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DOI: 10.1055/s-0042-119863
Progression von leichter kognitiver Störung zur Demenz in deutschen Hausarztpraxen: Eine retrospektive, datenbankgestützte Auswertung
Progression of Mild Cognitive Impairment to Dementia of Patients in German Primary Care Practices: A Retrospective Database AnalysisPublication History
Publication Date:
15 November 2016 (online)
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Zusammenfassung
Ziel der Studie Schätzung der Progressionsrate von der leichten kognitiven Störung (MCI) zur Demenz und Untersuchung möglicher Risikofaktoren in deutschen Hausarztpraxen.
Methodik 4057 Patienten über 40 Jahre aus 723 Hausarztpraxen, bei denen erstmals zwischen 2000 und 2014 eine MCI diagnostiziert wurde. Die wichtigste Zielvariable in der Studie war die zum ersten Mal dokumentierte Demenz-Diagnose, die zwischen dem Beobachtungsbeginn (erste MCI-Diagnose-Stellung) und dem Beobachtungsende (maximal 5 Jahre) gestellt wurde. Cox-Regression-Modelle wurden eingesetzt, um den Einfluss von Kovariablen (Alter, Geschlecht, Versicherungsstatus) auf das Risiko des Übergangs von MCI zur Demenz zu untersuchen.
Ergebnisse Das Durchschnittsalter betrug 73,9 Jahre, 43,9 % waren Männer, 5,2 % der Patienten waren privat versichert. 27,4 % Frauen und 25,7 % Männer entwickelten eine Demenz (P = 0,192.). Die Demenzrate stieg von 6,6 % in der Altersgruppe ≤ 60 Jahre auf 39,0 % in der Altersgruppe > 80 Jahre. Die Hazard Ratio wuchs mit jedem zusätzlichen Lebensjahr (HR = 1,06).
Schlussfolgerung Hausärzte dokumentieren die Diagnose „Leichte kognitive Störung“ (MCI). Einer von vier Patienten entwickelt in fünf Jahren eine Demenz. Alter, aber nicht Geschlecht oder Versicherungstyp war mit dem erhöhten Demenzrisiko assoziiert. Die Progressionsraten sind denen wissenschaftlicher Studien vergleichbar.
Abstract
Aim To estimate the rate of progression of mild cognitive impairment (MCI) to dementia and to identify potential risk factors in patients in German primary-care practices.
Methodology From those seen at 723 general physicians’ practices, this study included 4057 patients aged 40 years and above who were initially diagnosed with MCI between 2000 and 2014. The primary outcome was diagnosis of all-cause dementia recorded between the index date and the end of the five-year follow-up. Cox regression models were performed to examine MCI progression to dementia when adjusted for confounders (age, sex and health insurance type).
Results The mean age was 73.9 years. There were 43.9 % of men and 5.2 % of individuals with private health insurance coverage. There were 27.4 % of women and 25.7 % of men with dementia after the five-year follow-up (P = 0.192). The proportion of dementia increased with age from 6.6 % in the age group of ≤ 60 years to 39.0 % in the age group of > 80 years, with the hazard ratio increasing every additional year (HR = 1.06).
Conclusion About one out of four patients developed dementia in the five years following MCI diagnosis. Age but not sex or type of health insurance was associated with this higher risk.
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Literatur
- 1 Eschweiler GW. Leyhe T. Klöppel S. et al. New developments in the diagnosis of dementia. Dtsch Arztebl Int 2010; 107 (39) 677-683
- 2 Jessen F. Alzheimer-Krankheit. Neukonzeption vor dem Hintergrund aktueller Biomarkerforschung. Dtsch Arztbl 2016; 113 (21) 1028-1030
- 3 Kaduszkiewicz H. Eisele M. Wiese B. et al. Prognosis of mild cognitive impairment in general practice: results of the German AgeCoDe study. Ann Fam Med 2014; 12 (02) 158-165
- 4 Kaduszkiewicz H. Zimmermann T. van den Busche H. et al. Do general practioners recognize mild cognitive impairment in their patients?. JNutr Health Aging 2010; 14 (08) 697-702
- 5 Luck T. Luppa M. Briel S. et al. Incidence of Mild Cognitive Impairment: A Systematic Review. Dement Geriat Cogn Disord 2010; 29: 164-175
- 6 Thyrian JR. Eichler T. Pooch A. et al. Systematic, early identification of dementia and dementia care management are highly appreciated by general physicians in primary care – results within a cluster-randomized-controlled trial (DelpHi). J Multidiscip Healthc 2016; 9: 183-190
- 7 Becher H. Kostev K. Schröder-Bernhardi D. Validity and representativeness of the “Disease Analyzer” patient database for use in pharmacoepidemiological and pharmacoeconomic studies. Int J Clin Pharmacol Ther 2009; 47: 617-626
- 8 Bohlken J. Weber S. Rapp MA. et al. Continuous treatment with antidementia drugs in Germany 2003–2013: a retrospective database analysis. Int Psychogeriatr IPA 2015; 27: 1335-1342
- 9 Bohlken J. Jacob L. Schaum P. et al. Hip fracture risk in patients with dementia in German primary care practices. Dementia (London) 2015; DOI: 10.1177/1471301215621854. [Epub ahead of print] PMID: 26701959
- 10 Booker A. Bohlken J. Rapp MA. et al. Persistence with antidepressant drugs in patients with dementia: a retrospective database analysis. Int J Clin Pharmacol Ther 2016; 54: 323-329
- 11 Booker A. Jacob LE. Rapp M. et al. Risk factors for dementia diagnosis in German primary care practices. Int Psychogeriatr 2016; 28 (07) 1059-1065
- 12 Bruscoli M. Lovestone S. Is MCI just really early dementia? A systematic review of conversion studies. Int Psychogeriatr 2004; 16 (02) 129-140
- 13 Mitchell AJ. Shiri-Feshki M. Temporal trends in the long term risk of progression of mild cognitive impairment: a pooled analysis. J Neurol Neurosurg Psychiatry 2008; 79 (12) 1386-1391
- 14 Ward A. Tardiff S. Dye C. et al. Rate of Conversion from prodromal Alzheimer’s Disease to Alzheimer’s Dementia: a systematic review of the literature. Dement Geriatr Cogn Disord Extra 2013; 3: 320-332
- 15 Roberts RO. Knopman DS. Mielke MM. et al. Higher risk of progression to dementia in mild cognitive impairment cases who revert to normal. Neurology 2014; 82: 317-325
- 16 Vos SJ. Verhey F. Frölich L. et al. Prevalence and prognosis of Alzheimer’s disease at the mild cognitive impairment stage. Brain 2015; 138 (05) 1327-1338
- 17 Tifratene K. Robert P. Metelkina A. et al. Progression of mild cognitive impairment to dementia due to AD in clinical settings. Neurology 2015; 85 (04) 331-338
- 18 Schulz M. Bohlken J. Schulz M. et al. Diagnostische und therapeutische Leistungsdichte von neu erkrankten, zu Hause lebenden Patienten mit Demenz ZI Versorgungsatlas 18.9.2014. 1-33 www.versorgungsatlas.de
- 19 Arevalo-Rodriguez I. Smailagic N. Roqué I. et al. Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 2015; Mar 5;(3):CD010783. DOI: 10.1002/14651858.CD010783.pub2.
- 20 Folstein MF. Folstein SE. McHugh PR. Mini-Mental State (a practical method for grading the state of patients for the clinician). Journal of Psychiatric Research 12: 189-198
- 21 Eichler T. Thyrian JR. Hertel J. et al. Rates of formal Diagnosis of dementia in primary care: The effect of screening. Alzheimers Dement (Amst) 2015; 1 (01) 87-93
- 22 Kalbe E. Kessler J. Calabrese P. et al. DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia. International Journal of Geriatric Psychiatry 2004; 19: 136-143
- 23 Li JQ. Tan L. Wang HF. et al. Risk factors for predicting progression from mild cognitive impairment to Alzheimer’s disease: a systematic review and meta-analysis of cohort studies. J Neurol Neurosurg Psychiatry 2016; 87 (05) 476-484
- 24 Bohlken J. Peiseler GJ. Kohlmann T. Service Provision for Dementia Patients in the Outpatient Setting – Who should be responsible? A survey of 400 Primary Care Physicianns. Akt Neurol 2015; 42: 256-259
- 25 Grimmer T. Beringer S. Kehl V. et al. Trends of patient referral to a memory clinic and towards earlier diagnosis from 1985–2009. Int Psychogeriatr 2015; 27 (12) 1939-1944
- 26 van den Dungen P. Moll van Charante EP. van de Ven PM. et al. Dutch family physicians’ awareness of cognitive impairment among the elderly. BMC Geriatr 2015; 15: 105
- 27 Ihl R. Grass-Kapanke B. Lahrem P. et al. Entwicklung und Validierung eines Tests zur Früherkennung der Demenz mit Depressionsabgrenzung (TFDD)]. Fortschr Neurol Psychiatr 2000; 68: 413-422
- 28 Nasreddine ZS. Phillips NA. Bédirian V. et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695-699
- 29 Kaduszkiewicz H. Wiese B. Steinmann S. et al. Diagnosing an diagnosis coding in claims data from German statutory health insurance. Psychiatr Prax 2014; 41 (06) 319-323