[Development and validation of the Inventory of Needs in Memory Impairment (BIG-65): illness-related needs in people with cognitive impairment and dementia]. / Entwicklung und Validierung des Bedürfnisinventars bei Gedächtnisstörungen (BIG-65): Krankheitskorrelierte Bedürfnisse bei Menschen mit Hirnleistungsstörungen und Demenz.

BACKGROUND: There is growing evidence that individuals with cognitive impairment and dementia require systematic assessment of needs for the selection of optimal treatments. Currently no valid instrument is applicable for illness-related need assessment in this growing population. METHOD: The purpose of this study was to develop and validate a new instrument ("Bedürfnisinventar bei Gedächtnisstörungen", BIG-65) that systematically assesses illness-related needs. The development was based on an adequate theoretical framework and standardised procedural guidelines and validated to an appropriate sample of individuals attending a Swiss memory clinic (n = 83). RESULTS: The BIG-65 provides a comprehensive range of biopsychosocial and environmental needs items and offers a dementia-friendly structure for the assessment of illness-related needs. The BIG-65 has high face validity and very high test-retest reliability (rtt = 0,916). On average 3.5 (SD = 3.7) unmet needs were assessed. Most frequently mentioned needs were: "forget less" (50%), "better concentration" (23.2%), "information on illness" (20.7%), "information on treatments" (17.1%), "less worry", "less irritable", "improve mood", "improve orientation" (13.4% each). Needs profiles differed between patients with preclinical (subjective cognitive impairment, mild cognitive impairment) and clinical (dementia) diagnosis. DISCUSSION: The BIG-65 reliably assesses illness-related needs in individuals with moderate dementia. With decreasing cognitive functions or an MMSE <20 points, additional methods such as observation of the emotional expression may be applied. According to our results, individuals with cognitive impairment and dementia pursue individual strategies to stabilize their quality of life level. In addition to the assessment of objective illness symptoms the selection of optimal treatments may profit from a systematic needs assessment to optimally support patients in their individual quality of life strategies.

[There's not only Alzheimer's disease]. / Es gibt nicht nur die Alzheimer-Demenz.

We report the case of a 59 year old man with a rapidly progressive cognitive decline, neurologic symptoms and recurrent falls. One of the most important differential diagnoses was the lithiumintoxication with normal lithium blood levels. After reducing the lithiumdosis the neurological symptoms regressed completely, and only few cognitive impairments persisted.

[Severe behavioral disorder caused by an organic disease]. / Schwere Verhaltensstörung mit organischer Ursache.

A 65-year-old architect was admitted to our Memory Clinic because of rapidly progressive dementia accompanied by behavioral disorders, which severely restricted his functional independence. The physical examination revealed several focal neurological signs, and neuroimaging confirmed a cerebellar hemorrhage, multiple microbleeds and an ischemic lacunar infarct. Executive functioning was highly impaired. This case report illustrates cerebral amyloid angiopathy as an important entity of vascular dementia and highlights the importance of neuroimaging in patients with suspected vascular cognitive disorders.

[Vitamin B12 deficiency in geriatrics]. / Vitamin B12-Mangel in der Geriatrie.

Cobalamin deficiency increases with advancing age. The cut-off point of serum concentration should be raised, because many elderly people with "normal" serum vitamin B12 concentrations are metabolically deficient in cobalamin. The measurement of the metabolites homocysteine and/or methylmalonic acid is recommended. Cobalamin deficiency may result in a variety of atypical symptoms. Hematological changes typical of megaloblastic anemia are absent in a majority of patients with neuropsychiatric disorders. Generally underlying pernicious anemia is not the main cause of cobalamin deficiency in the elderly. Protein-bound cobalamin malabsorption due to atrophic gastritis with hypo- or achlorhydria is a common cause of cobalamin deficiency in elderly people. An important manifestation of cobalamin deficiency is cognitive impairment. Much controversy exists on the subject of the association of dementia of the Alzheimer type with cobalamin deficiency. In several studies dementia has been related to low serum cobalamin levels. Physicians should be liberal of cobalamin therapy. The window of opportunity for effective intervention may be as short as one year from the onset of medical symptoms. At last a compilation of recommendations is given.

[Discharge from the geriatric clinic: factors predicting independent living at home]. / Entlassung aus der Geriatrieklinik: Faktoren, die ein Verbleiben zu Hause voraussagen.

This article presents the predictors for living at home 3 months, 6 months, 12 months, and 24 months after hospitalization in a geriatric clinic. The multivariate regression analysis revealed the predictive factors for living at home after 3 months: Incontinence, functional status judged by the physician, and balance performance. For living at home at 6 months, balance performance, handgrip were predictive, and at 12 months, balance performance, physicians judgement of functional abilities and Barthel-Index had the most predictive value. The only factor that was recognized to be predictive for living at home at 24 months was the physician's judgement of the functional abilities of the patient. It is concluded that the functional status measured by observation but preferably by performance is of predictive value for living at home from 6 months to 12 months after acute hospitalization.