Stefan G. Schröder

Erotomania Variants in Dementia

Erotomania is a delusional syndrome in which an affected individual is convinced that another person loves him or her. Erotomania usually occurs in middle-aged female patients. Only 3 cases have been described in dementia so far. The authors report 2 cases, in Alzheimer’s disease and vascular dementia, in which erotomania emerged in the early stage of the underlying disorder. In both cases, erotomania partially responded to antipsychotic treatment. Erotomania may be understood in evolutionary terms as a pathologic deviation of an evolved psychological mechanism relating to mate selection and may therefore account for the typical sex distribution of the syndrome in favor of women and the onset of the disorder, usually during the late reproductive phase. The association of erotomania with dementing disorders may tentatively be interpreted to suggest that such complex psychological mechanisms and behaviors as involved here in “organic” delusions may have distinct, “hard-wired” representations in the human brain.

Agitation in the morning: symptom of depression in dementia?

To investigate the possible correlations between depression in dementia and agitation in the morning by a prospective naturalistic study.

[Impact of vascular pathology on survival times of 173 dementia patients--Hachinski's ischemic score as a predictive tool for clinical purposes].

Alzheimers disease and vascular dementia still may be looked upon as distinct nosologic entities, representing the two main etiologic categories of senile dementia. However, rather recent findings suggest a comorbidity of neurodegenerative and ischemic pathology in a majority of dementia cases in later life. The effect of the vascular pathology on the survival time was studied in 173 dementia outpatients. For 147 patients with complete datasets, we were able to gain information concerning their survival time. As an indicator of cerebrovascular morbidity the 18-point ischemic scale of Hachinski (HIS) was correlated with the survival time. Thus, we did not use the HIS for its original purpose to differentiate between degenerative and vascular dementia, but to roughly evaluate the cerebrovascular impact in a continuum model. Using the Cox model we calculated mortality risks for every point on the HIS. We found a Cox hazard ratio of 1.038 for each supplementary point on the HIS, which equals a 3.8% higher relative mortality risk. The result misses significance (p=0.092), but indicates a clear tendency towards a shortening of survival time by vascular comorbidity. Future prospective studies should integrate brain imaging to further corroborate our findings.ZusammenfassungBei der Ätiopathogenese der Altersdemenz wurden lange Zeit die vaskuläre Demenz und die Alzheimerdemenz als entgegengesetzte Pole verstanden. An diesem Paradigma orientiert sich die Differenzialdiagnostik mittels der Ischämie-Skala nach Hachinski (HIS), anhand derer zwischen beiden Haupt-Demenzformen unterschieden werden soll. Die aktuelle Demenzforschung favorisiert allerdings im Sinne eines Paradigmenwechsels als Hauptform der senilen Demenz eine gemischte vaskulär-degenerative Pathogenese. Vor diesem Hintergrund lautet die Fragestellung unserer „Follow-up“-Studie: Verkürzt zerebrovaskuläre Morbidität die Überlebenszeit Demenzkranker? Zur Evaluation zerebrovaskulärer Morbidität verwendeten wir die 18-Punkte-Ischämie-Skala nach Hachinski (HIS). Insofern benutzten wir die HIS nicht zu ihrem ursprünglichen Zweck (Differenzialdiagnose), sondern – einem nosologischen Kontinuitätsmodell zufolge – zur Abschätzung der „Vaskularität“. Für 173 Patienten mit Alzheimerdemenz oder vaskulärer Demenz (ICD-10-Nummern F00 und F01) wurde die Überlebenszeit ermittelt und mit dem Ischämie-Score nach Hachinski (IS) korreliert. Unter Anwendung des Cox-Modells wurden Sterberisiken ermittelt. Die Hazard-Ratio nach Cox beträgt 1,038, was einem um 3,8% höherem Sterberisiko pro einzelner Punkterhöhung auf der HIS entspricht. Die Cox-Regression bestätigt trendmäßig die Ausgangshypothese, verfehlt jedoch mit einem p von 0,092 das Signifikanzniveau. Die vaskuläre Komponente von Demenzerkrankungen bringt eine Verkürzung der Überlebenszeit mit sich. Weiterführende Studien unter Verwendung bildgebender Verfahren könnten hilfreich sein, um Prognostik und differentielle Interventionsstrategien bei Demenz zu optimieren.AbstractAlzheimers disease and vascular dementia still may be looked upon as distinct nosologic entities, representing the two main etiologic categories of senile dementia. However, rather recent findings suggest a comorbidity of neurodegenerative and ischemic pathology in a majority of dementia cases in later life. The effect of the vascular pathology on the survival time was studied in 173 dementia outpatients. For 147 patients with complete datasets, we were able to gain information concerning their survival time. As an indicator of cerebrovascular morbidity the 18-point ischemic scale of Hachinski (HIS) was correlated with the survival time. Thus, we did not use the HIS for its original purpose to differentiate between degenerative and vascular dementia, but to roughly evaluate the cerebrovascular impact in a continuum model. Using the Cox model we calculated mortality risks for every point on the HIS. We found a Cox hazard ratio of 1.038 for each supplementary point on the HIS, which equals a 3.8% higher relative mortality risk. The result misses significance (p = 0.092), but indicates a clear tendency towards a shortening of survival time by vascular comorbidity. Future prospective studies should integrate brain imaging to further corroborate our findings.

Welchen Einfluss haben zerebrale Durchblutungsstörungen auf die Überlebenszeit Demenzerkrankter

Alzheimers disease and vascular dementia still may be looked upon as distinct nosologic entities, representing the two main etiologic categories of senile dementia. However, rather recent findings suggest a comorbidity of neurodegenerative and ischemic pathology in a majority of dementia cases in later life. The effect of the vascular pathology on the survival time was studied in 173 dementia outpatients. For 147 patients with complete datasets, we were able to gain information concerning their survival time. As an indicator of cerebrovascular morbidity the 18-point ischemic scale of Hachinski (HIS) was correlated with the survival time. Thus, we did not use the HIS for its original purpose to differentiate between degenerative and vascular dementia, but to roughly evaluate the cerebrovascular impact in a continuum model. Using the Cox model we calculated mortality risks for every point on the HIS. We found a Cox hazard ratio of 1.038 for each supplementary point on the HIS, which equals a 3.8% higher relative mortality risk. The result misses significance (p=0.092), but indicates a clear tendency towards a shortening of survival time by vascular comorbidity. Future prospective studies should integrate brain imaging to further corroborate our findings.ZusammenfassungBei der Ätiopathogenese der Altersdemenz wurden lange Zeit die vaskuläre Demenz und die Alzheimerdemenz als entgegengesetzte Pole verstanden. An diesem Paradigma orientiert sich die Differenzialdiagnostik mittels der Ischämie-Skala nach Hachinski (HIS), anhand derer zwischen beiden Haupt-Demenzformen unterschieden werden soll. Die aktuelle Demenzforschung favorisiert allerdings im Sinne eines Paradigmenwechsels als Hauptform der senilen Demenz eine gemischte vaskulär-degenerative Pathogenese. Vor diesem Hintergrund lautet die Fragestellung unserer „Follow-up“-Studie: Verkürzt zerebrovaskuläre Morbidität die Überlebenszeit Demenzkranker? Zur Evaluation zerebrovaskulärer Morbidität verwendeten wir die 18-Punkte-Ischämie-Skala nach Hachinski (HIS). Insofern benutzten wir die HIS nicht zu ihrem ursprünglichen Zweck (Differenzialdiagnose), sondern – einem nosologischen Kontinuitätsmodell zufolge – zur Abschätzung der „Vaskularität“. Für 173 Patienten mit Alzheimerdemenz oder vaskulärer Demenz (ICD-10-Nummern F00 und F01) wurde die Überlebenszeit ermittelt und mit dem Ischämie-Score nach Hachinski (IS) korreliert. Unter Anwendung des Cox-Modells wurden Sterberisiken ermittelt. Die Hazard-Ratio nach Cox beträgt 1,038, was einem um 3,8% höherem Sterberisiko pro einzelner Punkterhöhung auf der HIS entspricht. Die Cox-Regression bestätigt trendmäßig die Ausgangshypothese, verfehlt jedoch mit einem p von 0,092 das Signifikanzniveau. Die vaskuläre Komponente von Demenzerkrankungen bringt eine Verkürzung der Überlebenszeit mit sich. Weiterführende Studien unter Verwendung bildgebender Verfahren könnten hilfreich sein, um Prognostik und differentielle Interventionsstrategien bei Demenz zu optimieren.AbstractAlzheimers disease and vascular dementia still may be looked upon as distinct nosologic entities, representing the two main etiologic categories of senile dementia. However, rather recent findings suggest a comorbidity of neurodegenerative and ischemic pathology in a majority of dementia cases in later life. The effect of the vascular pathology on the survival time was studied in 173 dementia outpatients. For 147 patients with complete datasets, we were able to gain information concerning their survival time. As an indicator of cerebrovascular morbidity the 18-point ischemic scale of Hachinski (HIS) was correlated with the survival time. Thus, we did not use the HIS for its original purpose to differentiate between degenerative and vascular dementia, but to roughly evaluate the cerebrovascular impact in a continuum model. Using the Cox model we calculated mortality risks for every point on the HIS. We found a Cox hazard ratio of 1.038 for each supplementary point on the HIS, which equals a 3.8% higher relative mortality risk. The result misses significance (p = 0.092), but indicates a clear tendency towards a shortening of survival time by vascular comorbidity. Future prospective studies should integrate brain imaging to further corroborate our findings.

Do dementia patients living at home live longer than in a nursing home

Many studies have shown that the number of new dementia diagnoses in Germany is increasing yearly. Thus, two social tasks are important: the adequate support and care of dementia patients, now and in the future, as well as covering the costs thereof. The survival period of dementia patients has a central meaning - especially for health policy planning. Therefore, the question of our 8-year follow-up study was whether living conditions affect the survival period of dementia patients? A total of 173 dementia outpatients (ICD-10 numbers F00 and F01) were screened for survival time and living conditions. For deceased patients, a close reference person was interviewed, and the exact date of death was recorded. For statistical evaluation, the Cox proportional hazard model was used and dying risks were determined. Our investigation shows that a clear difference exists in the survival period of dementia patients, according to whether they have lived at home or in a senior citizens home. Patients in senior citizens homes had a higher relative dying risk of around 53.1% (hazard ratio), than for those cared for at home (p=0.047). Prospective research is needed to gain more evidence about the impact of social factors, e.g., living conditions, on the survival time of demented patients.

Neuroleptic-induced akathisia and early onset tardive dyskinesia in affective disorder due to Cushing's syndrome

Abstract A major portion of patients with Cushings syndrome develop organic affective or schizophreniform disorders in which hypercortisolemia is considered to be involved in the pathogenesis [1]. They often require neuroleptic treatment in addition to definitive therapy. There is little knowledge of whether these patients are particularly susceptible to developing neuroleptic-induced extrapyramidal side effects. There are animal models suggesting an enhanced dopamine receptor sensitivity due to chronic adrenocortical hyperfunction and in which apomorphine induced stereotypical gnawing behavior in rats may serve as a model for tardive dyskinesia [2]. Since neuroleptic treatment is usually restricted to a short period of time in patients with Cushings syndrome there are no case reports on persistent akathisia and severe tardive dyskinesia. We report a case of a 64-year-old woman suffering from acute persistent akathisia and early onset tardive dyskinesia after 6 weeks of neuroleptic treatment. The aim of this paper is to emphasize the importance of a thorough monitoring of neuroleptic treatment in patients with organic psychotic disorders and to discuss possible risk factors and treatment regimes.

Changeable production systems by the use of a holistic modularization: considering of technology, organization and staff

Abstract The steadily alternating and unpredictable requirements for industrial companies implicate the challenge to enhance production systems. As a consequence, the need for action leads to a paradigm shift in production. A transformation from a flexible production to a changeable company occurs. In this context, changeability will be decisive for the desired success. Production systems are used for the purpose of manufacturing products and are attributed to socio-technical systems. A production system is a unit used to realize the production and can include a single machine as well as a complete production area or the whole factory. The staff is also part of production systems and does not only assume organizational responsibilities but also technical tasks. Many already known drivers of change, e.g. new innovations in technologies, have an impact on these socio-technical systems. One chance to react to changing requirements is to apply the principle of modularization. Conventionally, modularization is considered in a technical context. The consideration of staff and organization is disregarded. This article introduces a new approach to design changeable production systems on the basis of modularization, including the dimensions of technology, organization and staff, which will enable industrial companies to make these complex socio-technical systems manageable.

Leben Demenzkranke zu Hause länger als im Heim?@@@Do dementia patients living at home live longer than in a nursing home?

Many studies have shown that the number of new dementia diagnoses in Germany is increasing yearly. Thus, two social tasks are important: the adequate support and care of dementia patients, now and in the future, as well as covering the costs thereof. The survival period of dementia patients has a central meaning - especially for health policy planning. Therefore, the question of our 8-year follow-up study was whether living conditions affect the survival period of dementia patients? A total of 173 dementia outpatients (ICD-10 numbers F00 and F01) were screened for survival time and living conditions. For deceased patients, a close reference person was interviewed, and the exact date of death was recorded. For statistical evaluation, the Cox proportional hazard model was used and dying risks were determined. Our investigation shows that a clear difference exists in the survival period of dementia patients, according to whether they have lived at home or in a senior citizens home. Patients in senior citizens homes had a higher relative dying risk of around 53.1% (hazard ratio), than for those cared for at home (p=0.047). Prospective research is needed to gain more evidence about the impact of social factors, e.g., living conditions, on the survival time of demented patients.