[Polypharmacy is an indicator for a poor prognosis, which is not altered by deprescribing in nursing home]. / Polypharmazie ist ein Indikator für kurze Überlebensdauer im Pflegeheim - Daran ändert das Absetzen von Medikamenten nichts.

AIM: To examine the influence of polypharmacy ordered by the pretreating site and deprescribing (i.e. the appropriate withdrawal of prescribed drugs) by the nursing home physician on survival time. METHODS: Retrospective Analysis of medical databasis from 1,249 patients, thereof 611 in a nursing home with practice of deprescribing. RESULTS: 70% of the patients with excessive polypharmacy (>9 drugs), 57% of those with polypharmacy (6 to 9 drugs) and 43% of the remaining patients (<6 drugs) deceased within 286 days after admission (chi-squared 2 DF = 43.72; p <0.001). Deprescribing by the nursing home physician at admission revealed no influence on survival time. CONCLUSION: Polypharmacy is not the reason, but an indicator for a poor prognosis, which is not altered by deprescribing.

[Cost reduction in long-term nursing thanks to a memory clinic--results of a case control study]. / Kostenreduktion im Langzeitpflegebereich dank Memoryklinik--Resultate einer Fallkontrollstudie.

Between 1991 and 1995, 334 persons from the city of Zurich have been investigated at the gerontologic counselling facility of the memory clinic of the nursing home Entlisberg near Zurich. 49 (14.7%) of these persons suffered from a treatable disease (16 from depression, 13 from chronic intoxication, 20 from other treatable diseases), 10 from other disturbances (debility or postapoplectic state), and 275 from dementia. In 45% of the cases dementia was moderate, in 47% moderate to severe, and in 8% severe. In most cases dementia was of Alzheimer's type (60.7%), others were of multi-infarct type (17.5%), of mixed type (13.1%), or other types (8.7%). Until march 1996, 64 (19.4%) of these 334 on the average 74-year-old persons treated in the memory clinic have been admitted to a city nursing home. They have compared to a random sample, including 312 demented persons of similar ages and similar date of admittance to the same institutions. The proportion of demented persons cared before admittance by a spouse was about 28% in both groups. On an average, the mini mental state (Zurich variant) at admittance to a nursing home was 10.95 points in patients from the memory clinic, compared to 13.43 points in the control group. Thus, patients that have formerly been advised and trained entered the nursing home in a state of dementia more advanced by 2.48 points. Based on an average yearly demelioration by about 2.4 points, this means admittance to a nursing home is delayed by 376 days. Patients for whom admittance to a nursing home could be avoided completely by the treatment proposed by the counselling were not considered in this calculation.

[Verbal ability of Alzheimer's disease patients and very elderly control patients using the Aachen aphasia test]. / Untersuchung der sprachlichen Fähigkeiten von Alzheimer-Patienten und hochbetagten Kontrollpatienten mit dem Aachener Aphasie-Test.

We assessed language function, using the Aachen aphasia test (AAT), in 14 subjects with Alzheimer's disease and 6 control patients. Aphasia did not occur in control patients, but in 11 of 14 Alzheimer's disease patients. Impairment of object naming was the most prevalent abnormality. Performance in AAT subtests repetition, written language, object naming, comprehension and token test correlated strongly with Mini-Mental State scores.

[Movement patterns of demented and non-demented nursing home patients using the Involuntary Movements and Extrapyramidal Scale. Effects of pharmacotherapy]. / Untersuchung des Bewegungsmusters von dementen und nichtdementen Krankenheimpatienten mit der "Involuntary Movements and Extrapyramidal Scale". Effekte der Pharmakotherapie.

We applied the involuntary movements and extrapyramidal scale in 54 patients (41 with dementia, 13 without dementia) of the Käferberg nursing home. Increased severity of parkinsonism was negatively correlated with Mini-Mental State scores (mnestic function r = 0.479, p less than 0.001/spatial function r = -0.617, p less than 0.001) and with activities of daily living scores (r = 0.635, p less than 0.001). Increased severity of parkinsonism and impaired memory are associated with poor performance in activities of daily living.

[Comparative study between the Folstein mini-mental state and the Zurich variant in demented and non-demented patients]. / Vergleichsuntersuchung zwischen dem "Mini-Mental State" nach Folstein und dessen Zürcher Variante bei dementen und nichtdementen Patienten.

The "Mini-Mental State" examination developed by Folstein is a well established psychometric test in the assessment of senile dementia. We applied a modified version, the Zurich variant of the Folstein-MMS. A comparative study with both tests in a total of 53 patients (25 with dementia, 28 without dementia) of the Käferberg nursing home revealed highly correlating scores (r = 0.878, p less than 0.001).