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Objective: A restrictive use of antipsychotic drugs in patients with Alzheimer's disease (AD) is recommended due to an increased risk of cerebrovascular events and mortality. We hypothesise that the prescription of antipsychotics is associated with the patients' socio-demographic and clinical status (e.g., dementia severity). Methods: The prescription of antipsychotics was cross-sectionally evaluated in 272 community-dwelling and 123 institutionalised patients with AD across all severity stages of dementia. The patients' clinical characteristics covered the cognitive status, neuropsychiatric symptoms, daily activities, and quality of life (HrQoL). To determine associations with the use of antipsychotics bivariate and logistic regression analyses were conducted. Results: Totally, 25% of the patients were treated with antipsychotics. significantly less frequently than nursing home inhabitants (15.1% vs. 45.5%). Severely demented patients (MMSE 0-9) received antipsychotics most often (51.5%). Additionally, multiple regression analyses revealed a higher chance of prescription for participants with depressive symptoms (OR 2.3, 95% CI: 1.019-5.160) and those treated by neuropsychiatric specialists (OR 3.4, 95% CI: 1.408-8.328). Conclusions: Further longitudinal studies are required to assess the appropriateness of indications for antipsychotics and the reasons for a higher use in nursing home inhabitants and patients with severe dementia and depression. [ABSTRACT FROM AUTHOR]

Background: To prospectively determine health status and health utility and its predictors in patients with multiple sclerosis (MS). Methods: A total of 144 MS patients (mean age: 41.0 ±11.3y) with different subtypes (patterns of progression) and severities of MS were recruited in an outpatient university clinic in Germany. Patients completed a questionnaire at baseline (n = 144), 6 months (n = 65) and 12 months (n = 55). Health utilities were assessed using the EuroQol instrument (EQ-5D, EQ VAS). Health status was assessed by several scales (Expanded Disability Severity Scale (EDSS), Modified Fatigue Impact Scale (M-FIS), Functional Assessment of MS (FAMS), Beck Depression Inventory (BDI-II) and Multiple Sclerosis Functional Composite (MSFC)). Additionally, demographic and socioeconomic parameters were assessed. Multivariate linear and logistic regressions were applied to reveal independent predictors of health status. Results: Health status is substantially diminished in MS patients and the EQ VAS was considerably lower than that of the general German population. No significant change in health-status parameters was observed over a 12-months period. Multivariate analyses revealed M-FIS, BDI-II, MSFC, and EDSS to be significant predictors of reduced health status. Socioeconomic and socio-demographic parameters such as working status, family status, number of household inhabitants, age, and gender did not prove significant in multivariate analyses. Conclusion: MS considerably impairs patients' health status. Guidelines aiming to improve self-reported health status should include treatment options for depression and fatigue. Physicians should be aware of depression and fatigue as co-morbidities. Future studies should consider the minimal clinical difference when health status is a primary outcome. [ABSTRACT FROM AUTHOR]

Introduction: In neuropsychological diagnostics, the assignment of cognitive tests to domains is usually not empirically based. Hence, we aimed to assess the dimensionality structure of cognition in individuals with Parkinson's disease (PD) and conceptually replicate the findings in cognitively healthy individuals (CHIs)., Methods: We performed Exploratory Graph Analysis (EGA) for dimensionality analysis of cognitive test scores in N  = 698 individuals with PD from the DEMPARK/LANDSCAPE study. Redundancy was reduced based on Unique Variable Analysis (UVA) before re-performing EGA. CHI data ( N  = 60,398) served as a conceptual replication base., Results: EGA identified five dimensions. After removing redundancy identified by UVA, EGA identified a unidimensional structure of cognitive test scores. The findings were conceptually replicated in CHIs., Discussion: The findings imply the need to re-evaluate the composition of cognitive test batteries to reduce redundancy and improve the validity of cognitive diagnostics. Cognition may be better described as a network of interrelated cognitive functions rather than a factorial structure of latent cognitive domains., Highlights: Cognitive test scores of the same paradigm were strongly associated with each other.This finding indicates redundancy in the cognitive test battery.After removing redundancy, scores were best represented by unidimensional structures.The findings in Parkinson's disease were conceptually replicated in healthy controls.The results suggest that cognition should be viewed as a complex "network" of interrelated functions., Competing Interests: D.S., M.B.G., D.B., R.H.R., B.M., K.R., O.R., S.R., J.B.S., A.S., C.T., H.U.W., R.D., and A.O. have no competing interests to declare. E.K. received grants from the German Ministry of Education and Research, the Joint Federal Committee, and The German Parkinson Foundation, all outside the submitted work. E.K. received honoraria from the companies EISAI GmbH, Germany, memodio GmbH, Germany, Desitin GmbH, Germany, and Prolog GmbH, Germany, all outside the submitted work. J.K. is a consultant and speaker for AbbVie, Bial, Biogen, Desitin, Esteve, Novartis, Roche, STADA, UCB Pharma, and Zambon; in addition, he is Specialty Chief Editor for Frontiers in Neurology (section Applied Neuroimaging) and Associate Editor (Neurology) for Therapeutic Advances in Chronic Disease. I.L.S. reports funding from Bayer AG and travel grants from Desitin and the German Society for Neurology outside the submitted work. K.W. receives funding from the Deutsche Forschungsgemeinschaft (German Research Association) and STADAPHARM GmbH outside the present study. He has received honoraria for presentations/advisory boards/consultations from BIAL, Indorsia, Boston Scientific and STADAPHARM GmbH, outside the present study. He has received royalties from Thieme Press and Elsevier Press. He serves as an editorial board member of Wiley's Parkinson's Disease, Behavioural Neurology, and PLOS One. Author disclosures are available in the Supporting Information., (© 2025 The Author(s). Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.)

Introduction: Large studies on cognitive profiles of patients with mild cognitive impairment (MCI) due to Alzheimer's disease (AD-MCI) compared to Parkinson's disease (PD-MCI) are rare., Methods: Data from two multicenter cohort studies in AD and PD were merged using a unified base rate approach for the MCI diagnosis. Cognitive profiles were compared using scores derived from the Consortium to Establish a Registry for Alzheimer's Disease battery., Results: Patients with AD-MCI showed lower standardized scores on all memory test scores and a language test. Patients with PD-MCI showed lower standardized scores in a set-shifting measure as an executive task. A cross-validated logistic regression with test scores as predictors was able to classify 72% of patients correctly to AD-MCI versus PD-MCI., Discussion: The applied test battery successfully discriminated between AD-MCI and PD-MCI. Neuropsychological test batteries in clinical practice should always include a broad spectrum of cognitive domains to capture any cognitive changes., Competing Interests: AO, SW, SR, AP, ASp have nothing to disclose. LF received consulting honoraria or lecture fees from Abbott, Allergan, Avanir, Axon Neuroscience, Biogen, Boehringer Ingelheim, Eisai, Functional Neuromodulation, InfectoPharm, MerckSharpe & Dohme, NovoNordisk, Roche, and Willmar Schwabe outside the submitted work; received honoraria for work in study committees (endpoint committees or data/safety monitoring boards) from Avanir, Pharmatrophix, Forschungszentrum Jülich, Neuroscios, and Vivoryon, outside the submitted work. MH, FJ, JKo, WM have nothing to disclose. OP received consulting honoraria or lecture fees from Abbvie, Biogen, and Roche, outside the submitted work; received grant support/case payment for work in clinical trials from Biogen, Roche, Novartis, Janssen, Pharmatrophix, Eisai, and Fujifilm, outside the submitted work. AR, JWi have nothing to disclose. ILS reports grants from International Parkinson Fonds (Deutschland) GmbH (IPD), grants from Johnson & Johnson, a grant from the Michael J. Fox Foundation, grants from European Commission, H2020‐TWINN‐2015, outside the submitted work. SB, DB, JBS, KR, JWoj have nothing to disclose. JKa has received fees as speaker and/or advisor from UCB Pharma, Desitin, Novartis, Bial, Zambon, Medtronic, Desitin, AbbVie, NeuroDerm, and Teva Pharmaceuticals. ASt, MBG, RHR have nothing to disclose. KW reports personal fees from BIAL, personal fees from Desitin, personal fees from UCB, personal fees from Stadapharm, outside the submitted work. BM, CT, HUW, OR have nothing to disclose. RD reports personal fees from AbbVie, personal fees and non‐financial support from Axon Neuroscience, non‐financial support from Akademie für medizinische Fortbildung, personal fees from Agentur Süß, personal fees and non‐financial support from Bayer, grants from Baxter, personal fees from Bial, personal fees and non‐financial support from Biogen, personal fees and non‐financial support from Bayer Vital, personal fees and non‐financial support from BB‐Biotech, grants and non‐financial support from Deutsche Gesellschaft für Neurologie, non‐financial support from Deutscher Hausärzteverband, personal fees from Deutsches Zentrum für neurodegenerative Erkrankungen, grants and non‐financial support from Deutsche Parkinson Vereinigung, non‐financial support from Deutsche Gesellschaft Parkinson, personal fees and non‐financial support from Desitin, non‐financial support from European Brain Council, grants from EU‐Horizon, grants, personal fees and non‐financial support from Eisai, personal fees from Elsevier, grants from Ernst und Margot Faber Stiftung, personal fees and non‐financial support from Gemeinsamer Bundesausschuss, personal fees and non‐financial support from GE Healthcare, grants from GE Healthcare General Electric, personal fees and non‐financial support from International Parkinson and Movement Disorder Society, personal fees and non‐financial support from Institut für hausärztliche Fortbildung im Deutschen Hausärzteverband, personal fees and non‐financial support from IAK+, personal fees and non‐financial support from Johanniter, personal fees from Kohlhammer, grants and personal fees from Lilly, grants from Michael J. Fox Foundation, grants, personal fees and non‐financial support from Novartis, personal fees from Ono Pharma, personal fees and non‐financial support from Pfitzer, personal fees and non‐financial support from Paul‐Martini‐Stiftung, non‐financial support from Programm Demenz Prävention, personal fees and non‐financial support from Roche, personal fees and non‐financial support from Schwabe, personal fees from Springer Verlag, grants from Stichting International Parkinson Fonds, personal fees from Thieme Verlag, personal fees and non‐financial support from UCB Pharma, personal fees from Hummingbird, grants from BMBF, outside the submitted work; In addition, Dr. Dodel has a patent Alpha‐Synuclein Epitopbereiche (Bindungsstellen) natürlich vorkommender humaner Alpha‐Synuclein Autoantikörper zur Diagnostik und Therapie von Morbus Alzheimer und anderen neurodegenerativen Erkrankungen issued, a patent Diagnosis of Alzheimer's Disease and other neurodementia diseases of AD‐type and AD‐therapeutic application issued, a patent Diagnosis, Prohylaxis and Therapy of Alzheimer's Disease and other neurodementing disorders issued, a patent ELISA‐Test zur Bestimmung von Amyloid Beta Auto‐Antikörpern in humanen Serum‐/Plasma‐/CSF‐Proben issued, a patent Herstellung von oligomeren (trimeren) beta‐Amyloid Molekülen mittels spezifischer Mutationen issued, a patent Künstliche Mini‐Amyloide zur Diagnose und Behandlung der Alzheimer Demenz issued, a patent Naturally occurring autoantibodies against alpha‐synuclein that inhibit the aggregation and cytotoxicity of alpha‐synuclein mit Dr. Rentschler Holding GmbH & Co KG issued, and a patent Verfahren, insbesondere Enzyme‐linked Immunosorbent Assay (ELISA) zum in vitro Nachweis von Amyloid beta Autoantikörpern, Mikrotiterplatte und Testkit issued. MW has nothing to disclose. EK reports grants from the German Ministry of Education and Research, Parkinson Fonds Deutschland gGmbH, the German Parkinson Society; speaker honoraria from: Oticon GmbH, illy Pharma GmbH, Bernafon AG; Desitin GmbH, outside the submitted work., (© 2021 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.)

Objectives: Parkinson's disease (PD) is the second most common neurodegenerative disorder and is further associated with progressive cognitive decline. In respect to motor phenotype, there is some evidence that akinetic-rigid PD is associated with a faster rate of cognitive decline in general and a greater risk of developing dementia.The objective of this study was to examine cognitive profiles among patients with PD by motor phenotypes and its relation to cognitive function., Methods: Demographic, clinical and neuropsychological cross-sectional baseline data of the DEMPARK/LANDSCAPE study, a multicentre longitudinal cohort study of 538 patients with PD were analysed, stratified by motor phenotype and cognitive syndrome. Analyses were performed for all patients and for each diagnostic group separately, controlling for age, gender, education and disease duration., Results: Compared with the tremor-dominant phenotype, akinetic-rigid patients performed worse in executive functions such as working memory (Wechsler Memory Scale-Revised backward; p=0.012), formal-lexical word fluency (p=0.043), card sorting (p=0.006), attention (Trail Making Test version A; p=0.024) and visuospatial abilities (Leistungsprüfungssystem test 9; p=0.006). Akinetic-rigid neuropsychological test scores for the executive and attentive domain correlated negatively with non-tremor motor scores. Covariate-adjusted binary logistic regression analyses showed significant odds for PD-mild cognitive impairment for not-determined as compared with tremor-dominant (OR=3.198) and akinetic-rigid PD (OR=2.059). The odds for PD-dementia were significant for akinetic-rigid as compared with tremor-dominant phenotype (OR=8.314)., Conclusion: The three motor phenotypes of PD differ in cognitive performance, showing that cognitive deficits seem to be less severe in tremor-dominant PD. While these data are cross-sectional, longitudinal data are needed to shed more light on these differential findings., Competing Interests: Competing interests: GD has received lecture fees from Boston Scientific and has been serving as a consultant for Boston Scientific. He received royalties from Thieme Publishers. He is a government employee and receives through his institution funding for his research from the German Research Council, the German Ministry of Education and Research, and Medtronic. KW received reimbursement of congress fees from BIAL and Desitin; and grants from the Federal Ministry of Education and Research and the German Research Foundation., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: The self-assessment of health-related quality of life (HrQoL) in patients with Alzheimer's disease (AD) and mild cognitive impairment is commonly higher than the proxy-assessment by caregivers. This study aims at evaluating sociodemographic and clinical factors to explain this difference., Methods: HrQoL of 241 community-dwelling patients was analysed using the dementia-specific Quality of Life-Alzheimer's Disease questionnaire (QoL-AD). Behavioural and psychological symptoms and functional capacity were evaluated using the Geriatric Depression Scale (GDS), the Neuropsychiatric Inventory (NPI) and the Alzheimer's Disease Cooperative Study-Activities of Daily Living scale (ADCS-ADL)., Results: The self-assessment of patients' HrQoL was significantly higher than the caregiver-ratings (mean difference: 7.4 ± 5.6, p < 0.001). Considerable influencing factors were the extent of depressive symptoms (GDS), the degree of impairment in functional performance (ADCS-ADL) and the relationship between patients and caregivers., Conclusion: Independent variables explained 23 % of the variance in the difference between self- and proxy-assessment of HrQoL. Future studies should include further influencing factors such as caregivers' mental health., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Recent research efforts have focused on the effects of deep brain stimulation of the subthalamic nucleus (STN DBS) for selected patients with mild-to-moderate PD experiencing motor complications., Objectives: We assessed the cost utility of subthalamic DBS compared with the best medical treatment for German patients below the age of 61 with early motor complications of PD., Methods: We applied a previously published Markov model that integrated health utilities based on EuroQoL and direct costs over patients' lifetime adjusted to the German health care payer perspective (year of costing: 2013). Effectiveness was evaluated using the Parkinson's Disease Questionnaire 39 summary index. We performed sensitivity analyses to assess uncertainty., Results: In the base-case analysis, the incremental cost-utility ratio for STN DBS compared to best medical treatment was 22,700 Euros per quality-adjusted life year gained. The time to, and costs for, battery exchange had a major effect on the incremental cost-utility ratios, but never exceeded a threshold of 50,000 Euros per quality-adjusted life year., Conclusions: Our decision analysis supports the fact that STN DBS at earlier stages of the disease is cost-effective in patients below the age of 61 when compared with the best medical treatment in the German health care system. This finding was supported by detailed sensitivity analyses reporting robust results. Whereas the EARLYSTIM study has shown STN DBS to be superior to medical therapy with respect to quality of life for patients with early motor complications, this further analysis has shown its cost-effectiveness. © 2016 International Parkinson and Movement Disorder Society., (© 2016 International Parkinson and Movement Disorder Society.)