Demenzabklärung: Validität der Diagnose im Follow-Up – Eine deskriptive Analyse der ersten 143 Patienten der Memory Clinic St. Gallen

Praxis ◽  
2004 ◽  
Vol 93 (14) ◽  
pp. 553-558
Author(s):  
Schwenk ◽  
Inglin ◽  
Hürny
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Medikamentöse Therapie ◽  
Bildgebende Verfahren ◽  
Memory Clinic ◽  
Vaskuläre Demenz ◽  
Kognitive Störung

Bei 143 von 1995 bis 1999 in der Memory Clinic St. Gallen mit Verdacht auf Demenz ambulant abgeklärten Patienten wurden soziodemographische, medizinische und Follow-Up-Daten deskriptiv ausgewertet. 63% der Untersuchten litten an einer Demenz, 14% an «mild cognitive impairment», 1% an einer vorbestehenden Minderbegabung und 22% wiesen keine kognitive Störung auf. Bezüglich Demenzursachen war der Alzheimer-Typ mit 40% am häufigsten, vaskuläre Demenz und «reversible Demenzformen» mit 2,8% bzw. 2,1% hingegen unterrepräsentiert. Bei 63 von 143 Patienten wurde der medizinische und soziale Verlauf über ein Mittel von 16 Monaten retrospektiv untersucht mit der Frage, ob die Durchführung weiterer diagnostischer Massnahmen, wie bildgebende Verfahren, erweiterte Labordiagnostik oder die probatorische medikamentöse Therapie durch den Hausarzt, die initial gestellte Diagnose beeinflusste. Bei 87,3% der Patienten bestätigte sich im Follow-Up die bei der ambulanten Abklärung gestellte Diagnose. In den meisten Fällen von Demenz kann somit auf teure Zusatzdiagnostik verzichtet werden.

scholarly journals The Gothenburg MCI study: Design and distribution of Alzheimer’s disease and subcortical vascular disease diagnoses from baseline to 6-year follow-up

2015 ◽  
Vol 36 (1) ◽  
pp. 114-131 ◽  
Author(s):  
Anders Wallin ◽  
Arto Nordlund ◽  
Michael Jonsson ◽  
Karin Lind ◽  
Åke Edman ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Vascular Disease ◽  
Mixed Type ◽  
Disease Entity ◽  
Memory Clinic ◽  
Mixed Type Dementia

There is a need for increased nosological knowledge to enable rational trials in Alzheimer’s disease (AD) and related disorders. The ongoing Gothenburg mild cognitive impairment (MCI) study is an attempt to conduct longitudinal in-depth phenotyping of patients with different forms and degrees of cognitive impairment using neuropsychological, neuroimaging, and neurochemical tools. Particular attention is paid to the interplay between AD and subcortical vascular disease, the latter representing a disease entity that may cause or contribute to cognitive impairment with an effect size that may be comparable to AD. Of 664 patients enrolled between 1999 and 2013, 195 were diagnosed with subjective cognitive impairment (SCI), 274 with mild cognitive impairment (MCI), and 195 with dementia, at baseline. Of the 195 (29%) patients with dementia at baseline, 81 (42%) had AD, 27 (14%) SVD, 41 (21%) mixed type dementia (=AD + SVD = MixD), and 46 (23%) other etiologies. After 6 years, 292 SCI/MCI patients were eligible for follow-up. Of these 292, 69 (24%) had converted to dementia (29 (42%) AD, 16 (23%) SVD, 15 (22%) MixD, 9 (13%) other etiologies). The study has shown that it is possible to identify not only AD but also incipient and manifest MixD/SVD in a memory clinic setting. These conditions should be taken into account in clinical trials.

Evaluation of Dementia

1999 ◽  
Vol 56 (2) ◽  
pp. 94-97 ◽  
Author(s):  
Inglin
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Mental Status ◽  
Bildgebende Verfahren ◽  
Leichte Kognitive Störung ◽  
Kognitive Störung ◽  
Neuropsychologische Tests ◽  
Neuropsychologische Untersuchungen ◽  
Frühzeitige Diagnostik

Eine Demenzabklärung soll in drei Schritten erfolgen: 1. Zu Beginn jeder Demenzabklärung muß die Frage beantwortet werden, ob überhaupt eine Demenz vorliegt. Insbesondere gilt es, ein Delirium sowie eine leichte kognitive Störung («mild cognitive impairment») abzugrenzen. Zur Demenzdiagnostik gehören eine sorgfältige Anamneseerhebung sowie neuropsychologische Untersuchungen. Demenzscreening-Instrumente sind der Mini-Mental-Status sowie der Uhrentest, in Frühfällen sind umfassendere neuropsychologische Tests durch entsprechende Spezialisten nötig. 2. Bei Bestätigung einer Demenz muß die Frage der Ätiologie beantwortet werden. Internistischer Status, Neuro- und Psychostatus, neuropsychologische Untersuchungen, Laboruntersuchungen sowie meist bildgebende Verfahren und allenfalls weitere Zusatzuntersuchungen vermögen oft die Ursache einer Demenz aufzudecken. Eine frühzeitige Diagnostik hilft vor allem, reversible Prozesse rechtzeitig zu therapieren. 3. Unerläßlicher Bestandteil jeder Demenzabklärung muß schließlich auch die Evaluation der Betreuungssituation sein, mit nachfolgender Beratung.

Leichte kognitive Störungen und Demenz bei Patienten mit Morbus Parkinson

2014 ◽  
Vol 25 (1) ◽  
pp. 17-30 ◽  
Author(s):  
Elke Kalbe ◽  
Annette Petrelli
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Morbus Parkinson ◽  
Kognitive Störungen ◽  
Kognitive Störung

Neuropsychologische Defizite bei Parkinsonpatienten sind häufig und umfassen typischerweise exekutive Störungen, Gedächtnis- (v. a. strategische Enkodier- und Abruf‐) Defizite, visuell-räumliche sowie Aufmerksamkeitsstörungen. Die Punktprävalenz der leichten kognitiven Störungen bei Parkinsonpatienten (Mild Cognitive Impairment in Parkinson′s Disease, PD-MCI), für die 2012 Forschungskriterien publiziert wurden, wird im Mittel auf 27 % geschätzt werden; die Punktprävalenz der Parkinson-Demenz (Parkinson′s Disease Dementia, PDD) wird mit etwa 30 % angegeben. Longitudinal entwickeln die meisten Parkinsonpatienten während ihrer Erkrankung eine kognitive Störung. Aufgrund ihrer Häufigkeit und Relevanz ist es wichtig, diese zu diagnostizieren. Für die Therapie der PDD ist der Acetylcholinesterasehemmer Rivastigmin zugelassen; andere zugelassene Behandlungsmöglichkeiten existieren derzeit nicht. Die Evidenzlage zu nicht-pharmakologischen Interventionsansätzen ist bislang unzureichend; erste Studien zur Wirksamkeit kognitiven Trainings sowie physischer Aktivität sind jedoch vielversprechend.

Elucidating the risk factors for progression from amyloid-negative amnestic mild cognitive impairment to dementia

2020 ◽  
Vol 17 ◽  
Author(s):  
Hyung-Ji Kim ◽  
Jae-Hong Lee ◽  
E-nae Cheong ◽  
Sung-Eun Chung ◽  
Sungyang Jo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Amnestic Mild Cognitive Impairment ◽  
Amyloid Pet ◽  
Clinical Progression ◽  
Amnestic Mci

Background: Amyloid PET allows for the assessment of amyloid β status in the brain, distinguishing true Alzheimer’s disease from Alzheimer’s disease-mimicking conditions. Around 15–20% of patients with clinically probable Alzheimer’s disease have been found to have no significant Alzheimer’s pathology on amyloid PET. However, a limited number of studies had been conducted this subpopulation in terms of clinical progression. Objective: We investigated the risk factors that could affect the progression to dementia in patients with amyloid-negative amnestic mild cognitive impairment (MCI). Methods: This study was a single-institutional, retrospective cohort study of patients over the age of 50 with amyloidnegative amnestic MCI who visited the memory clinic of Asan Medical Center with a follow-up period of more than 36 months. All participants underwent brain magnetic resonance imaging (MRI), detailed neuropsychological testing, and fluorine-18[F18]-florbetaben amyloid PET. Results: During the follow-up period, 39 of 107 patients progressed to dementia from amnestic MCI. In comparison with the stationary group, the progressed group had a more severe impairment in verbal and visual episodic memory function and hippocampal atrophy, which showed an Alzheimer’s disease-like pattern despite the lack of evidence for significant Alzheimer’s disease pathology. Voxel-based morphometric MRI analysis revealed that the progressed group had a reduced gray matter volume in the bilateral cerebellar cortices, right temporal cortex, and bilateral insular cortices. Conclusion: Considering the lack of evidence of amyloid pathology, clinical progression of these subpopulation may be caused by other neuropathologies such as TDP-43, abnormal tau or alpha synuclein that lead to neurodegeneration independent of amyloid-driven pathway. Further prospective studies incorporating biomarkers of Alzheimer’s diseasemimicking dementia are warranted.

Analyses of Visuospatial and Visuoperceptual Errors as Predictors of Dementia in Parkinson’s Disease Patients with Subjective Cognitive Decline and Mild Cognitive Impairment

2020 ◽  
pp. 1-11
Author(s):  
Iván Galtier ◽  
Antonieta Nieto ◽  
María Mata ◽  
Jesús N. Lorenzo ◽  
José Barroso
Keyword(s):  
Risk Factors ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Cognitive Decline ◽  
Poor Performance ◽  
Subjective Cognitive Decline ◽  
Independent Risk Factors

ABSTRACT Objective: Subjective cognitive decline (SCD) and mild cognitive impairment (MCI) in Parkinson’s disease (PD) are considered as the risk factors for dementia (PDD). Posterior cortically based functions, such as visuospatial and visuoperceptual (VS-VP) processing, have been described as predictors of PDD. However, no investigations have focused on the qualitative analysis of the Judgment of Line Orientation Test (JLOT) and the Facial Recognition Test (FRT) in PD-SCD and PD-MCI. The aim of this work was to study the VS-VP errors in JLOT and FRT. Moreover, these variables are considered as predictors of PDD. Method: Forty-two PD patients and 19 controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD-MCI. Analyses of errors were conducted following the procedure described by Ska, Poissant, and Joanette (1990). Follow-up assessment was conducted to a mean of 7.5 years after the baseline. Results: PD-MCI patients showed a poor performance in JLOT and FRT total score and made a greater proportion of severe intraquadrant (QO2) and interquadrant errors (IQO). PD-SCD showed a poor performance in FRT and made mild errors in JLOT. PD-MCI and QO2/IQO errors were independent risk factors for PDD during the follow-up. Moreover, the combination of both PD-MCI diagnosis and QO2/IQO errors was associated with a greater risk. Conclusions: PD-MCI patients presented a greater alteration in VS-VP processing observable by the presence of severe misjudgments. PD-SCD patients also showed mild difficulties in VS-SP functions. Finally, QO2/IQO errors in PD-MCI are a useful predictor of PDD, more than PD-MCI diagnosis alone.

scholarly journals 332 - Electroconvulsive therapy in older adults with major depression was not associated with cognitive decline during a 15-year follow-up

2020 ◽  
Vol 32 (S1) ◽  
pp. 91-91
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Major Depression ◽  
Cognitive Decline ◽  
Electroconvulsive Therapy ◽  
Antidepressant Treatment ◽  
Community Sample ◽  
Control Group

AUTHORS:Kerstin Johansson, Karolina Thömkvist, Ingmar Skoog and Sacuiu SF* (*presenter)OBJECTIVE:To determine the effects of electroconvulsive therapy (ECT) in major depression in relation to the development of dementia during long-term follow-up.METHOD:In an observational clinical prospective study of consecutive patients 70 years and older diagnosed with major depression at baseline 2000-2004 (n=1090), who were free of dementia and received antidepressant treatment, with or without ECT, we sought to determine if cognitive decline (mild cognitive impairment and dementia) during 15 -year follow-up was associated with receiving ECT at baseline. The control group was selected among the participants in the Gothenburg H70 Birth Cohort Studies matched by age group and sex 1:1.RESULTS:Among patients with affective syndromes 7% received ECT. During follow-up, 157 patients were diagnosed with dementia, equal proportions among those who received ECT (14.5%) and those who did not receive ECT (14.5%). The relation between ECT and cognitive decline remained non-significant irrespective antidepressive medication or presence of mild cognitive impairment at baseline.CONCLUSION:Preliminary results indicate that ECT was not associated with the development of cognitive decline in the long-term in a hospital-based cohort of 70+ year-olds. The results remain to verify against controls from a representative community sample.

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