Toro P, Schönknecht P, Schröder J. Type II diabetes in mild cognitive impairment and Alzheimer's disease: results from a prospective population-based study in Germany. J Alzheimers Dis. 2009 Apr;16(4):687-91.

Diabetes mellitus type 2 (T2DM) is considered to be an important risk factor for mild cognitive impairment (MCI) and subsequent Alzheimer's disease (AD). The majority of studies relating T2DM to MCI and AD were performed in North America. We investigated the potential impact of T2DM on the development of MCI and AD in the Interdisciplinary Longitudinal Study on Adult Development and Aging which involves a representative birth cohort of subjects born between 1930 and 1932 in Germany. Subjects received a thorough psycho-geriatric examination and neuropsychological testing; particular care was taken to exclude subjects with severe medical or neurological conditions sufficient to explain the cognitive deficits, or other major psychiatric disorders. When compared to healthy subjects (n=159), patients with MCI (n=108) or AD (n=26) showed a tendency towards increased prevalence rates for T2DM (17% vs. 23%; chi2=1.7, p=0.18). In both patients with MCI and controls, T2DM was associated with psychomotor slowing but not deficits in other cognitive domains typically involved in MCI. Our findings indicate that T2DM is involved in MCI and may aggravate the clinical picture as a concomitant factor.

Schwalen S, Förstl H. [Alzheimer's disease: knowledge and attitudes in a representative survey]. Neuropsychiatr. 2008;22(1):35-7.

Dementia is a prevalent syndrome in ageing societies and therefore of significant medical and social importance for the general population. We have studied knowledge and attitudes towards Alzheimer's dementia (AD) of 1245 epidemiologically representative individuals between 14 and 99 years. Only 13% mentioned memory disturbances, e.g. forgetfulness, as hallmarks of AD; 54% knew that age was a major risk factor; 47% felt that "brain-jogging" was therapeutically useful. In case of developing AD, more than 70% wished to be informed together with a close relative or friend; 7% felt that nobody else should know about their problem; and many more than 50% expected information on treatment, course, symptoms and causes. These results demonstrate, that there is a remarkable lack of relevant information on AD in the general population, and that most individuals wished to be informed about a potential diagnosis of AD together with their family and friends.

Brüne-Cohrs U, Juckel G, Schröder SG. [The quality of the diagnostic assessment of dementia in nursing homes]. Z Arztl Fortbild Qualitatssich. 2007;101(9):611-5.

The increasing prevalence of psychogeriatric disorders among nursing home (NH) residents poses a challenge to both specialists and non-specialists. Dementia is the most common disorder among NH residents. However, studies show a lack of diagnostic and therapeutic precision in dementia among this population. Our own data show that 40% of 200 NH residents were not accurately diagnosed with dementia according to ICD-10 criteria. A substantial number of healthy subjects were pre-diagnosed with a cognitive disorder without fulfilling the criteria for dementia or mild cognitive impairment. Obligatory psychogeriatrical education is warranted for GPs as well as for specialists to improve medical treatment of dementia in NH residents.

Bickel H, Bürger K, Hampel H, Schreiber Y, Sonntag A, Wiegele B, Förstl H, Kurz A. [Presenile dementia in memory clinics--incidence rates and clinical features] Nervenarzt. 2006 Sep;77(9):1079-85.

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.

Bickel H. [Dementia syndrome and Alzheimer disease: an assessment of morbidity and annual incidence in Germany] Gesundheitswesen. 2000 Apr;62(4):211-8.

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.

Drach LM, Steinmetz HE, Wach S, Bohl J. High proportion of dementia with Lewy bodies in the postmortems of a mental hospital in Germany. Int J Geriatr Psychiatry. 1997 Mar;12(3):301-6.

OBJECTIVE: Dementia with Lewy bodies (DLB) is under-recognized in Germany. No data on the number of patients suffering from this condition in Germany are available at present. We were interested in the proportion of DLB in the postmortems of demented inpatients in the care of a psychogeriatric service. DESIGN: In a retrospective study we examined consecutive postmortems of inpatients who died in one mental hospital. SETTING: A suburban and rural old age psychiatry service in Germany. PATIENTS: 103 consecutive postmortems had been performed from 9/1987 to 6/1995. Fifty-nine (57.3%) of all cases warranted the clinical diagnosis of dementia (DSM-III-R). MEASURES: The causes of dementia were examined histologically. Lewy bodies (LBs) were detected with ubiquitin immunohistochemistry. RESULTS: DLB was the third most frequent cause of dementia (13.6% of demented), after dementia of Alzheimer's type (DAT) (35.6%) and mixed DAT and vascular dementia (15.3%), but ahead of 'pure' vascular dementia (MID). The DLB group showed a male preponderance compared with the DAT, MID and mixed group of our series. The DLB patients died younger than the DAT patients. The differences, however, were not statistically significant. All DLB cases showed neurofibrillary and amyloid pathology sufficient to warrant an additional diagnosis of DAT. Cases with 'pure' LB pathology had not been detected in our series. CONCLUSIONS: Our results indicate that by using appropriate methods, ie ubiquitin immunohistochemistry, a considerable number of DLB cases can be detected in postmortems of demented patients from German mental hospitals.

Neubauer S, Holle R, Menn P, Grossfeld-Schmitz M, Graesel E. Measurement of informal care time in a study of patients with dementia. Int Psychogeriatr. 2008 Dec;20(6):1160-76. Epub 2008 Jul 8.

BACKGROUND: Previous assessments of informal care time have tended to consider only the amount of time spent with the patient by the primary informal caregiver; however, in many cases, more than one person is providing care for the patient. We assess total informal care time of people caring for patients with dementia, and estimate the bias that can arise if consideration is not made of the time spent by all participating informal caregivers. METHOD: We used an extended version of the questions on informal care time from the Resource Utilization in Dementia (RUD) instrument. Caregivers were asked to state the number of days and the number of hours on a typical day they had assisted the patient in activities of daily living (ADL), instrumental ADL (IADL), and supervision during the last four weeks. Multivariate regression analyses were conducted to identify factors that could account for the amount of informal care time. RESULTS: 357 informal caregivers took part. Values were missing from only 4.5% of all interviews. On average, the primary informal caregiver cared for the patient 1.5, 2.1 and 1.9 hours per day in ADL, IADL and supervision respectively. Fifty-seven percent of all patients had more than one informal caregiver. Total informal care time was underestimated by about 14% if the time of caregivers other than the primary caregiver was not taken into account. The informal care time was significantly higher if the caregiver was the patient's partner and the patient's health status was lower. CONCLUSION: Our results show that most previous studies probably underestimated costs of informal care because the time of informal caregivers other than the primary caregiver was not considered.

Teipel SJ, Ewers M, Reisig V, Schweikert B, Hampel H, Happich M. Long-term cost-effectiveness of donepezil for the treatment of Alzheimer's disease. Eur Arch Psychiatry Clin Neurosci. 2007 Sep;257(6):330-6.

BACKGROUND: (Acetyl-)cholinesterase (ChE) inhibitors have been approved for the treatment of mild to moderate Alzheimer's disease (AD). However, use of ChE inhibitors is limited by budget constraints and disincentives on the side of health insurances and nursing care insurances. OBJECTIVE: To analyse under what conditions the application of the acetylcholinesterase inhibitor donepezil is favourable for the treatment of patients with AD from the perspective of health insurance and nursing care insurance companies in Germany, taking into account factors such as start and duration of treatment, duration of follow-up, drug costs, internalization of opportunity costs and varying mortality and efficacy rates. METHODS: Transition probabilities from a Swedish study and German cost data for donepezil were merged in a Markov model to follow a cohort of patients over a period of 5-10 years. We defined a base case with 1 year treatment and follow-up over 5 years and varied treatment length, follow-up interval and cost factors in sensitivity analyses. RESULTS: In the base case, the ChE inhibitor donepezil did not lead to cost savings but to a cost-effective outcome on side of health insurances and nursing care insurances. Early treatment of AD and internalization of opportunity costs (caring time devoted to patients) led to less costs per quality adjusted life years gained. However, results are very sensitive with respect to varying mortality and efficacy rates. CONCLUSION: The application of donepezil may be cost-effective, but considerable uncertainties remain. Moreover, the way the reimbursement system in Germany is presently arranged does not support the application of ChE inhibitors.

Bickel H. [Dementia in advanced age: estimating incidence and health care costs] Z Gerontol Geriatr. 2001 Apr;34(2):108-15.

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.