[The German S3 guidelines on dementia]. / Die S3-Leitlinien Demenzen.

Due to the demographic development, the number of dementia patients in Germany is continuously increasing. The complex care situation of those affected calls for meaningful guidelines. In 2008, the first S3 guideline on dementia was published, coordinated by the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and the German Association for Neurology (DGN) and accompanied by the Association of the Scientific Medical Societies in Germany (AWMF). An update was published in 2016. In recent years, the diagnostic possibilities for Alzheimer's disease, in particular, have greatly developed and a new disease concept has emerged that includes mild cognitive impairment (MCI) as part of the clinical manifestation of the disease and also enables the diagnosis of Alzheimer's disease in this phase. In the area of treatment, the first causal disease-modifying therapies will likely soon be available. Furthermore, epidemiological studies have also shown that up to 40% of the risks for dementia are dependent on modifiable risk factors, making prevention increasingly more important. In order to do justice to these developments a completely updated S3 guideline on dementia is currently being developed, which will be available digitally for the first time in the form of an app and which, in the sense of living guidelines, will enable rapid adjustments to progress in the future.

[Brain health services: individual dementia risk profiling at the Cologne Alzheimer Prevention Center]. / Brain Health Services: Erfassung des individuellen Demenzrisikos am Kölner Alzheimer Präventionszentrum.

BACKGROUND: According to current knowledge approximately 30-40% of all cases of dementia can be attributed to modifiable risk factors. As a result, dementia prevention and the concept of brain health are becoming increasingly relevant. RESEARCH QUESTION: The requirements for brain health services and their implementation are discussed and the Cologne Alzheimer Prevention Center (KAP) of the University Hospital Cologne is described as an example. MATERIAL AND METHODS: In addition to a report on international brain health initiatives, the main activities of the KAP are presented. A program for individual risk profiling and risk communication is provided, which was piloted in the KAP in the context of the "Individual risk profiling for Alzheimer's disease and dementia prevention (INSPIRATION)" study. The prevalence of risk factors in a cognitively healthy sample aged 50-86 years (n = 162) with interest in dementia prevention is presented. RESULTS: The most common risk factors were non-Mediterranean diet, obesity, subjective poor sleep quality and increased stress. Based on these results, preventive interventions can be developed that are adapted to the individual risk profile as a personalized medicine approach. DISCUSSION: Structures such as the KAP can provide individual risk factor assessment and personalized dementia prevention. The efficacy of this approach on dementia risk reduction needs to be evaluated.

Progression of Subjective Cognitive Decline to MCI or Dementia in Relation to Biomarkers for Alzheimer Disease: A Meta-analysis.

BACKGROUND AND OBJECTIVES: The risk of mild cognitive impairment (MCI) or dementia in individuals with subjective cognitive decline (SCD) and biomarkers indicating Alzheimer disease (AD) pathology in comparison with individuals with SCD without biomarker evidence for AD is critical to delineate the potential role of biomarker assessment in this group. We performed a meta-analysis of studies on this topic. METHODS: Three databases (PubMed, PsycINFO, and Cochrane) were searched from inception to May 7, 2021. Search strings included the terms: subjective cognitive decline, biomarker, amyloid, tau, risk, Alzheimer, mild cognitive impairment, and dementia. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines, 2 researchers independently performed literature search, data collection, and data extraction. We summarized odds ratios (ORs) in random-effects meta-analyses and calculated sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs), and likelihood ratios. The primary outcome was the OR of progression from SCD to MCI or dementia in cases with biomarkers indicative of AD pathology relative to the chance of progression in cases with biomarkers indicating no AD pathology. RESULTS: Of 4,147 studies screened, 8 studies were selected. The risk of bias analysis revealed a low risk of bias in all studies. The prevalence of abnormal biomarkers ranged between 15.6% and 35.9% for amyloid, 11.1% and 33.6% for phosphorylated tau (p-tau), 12.3% and 46.3% for total tau (t-tau), and 7.8% and 24.4% for full AD pathology (amyloid pathology with either increased p-tau or t-tau). The chance of clinical progression was increased in cases of amyloid pathology only (OR 5.89, 95% CI 2.33-14.90), elevated p-tau (OR 3.99, 95% CI 2.34-6.85), elevated t-tau (OR 2.26, 95% CI 1.14-4.48), and full AD pathology (OR 11.36, 95% CI 1.97-65.41). The latter showed a PPV of 59.7% (95% CI 48.8%-69.3%) and an NPV of 89.4% (95% CI 86.7%-91.7%), whereas amyloid pathology only showed a PPV of 28.2% (95% CI 23.7%-32.2%) and an NPV of 94.9% (95% CI 93.4%-96.2%). DISCUSSION: Individuals with SCD and full AD pathology have a substantially increased risk of developing MCI or dementia in comparison with individuals with SCD without AD pathology. TRIAL REGISTRATION INFORMATION: PROSPERO CRD42020175282.

Combined cognitive and motor training improves the outcome in the early phase after stroke and prevents a decline of executive functions: A pilot study.

BACKGROUND: The negative impact of cognitive dysfunction on motor rehabilitation as a relearning-process is well known in stroke patients. However, evidence for combined cognitive and motor training (CMT) is lacking. OBJECTIVE: To evaluate the effects of combined CMT in early stroke rehabilitation. METHODS: In a controlled pilot study, 29 moderately affected stroke patients with low-level motor performance and cognitive impairment received motor therapy plus either cognitive (experimental group, EG) or low-frequency ergometer training (control group, CG) for eight days. RESULTS: Both groups improved their motor functioning significantly. After training, between-group comparison revealed significant differences for cognitive flexibility and trends for set-shifting, working memory, and reaction control in favor of the EG. Within-group effects showed improvement across all cognitive domains in the EG, which correlated with gains in bed-mobility, while the CG showed no significant improvement in cognition. Rather, a trend towards reaction control decline was observed, which correlated with less functional progression and recovery. Furthermore, a decline in cognitive flexibility, set-shifting, and working memory was descriptively observed. CONCLUSIONS: Combined CMT may enhance cognition and motor relearning early after stroke and is superior to single motor training. Further studies are needed to replicate these results and investigate long-term benefits.