Quandt, Rüdiger, Rughase-Block, Gisela, Köllner, Hans-Michael, Strohbehn, Enno, Haller, Thomas, Group, AgeCoDe Study, Jesse, Nadine, Domsch, Martin, Dahlke, Marcus, Lipp, Thomas, Lipp, Ina, Rauchmaul, Gabriele, Ebert, Hans Jochen, Gabriel-Müller, Angelika, Taut, Hans-Christian, Voß, Hella, Abholz, Heinz-Harald, Mühlmann, Ute, Schmidt, Holger, Müller, Gabi, Hager, Eva, Tunze, Bettina, Bräutigam, Barbara, Paschke, Thomas, Schmalbruch, Ina, Kässner, Gunter, Pförtzsch, Iris, Bachmann, Cadja, Ernst-Brennecke, Brigitte, Rahnefeld, Uwe, Striegler, Petra, Gierth, Marga, Krügel, Anselm, Boehm, Margret, Harnisch, Dagmar, Kornisch-Koch, Simone, Höne, Birgit, Schönherr, Lutz, Köhler, Mirjam, Bickel, Horst, Hambsch, Frank, Meitsch, Katrin, Krägelin-Nobahar, Britta, Herzig, Cornelia, Georgi, Astrid, Schwarzmann, Erhard, Schinagl, Gerd, Pehnke, Ulrike, Dayab, Mohammed, Müller, Sabine, Blank, Wolfgang, Onnasch, Jörg-Friedrich, Brosig, Michael, Frydetzki, Dorothea, Abschke, Uwe, Sperling, Volkmar, Gläser, Ulrich, Lebuser, Frank, Hagert, Detlef, Bauer, Viet-Harold, Becker, Hartwig, van den Bussche, Hendrik, Becker, Hermine, Besier, Werner, Böttcher-Schmidt, Hanna, Füllgraf-Horst, Susanne, Göry, Enikö, Grella, Hartmut, Grimm, Hans Heinrich, Heck, Petra, Hemler, Werner, Henn, Eric, Eifflaender-Gorfer, Sandra, Löb, Violetta, Maaßen-Kalweit, Grid, Mühlig, Hubertus, Müller, Arndt, Orlovius, Gerhard, Perleberg, Helmut, Radon, Brigitte, Renz, Helmut, Rieder, Carsten, Rosen, Michael, Ernst, Annette, Scheer, Georg, Schilp, Michael, Schmid, Angela, Schneider, Matthias, Schneider, Christian, Stahl, Rüdiger, Uhle, Christian, Wachter, Jürgen, Weihs, Necla, Weingärtner, Brigitte, Jessen, Frank, Werner, Monika, Willhauck, Hans-Georg, Wochele, Eberhard, Wolfram, Bernhard, Ruile, Helmut, Koeppel, Andreas, Dick, Peter, Holtz, Karl-Friedrich, Schmidt, Gabriel, Fischer, Lutz-Ingo, Kaduszkiewicz, Hanna, Thaller, Johann, Bloß, Guntram, Kreuzer, Franz, Holthausen, Günther, Maier, Karl Ludwig, Krebs, Walter, Mohr, Christoph, Koschine, Heinz, Ellersdorfer, Richard, Speth, Michael, Kaufeler, Teresa, Kleinhans, Maria, Koutsouva-Sack, Panagiota, Staudinger, Gabriele, Eiber, Johann, Thiel, Stephan, Gold, Cornelia, Nalbach, Andrea, Reichert, Kai, Rückgauer, Markus, Neef, Martin, Koppara, Alexander, Fleischmann, Viktor, Mayer, Natalija, Spiegl, Andreas, Renner, Fritz, Weishappel-Ketisch, Eva, Kochems, Thomas, Hunger, Hartmut, Hofbeck, Marianne, Neumeier, Alfred, Goldhofer, Elfriede, Lange, Carolin, Bommer, Thomas, Vollmuth, Reinhold, Lanzinger, Klaus, Bustami-Löber, Simone, Pauli, Ramona, Lindner, Jutta, Brandt, Gerlinde, Hohentanner, Otto, Urban-Hüttner, Rosita, Porz, Peter, Wiese, Birgitt, Luck, Tobias, Zimmerhackl, Bernd, Naumann, Barbara, Vach, Margarete, Hallwachs, Alexander, Haseke, Claudia, Ploch, Andreas, Bürkle-Grasse, Paula, Swobodnik, Monika, Tröger, Corina, Jost, Detlev, Mayer, Manfred, Steinhuber, Roman, Narr, Renate, Nehmann-Hörwick, Gabriele, Pillin, Helmut, Loth, Frank, Rücker, Beate, Fritz, Nicola, Rafferzeder, Michael, Zirpel, Dietmar, Romberg, Heinz-Peter, Mösch, Edelgard, Marx, Manfred, Prechtel, Eberhard, Alfen, Theodor, Fliedner, Michael, Hodgson, Binjamin, Schiller, Gerhard, Hoff, Bernhard, Kirsch, Michael, Miasnikov, Vladimir, Lüttringhaus, Dieter, Prokein, Jana, Krug, Bernd-Uwe, Hütter, Petra, Lau, Dietrich, Schröder-Höch, Ursula, Herzog, Wolfgang, Weidner, Klaus, Titova, Ljudmila, Moritz, Andrea, Amm, Martina, Bauer, Horst, Schumacher, Anna, Ziehbold, Sabine, Assmann, Heinz-Michael, Arnold, Gerhard, Ludwig, Ingrid, Noky, Adolf, Kunzendorf, Gerhard, Herbst, Helga, Hofmann, Andreas, Allwein, Eugen, Friedrich, Peter, Riedel-Heller, Steffi, Kirchner, Hans-Georg, Kirchner, Elke, Kahmann, Ulf, Eimers-Kleene, Jörg, Reich, Paul, Stahl, Eberhard, Lunow, Reinhold, Undritz, Klaus, Voss, Bernd, Spreer, Achim, Steinmann, Susanne, Brenig, Oliver, Müller, Bernhard G, Eich, Ralf, Vossel, Angelika, Leggewie, Dieter, Schmidt, Angelika, Aghdai-Heuser, Nahid, Witten, Lutz, Igel, Michael, Hodgson, Benjamin, Wagner, Michael, Hamkens, Werner, Ackermann, Angela, Wirtz, Clemens, Opitz, Rolf, Bausch, Jürgen, Mecking, Dirk, Ganßauge, Friederike, Peters, Elmar, Wester, Alfons, Petersen, Werner, Weckbecker, Klaus, Daase, Martin, Rüsing, Martin, von Sethe, Christoph, Borngräber, Wilmhard, Colling-Pook, Brigitte, Weidner, Ullrich, Rieger, Peter, Witte, Lutz, Busch, Hans-Wilhelm, Unger, Jürgen, Wolfsgruber, Steffen, Preis, Angela, Mann, Michael, Haeberle, Ernst, Köhler, Horst, Schäfer, Ruth, Sliwiok, Helmut, Brühl, Volker L, Stöver, Hans-Heiner, Deest, Harald, Ackermann-Körner, Margret, Heser, Kathrin, Adrian, Claudia, Reinstorff, Dieter, Schlüter, Christamaria, Heinrichs, Henrik, Dankwarth, Ole, Böse, Michael, Ryll, Ulricke, Bauer, Reinhard, Möltgen, Dieter, Schnakenbeck, Sven, Beckmann, Karin, Liese, Hanna, Callsen, Annegret, Schiewe, Ewa, Gehm, Holger, Lambert, Volker, Hinkel-Reineke, Karin, Stolzenbach, Carl-Otto, Berdin, Peter, Windler, Friedhelm, Weidnitzer, Sabine, Rosenkranz, Erika, Bürfent, Inge, Letzien, Norbert, Klossek, Doris, Liebsch, Martin, Zwicker, Andrea, Hantel, Ulrike, Pilz, Monika, Kirschner, Volker, Arnold, Rainer, Poser, Ulrich, Barthel, Wolfgang, von Aswege, Johann, Blechinger, Fritz, Fähnle, Marcus, Fritz, Reiner Walter, Jünemann, Susanne, Kirsch, Gabriele, Kulinna, Jürgen, Legner-Görke, Andreas, Lehr, Christa, Meer, Wolfgang, Panzer, Christina, Honig, Wolf-Dietrich, Raabe, Achim, Schmidt-Back, Helga, Schürmann, Ralf, Stieglitz, Hans-Günter, von der Heide, Marie-Luise, Knauer, Luitpold, Schmid, Elmar, Kastner, Jörg, Janssen, Ulrike, Standl, Albert, Gülle, Peter, Göttl, Clemens, Franze, Marianne, Moser, Gerhard, Blümm, Almut, Weber, Petra, Poetsch, Wolfgang, Puppe, Heinrich, Specht, Gerd, Badmann, Leonard, Leveringhaus, May, Schützendorf, Heribert, Posern, Michael, Huber, Christoph, Potkowski, Ralph, Eder, Christiane, Schwandner, Michael, Weigert, Rudolf, Benz, Elisabeth, Straimer, Annemarie, Uhlenbrock, Arndt, Tebarth, Franziska, Werner, Klaus-Michael, Göbel-Schlatholt, Maria, Kaschell, Hans-Jürgen, Stahlschmidt, Markus, Fischer, Klaus, Weisbach, Wolf-Rüdiger, Tschoke, Martin, Dorn, Jürgen, Menke, Helmut, Sievert, Erik, Weeg, Dagmar, Kröckert, Ulrich, Salingré, Gabriele, Mörchen, Christian, Raab, Peter, Baszenski, Angela, Loth, Clärli, Knaak, Christian, Hötte, Peter, Pieper, Jörg, Wassermann, Dirk, Olbrich, Julia, Leyendecker, Hans Josef, Gohde, Gerhard, Simons, Barbara, Brünger, Achim, Petersen, Uwe, Wahl, Heike, Tewes, Rainer, Junghans-Kullmann, Doris, Grimm-Kraft, Angela, Bohnau, Harald, Pentzek, Michael, Pinsdorf, Ursula, Busch, Thomas, Keller, Gisela, Fuchs-Römer, Susanne, Beisel, Wolfgang, Richter-Polynice, Birgitt, Cupsa, Florinela, Unkelbach, Roland Matthias, Damanakis, Barbara, Frenkel, Michael, Fuchs, Angela, Ebeling, Klaus-Wolfgang, Berger, Pauline, Gillhausen, Kurt, Hellmessen, Uwe, Hümmerich, Helga, Heede, Hans-Christian, Kormann, Boguslaw-Marian, Peters, Wolfgang Josef, Schott, Ulrich, and Matzies, Dirk

Subjects
Gerontology, Male, Aging, psychology [Cognition Disorders], lcsh:Geriatrics, Neuropsychological Tests, Cohort Studies, Social support, medicine, Dementia, psychology [Aging], Humans, ddc:610, Longitudinal Studies, Prospective Studies, Prospective cohort study, Aged, diagnosis [Cognition Disorders], Aged, 80 and over, mortality [Cognition Disorders], medicine.diagnostic_test, Proportional hazards model, business.industry, Social Support, Cognition, Neuropsychological test, medicine.disease, lcsh:RC952-954.6, Structured interview, Female, Geriatrics and Gerontology, Cognition Disorders, business, Research Article, Cohort study, Demography, Follow-Up Studies
Abstract

Background Social support has been suggested to positively influence cognition and mortality in old age. However, this suggestion has been questioned due to inconsistent operationalisations of social support among studies and the small number of longitudinal studies available. This study aims to investigate the influence of perceived social support, understood as the emotional component of social support, on cognition and mortality in old age as part of a prospective longitudinal multicentre study in Germany. Methods A national subsample of 2,367 primary care patients was assessed twice over an observation period of 18 months regarding the influence of social support on cognitive function and mortality. Perceived social support was assessed using the 14-item version of the FSozU, which is a standardised and validated questionnaire of social support. Cognition was tested by the neuropsychological test battery of the Structured Interview for the Diagnosis of Dementia (SIDAM). The influence of perceived support on cognitive change was analysed by multivariate ANCOVA; mortality was analysed by multivariate logistic and cox regression. Results Sample cognitive change (N = 1,869): Mean age was 82.4 years (SD 3.3) at the beginning of the observation period, 65.9% were female, mean cognition was 49 (SD 4.4) in the SIDAM. Over the observation period cognitive function declined in 47.2% by a mean of 3.4 points. Sample mortality (N = 2,367): Mean age was 82.5 years (SD 3.4), 65.7% were female and 185 patients died during the observation period. Perceived social support showed no longitudinal association with cognitive change (F = 2.235; p = 0.135) and mortality (p = 0.332; CI 0.829-1.743). Conclusions Perceived social support did not influence cognition and mortality over an 18 months observation period. However, previous studies using different operationalisations of social support and longer observation periods indicate that such an influence may exist. This influence is rather small and the result of complex interaction mechanisms between different components of social support; the emotional component seems to have no or only a limited effect. Further research is needed to describe the complex interactions between components of social support. Longer observation periods are necessary and standardised operationalisations of social support should be applied.

Published
2012
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18. Prediction of Dementia in Primary Care Patients

Author

Jessen, Frank, Wiese, Birgitt, Riedel-Heller, Steffi G, Ebert, Jochen, Gabriel, Angelika, Hager, Eva, Kässner, Gunter, Lipp, Ina, Lipp, Thomas, Mühlmann, Ute, Müller, Gabi, Paschke, Thomas, Rauchmaul, Gabriele, Wagner, Michael, Schmalbruch, Ina, Schmidt, Holger, Taut, Hans-Christian, Voss, Ute, Winkler, Bettina, Ziehbold, Sabine, Allwein, Eugen, Bloss, Guntram, Dick, Peter, Eiber, Johann, Weyerer, Siegfried, Fischer, Lutz-Ingo, Friedrich, Peter, Herbst, Helga, Hofmann, Andreas, Holthausen, Günther, Holtz, Karl-Friedrich, Kahmann, Ulf, Kirchner, Elke, Kirchner, Hans Georg, Knauer, Luitpold, Maier, Wolfgang, Koeppel, Andreas, Koschine, Heinz, Krebs, Walter, Kreuzer, Franz, Maier, Karl Ludwig, Mohr, Christoph, Schmid, Elmar, Schmidt, Gabriel, Thaller, Johann, Ellersdorfer, Richard, van den Bussche, Hendrik, Speth, Michael, Ackermann, Angela, Berger, Pauline, Cupsa, Florinela, Damanakis, Barbara, Ebeling, Klaus-Wolfgang, Flettner, Tim Oliver, Frenkel, Michael, Ganssauge, Friederike, Gillhausen, Kurt, Group, AgeCoDe Study, Heede, Hans-Christian, Hellmessen, Uwe, Hodgson, Benjamin, Hoff, Bernhard, Hümmerich, Helga, Korman, Boguslaw-Marian, Lüttringhaus, Dieter, Matzies, Dirk, Miasnikov, Vladimir, Peters, Wolfgang Josef, Abholz, Heinz-Harald, Richter-Polynice, Birgitt, Schiller, Gerhard Erich Richard, Schott, Ulrich, Schumacher, Andre, Siegmund, Harald, Thraen, Winfried, Unkelbach, Roland Matthias, Wirtz, Clemens, Angermeyer, Matthias, Bachmann, Cadja, Dichgans, Martin, Bickel, Horst, Finckh, Ulrich, Frenzen, Anja, Tebarth, Franziska, Kaufeler, Teresa, Luppa, Melanie, Mayer, Manfred, Romberg, Heinz-Peter, Sandholzer, Hagen, Wollny, Anja, Bormann, Gundula, Eiffländer-Gorfer, Sandra, Bouché, Winfried, Fischer-Radizi, Doris, Funke, Michael, Gatermann, Heike, Herzog, Wolfgang, Hütter, Petra, Kavka-Ziegenhagen, Stefanie, Klötzl, Günther, Krug, Bernd-Uwe, Lau, Dietrich, Fuchs, Angela, Linn, Ursula, Moritz, Andrea, Münter, Karl-Christian, Niemann, Detlef, Richard-Klein, Klaus, Schreiber, Walter, Schröder-Höch, Ursula, Schulze, Gerhard, Stelter, Klaus, Stolzenbach, Carl-Otto, Kaduszkiewicz, Hanna, Titova, Ljudmila, Weidner, Klaus, Witt, Otto-Peter, Zeigert, Eckehard, Arnold, Gerhard, Bauer, Veit-Harold, Besnier, Werner, Böttcher-Schmidt, Hanna, Grella, Hartmut, Kunzendorf, Gernot, Köhler, Mirjam, Ludwig, Ingrid, Mühlig, Hubert, Müller, Arnt, Noky, Adolf, Perleberg, Helmut, Rieder, Carsten, Rosen, Michael, Scheer, Georg, Schilp, Michael, Luck, Tobias, Schneider, Matthias, Wachter, Jürgen, Weingärtner, Brigitte, Willhauck, Hans-Georg, Eimers-Kleene, Jörg, Fischer, Klaus, Goebel-Schlatholt, Maria, Gülle, Peter, Honig, Wolf-Dietrich, Kaschell, Hans Jürgen, Mösch, Edelgard, Liese, Hanna, Marx, Manfred, Prechtel, Eberhard, Schützendorf, Heribert, Straimer, Annemarie, Tschoke, Martin, Werner, Karl-Michael, Mayen, Herrmut, Alfen, Theodor, Pentzek, Michael, Honnef, Bad, Weckbecker, Klaus, Bürfent, Inge, von Aswege, Johann, Uhlenbrock, Arndt, Weisbach, Wolf-Rüdiger, Amm, Martina, Assmann, Heinz-Michael, Bauer, Horst, and Bräutigam, Barbara

Subjects
Male, Pediatrics, medicine.medical_specialty, Activities of daily living, Genotype, Population, Psychological intervention, lcsh:Medicine, Neuropsychological Tests, Sensitivity and Specificity, Health Services Accessibility, Cohort Studies, genetics [Dementia], Alzheimer Disease, Humans, Medicine, Dementia, Verbal fluency test, ddc:610, Longitudinal Studies, lcsh:Science, education, Psychiatry, Primary Care, Aged, Aged, 80 and over, education.field_of_study, Multidisciplinary, Framingham Risk Score, methods [Primary Health Care], Primary Health Care, business.industry, lcsh:R, Prognosis, medicine.disease, diagnosis [Dementia], Mental Health, Neurology, Geriatrics, Cohort, lcsh:Q, Female, business, Research Article, Cohort study
Abstract

BACKGROUND: Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting. METHODOLOGY/PRINCIPAL FINDINGS: We performed a longitudinal cohort study in 3.055 non-demented individuals above 75 years recruited via primary care chart registries (Study on Aging, Cognition and Dementia, AgeCoDe). After the baseline investigation we performed three follow-up investigations at 18 months intervals with incident dementia as the primary outcome. The best set of predictors was extracted from the baseline variables in one randomly selected half of the sample. This set included age, subjective memory impairment, performance on delayed verbal recall and verbal fluency, on the Mini-Mental-State-Examination, and on an instrumental activities of daily living scale. These variables were aggregated to a prediction score, which achieved a prediction accuracy of 0.84 for AD. The score was applied to the second half of the sample (test cohort). Here, the prediction accuracy was 0.79. With a cut-off of at least 80% sensitivity in the first cohort, 79.6% sensitivity, 66.4% specificity, 14.7% positive predictive value (PPV) and 97.8% negative predictive value of (NPV) for AD were achieved in the test cohort. At a cut-off for a high risk population (5% of individuals with the highest risk score in the first cohort) the PPV for AD was 39.1% (52% for any dementia) in the test cohort. CONCLUSIONS: The prediction score has useful prediction accuracy. It can define individuals (1) sensitively for low cost-low risk interventions, or (2) more specific and with increased PPV for measures of prevention with greater costs or risks. As it is independent of technical aids, it may be used within large scale prevention programs.

Published
2011
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