[Cognitive rehabilitation in early stage Alzheimer's disease]. / Kognitive Rehabilitation bei Alzheimer-Krankheit im Frühstadium.

BACKGROUND: Dementia impairs the coping with routine daily tasks and social relationships due to an increasing degeneration of cognitive abilities. An appropriate treatment must adequately consider the effects of declined cognitive abilities on patients and their environment. Therefore, in recent times, integrative procedures for cognitive rehabilitation (CR) have become increasingly important for the therapy of patients with mild cognitive impairment (MCI) and mild dementia (MD). CR approaches provide compensatory possibilities for clearly defined routine challenges and the individual needs of those affected. MATERIAL AND METHODS: This overview article in the form of a selective review elaborates factors for the effectiveness of CR on the basis of the currently available literature: 1) individuality - consideration of personal needs and targets, 2) compensation - mediation of skills and strategies to compensate for cognitive impairments, 3) interaction - inclusion of relatives and environmental conditions and 4) integration - integration of various therapeutic disciplines and methods. RESULTS AND DISCUSSION: On the basis of this assessment with regards to the content, a critical analysis of the methods of short and long-term therapeutic effects on MCD and MD was carried out. Although the resulting factors were of high long-term relevance for the improvement of depression and quality of life, effects on cognition were more pronounced for MCI than for MD, which emphasizes the importance of beginning therapy as early as possible. The results show that future studies on effectiveness must employ endpoints relevant for routine daily life, and that the possibility of an implementation of therapeutic concepts in a healthcare system should be considered as an essential criterion.

[Do dementia patients living at home live longer than in a nursing home?]. / Leben Demenzkranke zu Hause länger als im Heim?

Many studies have shown that the number of new dementia diagnoses in Germany is increasing yearly. Thus, two social tasks are important: the adequate support and care of dementia patients, now and in the future, as well as covering the costs thereof. The survival period of dementia patients has a central meaning - especially for health policy planning. Therefore, the question of our 8-year follow-up study was whether living conditions affect the survival period of dementia patients? A total of 173 dementia outpatients (ICD-10 numbers F00 and F01) were screened for survival time and living conditions. For deceased patients, a close reference person was interviewed, and the exact date of death was recorded. For statistical evaluation, the Cox proportional hazard model was used and dying risks were determined. Our investigation shows that a clear difference exists in the survival period of dementia patients, according to whether they have lived at home or in a senior citizen's home. Patients in senior citizen's homes had a higher relative dying risk of around 53.1% (hazard ratio), than for those cared for at home (p=0.047). Prospective research is needed to gain more evidence about the impact of social factors, e.g., living conditions, on the survival time of demented patients.

[Psychosis in elderly post-traumatic stress disorder patients]. / Psychotische Syndrome bei kriegstraumatisierten älteren Patienten.

BACKGROUND: Late-onset post-traumatic stress disorder (PTSD) patients with traumatic experiences from World War II often present psychotic features. METHODS: Twelve psychotic elderly PTSD patients were compared with 22 nonpsychotic elderly PTSD patients for age, marital status, age of traumatization, age of onset of psychiatric symptoms, and psychiatric comorbidities. The contents of delusions and hallucinations were registered as well as trauma details. RESULTS: The psychotic PTSD patients were significantly older (80 years vs 74), later traumatized (20 years vs 14), more frequently demented (75% vs 27%), and more frequently widowed (83% vs 50%). The contents of their psychotic features often were related to traumatic experiences in early life. CONCLUSIONS: Psychoses of traumatized elderly patients should be registered regarding psychotic content to discover a possible relation between traumatic experiences and psychosis. The International Classification of Diseases 11th Edition should include the subtype "PTSD with simultaneous psychotic features."

[Impact of vascular pathology on survival times of 173 dementia patients--Hachinski's ischemic score as a predictive tool for clinical purposes]. / Welchen Einfluss haben zerebrale Durchblutungsstörungen auf die Uberlebenszeit Demenzerkrankter? Korrelation der Uberlebenszeit von 173 Demenzerkrankten mit dem Ischämie-Score nach Hachinski.

Alzheimer's disease and vascular dementia still may be looked upon as distinct nosologic entities, representing the two main etiologic categories of senile dementia. However, rather recent findings suggest a comorbidity of neurodegenerative and ischemic pathology in a majority of dementia cases in later life. The effect of the vascular pathology on the survival time was studied in 173 dementia outpatients. For 147 patients with complete datasets, we were able to gain information concerning their survival time. As an indicator of cerebrovascular morbidity the 18-point ischemic scale of Hachinski (HIS) was correlated with the survival time. Thus, we did not use the HIS for its original purpose to differentiate between degenerative and vascular dementia, but to roughly evaluate the cerebrovascular impact in a continuum model. Using the Cox model we calculated mortality risks for every point on the HIS. We found a Cox hazard ratio of 1.038 for each supplementary point on the HIS, which equals a 3.8% higher relative mortality risk. The result misses significance (p=0.092), but indicates a clear tendency towards a shortening of survival time by vascular comorbidity. Future prospective studies should integrate brain imaging to further corroborate our findings.

Patients' use of alternative methods parallel to psychiatric therapy: does the migrational background matter?

OBJECTIVE: Unconventional medicine is widespread in nearly every culture and often used parallel to professional help. This survey evaluates the use of unconventional methods of psychiatric in-patients with vs. without a background of migration. METHOD: A total of 167 psychiatric in-patients underwent a structured interview. One hundred patients were migrants (group 1) and were compared with 67 German in-patients (group 2). RESULTS: Nearly 50% of all patients reported of at least one unconventional therapy. Both migrants and natives used healing methods parallel to professional help. The migrant group rathered to use folk medical concepts and the native group rathered alternative medicine. Around half of the patients with experience of complementary therapy believed it to be efficacious. CONCLUSION: The results suggest that nearly half of the psychiatric patients use alternative medicine and a quarter believe in its efficacy. People with a more traditional background tend to use folk medical practices.

[A case of delusional jealousy in Parkinson disease ]. / Uber einen Fall von Eifersuchtswahn bei Morbus Parkinson.

Delusional jealousy has been reported in organic and "functional" psychotic disorders. In organic psychoses, delusional jealousy is usually associated with impaired orientation or other cognitive disturbances. Delusional jealousy in Parkinson's disease has rarely been reported in the scientific literature. A case of a 49-year-old man suffering from this pathology in the course of Parkinson's disease is presented as to clinical picture, therapy, course, and outcome.