[Retrospective analysis of routine-MRI and correlation with aetiology of dementia, severity and neuropsychology in a memory-clinic population]. / Retrospektive Analyse der MRT-Routinebefunde und Korrelation mit Demenzätiologie, Schweregrad und neuropsychologischen Befunden von Patienten aus einer universitären Gedächtnisambulanz.

BACKGROUND: The contribution of potential treatable dementia aetiologies diagnosed using cerebral imaging varied considerably in previous studies and was not evaluated in a recent larger German sample of patients from a memory clinic. MATERIAL AND METHODS: MRI images of 502 patients were retrospectively reassessed. Beside the proportion of potentially treatable dementia aetiology, the extent of whole brain atrophy (semiquantitative) and vascular white matter lesions were assessed. RESULTS: Mean age of the patients was 63.7 ± 13.1 years; 49 % were female, mean MMST was 24.2 ± 5.5. In 74 % there was an agreement between the clinical dementia syndrome and MRI. 9 % (45 patients) had clearly discrepant imaging results, according to MRI criteria (21 × ischaemia, 20 × normal pressure hydrocephalus (NPH), 4 × intracerebral haemorrhage). These patients could not not be differentiated using age and MMST alone as clinical criteria. There was a significant correlation between global brain atrophy and MMST (r = -0.32; p < 0.001) and white matter lesion score (r = 0.28; p < 0.001). CONCLUSION: In 9 % there was a clear discrepancy between MRI results and the clinical syndrome diagnosis in memory-clinic patients. As known from earlier studies and current German 3 rd generation guidelines, it is reasonable to perform MRI imaging in dementia to improve the aetiological and differential diagnoses and to detect a different aetiology that can be missed using the clinical dementia criteria alone.

Validation of the German revised Addenbrooke's cognitive examination for detecting mild cognitive impairment, mild dementia in alzheimer's disease and frontotemporal lobar degeneration.

BACKGROUND/AIMS: The diagnostic accuracy of the German version of the revised Addenbrooke's Cognitive Examination (ACE-R) in identifying mild cognitive impairment (MCI), mild dementia in Alzheimer's disease (AD) and mild dementia in frontotemporal lobar degeneration (FTLD) in comparison with the conventional Mini Mental State Examination (MMSE) was assessed. METHODS: The study encompasses 76 cognitively healthy elderly individuals, 75 patients with MCI, 56 with AD and 22 with FTLD. ACE-R and MMSE were validated against an expert diagnosis based on a comprehensive diagnostic procedure. Statistical analysis was performed using the receiver operating characteristic method and regression analyses. RESULTS: The optimal cut-off score for the ACE-R for detecting MCI, AD, and FTLD was 86/87, 82/83 and 83/84, respectively. ACE-R was superior to MMSE only in the detection of patients with FTLD [area under the curve (AUC): 0.97 vs. 0.92], whilst the accuracy of the two instruments did not differ in identifying MCI and AD. The ratio of the scores of the memory ACE-R subtest to verbal fluency subtest contributed significantly to the discrimination between AD and FTLD (optimal cut-off score: 2.30/2.31, AUC: 0.77), whereas the MMSE and ACE-R total scores did not. CONCLUSION: The German ACE-R is superior to the most commonly employed MMSE in detecting mild dementia in FTLD and in the differential diagnosis between AD and FTLD. Thus it might serve as a valuable instrument as part of a comprehensive diagnostic workup in specialist centres/clinics contributing to the diagnosis and differential diagnosis of the cause of dementia.

Short-term influence of elevation of plasma homocysteine levels on cognitive function in young healthy adults.

BACKGROUND: Acute homocysteine elevation has been shown to have a significant impact on cognitive function in animal models. OBJECTIVES: Investigation of the short-term impact of elevation of plasma homocysteine levels through a dietary intervention on cognitive abilities of young healthy adults. PARTICIPANTS: 100 healthy medical students of both genders were enrolled in the study. DESIGN AND MEASUREMENTS: Homocysteine levels and cognitive abilities were measured at 08:30 (before breakfast) and at 15:00 (two hours after lunch and six hours after breakfast). Food intake was restricted to specified comestibles. The cognitive assessment comprised a version of the Short Test for General Intelligence, three subtests of the Syndrome Short Test and the Stroop test. RESULTS: At 15:00 plasma homocysteine was significantly elevated in 56 participants (P < 0.00001), whilst in 44 it was decreased (P < 0.00001) in comparison to baseline (08:30). The decrease was however of limited clinical significance. The differences in the changes in cognitive performance between the two groups did not attain statistical significance (P > 0.05) and the direction of the changes did not differ between them. Accordingly, the multiple linear regression analysis did not reveal an important influence of homocysteine elevation on cognitive performance variations. CONCLUSIONS: Significant increase of plasma homocysteine is not associated with a straightforward inhibitory or facilitatory short-term effect on physiological cognitive parameters in young healthy adults.

[Usage of drugs with potential adverse effects on cognition in a memory-clinic]. / Verwendung von Medikamenten mit ungünstigen Wirkungen auf die Kognition in einer Gedächtnissprechstunde.

Cognitive decline is a frequent clinical symptom in elderly patients. In particular, memory disturbances are an early sign and a risk factor for subsequent development of neurodegenerative dementia. At the same time, elderly patients often receive multiple medications due to an increasing number of acquired diseases. Certain drugs have adverse side effects on cognition due to interference with the cholinergic or GABA-ergic system. This could lead to underestimation of the actual cognitive status at initial clinical presentation. In the present study we included 221 patients (mean age 68,5 years) who presented for the first time in a specialized memory-clinic and who had or developed dementia during follow up. Most patients had mixed vascular-degenerative dementia (57 %). On average, patients took 2.1 drugs. 19.9 % of the patients had medications with potential adverse effects on cognition. Patients with medication affecting cognition had a worse cognitive performance than patients with a medication not influencing cognitive functioning (Mini-Mental vs. 18.8. 22.01, p = 0.01) in univariate analysis. Psychotropic drugs were used less frequently (38 %) than primary non-CNS medication. The results remained unchanged even after performing a case-control study with the mixed dementia population with age and gender matched patients. However, in multivariate analysis, only the absolute number of medication taken remained as an independent factor. Our data highlight the clinical importance of medication history in the diagnostic work-up of cognitive impairment. The absolute number of medication taken seems to be more important than medication with possible adverse side effects on cognition.

[Sensitivity of neurochemical dementia diagnostics in CSF compared to 99mTc-SPECT in Alzheimer's dementia]. / Vergleichende Sensitivität der neurochemischen Demenzdiagnostik im Liquor und rCBF im 99mTc-SPECT bei Patienten mit Alzheimerdemenz.

The diagnosis of Alzheimer's dementia is currently changing from a late and exclusion diagnosis towards a pathophysiology-based early and positive diagnosis. Especially advances in neuro-chemical dementia diagnostics in the cerebrospinal fluid (NDD-CSF) and imaging techniques like PET, SPECT or MRI are of particular interest. Unfortunately, many studies investigated only either one or other technique. In the present study 56 patients (average 67.1 years; average mini-mental status test (MMST) 22.2) were examined with the clinical diagnosis of Alzheimer's dementia. All patients both underwent NDD-CSF as well as 99mTc-SPECT. Only the SPECT, but not the NDD-CSF correlated with disease severity. Sensitivity of NDD-CSF was 89 % and SPECT 48 % for all patients and 93 % resp. 61 % for patients with MMST < 24. Below MMST 20 both methods had equal sensitivity. Both diagnostic techniques showed no statistic coherence (p = 0.27), neither after correction for subgroups like disease severity or the APOE genotype. Our results are compatible with the hypothesis that the NDD-CSF reflects beta-amyloid-aggregation and Tau-Protein pathology as a pathophysiologic biomarker. Our results suggest that SPECT is rather a state parameter for the rCBF changes following cortical neurodegeneration.

[Comparison of patient therapy adherence of two structural different memory clinics]. / Vergleich der Therapietreue von zwei regional benachbarten Gedächtnissprechstunden mit unterschiedlicher Struktur.

There are more than 100 memory clinics established in Germany, Austria and German-speaking Switzerland. We compared the impact of the structure of two German memory clinics (Erlangen and Nuremberg) on therapeutic outcome. 483 patients suffering from dementia with indication for antidementive therapy were included in this study. The data ascertainment included patient-related data, the mini mental score, comorbidity as well as psychiatric drug therapy. After a mean follow-up of 3.7 years, we performed a single cross-sectional survey covering over 90 % of patients to assess clinical course and adherence to therapy. The patients of the Erlangen University Memory Clinic were significantly younger (69.8 +/- 9.49 vs. 74.6 +/- 10.7 years; p = 0.01) and had a better mini mental score at their first presentation (20.9 +/- 9.4 vs. 19.5 +/- 5.9; p = 0.02). They showed a non-significantly faster disease progression (as measured by mini mental decline per year), than the patients from Nuremberg. Concerning the allocation of diagnosis, more late onset-dementias and dementias of a mixed type were treated at the Nuremberg clinic. At the university clinic, more dementias were of unclassified origin. Concomitant drug therapies, death rates and therapy adherence (53 %) were not different between the two clinics. The two memory clinics under investigation differed in patient age, disease severity and diagnostic assessment. Still, parameters of therapeutic outcome showed converging results.

[Neuropsychological complications after coronary bypass grafting]. / Neuropsychiatrische Komplikationen nach aortokoronarer Bypassoperation.

BACKGROUND: Coronary bypass grafting is more and more performed in elderly, atherosclerotic patients with increased risk of developing postoperative neuropsychological complications. In the present study, we investigated the relative importance of clinical, genetic or metabolic factors with possible impact on any of the primary endpoint encephalopathy, stroke and death after coronary bypass grafting. METHODS: 98 prospective patients (mean age 67.9 years, 23 females, 75 males) underwent conventional elective bypass surgery. All had standardized cardiovascular risk factor assessment, prior stroke, EuroSCORE, a neuropsychologic battery and testing for Apolipoprotein E (APOE) Genotype and Homocysteine. Follow up was possible on 90 patients postoperatively and after 3, 6 and 12 months, monitoring cognitive decline, death or dependency and general health assessment. RESULTS: Early mortality was 3.1 % (3 patients); 3 patients (3.0 %) developed postoperative ischemic stroke and 2 further strokes occurred within the next 3 months. Postoperative encephalopathy occurred in 14 patients (14.3 %). Homocysteine elevation or Apolipoprotein E 4 (APO E 4) did not correlate with immediate postoperative cognitive function. Patients with high EuroSCOREs had significantly lower postoperative Mini-Mental scores. Neither Homocysteine nor presence of an APO E 4 allele was associated with any postoperative endpoint at 3, 6 or 12 months after surgery. The EuroSCORE was modestly associated with postoperative encephalopathy (relative risk 1.3 - 1.5), but not with outcome after one year. Preoperative stroke was highly associated with postoperative ischemic stroke and cognitive decline on follow-up (relative risk 11), but not with postoperative encephalopathy. CONCLUSIONS: Amongst clinical factors, the EuroSCORE may indicate moderate risk increase for acute postoperative encephalopathy. Most strokes occur early after surgery. Patients having suffered stroke prior to cardiac surgery may represent a high-risk group in the acute as well as chronic outcome after cardiac surgery.