Rolf Nieczaj

Carotid atherosclerosis, vascular risk profile and mortality in a population-based sample of functionally healthy elderly subjects: the Berlin ageing study.

Abstract. Hillen T, Nieczaj R, Münzberg H, Schaub R, Borchelt M, Steinhagen‐Thiessen E (Humboldt‐University Berlin, Berlin; Department of Public Health Medicine/King’s College London, London; and Klinikum der Hansestadt Stralsund, Stralsund, Germany). Carotid atherosclerosis, vascular risk profile and mortality in a population‐based sample of functionally healthy elderly subjects: the Berlin Ageing Study. J Intern Med 2000; 247: 679–688.

Telematik in der Geriatrie – Potentiale, Probleme und Anwendungserfahrungen

Zusammenfassung Die Darstellung der modernen Kommunikations- und Informationstechnologie in den Medien verspricht auch älteren Menschen eine Chance zur Verbesserung der Lebensqualität. Mit „Neuen Medien” wie Bildtelefon oder PC, dem Internet und der elektronischen Post können geriatrische Patienten mit Beratungseinrichtungen, Ärzten, Therapeuten oder Pflegekräften, aber auch ihren eigenen Angehörigen oder Selbsthilfeeinrichtungen so vernetzt werden, dass sie bildgestützt kommunizieren und Informationen elektronisch erhalten oder übermitteln können. In der vorliegenden Arbeit wird untersucht, ob Versorgungsstrukturen in der Altersmedizin und Altenhilfe durch moderne Informations- und Kommunikationstechnologie („Telematik”) sinnvoll ergänzt oder sogar substituiert werden können. Trotz einer Vielzahl von Untersuchungen zur Telemedizin und zu Telematikanwendungen existieren nur wenige Studien, die eine Eignung für geriatrisch-rehabilitative Belange belegen. Eigene Anwendungserfahrungen aus einem geriatrischen Telematik-Projekt („TeleReha”) am Evangelischen Geriatriezentrum Berlin, in dem geriatrische Patienten und deren Angehörige mit professionellen Kräften aus dem Geriatriezentrum unter der Maßgabe des Erhalts eines Rehabilitationserfolges vernetzt wurden, zeigen aber, dass Telematik-gestützte Dienste von geriatrischen Patienten und deren Angehörigen als eine wertvolle zusätzliche Ressource angesehen werden, wenn sie mit einem qualifizierten Dienstleistungskonzept einhergehen. Abschließend werden die Potentiale, aber auch die Probleme von Telematikanwendungen in der Geriatrie diskutiert. Obwohl sich ein Bedarf beim geriatrischen Klientel identifizieren lässt, fehlt es in der Geriatrie noch an Initiativen, die notwendigen Konzepte und tragfähige Strukturen zu entwickeln. Das beachtliche Potential der telematischen Anwendungen für Geriatrie und Altenhilfe wird noch zu wenig beachtet. Gerade die Geriatrie kann und muss hier ihre spezifische Expertise einbringen, über die andere Disziplinen nicht gleichermaßen verfügen.Summary Modern telecommunication technology (telematics) has the potential to improve the quality of life for elders with physical and mental impairments as well as for their care giving relatives. Videophones, internet resources, and multimedia computers can be used for networking them together with social workers, nurse practitioners, physicians and therapeutic staff in service-centers. This can be viewed as a unique opportunity to establish and maintain instant and personalized access to various medical services in a situation where increasing needs are opposed to decreasing resources. However, it is not yet clear whether telematics is adequate, efficient, and effective in supporting care for geriatric patients. Some studies already showed its applicability and feasibility, but there are still no larger trials showing that maintenance or enhancement of autonomy can be achieved effectively by using new technologies. u2009u2009u2002This article reviews the literature on telematics in geriatrics and presents data of a tele-rehabilitation project (“TeleReha”, conducted at the Berlin Geriatric Center) which comprised mobility-impaired patients (N=13, mean age 72 yrs), care giving relatives (N=8), and geriatric professionals. Networking was established using ISDN technology with videophones or PC-based videoconferencing systems. Results showed that participants regard telecommunication devices as a valuable resource for their informational and communicational needs. Use of telecommunication systems was inversely related to physical mobility. Having access to professional service and counselling was rated highly important but also the opportunity to establish reliable contacts with non-professionals (relatives, other participants). Despite experienced technical problems, use of telecommunication systems was evaluated more positively in the post-test as compared to the pre-test. u2009u2009u2002In summary, current experience suggests that telematics can be used efficiently by geriatric patients and by relatives and professionals caring for them. However, evidence for a medically and economically effective use is still scarce. A lack of structural and organizational concepts for geriatric telematics initiatives can be identified which in part may be due to the fact that the considerable potentials of telematics applications are still largely unrecognized by geriatricians.

Primary and secondary prevention in dyslipidaemia in the elderly

Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of disability in advanced age. The relationship between coronary heart disease (CHD) and dyslipoproteinaemia is well known. The fact, however, that atherosclerosis is a systemic disease leads also to the consideration that patients suffering from cerebrovascular and peripheral arterial disease should benefit similarly from lipid lowering therapy as do patients with CHD. There is already growing evidence that the incidence of stroke may be markedly decreased by statin therapy. Though overall, the clinical significance of hypercholesterolaemia seems to decrease with increasing age, patients at age 65 to 75 tend to benefit even more than younger patients when elevated LDL-cholesterol is treated effectively. It should be noticed that prevention or postponement of cardiovascular events may also prevent premature functional limitations and disability in old age. Hence, it is suggested to screen elderly people with CVD for dyslipoproteinaemia and to treat elevated cholesterol levels by means of life style changes, nutritional therapy, and drug therapy. Treatment regimes should be considered depending upon complete risk stratification and geriatric assessment. Chronological age alone cannot be an argument to withhold a proven effective therapy from a growing segment of the population at risk.

Besteht auch bei multimorbiden geriatrischen Patienten ein Zusammenhang zwischen erhöhten Homocysteinspiegeln und kognitiven Defiziten?@@@Does an association between increased homocystein levels and cognitive dysfunction also exist in multimorbid geriatric patients?

ZusammenfassungHintergrundDer Zusammenhang zwischen Homocystein (Hcys)- bzw. Folsäurespiegeln im Blut und kognitiven Defiziten wurde bisher bei gesunden, nicht aber bei multimorbiden Senioren beschrieben. Die aktuelle Fragestellung ist daher, ob sich dieser Zusammenhang bei multimorbiden geriatrischen Patienten bestätigt.MethodikDer kognitive Status wurde von 189 (131 f/58 m) multimorbiden geriatrischen Patienten im Alter von 78,6 ± 7,3 Jahren mittels Syndrom-Kurztest (SKT) in einer Querschnittserhebung untersucht. Neben biochemischen Parametern (Plasma-Hcys, Serum-Folsäure, Vitamin B12, Blutbild), Ernährungsstatus (BMI, Mini Nutritional Assessment) wurde die Selbstständigkeit der Patienten erfasst. Die Bestimmung der Vitaminzufuhr erfolgte anhand des 3-Tage- Ernährungsprotokolls.ErgebnisseNach SKT zeigten 25,4% keine kognitive Leistungsstörungen, bei 21,2% lag ein Verdacht auf leichte kognitive Defizite vor, 12,7% hatten leichte, 9,0% mäßige und 31,7% schwere kognitive Defizite. Plasma Hcys-Spiegel waren unabhängig von kognitiven Defiziten um 20% erhöht. Folsäure und Vitamin B12 im Serum lagen im Normbereich, obwohl die Folsäurezufuhr um 75% vermindert war. Unterschiede zwischen SKT-Gruppen waren weder hinsichtlich Ernährungsstatus, Selbständigkeit, Anzahl der Diagnosen oder Medikation noch hinsichtlich biochemischer Parameter signifikant.SchlussfolgerungenEs wurden erhöhte Hcys-Spiegel bei multimorbiden geriatrischen Patienten mit kognitiven Defiziten und normalen Folsäure- und Vitamin B12- Konzentrationen analysiert. Hcys im Plasma erscheint als kein geeigneter biologischer Risikofaktor für kognitive Defizite bei multimorbiden geriatrischen Patienten.AbstractBackgroundTotal blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.MethodsAccording to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 ± 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B12, hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.ResultsAccording to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B12 levels were within range, though dietary folate intake (97 [80–128] µg/d) was reduced about 75% (recommendation 400 µg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B12 were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.ConclusionWe analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B12 concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.BACKGROUNDnTotal blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.nnnMETHODSnAccording to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 +/- 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B(12), hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.nnnRESULTSnAccording to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B(12) levels were within range, though dietary folate intake (97 [80-128] microg/d) was reduced about 75% (recommendation 400 microg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B(12) were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.nnnCONCLUSIONnWe analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B(12) concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.

Besteht auch bei multimorbiden geriatrischen Patienten ein Zusammenhang zwischen erhöhten Homocysteinspiegeln und kognitiven Defiziten

ZusammenfassungHintergrundDer Zusammenhang zwischen Homocystein (Hcys)- bzw. Folsäurespiegeln im Blut und kognitiven Defiziten wurde bisher bei gesunden, nicht aber bei multimorbiden Senioren beschrieben. Die aktuelle Fragestellung ist daher, ob sich dieser Zusammenhang bei multimorbiden geriatrischen Patienten bestätigt.MethodikDer kognitive Status wurde von 189 (131 f/58 m) multimorbiden geriatrischen Patienten im Alter von 78,6 ± 7,3 Jahren mittels Syndrom-Kurztest (SKT) in einer Querschnittserhebung untersucht. Neben biochemischen Parametern (Plasma-Hcys, Serum-Folsäure, Vitamin B12, Blutbild), Ernährungsstatus (BMI, Mini Nutritional Assessment) wurde die Selbstständigkeit der Patienten erfasst. Die Bestimmung der Vitaminzufuhr erfolgte anhand des 3-Tage- Ernährungsprotokolls.ErgebnisseNach SKT zeigten 25,4% keine kognitive Leistungsstörungen, bei 21,2% lag ein Verdacht auf leichte kognitive Defizite vor, 12,7% hatten leichte, 9,0% mäßige und 31,7% schwere kognitive Defizite. Plasma Hcys-Spiegel waren unabhängig von kognitiven Defiziten um 20% erhöht. Folsäure und Vitamin B12 im Serum lagen im Normbereich, obwohl die Folsäurezufuhr um 75% vermindert war. Unterschiede zwischen SKT-Gruppen waren weder hinsichtlich Ernährungsstatus, Selbständigkeit, Anzahl der Diagnosen oder Medikation noch hinsichtlich biochemischer Parameter signifikant.SchlussfolgerungenEs wurden erhöhte Hcys-Spiegel bei multimorbiden geriatrischen Patienten mit kognitiven Defiziten und normalen Folsäure- und Vitamin B12- Konzentrationen analysiert. Hcys im Plasma erscheint als kein geeigneter biologischer Risikofaktor für kognitive Defizite bei multimorbiden geriatrischen Patienten.AbstractBackgroundTotal blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.MethodsAccording to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 ± 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B12, hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.ResultsAccording to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B12 levels were within range, though dietary folate intake (97 [80–128] µg/d) was reduced about 75% (recommendation 400 µg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B12 were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.ConclusionWe analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B12 concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.BACKGROUNDnTotal blood homocysteine (Hcys) and folate have been investigated in association with cognitive dysfunction (CD) in healthy but not in multimorbid elderly patients. We hypothesized that total Hcys and folate are adequate markers to identify multimorbid elderly patients with CD.nnnMETHODSnAccording to the Short Performance Cognitive Test (SKT) CD was determined in a cross-sectional study with 189 (131 f/58 m) multimorbid elderly patients with a mean age of 78.6 +/- 7.3 yrs. Besides the analyses of biochemical parameters (Hcys, folate, vitamin B(12), hemogram) nutritional status (BMI, Mini Nutritional Assessment) as well as activities of daily living were assessed. Daily nutritional intake was measured with a 3-day nutrition diary. For analysis, we used the nutritional software program DGE-PC professional.nnnRESULTSnAccording to SKT 25.4% showed no cerebral cognitive dysfunction, 21.2% had a suspicion about incipient cognitive dysfunction, 12.7% showed mild, 9.0% moderate, 31.7% of patients severe cognitive deficits. Median plasma Hcys was about 20% elevated in multimorbid elderly patients independent of CD. Serum folate and vitamin B(12) levels were within range, though dietary folate intake (97 [80-128] microg/d) was reduced about 75% (recommendation 400 microg/d). Significant correlations between vitamin intake and plasma/serum levels of Hcys, folate and vitamin B(12) were not present. We did not find significant differences between SKT groups of nutritional status, activities of daily living, index of diseases, medications, or selected biochemical parameters.nnnCONCLUSIONnWe analysed elevated serum Hcys levels in multimorbid elderly patients with normal plasma folate and vitamin B(12) concentration and CD. Plasma Hcys or serum folate did not appear as an important biological risk factor on CD in multimorbid elderly patients.

Atherosclerotic disease in very old age: Preliminary results from the Berlin Aging Study (BASE)

Prevalence rates of atherosclerotic diseases and its association to risk- and protective factors were analyzed in an age and gender stratified sample of a Berlin population of 70-103-year-old subjects (BASE: Berlin Aging Study). The investigation revealed three essential findings. (i) Age-specific differences in the prevalence rates of coronary heart disease and peripheral vascular disease were not detectable. (ii) Cerebrovascular disease was less frequent among subjects over 90 years compared to younger subjects. (iii) Some well documented risk factors of cardiovascular morbidity (hypertension, obesity, low serum HDL-cholesterol) appeared to be unrelated to atherosclerotic manifestations in advanced old age. Hypertension, elevated serum-cholesterol and male sex, however, were significantly associated with cerebrovascular disease, as was smoking and male sex with peripheral vascular disease. The relatively low number of persons diagnosed with cerebrovascular disease.in the highest age-group (90-103 years) was probably due to selective mortality. In summary, this univariate analysis confirmed associations between cardiovascular morbidity, and risk factors also in advanced old age.