Cognition in older offenders in North Rhine-Westphalia: A comparison of prisoners and patients in forensic psychiatry hospitals.

The number of elderly delinquent individuals living in prisons and forensic hospitals is increasing. For both settings, complex needs have been described for the elderly related to age-related changes and frequent somatic disorders as well as mental disorders, primarily depressive symptoms.. One of the biggest challenges are cognitive impairments which have been described for both groups, probably not least due to frequent risk factors (e.g., substance abuse, depressive symptoms). Given that the group of forensic patients has a manifest mental illness, which is usually treated with psychopharmaceuticals, the question arises as to what extent cognitive deficits are more frequent here. For both groups, the detection of cognitive deficits with regard to therapy and release planning is of relevance. In sum, studies on cognitive function in both populations are rare, and the results are hard to compare due to different instruments to assess cognition. Sociodemographic, health-, and incarceration-related data were collected as well as neuropsychological functions using established instruments to evaluate global cognitive functioning (Mini-Mental State Examination [MMSE], DemTect), executive function (Frontal Assessment Battery [FAB], and Trail Making Test [TMT]). In the final sample, 57 prisoners and 34 forensic inpatients from North Rhine Westphalia, Germany being 60 years and older were included. The groups were comparable in age (prisoners: M = 66.5 years, SD ± 5.3; forensic inpatients: M = 66.8 years, SD ± 7.5) and education (prisoners: M = 11.47, SD ± 2.91; forensic inpatients: M = 11.39, SD ± 3.64), but the offenders in forensic psychiatry had spent significantly more time in the correctional setting than prisoners (prisoners: M = 8.6, SD ± 10.8; forensic inpatients: M = 15.6 years, SD ± 11.9). In both groups cognitive deficits were frequent. Depending on the tests and population, between 42% and 64% showed impairments in global cognition, and between 22% and 70% were classified with impaired executive functioning. We found no significant differences in global cognition or executive functions assessed with the TMT between the two groups. However, forensic inpatients were significantly more impaired in the FAB compared to the prisoners. The results emphasize the high frequency of cognitive dysfunction in both settings and a possibly higher frequency of "frontal" dysfunction in forensic inpatients, and, thus, indicate the relevance of routine neuropsychological diagnostic and treatment procedures in these settings.

[Impact of psychiatric disorders on the outcome of acute geriatric inpatient treatment: an exploratory investigation]. / Die Bedeutung psychischer Störungen für den stationär akutgeriatrischen Behandlungsverlauf: eine explorative Untersuchung.

BACKGROUND: Systematic study results of geriatric inpatient treatment assessing the impact of psychiatric disorders on treatment outcome are so far missing. This exploratory study investigated the impact of dementia, depression and delirium on treatment outcome in a geriatric department, compared to those individuals without psychiatric symptoms at the beginning of treatment. METHOD: From January to June 2018 treatment data from geriatric inpatient records were retrospectively evaluated. Functional measurements (Barthel index, timed up and go test, Tinetti test and the De Morton mobility index) were assessed at the start of geriatric treatment and at discharge. A multivariate variance analysis (MANOVA) was used to calculate the possible impact of psychiatric disorders on functional improvement during treatment and to find out if there were significant differences between the four defined groups (dementia, depression, delirium and mentally sound). RESULTS: A total of 280 geriatric inpatients with an average age of 84 years, were included in this study and showed a noticeable prevalence of psychiatric disorders: dementia 29%, depression 27%, and delirium 15%. As expected, the patients in the sample showed a high level of multimorbidity and polypharmacy. Functional improvement was present in each of the defined groups and significant differences between all groups were found. The results of MANOVA showed that none of the possible confounding variables, e.g. age, mini mental status examination (MMSE), degree of care, cognitive impairment, social status, gender and comorbid illness, had an important influence on the group results. CONCLUSION: This study of an acute geriatric department demonstrated that psychiatric disorders in these multimorbid, aged patients did not prevent functional improvement by treatment, showed significant differences during the course of treatment and outcome and compared to inpatients without psychiatric symptoms.

[Willingness to participate in group beneficial dementia research]. / Bereitschaft zur Teilnahme an gruppennütziger Demenzforschung.

BACKGROUND: With the fourth Act on the amendment of pharmaceutical legal and other regulations it became law in Germany from the beginning of 2017 that under certain conditions, pharmaceutical research will be allowed with persons incapable of giving consent, even if this research may only be beneficial to other sufferers of the same disease, i. e. group beneficial research. OBJECTIVE: We conducted a semistructured, non-representative survey among psychiatric patients and their relatives. PARTICIPANTS AND METHODS: This survey was done for a period of 3 months until the end of September 2017 in the practice of M. H. with successively examined patients and their relatives. Patients incapable of giving consent related to dementia, depression and emergency cases, were excluded. Participants were asked about their attitudes related to evaluation of a) group beneficial research in principle, b) pharmaceutical withdrawal studies and c) research authorization. Sociodemographic and clinical variables were collected. RESULTS AND DISCUSSION: This study included 85 persons and all of them gave their informed consent to participation. The mean age was 70 years, 47% were male, 61% had a university degree and 46% an independent profession. Mild cognitive impairment was diagnosed in 26%. This survey revealed a relatively high basic approval of group beneficial dementia research as well as of pharmaceutical withdrawal studies. In addition, research authorization gained a substantially positive evaluation. Only a few participants were informed about the new law in force since 2017. The present results were drawn from an explorative study with an unrepresentative sample and, therefore, have to be interpreted with caution. They show, however, that in the general population more information and awareness about group beneficial research with persons incapable of giving informed consent should be achieved. The relatively high rate of approval in this study may reveal a widespread feeling of social responsibility; however, reported objections of the participants should also be seriously considered.

[Assessment of quality indicators with routine data: Presentation of a feasibility test in ten specialist clinics for psychiatry and psychotherapy]. / Erhebung von Qualitätsindikatoren anhand von Routinedaten : Darstellung eines Machbarkeitstests in 10 Fachkliniken für Psychiatrie und Psychotherapie.

BACKGROUND: Prior to nationwide implementation, the feasibility of newly developed quality indicators must be assessed. The aim of this multicenter feasibility test was an evaluation of the measurability of cross-sectoral quality indicators for depression and schizophrenia by means of routine data. METHODS: The feasibility of the quality indicators was assessed in ten specialist clinics for psychiatry and psychotherapy by means of retrospective analyses of anonymous routine data. The data were extracted from the routine clinical documentation of the hospital information systems and the data from the admission and discharge sheets of the basic documentation in psychiatry (BADO) were additionally used for some clinics. Analyses were conducted for all cases of adults diagnosed with depression or schizophrenia within predefined assessment periods. RESULTS: In total five indicators for depression and nine indicators for schizophrenia were assessed and evaluated as measurable or measurable to a limited extent, sometimes with slight adaptations in the operationalization of the indicator. Due to variations in documentation, some indicators could not be calculated for all clinics. Most indicators could be collated with the data from the BADO. CONCLUSION: An assessment of indicators that measure quality-relevant aspects of care in depression and schizophrenia, is partially feasible by means of current routine data documentation analysis from the participating clinics. However, differing documentation methodologies in the participating clinics impeded a uniform assessment; therefore, for the implementation of nationwide minimum standards for the quality assurance of mental healthcare, a uniform cross-sectoral documentation methodology should be adapted to consensus and relevant quality indicators. The BADO appears to be a suitable instrument for this purpose.

Association of lay beliefs about causes of depression with social distance.

OBJECTIVE: The aim of this study was to examine the association of lay attributions about causes of depression with attitudes and prejudiced behaviour towards people with depression. METHOD: Subjects (1631 German-speakers aged 18 and over, randomly selected) were interviewed in two German cities by telephone using a standardized questionnaire. The survey assessed knowledge about depression, stereotypical attitudes and social distance towards persons with depression. RESULTS: The results indicate that a majority of the respondents holds predominantly non-pejorative attitudes towards persons with depression. The majority estimated psychosocial causes as being most important for the genesis of depression. Stronger social distance was linked to an estimation of personal causes as relevant. Subgroup differences were apparent with respect to age, sex and reported contact to people with depression. CONCLUSION: Improvements in the education of the public about depression should be based on a multifactorial model. Future interventions should promote contact with people with depression and place special emphasis on conveying information in a suitable manner depending on the needs of different target groups.

Ten novel mutations in the NR5A1 gene cause disordered sex development in 46,XY and ovarian insufficiency in 46,XX individuals.

CONTEXT: Steroidogenic factor-1 (SF-1/NR5A1) is a nuclear receptor that regulates adrenal and reproductive development and function. NR5A1 mutations have been detected in 46,XY individuals with disorders of sexual development (DSD) but apparently normal adrenal function and in 46,XX women with normal sexual development yet primary ovarian insufficiency (POI). OBJECTIVE: A group of 100 46,XY DSD and two POI was studied for NR5A1 mutations and their impact. DESIGN: Clinical, biochemical, histological, genetic, and functional characteristics of the patients with NR5A1 mutations are reported. SETTING: Patients were referred from different centers in Spain, Switzerland, and Turkey. Histological and genetic studies were performed in Barcelona, Spain. In vitro studies were performed in Bern, Switzerland. PATIENTS: A total of 65 Spanish and 35 Turkish patients with 46,XY DSD and two Swiss 46,XX patients with POI were investigated. MAIN OUTCOME: Ten novel heterozygote NR5A1 mutations were detected and characterized (five missense, one nonsense, three frameshift mutations, and one duplication). RESULTS: The novel NR5A1 mutations were tested in vitro by promoter transactivation assays showing grossly reduced activity for mutations in the DNA binding domain and variably reduced activity for other mutations. Dominant negative effect of the mutations was excluded. We found high variability and thus no apparent genotype-structure-function-phenotype correlation. Histological studies of testes revealed vacuolization of Leydig cells due to fat accumulation. CONCLUSIONS: SF-1/NR5A1 mutations are frequently found in 46,XY DSD individuals (9%) and manifest with a broad phenotype. Testes histology is characteristic for fat accumulation and degeneration over time, similar to findings observed in patients with lipoid congenital adrenal hyperplasia (due to StAR mutations). Genotype-structure-function-phenotype correlation remains elusive.

Assessing the opinions and experiences of German-speaking psychiatrists regarding necessary changes for the 11th revision of the mental disorders chapter of the International Classification of Disorders (ICD-11).

We performed an Internet-based questionnaire survey of the opinions of German-speaking psychiatrists regarding the experiences with the 10th revision of the international classification of mental disorders (chapter F of ICD-10). We received 304 completed questionnaires including more than 500 free-text comments. The responding group was characterized by professionally experienced middle-aged psychiatrists. German-speaking psychiatrists were comparatively content with ICD-10. Most diagnostic categories received a "satisfied" or "very satisfied" rating by the majority of respondents. Negative "goodness of fit" ratings--a possible indicator of the need for revision--were not higher than 50% for any category. Based on free-text entries, neurasthenia was the single diagnostic category most often suggested for deletion in ICD-11. Changes were considered necessary mainly for dementias and personality disorders. Adult attention deficit disorder and narcissistic personality disorder were the two diagnostic categories most frequently suggested to be added as new categories. This study provides valuable information related to perceived clinical utility of the classification, though with a narrow sample. Information about clinicians' experiences should be combined with scientific evidence for the revision process of ICD-11.

[Overweight and obesity in children: known facts and new trends]. / Surcharge pondérale et obésité chez l'enfant: les acquis et tes nouvelles tendances.

The prevalence of overweight and obesity in children is increasing. A growing number of children are thus suffering from complications of obesity. Contributing factors can be found on an individual level as well as in the familial and social environment of affected children. Currently there is no single evidence-based treatment strategy available. Studies from family practice are scarce. Multimodal, long-term, easily accessible treatments as offered in family practice are promising and likely to be cost-effective. The sustainability of these changes in behavior still needs to be demonstrated.

A novel MRI-biomarker candidate for Alzheimer's disease composed of regional brain volume and perfusion variables.

BACKGROUND: Earlier evidence indicates that regional cerebral volume (rVOL) and blood flow (rCBF) variables carry independent information on incipient and early Alzheimer's disease (AD) and combining these modalities may increase discriminant performance. We compared single variables and combinations regarding their power for optimizing diagnostic accuracy. METHODS: Twelve cognitively normal elderly controls (CN), 30 subjects with mild cognitive impairment (MCI) and 15 with mild AD were examined by structural and perfusion-weighted magnetic resonance imaging (MRI) in single sessions at 1.5 Tesla. rVOLs were measured by manual volumetry, and rCBFs were calculated with a ROI-based co-localization technique. RESULTS: Applying single MRI variables for the differentiation of AD versus CN, the area under curve (AUC) of receiver operating characteristic curves (ROCCs) was highest for rVOL variables (maximum of 0.972 for right amygdala). A composite marker selected and weighted by logistic regression containing left amygdalar rCBF, left hippocampal and right amygdalar rVOLs gave a diagnostic accuracy for AD versus CN of 100%. Internal cross-validation revealed a reliability of 88.9%. CONCLUSIONS: Whilst external revalidation is mandatory employing a naturalistic sample containing disease controls, our phase I/II findings demonstrate that deducing composite markers from multimodal MRI acquisitions can optimize diagnostic accuracy for AD.

[Growth: what is normal?]. / Wachstum: Was ist normal?

Growth is an inherent property of life, which has to be checked and controlled by any general physician following children. Therefore, the common knowledge about the normal pattern/course of growth is essential in order to act proactively whenever the child's growth does not progress adequately.

Experimental arthritis: effect on growth parameters and total skeletal calcium.

Aim of the study was to investigate the possible mechanisms leading to stunted growth and osteoporosis in experimental arthritis. Fourty-two female rats of 7-8 weeks of age were randomly assigned to three groups of 14 animals each: (a) controls; (b) adjuvant-inoculated (AA); and (c) adjuvant-inoculated rats receiving 10 mg cyclosporin A (CsA) orally for 30 days. Biological parameters studied were: hindpaw swelling; vertebral length progression expressed as Delta increments between days 1 and 30 as a parameter of skeletal growth, and estimation of total skeletal mineral content by dual energy X-ray absorptiometry (n=10 each group) on day 30. Endocrine parameters measured were pulsatile release of growth hormone (rGH) on day 30 following jugular cannulation and measurement of insulin-like growth factor (IGF-1) in pooled plasma from rGH profiles. Results can be summarized as follows: Untreated AA rats exhibited local signs of inflammation in comparison with controls (hindpaw diameter 8.1-8.9 mm vs. 5.3-5.6 mm in controls). Treatment with CsA normalized this parameter (4.9-5.6 mm). Vertebral growth was significantly retarded in AA rats in comparison with controls (214+/-32 vs. 473+/-33 microm; p<0.001). Administration of CsA normalized vertebral size increment with a clear tendency to overgrowth (523+/-43 microm, n.s.). There was also a marked reduction in total skeletal mineral content in diseased (AA) rats as compared to controls (5.8+/-0.1 vs. 7.5+/-0.1g [OH-apatite]; p<0.001), and a moderate but significant increment above controls in the group receiving CsA (8.0+/-0.1 vs. 7.5+/-0.1g [OH-appatite]; p<0.04). Integrated rGH profiles exhibited a significant fall in arthritic rats and were completely restored to normal under CsA treatment. A trend toward higher rGH values was observed in the latter group (2908+/-554 in AA vs. 8317+/-1492 ng/ml/240 min in controls; p<0.001, and 10940+/-222 ng/ml/240 min, n.s. in the CsA group). There was a good correlation between skeletal growth and rGH pulsatility (r=0.81; p<0.001). IGF-1 followed a similar pattern (630+/-44 in AA vs. 752+/-30 ng/ml in controls; p<0.04, and 769+/-59 ng/ml in the CsA group, n.s. vs. controls). Thus, a clear tendency to skeletal overgrowth following treatment was observed in agreement with the hormonal data. It can therefore be concluded that, in experimental arthritis, attenuated GH-spiking and reduced circulating IGF-1 appear to be causally related to growth retardation, probably mimicking signs and symptoms observed in juvenile arthritis. Therapy with CsA is followed by normalization of hormonal and biological parameters accompanied by a catch up phenomenon in skeletal growth which is also observed clinically in juvenile arthritis. Generalized osteopenia is a prominent feature seemingly connected with the growth abnormalities as they parallel each other during the evolution of the disease and respond equally to therapy.

[Impaired calcium homeostasis, clinical impact]. / Störungen der Kalziumhomöostase im Kindesalter--wann muss man daran denken?

Abnormalities of the calcium homeostasis are, with exception of the neonatal period, not often to diagnose in childhood. However, as the clinical features may not only be quite heterogeneous but also present with a very changing pattern, abnormalities of calcium homeostasis have to be considered in many differential diagnoses. Extracellular fluid calcium or plasma calcium is very carefully controlled by fluxes of calcium, which occur between the extracellular fluid and the skeleton, as well as between gut and the kidneys. Therefore, in this review, first, the factors physiologically regulating calcium homeostasis and bone formation are summarized; and then, the situations in which the plasma calcium level should be measured in daily clinical practices are discussed.

[Is the metabolic syndrome a new childhood disease?]. / Das Metabolische Syndrom: Eine neue Kinderkrankheit?

Overweight and obesity in children and adolescents have become a major public health problem in recent years throughout the world. The medical consequences of obesity may manifest as an increase in the prevalence of the metabolic syndrome in children and adolescents putting them at increased risk for future cardiovascular diseases. Obesity can cause insulin resistance and might disturb glucose homeostasis eventually leading to type 2 diabetes in susceptible patients. Insulin resistance is also involved in the pathogenesis of dyslipidemia in obese children characteristically presenting as hypertriglyceridemia and low HDL cholesterol. Even elevated blood pressure might be present in obese kids. Here we present a 12-year-old boy diagnosed with the metabolic syndrome. The diagnostic criteria of the metabolic syndrome in children and adolescents are discussed. Thoughts about pathophysiology and therapeutic options are offered.

Improvement of coping abilities in patients with systemic lupus erythematosus: a prospective study.

OBJECTIVE: To evaluate a novel specific psychological intervention aimed at improving coping in patients with systemic lupus erythematosus (SLE). METHODS: 34 community living SLE patients were recruited for the study. Intervention was undertaken in groups of up to eight patients and in two blocks over six months each. Eight patients were enrolled as a waiting list group. The 18 group sessions focused on information about the disease and specific problems of SLE patients, combining psychoeducative and psychotherapeutic elements. Psychological and medical evaluations were conducted at baseline and after three, six, and 12 months, using validated instruments. RESULTS: The 34 SLE patients (91% female, mean age 42 years) improved significantly over a six month period on most of the psychological measuring instruments applied, such as depression, anxiety, and overall mental burden. The waiting list group showed no significant changes. CONCLUSIONS: Conceptualised psychoeducational support may produce a significant and sustained improvement in coping skills of SLE patients and hence in their quality of life.

[External quality assurance of inpatient treatment in schizophrenia. results of a multicenter study]. / Externe Qualitätssicherung der stationären Behandlung schizophrener Patienten. Ergebnisse einer multizentrischen Studie.

Due to legal regulations, external quality assurance is mandatory in Germany. Supported by the German Health Ministry (BMG), we present the results of a multicenter study in four hospitals with different structures on 1042 inpatients with the tracer diagnosis of schizophrenia (ICD 10). We defined disease-specific indicators of structure, process, and outcome quality, developed an assessment instrument, and implemented a feedback system for quality comparison. The resulting quality profiles are useful as a starting point for internal quality management.

[Improvement of agitation and anxiety in dementia patients after psychoeducative training of their caregivers]. / Verbesserung von Unruhezuständen und Angst bei Demenzkranken nach psychoedukativer Gruppenarbeit mit pflegenden Angehörigen.

It has been convincingly demonstrated that in dementia psycho-educative training of caregivers positively impacts on motivation for care and satisfaction of the caregivers. It has, however, been neglected to examine the effect of psycho-educative training on the behavioural and psychological symptoms of dementia sufferers. In a three-month, expert-based and conceptualized group intervention with caregiving relatives of demented patients we investigated, whether functional impairment and behavioural and psychological symptoms may improve, which of a set of independent variables may predict improvement, and how the group intervention will be appreciated by the caregivers. The group intervention yielded a significant improvement of memory-related functions in daily living and a significant decrease of agitation and anxiety of the demented patients. The presence of an additional somatic disease predicted worse outcome of the intervention with respect to the impairment of memory-related functions in daily living and of agitation. Anonymous inquiry of the caregivers with respect to their judgement of the intervention revealed high acceptance and appreciation. This study demonstrated that a psycho-educative group intervention with caregiving relatives of dementia sufferers is helpful for both the caregivers and the demented patient. This evidence of a positive mediate effect of the group intervention on the functional and behavioural impairment of the demented patients underscores the importance of nonpharmacological strategies in the treatment plan of dementia.

A 2-year follow-up of behavioural and psychological symptoms in Alzheimer's disease.

BACKGROUND: The aim was to examine the longitudinal occurrence and persistence of behavioural and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). METHODS: Following 60 patients with mild to severe AD over a period of 2 years with annual evaluations, the prospective occurrence and persistence of BPSD in AD were determined by using the Behavioural Abnormalities in AD Rating scale (BEHAVE-AD). Clinical and demographic features of the AD patients were analysed for their association with course features of these symptoms. RESULTS: All of the 60 AD patients experienced BPSD at some point during the 2-year period, particularly agitation was present in every patient within this period. 2-year persistence of BPSD in AD was frequently observed in patients with agitation and with depressiveness, with less frequency in patients with anxiety and aggressiveness, but not in patients with delusions or hallucinations. 2-year persistent aggressiveness was associated with older age and more functional impairment. More functional impairment was also related to 2-year non-persistent hallucinations. CONCLUSIONS: Counselling AD patients and their families and tailoring therapeutic strategies should take into account the different modi of BPSD in AD occurring and persisting longitudinally and interacting with functional disturbances.

Prodromal states in schizophrenia.

The vulnerability-stress-coping (VSC) model is the most influential heuristic concept in understanding the course of schizophrenia, whose prodromal status still offers unsolved conceptual and methodological issues. Improved knowledge about the prodromal phase would provide a better understanding of the developing psychopathology and psychophysiology of schizophrenia and could also be of predictive value to attune therapeutic actions to the course of the illness more precisely. To shed more light on the characteristics of prodromal states, data from a German multicenter study on intermittent versus maintenance neuroleptic long-term treatment in schizophrenia (ANI study) were reanalyzed with respect to the prevalence and profile, nature, time course, and predictive value of prodromal symptoms in impending relapse. The results demonstrate that prodromes are a category of symptoms on their own, but they share variance with other symptom domains. Treatment side effects, psychotic symptoms, dysphoric mood, and social dysfunction are all associated with prodromal states--the direction of this association, however, is still to be clarified. Prodromal symptoms are also related to the neuroleptic treatment strategy and its relapse-preventive efficacy--findings that underscore neuroleptic maintenance medication in preventing both overt and subthreshold psychotic morbidity in schizophrenia.

A comparison of ADAS and EEG in the discrimination of patients with dementia of the Alzheimer type from healthy controls.

Neuropsychometric tests (for instance the Alzheimer's Disease Assessment Scale, ADAS) and the EEG are often used in the diagnostic procedure of dementia. The validity of the instruments is only poorly investigated. The study aimed to investigate the accuracy of the discrimination between healthy controls and patients with dementia of the Alzheimer type (DAT) by ADAS and EEG. Thirty-six patients with DAT and 44 healthy controls were included. In a discriminant analysis of the 21 ADAS items and 18 EEG parameters (6 frequency bands, 12 topographic parameters), 6 ADAS items turned out to discriminate both groups with 100% sensitivity and specificity (remembering instructions, depression, following commands, pacing, restlessness and word finding difficulties). Regarding EEG parameters, 4 (topography of beta- and delta-activity and amplitude of delta-activity) led to a sensitivity and specificity of over 90%. Thus, both methods demonstrated an excellent discrimination between healthy controls and DAT. The slightly higher discrimination with the ADAS may depend on its closer relation to clinical symptoms. However, the EEG measuring functional activity reached nearly the same result. Both methods provide complementary information. A combination of both methods in the diagnostic procedure to detect dementia is recommended.

[Effects of family-centered group therapy with demented patients and their caregivers]. / Behandlungseffekte einer paartherapeutischen psychoedukativen Gruppenarbeit mit Demenzkranken und ihren pflegenden Angehörigen.

Alzheimer's disease, the most frequent cause of dementia, progressively takes the ability of acting autonomously from the sufferers, makes them more and more dependent from their partners and eventually dissolves their personal identity. The present 2-year study which conducted a novel form of family-centered group therapy with demented patients and their primary caregivers investigated the effects of an open, uncontrolled group therapy approach in 32 families (demented patients and caregivers) over a five-months period with weekly sessions, by using the BEHAVE-AD and the NOSGER for the moderately demented patients and the Befindlichkeits-Skala (BfS) for the primary caregivers. In addition, a structured instrument to determine the patterns of interaction between patient and caregiver was administered prospectively at each of the weekly sessions. The results demonstrate a significant improvement of communication abilities among the patients and a significant reduction of coping problems and of care burden with respect to the caregivers. The present family-centered group therapy shows that over a period of 5 months functional and communication abilities of the moderately demented patients may be maintained and caregiver burden may be significantly reduced.