Center for Geriatric Medicine

Offenburg, Germany

Center for Geriatric Medicine

Offenburg, Germany
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Wolfsgruber S.,University of Bonn | Wolfsgruber S.,German Center for Neurodegenerative Diseases | Jessen F.,University of Bonn | Jessen F.,German Center for Neurodegenerative Diseases | And 31 more authors.
Neurology | Year: 2015

Objective: To test whether, in individuals with mild cognitive impairment (MCI), different measures of subjective cognitive decline (SCD) in the memory domain predict abnormal CSF biomarkers of Alzheimer disease (AD). Methods: We analyzed the multicenter baseline (cross-sectional) data of 245 patients with MCI. SCD was measured quantitatively with the Subjective Memory Decline Scale (SMDS) and qualitatively by assessing particular concerns associated with self-experienced worsening of memory. Logistic regression models were used to examine associations between SCD and abnormal CSF biomarkers, taking into account objective memory impairment, depressive symptoms, and education as covariates. Results: Abnormal CSF β-amyloid 1-42 (Aβ42) and more depressive symptoms were associated with higher SMDS scores and with the report of memory concerns. Risk of abnormal CSF Aβ42 increased by an estimated 57% for a 1-SD increase in SMDS scores and was doubled in patients who had SMDS scores >4 or who reported memory concerns, respectively. In addition, both SCD measures predicted risk of having a biomarker signature indicative of prodromal AD defined as presence of low CSF Aβ42 together with either high CSF tau or CSF phosphorylated tau 181 levels. Conclusions: In MCI, specific aspects of SCD severity and quality are related to CSF biomarkers indicative of AD. This extends findings in pre-MCI samples and calls for an improved operational assessment of SCD in MCI. This might be useful for sample enrichment strategies for increased likelihood of AD pathology. © © 2015 American Academy of Neurology.


Wolfsgruber S.,University of Bonn | Wolfsgruber S.,German Center for Neurodegenerative Diseases | Wagner M.,University of Bonn | Wagner M.,German Center for Neurodegenerative Diseases | And 24 more authors.
PLoS ONE | Year: 2014

Background: Concerns about worsening memory ("memory concerns"; MC) and impairment in memory performance are both predictors of Alzheimer's dementia (AD). The relationship of both in dementia prediction at the pre-dementia disease stage, however, is not well explored. Refined understanding of the contribution of both MC and memory performance in dementia prediction is crucial for defining at-risk populations. We examined the risk of incident AD by MC and memory performance in patients with mild cognitive impairment (MCI). Methods: We analyzed data of 417 MCI patients from a longitudinal multicenter observational study. Patients were classified based on presence (n = 305) vs. absence (n = 112) of MC. Risk of incident AD was estimated with Cox Proportional-Hazards regression models. Results: Risk of incident AD was increased by MC (HR = 2.55, 95%CI: 1.33-4.89), lower memory performance (HR = 0.63, 95%CI: 0.56-0.71) and ApoE4-genotype (HR = 1.89, 95%CI: 1.18-3.02). An interaction effect between MC and memory performance was observed. The predictive power of MC was greatest for patients with very mild memory impairment and decreased with increasing memory impairment. Conclusions: Our data suggest that the power of MC as a predictor of future dementia at the MCI stage varies with the patients' level of cognitive impairment. While MC are predictive at early stage MCI, their predictive value at more advanced stages of MCI is reduced. This suggests that loss of insight related to AD may occur at the late stage of MCI. © 2014 Wolfsgruber et al.


Bartoszek G.,Witten/Herdecke University | Bartoszek G.,Martin Luther University of Halle Wittenberg | Fischer U.,Ludwig Maximilians University of Munich | von Clarenau S.C.,Center for Geriatric Medicine | And 8 more authors.
Archives of Gerontology and Geriatrics | Year: 2015

Introduction: Joint contractures are characterized as impairment of the physiological movement of joints due to deformity, disuse or pain and have major impact especially for older individuals in geriatric care. Some measures for the assessment of the impact of joint contractures exist. However, there is no consensus on which aspects should constantly be measured. Our objective was to develop a standard-set based on the ICF for describing functioning and disability in older individuals with joint contractures in geriatric care settings, giving special emphasis to activities and participation. Methods: The ICF-based standard set was developed in a formal decision-making and consensus process and based on an adapted version of the protocol to develop ICF Core Sets. These are sets of categories from the ICF, serving as standards for the assessment, communication and reporting of functioning and health for clinical studies, clinical encounters and multi-professional comprehensive assessment and management. Results: Twenty-three experts from Germany and Switzerland selected 105 categories of the ICF component Activities and Participation for the ICF-based standard set. The largest number of categories was selected from the chapter Mobility (50 categories, 47.6%). Conclusions: The standard set for older individuals with joint contractures provides health professionals with a standard for describing patients' activity limitations and participation restrictions. The standard set also provides a common basis for the development of patient-centered measures and intervention programs. The preliminary version of the ICF-based standard set will be tested in subsequent studies with regard to its psychometric properties. © 2015 Elsevier Ireland Ltd.


Rasche F.M.,University of Leipzig | Schmidt S.,Friedrich Loeffler Institute | Kretzschmar C.,Friedrich Loeffler Institute | Mertens M.,Friedrich Loeffler Institute | And 7 more authors.
Clinical Nephrology | Year: 2015

A 21-year-old male patient from Borna, Saxony, in Eastern Germany, suffered from acute kidney injury (AKI) and symptoms typical for a hantavirus infection. These symptoms included nausea, vomiting, abdominal pain, diarrhea, and acute renal failure. Serological investigations by indirect IgM and IgG in-house ELISAs, commercial immunofluorescence and line assays, as well as chemiluminescence focus reduction neutralization assay confirmed an acute Dobrava- Belgrade virus (DOBV) infection of the patient. Serological and RT-PCR analyses of striped field mouse (Apodemus agrarius) trapped in a neighboring region of the residence of the patient identified an infection by DOBV, genotype Kurkino. This is the first report of an autochthonous DOBV infection in a German patient living far from the known endemic region in the north of the country. This finding has implications for the awareness of physicians in areas which are not recognized as hantavirus endemic regions but where the reservoir host of the virus is present. © 2015 Dustri-Verlag Dr. K. Feistle.


Koppara A.,University of Bonn | Koppara A.,German Center for Neurodegenerative Diseases | Wolfsgruber S.,University of Bonn | Wolfsgruber S.,German Center for Neurodegenerative Diseases | And 27 more authors.
Journal of Alzheimer's Disease | Year: 2015

Background: The recently proposed latent variable δ is a new tool for dementia case finding. It is built in a structural equation modeling framework of cognitive and functional data and constitutes a novel endophenotype for Alzheimer's disease (AD) research and clinical trials. Objective: To investigate the association of δ with AD biomarkers and to compare the prediction of δ with established scales for conversion to dementia in patients with mild cognitive impairment (MCI). Methods: Using data from a multicenter memory clinic study, we examined the external associations of the latent variable δ and compared δ with well-established cognitive and functional scales and cognitive-functional composite scores. For that purpose, logistic regressions with cerebrospinal fluid (CSF) biomarkers and conversion to dementia as dependent variables were performed with the investigated scores. The models were tested for significant differences. Results: In patients with MCI, δ based on a broad range of cognitive scales (including theADAS-cog, theMMSE,and theCERAD neuropsychological battery) predicted an abnormal CSF Aβ42/tau ratio indicative of AD (n = 340, AUC= 0.78, p < 0.001), and predicted incident dementia within 1-3 years of follow-up (n = 525, AUC= 0.84, p < 0.001). These associations were generally stronger than for any other scale or cognitive-functional composite examined. Homologs of δ based on reduced test batteries yielded somewhat lower effects. Conclusion: These findings support the interpretation of δ as a construct capturing the disease-related "essence" of cognitive and functional impairments in patients with MCI and dementia, and suggest that δ might become an analytical tool for dementia research. © 2016 - IOS Press and the authors.


PubMed | University of Bonn, University of Leipzig, Albert Ludwigs University of Freiburg, University of Hamburg and 11 more.
Type: Journal Article | Journal: Journal of Alzheimer's disease : JAD | Year: 2015

The recently proposed latent variable is a new tool for dementia case finding. It is built in a structural equation modeling framework of cognitive and functional data and constitutes a novel endophenotype for Alzheimers disease (AD) research and clinical trials.To investigate the association of with AD biomarkers and to compare the prediction of with established scales for conversion to dementia in patients with mild cognitive impairment (MCI).Using data from a multicenter memory clinic study, we examined the external associations of the latent variable and compared with well-established cognitive and functional scales and cognitive-functional composite scores. For that purpose, logistic regressions with cerebrospinal fluid (CSF) biomarkers and conversion to dementia as dependent variables were performed with the investigated scores. The models were tested for significant differences.In patients with MCI, based on a broad range of cognitive scales (including the ADAS-cog, the MMSE, and the CERAD neuropsychological battery) predicted an abnormal CSF A42/tau ratio indicative of AD (n=340, AUC=0.78, p< 0.001), and predicted incident dementia within 1-3 years of follow-up (n=525, AUC=0.84, p< 0.001). These associations were generally stronger than for any other scale or cognitive-functional composite examined. Homologs of based on reduced test batteries yielded somewhat lower effects.These findings support the interpretation of as a construct capturing the disease-related essence of cognitive and functional impairments in patients with MCI and dementia, and suggest that might become an analytical tool for dementia research.


PubMed | Friedrich - Alexander - University, Erlangen - Nuremberg, University of Leipzig, University of Duisburg - Essen, Albert Ludwigs University of Freiburg and 12 more.
Type: Journal Article | Journal: PloS one | Year: 2014

Concerns about worsening memory (memory concerns; MC) and impairment in memory performance are both predictors of Alzheimers dementia (AD). The relationship of both in dementia prediction at the pre-dementia disease stage, however, is not well explored. Refined understanding of the contribution of both MC and memory performance in dementia prediction is crucial for defining at-risk populations. We examined the risk of incident AD by MC and memory performance in patients with mild cognitive impairment (MCI).We analyzed data of 417 MCI patients from a longitudinal multicenter observational study. Patients were classified based on presence (n=305) vs. absence (n=112) of MC. Risk of incident AD was estimated with Cox Proportional-Hazards regression models.Risk of incident AD was increased by MC (HR=2.55, 95%CI: 1.33-4.89), lower memory performance (HR=0.63, 95%CI: 0.56-0.71) and ApoE4-genotype (HR=1.89, 95%CI: 1.18-3.02). An interaction effect between MC and memory performance was observed. The predictive power of MC was greatest for patients with very mild memory impairment and decreased with increasing memory impairment.Our data suggest that the power of MC as a predictor of future dementia at the MCI stage varies with the patients level of cognitive impairment. While MC are predictive at early stage MCI, their predictive value at more advanced stages of MCI is reduced. This suggests that loss of insight related to AD may occur at the late stage of MCI.

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