[Lipid profile and cardiovascular risk of participants in the lipid measurement program in the industrial park in Höchst]. / Lipidprofil und kardiovaskuläres Risiko der Teilnehmer an den Lipidmesstagen im Industriepark Höchst.

BACKGROUND: Cardiovascular (CV) diseases are still the most frequent cause of death in industrial nations. Employer-initiated screening of the CV risk could make an early contribution to optimization of the prevention strategies. METHODS: In a cross-sectional study the CV risk profile (e.g., dyslipidemia, hypertension, smoking, diabetes mellitus and familial disposition) of 1436 employees at the industrial park in Frankfurt Höchst was analyzed. The total risk was estimated using the PROCAM score. RESULTS: A hypercholesterolemia (low-density lipoprotein, LDL >130 mg/dl) was detected in 36% of the participants. Of the high-risk participants (myocardial infarct, apoplexy and/or diabetes) 23.7% (n = 9/38) were in the target range for LDL as defined by the European Society of Cardiology (ESC) of below 70 mg/dl, 18.4% (n = 7) had levels between 70 and 100 mg/dl and 57.9% (n = 22) had levels of more than 100 mg/dl. In addition, more than half of the subjects (53.2%) had increased blood pressure values (defined as systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg). The prevalence of diabetes (blood sugar >126 mg/dl) was very low (1.3%) as was the frequency of manifest CV diseases (1.4% myocardial infarct or apoplexy, 2.9% stabile angina pectoris or peripheral arterial occlusive disease, PAOD). CONCLUSION: The data confirm that the risk factors high blood pressure and dyslipidemia are widespread and the achievement of target values is insufficient, particularly with a high risk of CV. Behavioral therapeutic and/or pharmaceutical measures should be instigated in order to better exploit the high preventive potential for carriers of these risk factors.

[App-based self-monitoring in type 2 diabetes]. / App-basiertes Selbstmonitoring bei Typ-2-Diabetes.

BACKGROUND: The success of self-monitoring in the treatment of type 2 diabetes mellitus has already been verified in several studies. To date there are a multitude of smartphone apps which support diabetic patients in systematically recording and analyzing relevant health data; however, most of these smartphone apps are primarily developed for a young target group. OBJECTIVE: As part of this study we examined to what extent a smartphone app for self-monitoring is used by older diabetic patients. METHODS: In this study 36 adults with type 2 diabetes mellitus older than 60 years were included. After a comprehensive training course the participants used the application for 3 months. Reminders for medication, physical activity and diet could be set and recorded health data, such as weight or blood sugar, could be entered into the app. After 3 months the data were analyzed concerning usage behavior and impact on overall health. RESULTS: Data analysis revealed intensive usage of the smartphone app (90 % on a daily basis). Furthermore, according to the patients, after the study period significant improvements in medication adherence and psychological well-being were recorded [t[35] = -2.24, p < 0.05). Additional motivational elements did not influence the usage behavior by older adults. CONCLUSION: Until now only a small proportion of older adults used smartphone health apps, despite the ubiquitous availability. These apps have to be tailored to the requirements of older adults so that the market will be opened up to them. Using self-monitoring apps can help older adults to structure their daily routine despite their disease.

Prevalence of skin diseases in hospitalized geriatric patients : Association with gender, duration of hospitalization and geriatric assessment.

BACKGROUND: Improvement of quality of life in old age and prevention of age-associated diseases have become the main focus of research into aging; however, information regarding the skin health status of geriatric patients still remains sparse. GOAL: To investigate the extent of dermatological diseases in hospitalized geriatric patients, map the most prevalent ones, check for any gender differences and document any correlations with duration of hospitalization and results of geriatric assessments. PATIENTS AND METHODS: A total of 110 hospitalized geriatric patients underwent a complete dermatological examination at the Evangelical Geriatric Hospital (Evangelisches Geriatriezentrum) Berlin. The collected information was stratified according to dermatological diagnosis, results of geriatric assessments, duration of hospitalization, age and gender of the patients. RESULTS: The average number of diagnosed skin diseases per patient was 3.7 ± 1.8 for the female population and 4.3 ± 2.0 for the male population. After categorizing all diagnosed skin diseases, infectious diseases were found to be most common in both female and male patients (55 % and 58 %, respectively) followed by vascular diseases (46.7 % and 54 %, respectively). Precancerous skin lesions and epithelial skin cancer were more frequent in men than in women (20 % vs. 6.7 %, p < 0.037 and 34 % vs. 13.3 %, p < 0.010, respectively). Pruritus showed a positive correlation with the duration of hospitalization and a negative correlation with the Barthel index and Tinetti score on the day of discharge, indicating that pruritus may have a significant impact on the physical condition of elderly multimorbid patients and on the static and dynamic balance abilities. CONCLUSION: Our results demonstrate that skin health in the elderly is compromised and disregarded and this should constitute one of the top priorities of healthcare specialists and physicians in the future.

[Severe hypertriglyceridemia : Diagnostics and new treatment principles]. / Schwere Hypertriglyzeridämie : Diagnostik und neue Therapieprinzipien.

Severe hypertriglyceridemia is defined at a plasma triglyceride (TG) concentration of >885 mg/dl and may result - in particular when clinical symptoms appear before the age of 40 - from "large variant" mutations in genes which influence the function of the lipoprotein lipase (LPL). For diagnosis, secondary factors have to be excluded and treated before further genetic tests are considered. Typical symptoms in almost all patients are recurrent, sometimes severe abdominal pain attacks, which can result in acute pancreatitis, the most important, sometimes life-threatening complication. To minimize the risk of severe pancreatitis, the aim is to maintain the plasma TG concentration <1000 mg/dl. Other clinical manifestations which can occur and are reversible are eruptive xanthomas, lipemia retinalis, hepatosplenomegaly, dyspnea syndrome, and impaired neurocognitive function. The hyperviscosity syndrome caused by chylomicronemia is seen as the underlying reason for some of the symptoms. Patients with mild-to-moderate hypertriglyceridemia have an increased cardiovascular risk. To lower this is the primary treatment goal here. Treatment mainly consists of a life-long, strict fat- and carbohydrate-restricted diet and the abstention from alcohol. Omega­3-Fatty acids and fibrates can be used to lower plasma TG levels. Recently, new gene therapy approaches for LPL-deficient patients have become available in Germany.

Prevalence and definition of sarcopenia in community dwelling older people. Data from the Berlin aging study II (BASE-II).

BACKGROUND: Sarcopenia describes the age-associated loss of muscle mass, strength and function. The aim of this study was to compare the prevalence of sarcopenia in a cohort of community dwelling elderly people living in Berlin, Germany, according to the criteria proposed by current consensus statements and to study the respective impact on self-reported physical performance. MATERIAL AND METHODS: This study included 1405 participants from the Berlin aging study II (BASE-II). The appendicular skeletal muscle mass index (SMI) was assessed with dual energy X-ray absorptiometry (DXA), muscle strength was measured by hand grip strength and the timed up and go" test (TUG) was performed as a functional parameter to reflect mobility. RESULTS: The prevalence of sarcopenia was 24.3 % in terms of reduced SMI only and considerably lower for sarcopenia with reduced grip strength (4.1 %) and sarcopenia with limited mobility (2.4 %). Only 0.6 % of the participants fulfilled all three criteria. Of the subjects with a normal SMI, 8.6 % had reduced grip strength and 5.1 % had limited mobility, whereas 1.3 % subjects fulfilled both criteria. Participants with reduced strength or function reported severe difficulties in performing physical tasks significantly more often than participants with normal or reduced SMI alone (p <0.029-p <0.0001). CONCLUSION: In BASE-II low skeletal muscle mass was much more frequent than reduced grip strength or poor function. Reduced strength and function were found to be associated with a greater impact on physical performance than reduced muscle mass. Low SMI does not seem to be a prerequisite for low strength or limitations in mobility.

[Polypharmacy and drug prescription in the elderly. Strategies for optimization]. / Polypharmazie und Arzneimitteltherapiesicherheit im Alter. Strategien zur Verbesserung.

BACKGROUND: When used appropriately, drugs are an effective and efficient intervention in the care of patients. However, elderly, multimorbid patients are especially prone to adverse side effects caused by the simultaneous intake of many drugs--this effect is called polypharmacy. Furthermore, adverse medical effects occur more frequently with elderly people compared to younger patients. This is due to age-specific metabolic changes and issues with compliance and adherence. Therefore, the indication for medication should be taken carefully and individually especially for elderly patients, in order to develop a realistic risk-benefit ratio, taking into consideration questions like quality of life and life expectancy. MATERIALS AND METHODS: In this paper, the current medical care situation of elderly people is presented; problems are identified and analyzed. RESULTS: Supported by a selected literature search, recommendations for improving medication safety are summarized.

Multimodal sensor-based fall detection within the domestic environment of elderly people.

BACKGROUND: Falls represent a major threat to the health of the elderly and are a growing burden on the healthcare systems. With the growth of the elderly population within most societies efficient fall detection becomes increasingly important; however, existing fall detection systems still fail to produce reliable results. OBJECTIVES: A study was carried out on sensor-based fall detection, analysis of falls with the help of fall protocols and the analysis of user acceptance of fall detection sensor technology through questionnaires. MATERIAL AND METHODS: A total of 28 senior citizens were recruited from a German community-dwelling population. The primary goal was a sensor-based detection of falls with accelerometers, video cameras and microphones. Details of the falls were analyzed with the help of medical geriatric assessments and standardized fall protocols. The study duration was 8 weeks and required a maximum of nine visits per subject. RESULTS: The study participants were 28 subjects with a mean age of 74.3 and a standard deviation (SD) of ± 6.3 years of which 12 were male and 16 female. A total of 1225.7 measurement days were recorded from all participants and the algorithms detected 2.66 falls per day. During the study period 15 falls occurred and 12 of these falls were correctly recognized by the fall detection system. CONCLUSION: Current fall detection technologies work well under laboratory conditions but it is still problematic to produce reliable results when these technologies are applied to real life conditions. Acceptance towards the sensors decreased after study participation although the system was generally perceived as useful or very useful.

[New AHA and ACC guidelines on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk : Statement of the D•A•CH Society for Prevention of Cardiovascular Diseases, the Austrian Atherosclerosis Society and the Working Group on Lipids and Atherosclerosis (AGLA) of the Swiss Society for Cardiology]. / Neue AHA- und ACC-Leitlinie zur Risikoreduktion von Herz-Kreislauf-Erkrankungen durch Cholesterinsenkung : Stellungnahme der D•A•CH-Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen e. V., der Österreichischen Atherosklerose Gesellschaft und der Arbeitsgruppe Lipide und Atherosklerose (AGLA) der Schweizer Gesellschaft für Kardiologie.

Guidelines for the reduction of cholesterol to prevent atherosclerotic vascular events were recently released by the American Heart Association and the American College of Cardiology. The authors claim to refer entirely to evidence from randomized controlled trials, thereby confining their guidelines to statins as the primary therapeutic option. The guidelines derived from these trials do not specify treatment goals, but refer to the percentage of cholesterol reduction by statin medication with low, moderate, and high intensity. However, these targets are just as little tested in randomized trials as are the cholesterol goals derived from clinical experience. The same applies to the guidelines of the four patient groups which are defined by vascular risk. No major statin trial has included patients on the basis of their global risk; thus the allocation criteria are also arbitrarily chosen. These would actually lead to a significant increase in the number of patients to be treated with high or maximum dosages of statins. Also, adhering to dosage regulations instead of cholesterol goals contradicts the principles of individualized patient care. The option of the new risk score to calculate lifetime risk up to the age of 80 years in addition to the 10-year risk can be appreciated. Unfortunately it is not considered in the therapeutic recommendations provided, despite evidence from population and genetic studies showing that even a moderate lifetime reduction of low-density lipoprotein (LDL) cholesterol or non-HDL cholesterol has a much stronger effect than an aggressive treatment at an advanced age. In respect to secondary prevention, the new American guidelines broadly match the European guidelines. Thus, the involved societies from Germany, Austria and Switzerland recommend continuing according to established standards, such as the EAS/ESC guidelines.

Extended-release niacin/laropiprant for lipid management: observational study in clinical practice.

AIMS: Patients with dyslipidaemia or hypercholesterolemia carry a substantially increased cardiovascular risk and need optimal treatment of this key risk factor. We aimed to investigate the utilisation, efficacy and tolerability of the single pill combination extended-release niacin/laropiprant 1000 mg/20 mg or 2000 mg /40 mg under conditions of primary care practice. METHODS: The present study was a prospective, non-interventional, observational study involving 885 primary care physicians throughout Germany. Data on adult patients treated with niacin/laropiprant one or two tablets daily within the labelled indication were documented for an average of 23 ± 7 weeks. The study was registered in the Association of research-based pharmaceutical companies (VFA) database under no. 354. RESULTS: A total of 2359 patients were analysed in the intent-to-treat population (mean age 61.1 years, 67% males) of whom 1917 could be followed up. Background statin therapy was often discontinued and only about 50% of patients received two tables niacin/laropiprant at the end of the study. Individual goal attainment rates as subjectively determined by the investigator were for LDL-C 59.4%, total cholesterol 59.5%, HDL-C 72.8% and TG 51.5%, respectively. Objective (laboratory) goal attainment rates according to NCEP ATP III criteria were lower: LDL-C <100 mg/dl goal was achieved in 17.8%, HDL-C >40 in males or >50 mg/dl in females in 37.9% and TG <150 mg/dl in 18.7%. Totally, 422 adverse events were noted in 231 patients (9.7%), of which 317 were considered drug-related. Flushing occurred in 15%. CONCLUSION: Niacin/laropiprant resulted in beneficial effects on serum lipids and was generally well tolerated. The full potential of the drug combination was not explored by most physicians due to discontinuation of statins and lack of titration of the combination. Overall, treatment effects were consistent with those seen in controlled trials.

[Cross-sectional field Q7"medicine of aging and the elderly" at the Charité - Universitätsmedizin Berlin : Curriculum and evaluation by students]. / Der Querschnittsbereich Q7 "Medizin des Alterns und des alten Menschen" an der Charité - Universitätsmedizin Berlin : Curriculum und Evaluation durch Studierende.

AIMS: There have only been a few publications focussing on how the curriculum Q7 "medicine of aging and the elderly" is implemented at German medical schools. In order to stimulate discussion about the implementation of Q7 the authors present the results of a survey of medical students of the Charité - Universitätsmedizin Berlin. The aim of the survey was to identify items that contribute to a good course and thus improve the quality of lectures and courses in geriatric medicine with the overall aim to encourage more students to become geriatricians after their studies. MATERIALS AND METHODS: Medical students from the fifth clinical semester were interviewed in anonymous form following each course using standardized questionnaires for organizational and didactic topics. Factor analysis, proof of reliability, descriptive statistics and correlation analysis were performed as statistical methods. RESULTS: The proof of reliability of questionnaires showed good internal consistency with Cronbachs alpha values of 0.88 (seminars), 0.91 (lectures) and 0.92 (bedside teaching). The overall response rate was very high (95.3%, n = 803 questionnaires). The ratings for questionnaire items in the three teaching formats (i.e. seminars, lectures, bedside teaching) ranged mostly from good to very good. In the correlation analysis across all three teaching formats clear communication of learning objectives, the treatment of topics according to their own expectations and the learning experience were rated as most relevant overall. CONCLUSIONS: The evaluation results indicate a high level of satisfaction with the curriculum of geriatrics at the Charité, which can therefore be recommended across faculties taking into account the criteria named.

[Neurological lower torso function test. A new assessment]. / Neurologischer Funktionstest unterer Rumpf. Ein neues Assessment.

The neurological lower torso function test was developed in addition to the Berg Balance Scale as an assessment for diagnosis and follow-up of lower torso stability and functioning in neurological patients, used for example in subjects in the early rehabilitation phase or still showing low motoric recovery after suffering a stroke. Due to the ground effect for changes in severely affected neurological patients, other tests currently available do not provide an adequate level of sensitivity. The neurological function test was integrated into the study "Combined whole body vibration and balance training using Vibrosphere" with 66 inpatient/partial inpatient neurological subjects ≥ 60 years. Based on six tasks, a qualitative assessment of the selective function of movement and posture tone of the lower extremity, the muscular system around the hip, and the lower torso are performed. Analogous to the Berg Balance Scale, a 5 point scale is used. It shows a high degree of reliability and responsiveness and can be performed with little effort of time and personnel.

High interindividual variability in LDL-cholesterol reductions after inclisiran administration in a real-world multicenter setting in Germany.

BACKGROUND AND AIMS: Low-density lipoprotein cholesterol (LDL-C) is the main therapeutic target in the treatment of hypercholesterolemia. Small interfering RNA (siRNA) inclisiran is a new drug, which targets PCSK9 mRNA in the liver, reducing concentrations of circulating LDL-C. In randomized trials, inclisiran demonstrated a substantial reduction in LDL-C. The German Inclisiran Network (GIN) aims to evaluate LDL-C reductions in a real-world cohort of patients treated with inclisiran in Germany. METHODS: Patients who received inclisiran in 14 lipid clinics in Germany for elevated LDL-C levels between February 2021 and July 2022 were included in this analysis. We described baseline characteristics, individual LDL-C changes (%) and side effects in 153 patients 3 months (n = 153) and 9 months (n = 79) after inclisiran administration. RESULTS: Since all patients were referred to specialized lipid clinics, only one-third were on statin therapy due to statin intolerance. The median LDL-C reduction was 35.5% at 3 months and 26.5% at 9 months. In patients previously treated with PCSK9 antibody (PCSK9-mAb), LDL-C reductions were less effective than in PCSK9-mAb-naïve patients (23.6% vs. 41.1% at 3 months). Concomitant statin treatment was associated with more effective LDL-C lowering. There was a high interindividual variability in LDL-C changes from baseline. Altogether, inclisiran was well-tolerated, and side effects were rare (5.9%). CONCLUSION: In this real-world patient population referred to German lipid clinics for elevated LDL-C levels, inclisiran demonstrated a high interindividual variability in LDL-C reductions. Further research is warranted to elucidate reasons for the interindividual variability in drug efficacy.

[Skin diseases in geriatric patients. Epidemiologic data]. / Hauterkrankungen beim geriatrischen Patienten. Epidemiologische Daten.

The incidence of skin diseases more common in older patients, e.g. inflammatory and autoimmune diseases, benign and malignant tumors and paraneoplastic syndromes, is increasing worldwide rapidly mainly due to early or lifelong UV-overexposure and to an aging population. In order to transform this demographic change into a chance a better understanding of the pathomechanisms of these diseases, an early diagnosis and therapy are essential steps. In addition, a joint effort to raise public awareness, patient education, preventive measures and consistent monitoring of high-risk groups is of great importance. In this article, the relationship between aging and associated skin diseases will be presented with a particular focus on the epidemiology and risk factors.

[Rivermead assessment of somatosensory performance: validation of a German version (RASP-DT)]. / Rivermead Assessment of Somatosensory Performance : Validierung einer deutschen Version (RASP DT).

BACKGROUND: Sensory deficits after stroke are common and impact motor regeneration and the total length of hospital stay as well as quality of life factors including the independence to conduct daily life activities. There is currently no existing reliable and standardized assessment tool to measure somatosensory performance in the German language. The aim of our study was to translate the original version of the Rivermead assessment for somatosensory performance (RASP) into German and to study its reliability in a German-speaking population sample. METHODS: The translation of the English original version followed the protocol of the Medical Outcomes Trust. The German version was assessed with 60 patients with first time presentation of subacute stroke and AC1 coefficients were calculated to measure interrater reliability for the different subtests. RESULTS: The mean AC1 value was 0.75 (range 0.58-0.81). The interrater reliability was good to excellent for all subtests. CONCLUSION: The German version of the RASP (RASP-DT) developed in this study is a reliable assessment instrument for sensory deficits after stroke.

GAL@Home: a feasibility study of sensor-based in-home fall detection.

BACKGROUND: A considerable proportion of falls occur within the domestic environment. Sensor-based identification of falls in seniors' homes could help them to remain autonomous and self-sufficient in their own homes. The objective of this study was to evaluate fall detection systems within the home environment using optical and accelerometric sensor systems. METHODS: Portable triaxial accelerometers and optical sensors were used to detect falls in subjects with known problems of mobility and a recent fall history. RESULTS: Three subjects were investigated with the system. Overall nine falls occurred during the study period. Four falls were recorded by the accelerometric system and one fall by the optical system. Subjects with increased risk of falling as measured with mobility and fall risk assessments tend to fall more frequently. CONCLUSION: The study shows that there is a considerably large difference between fall-detector evaluation studies in domestic environments and in laboratory trials.

Combined whole body vibration and balance training using Vibrosphere®: improvement of trunk stability, muscle tone, and postural control in stroke patients during early geriatric rehabilitation.

Strokes are a leading cause of disability, immobility, and reduced ability to perform activities of daily living (ADLs) among the elderly. Balance and postural control are often affected in stroke patients. Physical therapy for the lower back to improve posture, mobility, and ADLs can be very time consuming. In this randomized, controlled study of 66 geriatric patients (mean age 74.5 years) with stroke-related paresis or hemiplegia, it was demonstrated that stroke patients may benefit more from 3 additional weeks of combined whole body vibration and balance training than from a comprehensive inpatient geriatric rehabilitation program in terms of trunk stability, postural control, and muscle tone.

[Assistance systems for the elderly: the SmartSenior project]. / Gesundheitstechnik für die alternde Bevölkerung: Das Beispiel "SmartSenior".

Demographic change is posing an enormous challenge for societies in industrialized countries: the number of elderly and chronically ill is on the rise, whereas the number of people in the work force is declining. Assistive technology can be an important factor in this process and will help to alleviate shortcomings of the present system. The following example of the joint research program "SmartSenior", which began in mid 2009, shows the stakeholders, challenges, and future trends of assistive technology for the elderly. There is potential for the application of modern technology in three areas: in the training of senior citizens' abilities and skills, in supporting the activities of daily life, and in the continuous monitoring of vital functions.

[Functional capabilities of users of mobility devices after femoral hip fracture. A comparison study]. / Funktionelle Kompetenzen von Mobilitätshilfsmittelnutzern nach hüftnaher Femurfraktur. Eine Vergleichsstudie.

BACKGROUND: The present study investigates the functional skills and capabilities of a sample of 105 patients treated at the Lutheran Geriatric Center Berlin after a hip fracture during a period of two years between 2004 and 2006. PATIENTS AND METHODS: Geriatric assessment instruments (Barthel index, Instrumental Activities of Daily Living Scale (IADL), Timed Up & Go (TUG), Tinetti, grip strength, Geriatric Depression Scale (GDS)) were implemented to measure the functional capabilities in this prospective study. The subjects were divided into three groups, characterized by the type of mobility device they used: crutches, a four-wheeled walker, or a wheel chair. Furthermore, the data were measured at three test intervals (t(0:): baseline before discharge, t(1): 4 weeks after discharge, t(2): 4 months after discharge). RESULTS: The results of the study differ significantly for each of the three groups at the different test intervals (Barthel index, IADL, TUG, Tinetti, grip strength, all p<0.000, ANOVA). The results of our investigation demonstrate a substantial difference in increase, stagnation or deterioration of capabilities for patients in all three groups. However, from t(1) to t(2) only the group using crutches as a mobility device demonstrated the highest increase of their capabilities in this specific areas (Tinetti, grip strength, IADL, TUG, p≤0.05, general linear model). The results of the study differ significantly for each of the three groups at the different test intervals (Barthel index, IADL, TUG, Tinetti, grip strength, all p <0.000, ANOVA). The results of our investigation demonstrate substantial differences in all three groups with respect to increase, stagnation, or deterioration of capabilities. However, from t(1) to t(2) only the group using crutches as a mobility device demonstrated the highest increase of their capabilities in these specific areas (Tinetti, grip strength, IADL, TUG, p≤0.001, general linear model) CONCLUSION: A group-specific approach, based on the mobility devices used, allowed for better differentiation of functional capabilities after femoral hip fracture.

Total serum homocysteine levels do not identify cognitive dysfunction in multimorbid elderly patients.

OBJECTIVES: Total blood homocysteine (Hcys) and folate levels have been investigated in association with cognitive dysfunction in healthy but not in multimorbid elderly patients. We hypothesized that total serum Hcys is an adequate marker to identify multimorbid elderly patients with cognitive dysfunction assessed by the Short Cognitive Performance Test (SKT) and Mini-Mental State Examination (MMSE). DESIGN: Cross-sectional study. SETTING: The study center was an acute geriatric hospital. PARTICIPANTS: A total of 189 multimorbid elderly patients were recruited. METHODS: Cognitive dysfunction was determined according to the SKT and MMSE. Biochemical parameters (Hcys, folate, vitamin B12, hemoglobin), nutritional status (BMI, Mini Nutritional Assessment, nutritional intake), and activities of daily living were assessed. RESULTS: According to the SKT, 25.4% of patients showed no cerebral cognitive dysfunction, 21.2% had suspected incipient cognitive dysfunction, 12.7% showed mild cognitive dysfunction, 9.0% had moderate cognitive dysfunction, and 31.7% of patients were demented. The median plasma Hcys value was elevated by approximately 20% in multimorbid elderly patients, independent of cognitive dysfunction. Serum folate and vitamin B12 concentrations were within normal ranges. We did not find significant differences in nutritional status, activities of daily living, numbers of diseases or medications, or selected biochemical parameters between the SKT groups. CONCLUSION: Elevated serum Hcys levels with normal plasma folate and vitamin B12 concentrations were observed in multimorbid elderly patients. The plasma Hcys level did not appear to be an important biological risk factor for cognitive dysfunction in multimorbid geriatric patients.

[Does an association between increased homocystein levels and cognitive dysfunction also exist in multimorbid geriatric patients]. / Besteht auch bei multimorbiden geriatrischen Patienten ein Zusammenhang zwischen erhöhten Homocysteinspiegeln und kognitiven Defiziten?

BACKGROUND: Total blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD. METHODS: According to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 +/- 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B(12), hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional. RESULTS: According to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B(12) levels were within range, though dietary folate intake (97 [80-128] microg/d) was reduced about 75% (recommendation 400 microg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B(12) were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters. CONCLUSION: We analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B(12) concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.