Michael Wagner

A conceptual framework for research on subjective cognitive decline in preclinical Alzheimer's disease

There is increasing evidence that subjective cognitive decline (SCD) in individuals with unimpaired performance on cognitive tests may represent the first symptomatic manifestation of Alzheimers disease (AD). The research on SCD in early AD, however, is limited by the absence of common standards. The working group of the Subjective Cognitive Decline Initiative (SCD‐I) addressed this deficiency by reaching consensus on terminology and on a conceptual framework for research on SCD in AD. In this publication, research criteria for SCD in pre‐mild cognitive impairment (MCI) are presented. In addition, a list of core features proposed for reporting in SCD studies is provided, which will enable comparability of research across different settings. Finally, a set of features is presented, which in accordance with current knowledge, increases the likelihood of the presence of preclinical AD in individuals with SCD. This list is referred to as SCD plus.

Controlled multicenter trial of laparoscopic transabdominal preperitoneal hernioplasty vs Shouldice herniorrhaphy

AbstractBackground: In February 1993 a prospective randomized multicenter trial was initiated to compare laparoscopic transabdominal preperitoneal hernioplasty to Shouldice herniorrhaphy as performed by surgeons of nonspecialized clinics.nMethods: Until January 1994, 87 patients with 108 hernias took part in the trial (43 Shouldice and 44 laparoscopic repairs).nResults: The laparoscopic procedure took significantly longer than did the open operation but caused less pain as measured by pain analogue score and consumption of paracetamol and narcotics. The postoperative complication rate was 26% in the open and 16% in the laparoscopic group. The patients in the laparoscopic group were discharged earlier and their convalescence was shorter than after open hernia repair. There has been one early recurrence in the laparoscopic and two in the open group to date with a mean follow-up of 201 days.nConclusions: Laparoscopic hernia repair causes less pain than the conventional operation and enables the patient to return to full work and usual activities earlier. The recurrence rate will not be known for 5 years.

Randomized controlled trial of laparoscopic transabdominal preperitoneal hernioplasty vs Shouldice repair

Background: There is a scarcity of data on long-term results after laparoscopic hernia repair. Herein we report on the outcome of a group of patients who were followed up for 5 years in a multicenter study on hernia repair. Methods: A total of 100 patients with 127 hernias were randomized to undergo either transabdominal preperitoneal (TAPP) or Shouldice hernia repair. Follow-up was by clinical examination and standardized questionnaire. Results: Of the 100 patients who underwent surgery, 84 were available for follow-up at 5 years. The TAPP procedure was less painful than the Shouldice repair, with fewer patients receiving narcotic analgesics. The median time to return to 100% activity was shorter in the laparoscopic group (21 days) than in the Shouldice group (40 days). Up to 60 months after the operation, the complication rate was lower in laparoscopically repaired hernias (19/66) than in the open group (25/61). There were two recurrences (3.9%) in the TAPP group and five in the Shouldice group (10.2%). Conclusion: The TAPP hernia repair yields comparable or better results than Shouldice herniorrhaphy in terms of postoperative pain, recovery, and recurrence rate.

Laparoscopic stapler appendectomy

AbstractBackground: The value of laparoscopic appendectomy remains controversial. Therefore, we investigated the accuracy of diagnostic laparoscopy in detecting acute appendicitis and tested the applicability and safety of stapling appendectomy as a routine procedure.nMethods: Data from 267 consecutive patients with suspicion of acute appendicitis were recorded prospectively.nResults: Histopathological examination revealed nonperforated and perforated appendicitis in 63.3% and 13.1%, respectively, and no inflammation in 10.8%. Other pathological findings were observed in 12.7%. Diagnostic laparoscopy detected appendicitis with a sensitivity and specificity of 95.6% and 96.6%, respectively; the positive and negative predictive value were 99.5% and 74.3%, respectively. Morbidity was 10.2% in total and 40% for perforated appendicitis. Planned laparoscopic reexploration reduced morbidity by 23.4% in patients with perforated appendicitis and substantial peritonitis. Mortality was 0.4%.nConclusions: Laparoscopy improves diagnostic accuracy for acute appendicitis and laparoscopic stapling appendectomy is a safe and efficient procedure for all forms of appendicitis.

Novel approaches for prevention of stroke related to transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) has emerged as a therapeutical option in patients with aortic stenosis. The methodology has evolved rapidly throughout the last decade. Nowadays, peri-procedural circulatory support, surgical vascular access, general anesthesia and mechanical ventilation are mainly reserved for selected patients. However, numerous challenges need to be addressed in order to further improved outcome of this distinct cohort: patient selection in general, vascular access strategies, long-term valve performance and paravalvular leakage. Another key issue is the risk of cerebrovascular events related to TAVI. In this article, the authors review the current literature on the risk of cerebrovascular events, the underlying mechanisms, the diagnostic read-outs of cerebral injury and their prognostic value, and ultimately discuss conceivable concepts for prevention of stroke associated with TAVI.

Excess health care costs of late-life depression - Results of the AgeMooDe study.

INTRODUCTIONnThe study aimed at determining excess costs of late-life depression from a societal perspective. Moreover, the impact of recognition of depression by GPs on costs was investigated.nnnMETHODSnCross-sectional data were obtained from a large multicenter observational cohort study (AgeMooDe). Participants (n=1197) aged 75 years or older and were recruited via their GPs in Leipzig, Bonn, Hamburg, and Mannheim in Germany from May 2012 until December 2013. In the base case analysis, depression was assessed using the Geriatric Depression Scale (GDS; cutoff GDS≥6). Data on health care utilization and costs were based on participants self-reports for inpatient treatment, outpatient treatment, pharmaceuticals, and formal and informal nursing care.nnnRESULTSnUnadjusted mean costs in a six-month period for depressed individuals (€5031) exceeded those of non-depressed (€2700) by the factor 1.86 and were higher in all health care sectors considered. Statistically significant positive excess costs persisted in all formal health care sectors after adjusting for comorbidity and socio-demographics. Recognition of depression by the GP did not moderate the relationship of depression and health care costs.nnnLIMITATIONSnAnalyses were restricted to a cross-sectional design, not permitting any conclusions on causal interference of the variables considered.nnnCONCLUSIONnThe findings stress the enormous burden of depression in old age for all sectors of the health care system. The fact that GPs recognition of depression does not moderate the relationship between depression and costs adds further insights into the economics of this frequent psychiatric disorder.

The Impact of Depressive Symptoms on Healthcare Costs in Late Life: Longitudinal Findings From the AgeMooDe Study

OBJECTIVEnTo examine whether depressive symptoms affect healthcare costs in old age longitudinally.nnnDESIGNnMulticenter prospective observational cohort study (two waves with nt1u2009=u20091,195 and nt2u2009=u2009951) in Germany.nnnSETTINGnCommunity.nnnPARTICIPANTSnParticipants aged 75 years and older recruited via general practitioners.nnnMEASUREMENTSnDepressive symptoms were assessed by the Geriatric Depression Scale (GDS). The health-related resource use was measured retrospectively from a societal perspective based on a questionnaire, covering outpatient services, inpatient treatment, pharmaceuticals, as well as formal and informal nursing care. Hybrid regression models were used to determine the between- and within-effect of depressive symptoms on healthcare costs, adjusting for important covariates.nnnRESULTSnSix-month total cost increased from €3,090 (t1) to €3,748 (t2). The hybrid random effects models showed that individuals with more depressive symptoms had higher healthcare costs compared with individuals with less depressive symptoms (between-effect). Moreover, an intra-individual increase in depressive symptoms increased healthcare costs by €539.60 (within-effect) per symptom on GDS.nnnCONCLUSIONSnOur findings emphasize the economic importance of depressive symptoms in old age. Appropriate interventions to treat depressive symptoms in old age might also be a promising strategy to reduce healthcare costs.

Circulating metabolites and general cognitive ability and dementia: Evidence from 11 cohort studies

Identifying circulating metabolites that are associated with cognition and dementia may improve our understanding of the pathogenesis of dementia and provide crucial readouts for preventive and therapeutic interventions.

Reduced future-oriented decision making in individuals with subjective cognitive decline: A functional MRI study

Subjective cognitive decline (SCD) refers to an at‐risk state of Alzheimers disease and subtle cognitive deficits that have been observed in this condition. Currently, it is unknown whether complex cognitive processes relevant to everyday life, such as future‐oriented choice behavior, are also altered in SCD.

Tau plasma levels in subjective cognitive decline: Results from the DELCODE study

Previous studies have demonstrated increased tau plasma levels in patients with Alzheimer’s disease (AD) and mild cognitive impairment (MCI) due to AD. Much less is known whether increased tau plasma levels can already be detected in the pre-MCI stage of subjective cognitive decline (SCD). In the present study we measured tau plasma levels in 111 SCD patients and 134 age- and gender-matched cognitively healthy controls participating in the DZNE (German Center for Neurodegenerative Diseases) longitudinal study on cognition and dementia (DELCODE). Tau plasma levels were measured using ultra-sensitive, single-molecule array (Simoa) technology. We found no significant different tau plasma levels in SCD (3.4u2009pg/ml) compared with healthy controls (3.6u2009pg/ml) after controlling for age, gender, and education (pu2009=u20090.137). In addition, tau plasma levels did not correlate with Aβ42 (ru2009=u20090.073; pu2009=u20090.634), tau (ru2009=u2009−0.179; pu2009=u20090.240), and p-tau181 (ru2009=u2009−0.208; pu2009=u20090.171) cerebrospinal fluid (CSF) levels in a subgroup of 45 SCD patients with available CSF. In conclusion, plasma tau is not increased in SCD patients. In addition, the lack of correlation between tau in plasma and CSF in the examined cohort suggests that tau levels are affected by different factors in both biofluids.