RSS-Feed abonnieren
DOI: 10.1055/s-0029-1223473
© Georg Thieme Verlag KG Stuttgart · New York
MMST zur Überlebensprognostik bei Demenz
8-Jahre-Follow-up-Studie bei 145 ambulanten DemenzpatientenMMSE for Survival Prognostics in DementiaAn 8-Year Follow-Up Study in 145 OutpatientsPublikationsverlauf
Publikationsdatum:
24. Februar 2010 (online)
![](https://www.thieme-connect.de/media/psychiat-praxis/201002/lookinside/thumbnails/10.1055-s-0029-1223473-1.jpg)
Zusammenfassung
Anliegen Inwieweit lassen sich Überlebenszeiten bei Demenz aus dem Punktwert des Mini-Mental-Status-Tests berechnen? Methode Bei 145 Demenzpatienten wurde anhand von Cox-Regressionsanalysen das Sterberisiko für Demenzschweregrade und MMST-Einzelwerte berechnet. Ergebnisse Gemäß Cox-Regression erhöht sich das relative Sterberisiko pro Stufe im Demenzschweregrad (leicht / mittel / schwer) je um 36,2 % (p = 0,023), pro abnehmendem MMST-Punkt um 4,1 % (p = 0,005). Schlussfolgerung Der MMST-Punktwert kann als Prognosefaktor im Rahmen individueller Beratung und Planung sowie für gesundheits- und sozialpolitisches Management herangezogen werden.
Abstract
Objective Evaluation of the predictive power of the Mini-Mental State Examination (MMSE) for survival analyses of dementia patients. Methods In an 8-year follow-up study for 145 dementia outpatients the survival and relative death risks (hazard ratios) were calculated with Kaplan Meier and Cox-regression analyses. Results Following Cox-regression the relative death risk increases by 36.2 % per severity level of dementia (mild / moderate / severe), p = 0.023. Per single MMSE point lost, the relative death risk rises by 4.1 % (p = 0.005). Kaplan Meier analysis supports the result. Conclusions MMSE scores may in fact be used for dementia survival prognoses in counseling family and professional caregivers of dementia patients, but also for socioeconomic management of the increasing dementia burden for society.
Schlüsselwörter
Demenz - MMST - Überlebenszeit - Prognose - Hazard Ratio
Keywords
dementia - MMSE - survival - prognosis - hazard ratio
Literatur
- 1 Bundesministerium für Familien, Senioren, Frauen und Jugend (BMFSFJ) .Fünfter Bericht zur Lage der älteren Generation. Bundesministerium für Familien, Senioren, Frauen und Jugend 2005: 35-80
- 2 Hux M J, O'Brien B J, Iskedjian M. et al . Relation between severity of Alzheimer's disease and costs of caring. CMAJ. 1998; 159 457-465
- 3 Wolstenholme J, Fenn P, Gray A. et al . Estimating the relationship between disease progression and cost of care in dementia. Br J Psychiatry. 2002; 181 36-42
- 4 Caro J, Ward A, Ishak K. et al . To what degree does cognitive impairment in Alzheimer's disease predict dependence of patients on caregivers?. BMC Neurol. 2002; 2 6
- 5 Rainer M, Jungwirth S, Kruger-Rainer C. et al . Family caregivers of patients with dementia: impact of factors of burden. Psychiat Prax. 2002; 29 142-147
- 6 Andersen C K, Wittrup-Jensen K U, Lolk A. et al . Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia. Health Qual Life Outcomes. 2004; 2 52
- 7 Waring S C, Doody R S, Pavlik V N. et al . Survival among patients with dementia from a large multi-ethnic population. Alzheimer Dis Assoc Disord. 2005; 19 178-183
- 8 Artaz M A, Boddaert J, Heriche-Taillandier E. et al . Medical comorbidity in Alzheimer's disease: baseline characteristics of the REAL.FR Cohort. Rev Med Interne. 2006; 27 91-97
- 9 Foley D J, Brock D B, Lanska D J. Trends in dementia mortality from two National Mortality Followback Surveys. Neurology. 2003; 60 709-711
- 10 Nitrini R, Caramelli P, Herrera Jr E. et al . Mortality from dementia in a community-dwelling Brazilian population. Int J Geriatr Psychiatry. 2005; 20 247-253
- 11 Boersma F, Van Den B W, Deeg D J. et al . Survival in a population-based cohort of dementia patients: predictors and causes of mortality. Int J Geriatr Psychiatry. 1999; 14 748-753
- 12 Barton C, Miller B, Yaffe K. Improved evaluation and management of cognitive impairment: results of a comprehensive intervention in long-term care. J Am Med Dir Assoc. 2006; 7 84-89
- 13 Perneczky R, Wagenpfeil S, Komossa K. et al . Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry. 2006; 14 139-144
- 14 Walsh J S, Welch H G, Larson E B. Survival of outpatients with Alzheimer-type dementia. Ann Intern Med. 1990; 113 429-434
- 15 Berg S, Jeppson L. Cognitive functioning and survival in psychogeriatric patients. Acta Psychiatr Scand. 1991; 84 160-162
- 16 Wolf R, Weber S. Factors affecting delayed initial diagnosis of dementing diseases. Z Gerontol Geriatr. 1998; 31 209-221
- 17 Perneczky R, Wagenpfeil S, Komossa K. et al . Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry. 2006; 14 139-144
- 18 Tierney M C, Charles J, Naglie G. et al . Risk factors for harm in cognitively impaired seniors who live alone: a prospective study. J Am Geriatr Soc. 2004; 52 1435-1441
- 19 Larson E B, Shadlen M F, Wang L. et al . Survival after initial diagnosis of Alzheimer disease. Ann Intern Med. 2004; 140 501-509
- 20 Aguero-Torres H, Fratiglioni L, Guo Z. et al . Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm. J Am Geriatr Soc. 1998; 46 444-452
- 21 Bowen J D, Malter A D, Sheppard L. et al . Predictors of mortality in patients diagnosed with probable Alzheimer's disease. Neurology. 1996; 47 433-439
- 22 Tschanz J T, Corcoran C, Skoog I. et al . Dementia: the leading predictor of death in a defined elderly population: the Cache County Study. Neurology. 2004; 62 1156-1162
- 23 Ganguli M, Dodge H H, Shen C. et al . Alzheimer disease and mortality: a 15-year epidemiological study. Arch Neurol. 2005; 62 779-784
- 24 Bonaiuto S, Mele M, Galluzzo L. et al . Survival and dementia: a 7-year follow-up of an Italian elderly population. Arch Gerontol Geriatr. 1995; 20 105-113
- 25 Frisoni G B, Fratiglioni L, Fastbom J. et al . Mortality in nondemented subjects with cognitive impairment: the influence of health-related factors. Am J Epidemiol. 1999; 150 1031-1044
- 26 Noale M, Maggi S, Minicuci N. et al . Dementia and disability: impact on mortality. The Italian Longitudinal Study on Aging. Dement Geriatr Cogn Disord. 2003; 16 7-14
- 27 Bhargava D, Weiner M F, Hynan L S. et al . Vascular disease and risk factors, rate of progression, and survival in Alzheimer's disease. J Geriatr Psychiatry Neurol. 2006; 19 78-82
- 28 Bracco L, Gallato R, Grigoletto F. et al . Factors affecting course and survival in Alzheimer's disease. A 9-year longitudinal study. Arch Neurol. 1994; 51 1213-1219
- 29 Wolfson C, Wolfson D B, Asgharian M. et al . A reevaluation of the duration of survival after the onset of dementia. N Engl J Med. 2001; 344 1111-1116
- 30 Karlawish J H, Casarett D, Propert K J. et al . Relationship between Alzheimer's disease severity and patient participation in decisions about their medical care. J Geriatr Psychiatry Neurol. 2002; 15 68-72
- 31 Luck T, Busse A, Hensel A. et al . Leichte kognitive Beeinträchtigungen und Demenzentwicklung. Ergebnisse einer bevölkerungsrepräsentativen Längsschnittstudie (LEILA 75+). Psychiat Prax. 2008; 35 331-336
- 32 Aurich C, Riedel-Heller S G, Becker T. Does education prevent dementia?. Psychiat Prax. 1999; 26 112-115
- 33 Kissler S, Hötte S D, Lankers D. et al . Welchen Einfluss haben zerebrale Durchblutungsstörungen auf die Überlebenszeit Demenzerkrankter?. Z Gerontol Geriatr. 2008; 41 51-55
- 34 Lankers D, Kissler S, Hötte S D. et al . Welchen Einfluss hat die Wohnform auf die Überlebenszeit Demenzerkrankter?. Z Gerontol Geriatr . 2010 angenommen;
- 35 Riedel-Heller S, Bramesfeld A, Roick C. et al . Der Ruf nach mehr Versorgungsforschung. Psychiat Prax. 2008; 35 157-159
Priv.-Doz. Dr. med. habil. Stefan Georg Schröder
Ernst-Moritz-Arndt-Universität Greifswald, Arbeitsgruppe Gerontopsychiatrie, Chefarzt der Klinik für Psychiatrie, Psychotherapie und Psychosomatik, KMG Klinikum Güstrow
Friedrich-Trendelenburg-Allee 1
18273 Güstrow
eMail: s.schroeder@kmg.ag