Alzheimer Disease: Bickel H

Förstl H, Werheid K, Ulm K, Schönknecht P, Schmidt R, Pantel J, Hörr R, Gutzmann H, Gertz HJ, Frölich L, Bickel H. · Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München. · Dtsch Med Wochenschr. · Pubmed #19142839 No free full text.

Abstract: Long-term studies will be pivotal in order to examine the efficacy of preventive and early therapeutic interventions during the preclinical phase of dementia. Biomarkers will be of importance due to the large sample sizes and the necessary logistic efforts, high drop-out rates and slow clinical progression. The validity of functional and even structural imaging methods is currently investigated with early and promising results; it is presently unclear whether conventional csf-markers of Alzheimer's disease (beta-amyloid and tau-proteins) are sufficiently sensitive to monitor the effects of early interventions. It also remains doubtful whether modifications of these methods will ever be useful and available for practical purposes.

Bickel H. · AG Psychiatrische Epidemiologie Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München Klinikum rechts der Isar Ismaninger Strasse 22 81675 München, Germany. · Z Gerontol Geriatr. · Pubmed #11393002 No free full text.

Abstract: Based on results from large-scale epidemiological field studies in the western industrial countries, 930,000 elderly people in Germany were estimated to suffer from a dementing disorder at the end of 1996. Following the most recent population projection, a population increase of the number of elderly people (65 yrs. and above) from 12.9 million (mio.) in 1996 to more than 20 mio. in 2030 is anticipated. Based on the assumption that age-specific prevalence rates of dementia will remain stable, a steep rise in patient numbers by an average of 20,000 per year can thus be expected, reaching 1.56 mio. in 2030 and more than 2 mio. in 2050. Studies on the cost of illness point to an enormous economic burden caused by dementia. The unpaid informal care provided by relatives and the high expenses for long-term institutional care can be considered as the most significant components of total costs. Currently, the medical costs associated with diagnosis and treatment, however, appear as an almost negligible fraction of the total costs.

Jessen F, Wiese B, Cvetanovska G, Fuchs A, Kaduszkiewicz H, Kölsch H, Luck T, Mösch E, Pentzek M, Riedel-Heller SG, Werle J, Weyerer S, Zimmermann T, Maier W, Bickel H. · Department of Psychiatry, University of Bonn, Bonn, Germany. · Psychol Med. · Pubmed #17623488 No free full text.

Abstract: BACKGROUND: The association of subjective memory impairment (SMI) with cognitive performance in healthy elderly subjects is poor because of confounds such as depression. However, SMI is also a predictor for future dementia. Thus, there is a need to identify subtypes of SMI that are particularly related to inferior memory performance and may represent at-risk stages for cognitive decline.METHOD: A total of 2389 unimpaired subjects were recruited from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe), as part of the German Competence Network on Dementia. Clusters of SMI according to patterns of response to SMI questions were identified. Gender, age, depressive symptoms, apolipoprotein E (apoE) genotype, delayed recall and verbal fluency were included in a Classification and Regression Tree (CART) analysis to identify discriminators between the clusters. RESULTS: We identified three clusters. Cluster 1 contained subjects without memory complaints. Cluster 2 contained subjects with general memory complaints, but mainly without memory complaints on individual tasks of daily living. Cluster 3 contained subjects with general memory complaints and complaints on individual tasks of daily living. Depressive symptoms, as the first-level discriminator, distinguished between clusters 1 and 2 versus cluster 3. In subjects with only a few depressive symptoms, delayed recall discriminated between cluster 1 versus clusters 2 and 3. CONCLUSIONS: In SMI subjects with only a minor number of depressive symptoms, memory complaints are associated with delayed recall. As delayed recall is a sensitive predictor for future cognitive decline, SMI may be the first manifestation of future dementia in elderly subjects without depression.

Bickel H, Mösch E, Förstl H. · Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Klinikum rechts der Isar, Germany. · Psychiatr Prax. · Pubmed #17443456 No free full text.

Abstract: OBJECTIVE: The suitability of the SIDAM (Structured Interview for the Diagnosis of Dementia) for the detection of pre-clinical stages of dementia. METHODS: Prospective study of a sample of 794 non-demented elderly persons in the age bracket from 65 to 85 who were initially being treated in general hospitals. A cognitive screening with the SIDAM was performed during their stay in the hospital. After discharge the occurrence of dementia was determined in four follow-up studies at one-year intervals. RESULTS: During the follow-up, 100 newly developed cases of dementia were diagnosed. A lower performance in the SIDAM was associated with a significantly higher risk of the development of dementia. In comparison with the upper quartile in total SIDAM score the relative risk of a dementia amounted to 2.6 (1.0-6.8) for the second quartile, 4.5 (1.9-11.0) for the third quartile and 13.3 (5.7-31.1) for the fourth quartile. The highest predictive validity was found for memory performance, in particular for free delayed recall. CONCLUSIONS: Risk groups for dementia can be identified by the use of a brief cognitive screening procedure.

Bickel H, Riemenschneider M, Kurz A. · Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Klinikum rechts der Isar. · Psychiatr Prax. · Pubmed #16583352 No free full text.

Abstract: OBJECTIVE: The aim of the study was to examine the relationship of head circumference as a marker of maximal attained brain size to late-life cognitive impairment and dementia. METHODS: Cognitive performance was assessed and the presence of dementia was diagnosed in a cross-sectional study of 442 Catholic sisters aged 65 years and over. RESULTS: A head circumference below average was significantly associated with the presence of dementia even after adjustment for age, body mass index and presence of one or two apolipoprotein E epsilon4 alleles (OR = 2.0; 95% CI: 1.1-3.6). The combination of small head circumference and apolipoprotein E epsilon4 strongly increased the risk of dementia (OR = 3.59; 95% CI: 1.44-8.97). CONCLUSIONS: The findings support the hypothesis that a larger head size reduces the risk of cognitive decline and dementia in old age.

Bickel H, Bürger K, Hampel H, Schreiber Y, Sonntag A, Wiegele B, Förstl H, Kurz A. · Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Germany. · Nervenarzt. · Pubmed #15959749 No free full text.

Abstract: This study describes the clinical features of presenile dementia diagnosed in memory clinics. It further gives an estimate of the declared incidence for the German city of Munich and surrounding counties. Twelve memory clinics in Switzerland and Germany were considered, among them all of the four in Munich. A total of 267 patients with onset of illness under the age of 65 were included. Only 16 patients (6%) were younger than 50. Men and women were affected about equally often. The most common cause of dementia was Alzheimer's disease (67%), followed by frontotemporal degeneration (13.5%) and vascular (5.6%) dementia. The declared incidence was estimated at 8.3 new cases of dementia per year among 100,000 persons in the 50-64 age range, with an incidence rate of Alzheimer's disease at 6.3/100,000. It can be concluded that memory clinics fulfill an important function in the care of patients with presenile dementia, since they are highly utilized by younger patients in early stages of the illness.

Förstl H, Bickel H, Lautenschlager N, Riemenschneider M, Kurz A. · Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München. · MMW Fortschr Med. · Pubmed #11460413 No free full text.

Abstract: Forgetfulness is defined as a subjectively bothersome impairment of the ability to recall facts that are unequivocally known to be stored in the memory. Objectifiable memory deficits may accompany numerous physical and neurological illnesses, but may also be seen in depressive states. Below average-for-age cognitive performances that do not reach the level of dementia are referred to as mild cognitive impairment, which in some cases represents a pre-dementia stage of Alzheimer's disease. Its recognition and differentiation from age-related performance deficits is now possible using simple, but sensitive neuropsychological tests. An important aim of the diagnostic work-up is the recognition of potentially reversible causes. For this purpose, physical examination and laboratory investigations are helpful. Structural and functional imaging procedures can provide information about cerebral causes. Biochemical indicators of neurogenerative processes are currently being developed. Cognitive training measures possibly have only a small and temporary effect. In patients with mild cognitive impairment, nootropic agents apparently have a symptomatic effect. Whether antidementia agents are capable of stopping the progress of mild cognitive impairment to full-blown dementia is currently being investigated in ongoing trials.

Bickel H. · AG Psychiatrische Epidemiologie, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technischen Universität München. · Gesundheitswesen. · Pubmed #10844818 No free full text.

Abstract: Due to the increasing life expectancy and the growing number of elderly people, dementia is emerging as a major health problem. There is, however, a lack of consistent data on the number of prevalent and incident cases of dementia in Germany. The aim of the present study was to estimate the prevalence and the incidence of dementing disorders in general as well as Alzheimer's disease in particular on the basis of disease rates based on large-scale epidemiological field studies and meta-analyses, which were standardized according to the age structure of the German population. The results show that probably more than 900,000 persons in Germany suffer from a dementing illness, 650,000 among them from Alzheimer's disease. About 200,000 new cases of dementia develop during one year, among them 120,000 new cases of Alzheimer's disease. Due to the higher life expectancy of women as compared to men 70% of the patients are of female gender. As a consequence of the steep increase of disease rates with age, two-thirds of the prevalent cases and 60% of the incident cases are found among people in the age bracket of 80 and over, whereas only 3% are found among persons younger than 65 years of age. Additionally, an estimate of the distribution of cases by the 16 Federal states of Germany is given.

Schäufele M, Bickel H, Weyerer S. · Central Institute of Mental Health in Mannheim, Germany. · Int J Geriatr Psychiatry. · Pubmed #10556866 No free full text.

Abstract: OBJECTIVES: To evaluate a wide range of sociodemographic, neurological and clinical variables as to whether they predict mortality in a representative sample of demented elderly.DESIGN: A three-stage community survey was conducted, based on a total of 3721 elderly patients whose cognitive status was assessed by their general practitioners (stage I). A stratified random sample of patients underwent a standardized research interview, including cognitive testing and the assessment of mental status, physical illness, sensory impairment and motor disability (stage II). After a mean interval of 28 months, all patients were recontacted. For deceased patients a close reference person was interviewed and the exact date of death was recorded (stage III). The influence of the predictor variables on mortality was determined by using the Cox proportional hazards model.SUBJECTS: A stratified random sample of 117 patients in primary care (mean age 82 years) suffering from mild, moderate or severe dementia (Alzheimer type, vascular or mixed dementia).MATERIALS: Hierarchical Dementia Scale (HDS), a modified version of the Hamilton Depression Scale, other clinical rating scales and CAMDEX criteria for clinical diagnosis and a degree of severity of dementia.RESULTS: Fifty-three of the 117 demented patients had died during the follow-up interval. The mortality risk increased steeply with the degree of severity of dementia. By controlling for this variable, only age and motor disability contributed significantly to the prediction of mortality, whereas gender, social class, type of dementia, extrapyramidal signs and other clinical features showed no or only a weak effect on the outcome.CONCLUSION: The remaining life expectancy of the demented elderly depends primarily on the severity of the dementia, the patients' age and their general physical health. The influence of other clinical features which often have been hypothesized as indicators of specific subgroups of dementia was mainly due to their relationship to the disease severity.