Alzheimer Disease: Stoppe G

Stoppe G. · Psychiatrische Klinik und Poliklinik, Georg-August-Universität Göttingen. · Z Arztl Fortbild Qualitatssich. · Pubmed #10802897 No free full text.

Abstract: This article focuses on the special role of women and their problems regarding the epidemiology and pathogenesis of dementia, especially Alzheimer's disease (AD). Recent epidemiological studies reveal higher rates of women affected by the two major dementing conditions, AD and vascular dementia (VaD). However, it is under debate whether a pure gender effect accounts for this, because gender differences e.g. in education, life expectancy, psychosocial development and health behaviour must be included in the analysis. Therefore it seems to be reasonable to have a look on gender related variances in other risk and protective factors of dementia. Recently, the menopause attracted the interest of dementia researchers, because retrospective studies revealed a favourable effect of hormone replacement therapy (HRT) on the incidence of AD by about 50%. However, in spite of well known "positive effects" of estrogens on the central nervous system, there is still not enough evidence for a recommendation of HRT for the prevention of AD and other dementias.

Stoppe G, Staedt J. · Psychiatrische Klinik und Poliklinik Georg-August-Universität, Göttingen. · Z Gerontol Geriatr. · Pubmed #10436494 No free full text.

Abstract: Behavioral disorders in dementia are common and are the most important symptoms with regard to socio-economic burden. Up to now there is no common international agreement of how to define and measure these disorders. Antidementia trials focus mainly on cognition. Investigations of neurobiological corrolaries of disturbed behavior in the dementias are rare. The same holds true for studies on the longitudinal course of behavioral disorders and their interrelation. Many symptoms may be the expression of variable conditions, e.g., agitation may be related to anxiety or akathisia. In primary care, hospitals and nursing homes, antipsychotics are most often chosen for their treatment. The available data demonstrate at least a modest efficacy. New neuroleptics (risperidone, clozapine, olanzapine) offer some advantages with regard to the risk benefit ratio. Benzodiazepines are frequently prescribed, but seem to be superior to neuroleptics only for the treatment of sleep disorders. Antidepressants, carbamazepine or valproic acid offer some benefits, but do not provide immediate effects, which may the reason why they are used much less. For long-term treatment of many behavioral symptoms, they may however be superior. Drugs should also be chosen with regard to dementia etiology. For example, physicians should consider the high neuroleptic sensitivity in dementia of Lewy body type and the anticholinergic sensitivity in dementia of Alzheimer type. Empirical evidence indicates overtreatment of the demented population with sedating psychotropic drugs. With regard to the instability of behavioral disorders in the time course the necessity of drug treatment should always be (re)evaluated.

Stoppe G, Brandt CA, Staedt JH. · Department of Psychiatry, Georg-August-University, Goettingen, Germany. · Drugs Aging. · Pubmed #10069407 No free full text.

Abstract: Behavioural disorders are a common feature in dementia, especially in the later stages of the disease. The most frequent disorders are agitation, aggression, paranoid delusions, hallucinations, sleep disorders, including nocturnal wandering, incontinence and (stereotyped) vocalisations or screaming. Behavioural disorders, rather than cognitive disorders, are the main reason why caregivers place patients with dementia in a nursing home. However, although behavioural disorders are important, there is still no international agreement with respect to the description and definition of symptoms and syndromes. This also holds true for the wide variety of scales for quantification and measurement of behavioural disorders. Drug therapy should be considered after possible underlying causes such as physical illness, drug adverse effects and environmental stressors have been ruled out, or specifically addressed, and a behavioural approach has also failed. This article briefly reviews the evidence for non-antipsychotic drug therapies, which include a variety of substances. However, antipsychotics are the group of drugs which have been most frequently studied for the treatment of behavioural syndromes in dementia. Drug responsive symptoms include anxiety, verbal and physical agitation, hallucinations, delusions, uncooperativeness and hostility, whereas wandering, hoarding, unsociability, poor self-care, screaming and other stereotyped behaviour seem to be unresponsive to all drugs. Although the use of classical antipsychotics is limited by extrapyramidal symptoms, anticholinergic adverse effects, sedation and postural hypotension, the newer antipsychotics offer the chance of a better risk:benefit ratio. This article reviews the small amount of data published on the use of the newer antipsychotics, and concludes that risperidone at low dosages (0.5 to 2 mg/day) seems to be especially useful for the treatment of behavioural symptoms in dementia because of its negligible anticholinergic adverse effects. The use of clozapine is limited by its anticholinergic activity, at least in dementia of the Alzheimer and Lewy body types. However, in patients with psychosis arising from Parkinson's disease it seems to be the drug of choice, and similar activity is likely for olanzapine. There are no published data on other newer drugs, such as sertindole, quetiapine or ziprasidone. Future studies should also address questions of dementia heterogeneity and should compare different drug treatments and treatment combinations.

Olde Rikkert MG, van der Vorm A, Burns A, Dekkers W, Robert P, Sartorius N, Selmes J, Stoppe G, Vernooij-Dassen M, Waldemar G. · Department of Geriatrics, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands. · Am J Alzheimers Dis Other Demen. · Pubmed #18509105 No free full text.

Abstract: In this article, the authors describe how the European Dementia Consensus Network developed a consensus on research ethics in dementia, taking into account the questions posed by the era of genetic research and its new research methods. The consensus process started with a Delphi procedure to analyze relevant stakeholders' positions by describing their statements on the possibilities and limitations of research into genetic determinants of Alzheimer disease and to describe and analyze the moral desirability of genetic research on Alzheimer disease. The conclusions drawn from the Delphi procedure fuelled the development of the consensus statement, which is presented in this paper. The consensus statement aims to stimulate ethically acceptable research in the field of dementia and the protection of vulnerable elderly patients with dementia from application of inadequate research methods or designs.

Stoppe G. · Universitäre Psychiatrische Kliniken, Wilheml Klein-Strasse 27, Basel, Switzerland. · Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. · Pubmed #18345472 No free full text.

Abstract: Depression is the most frequent psychiatric disorder in old age. Some patients have had depressive episodes or other psychological disorder in an earlier part of their life span. Older people show more somatic or cognitive complaints compared to younger depressives. Risk factors for depression in old age are (incident) physical disorders, sleep disorders or loss of spouse. Depression worsens course and prognosis of comorbid somatic disorders. A major consequence is the high suicide rate in the elderly. Depression is also a risk factor for other disorders like dementia or institutionalisation. The interplay between depression and dementia and other organic brain disorders is complex und still unresolved. Depression in the elderly is a challenge for our health system. Recognition and treatment rates are still too low. Integrative treatment plans for depression with comorbid physical disorders or in various settings should be developed. With the growing elderly population the available evidence for treatment urgently has to be increased. In current practice drug therapies--mostly inadequate--dominate. Psychotherapy should be promoted and the number of old age psychotherapists increased.

Stoppe G, Knoblauch A, Haak S, Maeck L. · Universitäre Psychiatrische Kliniken Basel, Switzerland. · Psychiatr Prax. · Pubmed #17443455 No free full text.

Abstract: OBJECTIVE: Are there any differences between family physicians (FP) and primary care neuropsychiatrists (NP) with regard to their diagnostic competence of early dementia? METHODS: Trained interviewers presented written case vignettes to 68 NP and 122 FP during a structured interview. The case history described an otherwise healthy 70 years old patient complaining about cognitive disturbances suggesting incipient dementia. RESULTS: The survey is representative with a high response rate (71.8% FP and 67.3% NP). In both physician groups a vascular disease concept prevailed although the patient had no vascular risk factors. For primary and differential diagnosis NP considered depression more often. Overall only about 50% of physicians considered Alzheimer dementia. Regarding diagnostic methods the NP adhered significantly better to the current guidelines. While 31% of FP would apply dementia screening and 12% order neuroimaging, 76% and 74% of the NP mentioned these methods, respectively. CONCLUSIONS: There are negligible differences between NP and HA with regard to early diagnostic awareness of dementia. Vascular concepts prevail. However, both groups differ with regard to the diagnostic work-up. An increase of competence seems to be necessary in both groups.

Stoppe G, Haak S, Knoblauch A, Maeck L. · University Psychiatric Hospitals, Basel, Switzerland. · Dement Geriatr Cogn Disord. · Pubmed #17290103 No free full text.

Abstract: AIM: To measure the diagnostic competence of family physicians (FP) and neuropsychiatrists (NP) for moderate dementia. METHODS: Written case vignettes describing moderate dementia either of Alzheimer type or vascular type were randomized to a representative sample of 122 FP and 68 NP, corresponding to response rates of 71.8 and 67.3%, respectively. They served as the basis for a structured face-to-face interview. RESULTS: NP and FP did not differ with regard to their diagnostic considerations, however, concerning diagnostic workup. Vascular dementia was much better recognized than dementia of Alzheimer type. Neuropsychological tests and brain imaging would be done by 14.8 and 32.8% of the FP in the case of vascular dementia. In Alzheimer dementia they would apply these methods in 24.6 and 19.7%, respectively. The corresponding numbers for NP were about 60% in both cases for testing and more than 80% for brain imaging. CONCLUSIONS: There is still a wide gap between guidelines and practice in primary care. The apparent overdiagnosis of vascular dementia may be one reason for the low drug treatment rates.

Maeck L, Haak S, Knoblauch A, Stoppe G. · University Psychiatric Hospitals, Basel, Switzerland. · Int J Geriatr Psychiatry. · Pubmed #16955450 No free full text.

Abstract: OBJECTIVE: To investigate whether primary care competency in early diagnosis of dementia might have changed during 1993 and 2001. METHOD: By means of a representative follow-up survey 122 out of 170 (71.8%) family physicians (FPs) in Lower Saxony, Germany, were randomly assigned to two written case samples presenting a patient with mild cognitive impairment (case 1a vs. 1b: female vs. male patient) and moderate dementia (case 2a vs 2b: vascular type (VD) vs Alzheimer's disease (DAT)), respectively. By means of a structured face-to-face interview, they were asked for their diagnostic considerations. RESULTS: In comparison to 1993, dementia was significantly more frequently considered. However, there was a striking tendency in overestimating vascular aetiology and under-diagnosing probable DAT (case 1a/1b: DAT: 11.0% in 1993 vs 26.2% in 2001; VD: 2.1% in 1993 vs 17.2% in 2001). As a possible contributor to a dementia syndrome, concomitant medication was considered only exceptionally (case 2a/2b: 4.4% in 1993 vs 2.5% in 2001). Physicians above 50 years of age showed a significantly lower early diagnostic awareness. At follow-up, the presumed interest in geriatric (psychiatric) topics dramatically faded from 66.9% to 35.2%. CONCLUSIONS: Our results demonstrate a persistent need of training efforts aiming at the early recognition of dementia, especially of DAT, in primary care.

Haupt M, Rosenfeld S, Stoppe G. · Hirnleistungsstbrungen, Neuro-Centrum Dusseldorf. · MMW Fortschr Med. · Pubmed #16739359 No free full text.

Abstract: In two exploratory studies on the outpatient treatment of patients suffering from Alzheimer dementia research was done into the characteristics of therapy in medical practice on the basis of exemplary interviews of 100 doctors in 2000 and 2002. The interviewers discern the burden of the disease for the patients and their relatives. However, medical treatment is still too scarce and inappropriate as the prescribing of antidementia drugs shows, among which especially acetylcholinesterase inhibitors as drugs of first choice. The spectrum of non-pharmacological interventions is applied but psychosocial measures are under-represented. To maintain the Alzheimer patient's functional level and to thus relieve the caring relatives a multimodal therapy should be intensified preferably by comprehensive co-operations.

Stoppe G, Otto A, Koller M, Staedt J. · Psychiatrische Universitätsklinik Basel. · Psychiatr Prax. · Pubmed #15983888 No free full text.

Abstract: OBJECTIVE: By use of a 7-y-follow-up investigation of differences between geriatric psychiatric patients and their management in an integrated (with other adult age groups) care in the University Psychiatric Hospital (PUK) compared to those in a separated (only according to age) care in the Psychiatric State Hospital (LKH), which together treat all psychiatric inpatients in Goettingen, Germany, we wanted to show, whether progress can be made visible. METHOD: We performed standardized chart reviews of randomly selected groups of patients, who had been treated in the PUK (n = 104) and the LKH (n = 100) in the years 1998 and 1999. RESULTS: Again, organic brain diseases/dementia was the most frequent diagnosis in the LKH and depression that of the PUK. Less diagnostics were applied compared to the previous investigation, especially neuroimaging. Non-drug treatments are (documented) more frequently now in the LKH. Both institutions - data with respect to frequent syndromes are given - treated the wide majority of patients with psychoactive drugs, especially neuroleptics, typical antidepressants, benzodiazepines. Antidementia drugs were given significantly less. Hospital stays decrease in length. Compared to the respective investigation in Magdeburg there is some evidence supporting specialized care for the elderly. CONCLUSION: Budgetary restrictions could also be shown in inpatient treatment. Progress in specific drug treatment does not reach the patients as much as necessary.

Stoppe G, Otto A, Koller M, Staedt J. · Psychiatrische Universitätsklinik Basel. · Psychiatr Prax. · Pubmed #15983887 No free full text.

Abstract: OBJECTIVE: 7 years after our first investigation we were interested in the stability versus (trends of) change in geriatric psychiatric inpatients while the structure of services was mainly unchanged. METHOD: We performed standardised chart reviews of randomly selected groups of geriatric psychiatric inpatients who had been treated in 1998 and 1999 in the Psychiatric University Hospital (PUK; n = 104) or the Psychiatric State Hospital (LKH; n = 100), which together treat all psychiatric inpatients in the region. With regard to age, the PUK provides integrated and the LKH separated care. RESULTS: Mean patients' age decreased. Compulsory admissions according to state laws decreased significantly. Specialist treatment before admission decreased. Premedication showed a dramatic decrease of antidementia drug treatment and a nearly unchanged high rate of prescriptions of antipsychotics and benzodiazepines. CONCLUSION: With a lower age and lower rate of specialist treatment we could not find signs of a better outpatient care preceding hospital admission during follow-up.

Stoppe G, Pirk O, Haupt M. · Bereich Allgemeine Psychiatrie, Psychiatrische Universitätsklinik Basel, Schweiz. · Gesundheitswesen. · Pubmed #15672302 No free full text.

Abstract: STUDY OBJECTIVES: To practice evidence-based medicine is considered to improve health care, particularly of chronically ill patients. Taking Alzheimer's as an example the objective of this study is to explore as to how far ambulatory Alzheimer's patients receive the medical treatment with the best evidence available. METHOD: In 2000 and 2002 the health care situation of Alzheimer's disease patients was assessed by conducting telephone interviews with one hundred randomly selected general practitioners and specialists listed in the panel of the Institut fur Medizinische Statistik (IMS -- Institute for Medical Statistics). By means of a standardised questionnaire the interviewees' prescriptions were assessed as well as their knowledge of the medical therapy for Alzheimer's and the use of non-medical therapeutic measures. Besides, the interviewees' prescriptions were checked on the basis of quantitative data taken from the IMS panel. Cholinesterase inhibitors (ChE-I), which are accorded the best evidence presently available in the medical treatment of Alzheimer's, were seen as a marker for the improvement of health care in the course of the study. RESULTS AND CONCLUSIONS: The interviewed physicians considered the evidence of medical Alzheimer's disease therapy with cholinesterase inhibitors high. 67 % of the interviewees would use ChE-I as the drug of first choice if a near relative fell ill with Alzheimer's. However, the ChE-I prescriptions were limited to 13 % in the base year 2000 and to 24 % in the base year 2002. Obviously, the implementation of this medical therapy is hampered by budgetary regulations. The interviewees find it particularly disadvantageous that the prescription of ChE-I may overstrain the budgets allocated to their practices. As a consequence, the effort to improve the quality of health care by implementing evidence-based medicine is thwarted by the increasing pressure on German physicians to prescribe drugs according to economic viability.

Haupt M, Rosenfeld S, Stoppe G. · Neuro-Centrum Düsseldorf. · MMW Fortschr Med. · Pubmed #15526664 No free full text.

This publication has no abstract.

Günther C, von Hadeln K, Müller-Thomsen T, Alberici A, Binetti G, Hock C, Nitsch RM, Stoppe G, Reiss J, Gal A, Finckh U. · Department of Human Genetics, University Hospital Hamburg-Eppendorf, Butenfeld 42, 22529 Hamburg, Germany. · Neurosci Lett. · Pubmed #15464268 No free full text.

Abstract: Mitochondrial transcription factor A (TFAM) is essential for transcription and replication of mammalian mitochondrial DNA (mtDNA). Disturbance of maintenance of mtDNA integrity or mitochondrial function may underlay neurodegenerative disorders such as Alzheimer disease (AD). TFAM, the gene encoding TFAM maps to chromosome 10q21.1, a region that showed linkage to late-onset AD in several study samples. We screened TFAM for single nucleotide polymorphisms (SNPs) and genotyped the G>C SNP rs1937, coding for S12T in mitochondrial signal sequence of TFAM, and the A>G SNP rs2306604 (IVS4+113A>G) in 372 AD patients and 295 nondemented control subjects. There was an association of genotype rs1937G/G with AD in females and an association of a TFAM haplotype with AD both in the whole sample and in females. The findings suggest that a TFAM haplotype containing rs1937 G (for S12) may be a moderate risk factor for AD.

Verhey FR, Houx P, Van Lang N, Huppert F, Stoppe G, Saerens J, Böhm P, De Vreese L, Nordlund A, DeDeyn PP, Neri M, Peña-Casanova J, Wallin A, Bollen E, Middelkoop H, Nargeot MC, Puel M, Fleischmann UM, Jolles J. · Department of Psychiatry and Neuropsychology, University of Maastricht, The Netherlands. · Int J Geriatr Psychiatry. · Pubmed #14716698 No free full text.

Abstract: BACKGROUND: The Alzheimer's Disease Assessment Scale (ADAS) is often used in international multicenter trials. Use across countries presupposes correct translation and adaptation of the scale, and maintenance of its psychometric properties. OBJECTIVES: To compare the various translations of the ADAS used in Western Europe, to design internationally harmonized translations and to validate these. SETTING: International cooperative study in eight European countries. METHODS: An inventory was made of existing versions of the ADAS-Cog used in eight European countries, and adaptations were made. The concurrent validity of the harmonized versions of the ADAS was tested in 283 patients with probable or possible Alzheimer's disease. The Nurses Observation Scale for Geriatrics (NOSGER), CAMCOG-R and MMSE was used to assess concordance between cognitive and behavioral measures. RESULTS: Differences between the versions mainly involved object naming, items for verbal memory, such as the number of trials allowed, the imagery value of the words selected as targets or distractors, and the number of parallel versions. These differences were eliminated by adapting and harmonizing the various versions of the ADAS-Cog. Thereafter, only small differences between the different countries were found, and patterns of correlation between ADAS-Cog, and the NOSGER, CAMCOG-R and MMSE were consistent. CONCLUSIONS: The study underlines the need to use harmonized versions of instruments for rating dementia in multinational studies. The findings indicate that the harmonization of the ADAS-Cog was successful.

Verhey FR, Huppert FA, Korten EC, Houx P, de Vugt M, van Lang N, DeDeyn PP, Saerens J, Neri M, de Vreese L, Peña-Casanova J, Böhm P, Stoppe G, Fleischmann U, Wallin A, Hellström P, Middelkoop H, Bollen W, Klinkenberg EL, Derix MM, Jolles J. · Institute Brain and Behaviour, University Hospital of Maastricht, The Netherlands. · Age Ageing. · Pubmed #12958004 links to  free full text

Abstract: BACKGROUND: Transnational and psychometrically appropriate versions of instruments used in the diagnosis of dementia are essential for comparing information between different countries. The Cambridge Examination for Mental Disorders of the Elderly incorporates a brief neuropsychological test battery, Cambridge Cognitive Examination (recently revised version), which provides objective data on performance across a number of cognitive domains. OBJECTIVE: To harmonise the Cambridge Cognitive Examination between seven European countries. METHOD: 40 patients with probable or possible Alzheimer's disease of each of the seven countries were administered the Cambridge Cognitive Examination. The Nurse Observation Scale for Geriatrics was used to assess concordance between cognitive and behavioural measures. RESULTS: Only small differences between the various Cambridge Cognitive Examination versions were found, and patterns of correlation between Cambridge Cognitive Examination and the Nurse Observation Scale for Geriatrics were consistent. CONCLUSION: These findings indicate that the harmonisation of the Cambridge Cognitive Examination was successful.

Finckh U, van Hadeln K, Müller-Thomsen T, Alberici A, Binetti G, Hock C, Nitsch RM, Stoppe G, Reiss J, Gal A. · Institut für Humangenetik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany. · Neurogenetics. · Pubmed #12898287 No free full text.

Abstract: Urokinase-type plasminogen activator (uPA) converts plasminogen to plasmin. Plasmin is involved in processing of amyloid precursor protein and degrades secreted and aggregated amyloid-beta, a hallmark of Alzheimer disease (AD). PLAU, the gene encoding uPA, maps to chromosome 10q22.2 between two regions showing linkage to late-onset AD (LOAD). We genotyped a frequent C/T single nucleotide polymorphism in codon 141 of PLAU (P141L) in 347 patients with LOAD and 291 control subjects. LOAD was associated with homozygous C/C PLAU genotype in the whole sample (chi2=15.7, P=0.00039, df 2), as well as in all sub-samples stratified by gender or APOE epsilon4 carrier status (chi2> or = 6.84, P< or =0.033, df 2). Odds ratio for LOAD due to homozygosity C/C was 1.89 (95% confidence interval 1.37-2.61). PLAU is a promising new candidate gene for LOAD, with allele C (P141) being a recessive risk allele or allele T (L141) conferring protection.

Staedt J, Sparfeld F, Otto A, Stoppe G. · Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Otto-von-Guericke-Universität, Magdeburg. · Psychiatr Prax. · Pubmed #12872183 No free full text.

Abstract: OBJECTIVE: We wanted to compare geriatric psychiatric patients and their management in an integrated (with other adult age groups) care in the Psychiatric University Hospital of Göttingen (IGV) compared to those in a separated (according to age) care in the Psychiatric University Hospital of Magdeburg (SGV). Compared to the former, the latter is also involved in the regional obligatory care system. METHOD: We performed standardised chart reviews of randomly selected groups of patients, wo had been treated in the IGV (n = 104) and the SGV (n = 144) in the years 1998 and 1999. RESULTS: Most patients of the SGV suffered from organic brain diseases/dementia (SGV: 57.6 %; IGV: 36.6 %). In the IGV, depression (51 %) and addiction (27.9 %) were the most frequent diagnoses. Disabilities of vision, audition, speech or tremor and muscle diseases were more often found in the SGV. Specialised diagnostics were performed mostly in the SGV. Both institutions treated the majority of patients with antipsychotic drugs. A program of ergotherapy and physiotherapy was significantly more often documented in the SGV. Nearly half of the SGV patients were released into changed living environments (IGV: 12.9 %). CONCLUSION: Patients with further progressed organic brain diseases/dementia as well as older, psychically and somatically more severely ill patients were treated more frequently in the SGV. Obligatory care seems to be the reason for this and not separation or integration. In general, separated care according to age seems to provide a more diversified treatment approach for the elderly.

Staedt J, Sparfeld F, Otto A, Stoppe G. · Klinik für Psychiatrie, Psychotherapie und Psychosomatische Medizin, Otto-von-Guericke-Universität, Magdeburg. · Psychiatr Prax. · Pubmed #12872182 No free full text.

Abstract: OBJECTIVE: We wanted to compare geriatric psychiatric patients and their management in an integrated (with other adult age groups) care in the Psychiatric University Hospital of Göttingen (IGV) compared to those in a separated (according to age) care in the Psychiatric University Hospital of Magdeburg (SGV). The latter provides care for a certain area, while the former is not obliged to. METHOD: We performed standardized chart reviews of randomly selected groups of patients, who had been treated in the IGV (n = 104) and the SGV (n = 144) in the years 1998 and 1999. RESULTS: The SGV patients were significantly older (71.8 +/- 8.9 years versus 67.2 +/- 7.4 years), more often bereaved and/or living alone. The SGV patients' treatment was initiated by law in 23.2 % (IGV 3 %) of the cases. Inpatient pretreatment of psychic disorders was reported in 40 % of the SGV patients and in only 3.9 % of IGV patients, respectively. In addition, the SGV patients had significantly more complicating diseases, like cerebro- and cardiovascular or neurological diseases. CONCLUSION: Older, more severely psychic and somatic ill patients were treated in the SGV. In general for about half of the cases, the hospital treatment had been the first psychiatric treatment at all. Since both are university departments differences in patient profile seem to be influenced by care system (integrated versus separated and obligatory).

Stoppe G, Stiens G, Staedt J. · Klinik und Poliklinik für Psychiatrie und Psychotherapie, Bereich Humanmedizin der Universität Göttingen. · Dtsch Med Wochenschr. · Pubmed #12854065 No free full text.

This publication has no abstract.

Stoppe G, Maeck L, Staedt J. · Klinik und Poliklinik für Psychiatrie und Psychotherapie, Bereich Humanmedizin der Universität Göttingen. · Dtsch Med Wochenschr. · Pubmed #12854064 No free full text.

This publication has no abstract.

Stoppe G, Sehmer-Kurz K. · Klinik und Poliklinik für Psychiatrie und Psychotherapie, Bereich Humanmedizin der Georg-August-Universität. · Dtsch Med Wochenschr. · Pubmed #12854063 No free full text.

This publication has no abstract.

Diehl J, Staehelin H, Wiltfang J, Hampel H, Calabrese P, Monsch A, Schmid R, Romero B, Schunk M, Kuhlmann HP, Wolter-Henseler DK, Mauerer C, Stoppe G, Kurz A, Anonymous00260. · Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München, Ismaninger Str. 22, 81675 Munich, Germany. · Z Gerontol Geriatr. · Pubmed #12825136 No free full text.

Abstract: The 7th annual meeting of the memory clinics of Germany, Switzerland and Austria in March 2002 in Göttingen, Germany was an optimal opportunity to make an inventory about the state of the art in diagnostic and therapy of dementia and mild cognitive impairment in German-speaking memory clinics. Several problems were discussed including difficulties in 1) diagnosis of patients with aphasia or foreign patients, 2) handling of demented patients without a caregiver, 3) psychological support for patients, who have been diagnosed in a very early stage, 4) misunderstandings between general practitioners, neurologists and psychiatrists in private practice on the one hand and the memory clinics on the other hand, 5) recommendations for prevention of dementia, 6) recommendations concerning dementia and car driving and 7) questions of genetic counselling. The following paper is a summary of the results of a workshop in Göttingen and gives practical recommendations based on the experiences of the memory clinics.

Menzer G, Müller-Thomsen T, Meins W, Alberici A, Binetti G, Hock C, Nitsch RM, Stoppe G, Reiss J, Finckh U. · Department of Human Genetics, University Hospital Hamburg-Eppendorf, Germany. · Am J Med Genet. · Pubmed #11304834 No free full text.

Abstract: In two recent studies from Germany, a strong association was found between the allelic variant T of the amino acid substitution encoding polymorphism 224 C/T (A38V) in exon 2 of the cathepsin D gene (CTSD) and late onset Alzheimer disease (AD). Other studies from Europe and the USA revealed ambiguous results. Therefore, we performed an independent association study on CTSD and AD in a sample of 324 Caucasian patients from Germany, Switzerland, and Italy with late onset AD, and 302 non-demented controls. We could not confirm an association between CTSD genotype and AD, although there was a slight but not significant increase in frequency of the T allele and T carrier status in AD. Post hoc data analyses suggested that there might be a stronger effect of CTSD genotype on AD risk in males, and an interaction between CTSD and APOE genotypes in males but not females.

Finckh U, von der Kammer H, Velden J, Michel T, Andresen B, Deng A, Zhang J, Müller-Thomsen T, Zuchowski K, Menzer G, Mann U, Papassotiropoulos A, Heun R, Zurdel J, Holst F, Benussi L, Stoppe G, Reiss J, Miserez AR, Staehelin HB, Rebeck GW, Hyman BT, Binetti G, Hock C, Growdon JH, Nitsch RM. · Division of Psychiatry Research, University of Zurich, August Forel Str 1, 8008 Zurich, Switzerland. · Arch Neurol. · Pubmed #11074789 links to  free full text

Abstract: OBJECTIVE: To determine whether the cystatin C gene (CST3) is genetically associated with late-onset Alzheimer disease (AD). DESIGN: A case-control study with 2 independent study populations of patients with AD and age-matched, cognitively normal control subjects. SETTING: The Alzheimer's Disease Research Unit at the University Hospital Hamburg-Eppendorf, Hamburg, Germany, for the initial study (n = 260). For the independent multicenter study (n = 647), an international consortium that included the Massachusetts Alzheimer's Disease Research Center at the Massachusetts General Hospital, Boston; the Scientific Institute for Research and Patient Care, Brescia, Italy; and Alzheimer's research units at the Universities of Basel and Zurich, Switzerland, and Bonn, Goettingen, and Hamburg, Germany. PARTICIPANTS: Five hundred seventeen patients with AD and 390 control subjects. MEASURES: Molecular testing of the KspI polymorphisms in the 5' flanking region and exon 1 of CST3 and the apolipoprotein E (APOE) genotype. Mini-Mental State Examination scores for both patients with AD and control subjects. RESULTS: Homozygosity for haplotype B of CST3 was significantly associated with late-onset AD in both study populations, with an odds ratio of 3.8 (95% confidence interval, 1.56-9.25) in the combined data set; heterozygosity was not associated with an increased risk. The odds ratios for CST3 B/B increased from 2.6 in those younger than 75 years to 8.8 for those aged 75 years and older. The association of CST3 B/B with AD was independent of APOE epsilon4; both genotypes independently reduced disease-free survival. CONCLUSIONS: CST3 is a susceptibility gene for late-onset AD, especially in patients aged 75 years and older. To our knowledge, CST3 B is the first autosomal recessive risk allele in late-onset AD.