Jeannette Bischkopf

Mild cognitive impairment: a review of prevalence, incidence and outcome according to current approaches

Objective:  Mild cognitive impairment is associated with an increased risk of developing dementia. However, agreement needs to be reached on clearly specified diagnostic criteria for mild cognitive impairment. The present paper critically reviews the different constructs of mild cognitive impairment on the basis of the available empirical evidence.

Subclassifications for mild cognitive impairment: prevalence and predictive validity.

BACKGROUND Mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. Recently published results of the Current Concepts in MCI Conference suggested subclassifications for MCI (MCI-amnestic, MCI-multiple domains slightly impaired, MCI-single nonmemory domain) based on the recognized heterogeneity in the use of the term. These subclassifications have not been empirically validated to date. METHOD A community sample of 1045 dementia-free individuals aged 75 years and over was examined by neuropsychological testing in a three-wave longitudinal study. The prevalences and the predictive validities for the subclassifications of MCI and their modifications (original criteria except for the report of subjective decline in cognitive function) were determined. RESULTS The prevalence was 1 to 15% depending on the subset employed. Subjects with a diagnosis of MCI progressed to dementia at a rate of 10 to 55% over 2.6 years, depending on the subset employed. MCI-amnestic achieved the highest positive predictive power (PPP). ROC curves of the subclassifications for MCI indicate that all but one subset for MCI failed to predict dementia (MCI-multiple domains slightly impaired-modified: AUC=0.585, P<0.01, 95% CI, 0.517-0.653). The use of modified criteria for MCI (original criteria except for the report of subjective decline in cognitive function) is associated with a higher diagnostic sensitivity but also with a reduction in diagnostic specificity and PPP. CONCLUSIONS Modified criteria should be applied if a concept for MCI with a high sensitivity is required and the original criteria (including subjective cognitive complaint) if a concept with high specificity and high PPP is required.

Mild cognitive impairment1: prevalence and predictive validity according to current approaches

Objectives – Mild cognitive impairment is associated with an increased risk of developing dementia. However, there is no consensus on diagnostic criteria and different concepts have rarely been evaluated in population‐based samples. This paper compares the prevalences and predictive validities for different concepts in a population‐based study. The aim was to identify a concept with the best relation of sensitivity and specificity in the prediction of dementia.

Adaptation of dementia screening for vision-impaired older persons: Administration of the Mini-Mental State Examination (MMSE)

In epidemiologic field studies on the prevalence and incidence of dementia the problems associated with the cognitive testing of visually impaired individuals are rarely discussed. In the Leipzig Longitudinal Study of the Aged (LEILA 75+) a version of the Mini-Mental State Examination for the visually impaired (MMSE-blind) was employed from which all items requiring image processing had been omitted. To be able to interpret the test results and include vision-impaired individuals in the field study, the scores for the full MMSE were estimated by conducting linear transformation of the scores obtained on the MMSE-blind. The method of linear transformation is based on certain theoretical assumptions that are examined in this article. Linear transformation of scores has proved to be a valid procedure only for individuals with very high or very low cognitive performance. Thus, evaluation of the estimated full MMSE scores based on the norms for the original MMSE is not recommended. A blind version of the MMSE with age- and education-specific norms that has been validated as a screening tool for dementia is therefore presented.

Development and Psychometric Characteristics of the Dissociation Tension Scale

The newly developed Dissoziations-Spannungs-Skala (Dissociation Tension Scale; DSS) is a self-rating instrument for the assessment of psychological and somatoform dissociative features (ranging from normal up to pathological) as well as aversive inner tension occurring within the past 7 days. The DSS contains 21 items assessing dissociative symptoms and 1 additional item assessing aversive inner tension. Ratings are made on a time-oriented scale ranging from 0% (never) to 100% (constantly). We measured the psychometric qualities of the DSS in a total of 294 patients and healthy controls. Internal consistency of the DSS was high (Cronbachs α = .92; Gutmanns split-half r = .92). We found good support for convergent, discriminant, and differential validity. There was clear evidence for the DSS being a sensitive instrument for the assessment of changing symptomatology. Assessment of dissociation and other psychopathological features over the same period of time are now possible.

[Wishes of nursing home residents concerning their life situation--results of a qualitative study].

Zusammenfassung. Im Hinblick auf eine zufriedenstellende Gestaltung der Lebenssituation alter Menschen in Altenpflegeheimen wurden Bewohner danach befragt, wie sie ihre aktuelle Lebenssituation im Heim einschätzen und welche Wünsche sie bezüglich dieser Lebenssituation haben. Der Untersuchung liegt eine repräsentative Stichprobe von n = 1656 Bewohnern von 24 Altenpflegeheimen einer ostdeutschen Großstadt zugrunde. Mit Hilfe einer inhaltsanalytischen Vorgehensweise wurden verschiedene Bedürfniskategorien der Bewohner herausgearbeitet und in ihrer Bedeutung für die Gestaltung und Organisation von Pflege im Heim analysiert. Im Ergebnis wurde deutlich, dass aus der Sicht der Heimbewohner vor allem Verbesserungen in der psychosozialen Betreuung in den Altenpflegeheimen erforderlich sind.Summary.Objektive:This study examined the wishes of nursing home residents concerning their life situation in the nursing home.Methods: Using a qualitative study design, a representative sample of nursing home residents (n = 1656) of 24 nursing homes in a city situated in the eastern part of Germany were interviewed.Results:The analyses of residents’ wishes lead to major domains such as the quality of care, interpersonal contact, architecture and organization of the house, diversification, financial support, as well as themes like health and death and the wish to leave the nursing home. Residents focus on an individualized approach to care.Conclusions:Nursing home residents’ views support the need to improve the psychological and social aspects of the quality of care. Implications of and consequences for the organization of care and concepts of nursing are discussed.

Diskurse Systemischer Paarberatung bei Partnergewalt

In den letzten Jahren ist das Beratungsangebot fur Frauen und Manner, die in ihren Beziehungen Gewalt erlebt haben, zunehmend vielfaltiger geworden. Dies betrifft auch die Frauenhauslandschaft: In den letzten Jahren sind auch im deutschsprachigen Raum Angebote entwickelt worden, die mit systemischen Beratungskonzepten arbeiten und sich dabei unter anderem an Angeboten orientieren, die sich im europaischen Ausland bereits bewahrt haben, so z. B. die niederlandischen Oranje Huizen.

„Pflege mit Herz, Gesundheit oder Sterben“

Zusammenfassung. Im Hinblick auf eine zufriedenstellende Gestaltung der Lebenssituation alter Menschen in Altenpflegeheimen wurden Bewohner danach befragt, wie sie ihre aktuelle Lebenssituation im Heim einschätzen und welche Wünsche sie bezüglich dieser Lebenssituation haben. Der Untersuchung liegt eine repräsentative Stichprobe von n = 1656 Bewohnern von 24 Altenpflegeheimen einer ostdeutschen Großstadt zugrunde. Mit Hilfe einer inhaltsanalytischen Vorgehensweise wurden verschiedene Bedürfniskategorien der Bewohner herausgearbeitet und in ihrer Bedeutung für die Gestaltung und Organisation von Pflege im Heim analysiert. Im Ergebnis wurde deutlich, dass aus der Sicht der Heimbewohner vor allem Verbesserungen in der psychosozialen Betreuung in den Altenpflegeheimen erforderlich sind.Summary.Objektive:This study examined the wishes of nursing home residents concerning their life situation in the nursing home.Methods: Using a qualitative study design, a representative sample of nursing home residents (n = 1656) of 24 nursing homes in a city situated in the eastern part of Germany were interviewed.Results:The analyses of residents’ wishes lead to major domains such as the quality of care, interpersonal contact, architecture and organization of the house, diversification, financial support, as well as themes like health and death and the wish to leave the nursing home. Residents focus on an individualized approach to care.Conclusions:Nursing home residents’ views support the need to improve the psychological and social aspects of the quality of care. Implications of and consequences for the organization of care and concepts of nursing are discussed.