Pattern of disturbance of different ventral frontal functions in organic depression.
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Anxiety↗
Biomedical subjects
F M Reischies
Publications and source records attributed to F M Reischies.
Age and dementia effect on neuropsychological test performance in very old age--influence of risk factors for dementia.
In old age a large part of the variance in cognitive performance in population samples is explained by normal aging; in addition many subjects over 80 years are demented and therefore dementia also explains a part of cognitive variability. The question is whether the different factors for dementia (such as ApoE4, external atrophy parameter of the cranial computer tomography [cCT], education, sex or serum zinc level) influence the relation between age or dementia and Mini Mental State (MMSE) performance. In an epidemiological study data were analyzed of N = 239 subjects for the above factors. Most statistically significant variables of the MMSE do not change the amount of the partial correlation coefficient between the parameters age or dementia and MMSE. The external atrophy, however, diminishes the magnitude of the partial correlation between age and MMSE. In contrast the dementia-MMSE relation is unchanged. This points to a generally similar factor structure of cognitive aging and dementia in old age, but differences exist with respect to the importance of the external atrophy parameter of the brain. Most factors investigated explain separate parts of variance of cognitive performance in old age.
Adult↗
[Depression in the very elderly].
In the Berlin Aging Study (BASE) an age and gender stratified sample of 516 persons aged 70 to over 100 was assessed by means of the semi-structured GMS-A interview, the CES-D-self-rating scale and the Hamiltion-Depression-observer-rating scale. Prevalence rates were 4.8% for Major Depression, 9.1% for all DSM III-R specified depressive disorders and 26.9% of subthreshold depression was included. There was no increase in prevalence rates with age but an increase in scores on the self rating CES-D. The prevalence rates for DSM III-R specified depression in females was 10.3% and almost double that of men (5.6%). Depressed persons do not show significant cognitive impairment as measured with the MMSE in comparison to controls. As compared to the total sample higher prevalence rates of overall depression were seen in persons with multimorbidity (36.8%) and lower rates in married persons. 13.2% of the elderly talked about feeling tired with life, 7.9% had thoughts about death and 1.2% reported suicidal ideation, which was closely linked to depressive disorders. In 44% of depressed cases undertreatment was observed. Only 6% got Antidepressants but 40% benzodiazepines.
Aged↗
[Normal and pathological cognitive aging].
The relation of age associated changes of cognitive functions to those of dementia diseases is not well investigated for very old age. Because aging as well as dementia diseases are associated with cognitive deficits, this leads to differential diagnostic problems in very old age. Relevant with respect to this differentiation are on the one hand the concepts of cognitive ageing, the dementia syndrome and dementia diseases, and on the other hand empirical findings with respect to 1. the neuropsychological crossectional pattern, 2. the premorbid intelligence or adult intelligence level, 3. the speed of decline. ad 1. The speed of cognitive processes shows a considerable reduction in normal aging. However, the reduction of learning and orientation as well as pronounced word-finding problems seem to be characteristic of the development of a dementia syndrome. ad 2. The importance of the level of adult intelligence is demonstrated by the possibility that a very old person with low adult intelligence level is diagnosed as demented without suffering from one of the dementia diseases. In the opposite case of a slowly progressive dementia disease in a person with a superior level of adult intelligence a diagnosis of dementia according the standard criteria can be given only in an advanced stage of the disease. ad 3. The importance of the speed of decline of cognitive performance for the diagnosis of dementia is discussed (e.g. < 1 point of the MMSE vs > 3 MMSE points per year). An optimization of the time course criterion (change-sensitive tests and an empirically determined cut-off) could improve the early dementia diagnosis, which relies up to now mostly on crossectional features. The more precise assessment of the deterioration speed would be an opportunity to investigate the factors or processes which determine the deterioration speed, knowledge of which in turn would be a starting point for development of therapy.
Adult↗
[Follow-up assessment of mood in depressive patients].
Three short, respectively promising self-rating scales used for the assessment of emotional states, especially depression, were examined: a visual analogue scale with only five items, a short version of the so-called "adjectives list" and a differentiated scale for recording current emotions, possible susceptibility to them and the ability to express them. We checked statistical parameters of item analysis, reliability, validity and time course measurement. This study was carried out with depressive inpatients (n = 35) at the time of admission and 4 weeks later in beginning remission. All three scales proved to be reliable (Cronbach-alpha between 0.48 and 0.97) and partially very valid instruments (concurrent validity between 0.04 and 0.87). In order to improve the documentation of a beginning response to therapeutic efforts, separate recordings of depressive subsyndromes such as "impetus" or "positive emotionality" seem to be quite promising approaches.
Adult↗
Association between age at onset of schizophrenia and obstetric complications.
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Adolescent↗
In an epidemiological sample the apolipoprotein E4 allele is associated to dementia and loss of memory function only in the very old.
The apolipoprotein E4 allele has been reported to be associated with late onset Alzheimer's disease. Here we report the relation of several neuropsychological test parameters and the diagnosis of dementia to the apolipoprotein E polymorphism in an epidemiological sample of 477 subjects aged 70-103 years. The apolipoprotein E4 allele was found to be associated with reduced performance in several sensitive neuropsychological memory tests and with diagnosis of dementia only in the oldest subjects (> 84 years). The association with dementia in this population based sample was much weaker than previously described and became only significant in a logistic regression analysis when age was included in the model.
Age Factors↗
[Dementia in the very elderly. Results of the Berlin Aging Study].
The frequency of dementia in very old subjects, the risk factors and the consequences of the disease were investigated in the Berlin Aging Study in an age- and gender-stratified design (ages 70-103 years, n = 516). Psychiatrists diagnosed a dementia syndrome according to DSM-III-R, applying the GMS-A and HAS interviews. The dementia frequency steeply increases until the 90-94 year group, but there is no further exponential increase for the 95+ group--instead for men the data show a plateau of dementia prevalence. Low education level turned out to be a risk factor, which explains the gender effect in a logistic regression analysis. The apolipoprotein E4 genotype was confirmed as a risk factor--however, only for the older subjects (85+). Dementia was a major reason for institutionalization. The 2-year mortality was no higher in dementia than for age-matched non-demented controls. The results gave a detailed picture of dementia in the very old. This is a prerequisite for planning facilities for psychiatric diagnostics and therapy as well as nursing care.
Aged↗
Age-related cognitive decline and vision impairment affecting the detection of dementia syndrome in old age.
BACKGROUND: Currently the Mini Mental State Examination (MMSE) is widely used as a screening instrument for dementia syndrome. Diagnostic validity may be lowered in old age by normal age-related cognitive decline. Furthermore, visual impairment, occurring frequently in old age, leads to missing values which prevent an interpretation of the test result. METHOD: In the Berlin Ageing Study (n = 516, age range 70-103 years) MMSE and clinical dementia diagnosis, made by a psychiatrist investigating all subjects by the Geriatric Mental State-A and History and Aetiology Schedule interviews, were investigated independently. The MMblind was analysed, an MMSE version for vision impairment in which all items requiring image processing are omitted. The study sample is population-based; dementia cases (DSM-III-R) were excluded on the basis of the clinical diagnosis. RESULTS: Norms are reported for very old age regarding MMSE as well as MMblind. There is a considerable age effect on MMSE scores. In contrast to MMSE, sensitivity and specificity of the shorter MMblind version are not reduced. CONCLUSIONS: The considerable age effect requires the adaptation of cut-off values for old age. The blind version of the MMSE seems to be a valid instrument improving the applicability of the MMSE in old age.
Age Factors↗
[Aging as a chance--aging as a risk].
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Activities of Daily Living↗
Incidental white-matter foci on MRI in "healthy" subjects: evidence of subtle cognitive dysfunction.
The clinical significance of incidental white-matter foci seen on MRI is controversial. Mainly using a computer-assisted neuropsychological test battery, we tested the hypothesis that there is a clinical correlate of these foci. We studied 41 individuals aged 45-65 years with no history of neurological or psychiatric disorder, in whom no indication of central nervous system abnormalities was found on standardised neurological examination. A computer-assisted neuropsychological test battery, with the advantage of precise measuring of both time and deviation (e.g. in position memory tests), and rating scales for emotional dysfunction were administered; selected soft neurological signs were assessed. In 16 subjects (39%) MRI showed high-signal foci in the white matter on spin-echo sequences. White-matter foci not adjacent to the lateral ventricles were found to be related to performance on immediate visual memory/visuoperceptual skills, visuomotor tracking/psychomotor speed and, to a lesser degree, learning capacity and abstract and conceptual reasoning skills. Subtle cognitive dysfunction would appear to be a clinical correlate of punctate white-matter foci on MRI of otherwise "healty" individuals.
Aged↗
Normal ageing, impaired cognitive functioning and senile dementia--a mixture distribution analysis.
Dementia scores in the population of very old subjects (70 to > 95) do not demonstrate an obviously bimodal distribution. Heterogeneity analysis shows that the assumption of two distributions explains the data significantly better than a one-distribution model. The first distribution component can be regarded as representing the normal range of scores and the second the pathological range. An additional finding shows the normal range distribution shifting to the pathological range with increasing age.
Aged↗
Saccadic tracking test--normal data and reliability.
A saccadic tracking test, which involves the scanning of a path guided by the direction of a sequence of arrows, was administered to 102 healthy control subjects. The data show a gender effect and a slight age and education effect. The internal consistency--estimated by Cronbach's alpha--was high, .94. The test promises to be a sensitive estimator of the capacity of a subject to explore a visual display, a skill necessary for a wide range of other test performances.
Adolescent↗
Myoclonus in patients treated with clozapine: a case series.
BACKGROUND: Various types of movement disorder have been reported to occur rarely in patients treated with clozapine. This paper describes five cases in which these phenomena appeared to be clearly associated with clozapine medication and discusses possible pharmacologic mechanisms and treatment options. METHOD: Inpatients receiving clozapine were investigated for the presence of movement disorders. We present five patients with clozapine-induced myoclonus, describe their patterns, and compare clinical features. RESULTS: Five patients treated with clozapine developed a similar pattern of movement disorder that can be described as myoclonus. The neurologic symptoms improved after the treatment was discontinued, the clozapine dose reduced, or concomitant carbamazepine administered. CONCLUSION: Clozapine can induce dose-dependent myoclonus. However, these symptoms can be relieved by reducing the dose of clozapine or giving carbamazepine so that discontinuation of clozapine treatment can be avoided.
Adult↗
Ventricle size and P300 in schizophrenia.
Both ventricular enlargement and reduced P3 amplitudes are consistent findings in schizophrenic patients, suggesting that the two measures reflect a common underlying pathophysiological process in schizophrenia. Investigating 14 stabilized schizophrenic outpatients, a relationship between the size of the lateral ventricles as well as of the third ventricle on CT scans and the auditory event-related P3 amplitude was, however, not found. This negative result suggests that ventricular enlargement and reduced P3 amplitudes in schizophrenics reflect different pathophysiological processes. It is assumed that the P3 amplitude is related rather to abnormalities in the temporal lobe of schizophrenic patients.
Adult↗
Anhedonia in schizophrenic, depressed, or alcohol-dependent patients--neurobiological correlates.
Anhedonia, dysphoria, and avolition are common symptoms of schizophrenic, depressive, and alcohol-dependent patients during withdrawal. These symptoms may be caused by a functional deficit of dopaminergic transmission in the dopaminergic reward system, ascending from the mesencephalon to the ventral striatum (nucleus accumbens). The dopaminergic reward system is functionally and anatomically closely connected with the ascending extrapyramidal pathways from the substantia nigra to the dorsal striatum. A dysfunction of both ascending dopaminergic pathways is therefore expected to cause both psychomotor slowing and dysphoria and anhedonia. This hypothesis is supported by PET and SPECT findings, which show that a reduced striatal density of unoccupied dopamine D2-receptors is correlated with extrapyramidal side-effects in neuroleptic-treated schizophrenics and with craving and dysphoria in drug-dependent patients. In order to further investigate the correlation of anhedonia, psychomotor slowing, and the status of the dopaminergic reward system, the density of striatal dopamine D2-receptors can be measured by IBZM-SPECT and related to psychomotor slowing and anhedonia in different states of schizophrenic, depressive, and alcohol-dependent patients.
Alcoholism↗
Psychopathology and the analysis of therapeutic effects.
The different domains of psychopathological research are described. An example of taxonomies that may be relevant for therapy is given. For the apathy scale of the AMDP system it is demonstrated that there is an equivalent severity of this syndrome in acute paranoid hallucinatory schizophrenia and in unipolar depression. In schizophrenia the apathy syndrome may subsume some, if not all, of the negative symptoms, that cause major problems for therapy. A common pathophysiological factor for the syndrome in the two diseases is discussed. A systematic psychopathological approach to the identification of pathophysiological factors of drug effects and their involvement in psychiatric diseases, including experimental variables, is characterized.
Humans↗
Prevalence of dementia in old age: clinical diagnoses in subjects aged 95 years and older.
Epidemiologic studies have consistently shown an exponential increase in the prevalence of dementia in the very old, but different standards of the investigators and the instruments, as well as the selection of the samples, limit the comparison of these studies. They usually include only a small number of participants aged 90 years and older. This investigation focuses on whether there is an exponential increase in the prevalence of dementia in people aged 90 years and older. The Berlin Aging Study (BASE) consists of a representative sample of elderly aged 70 to 105 years stratified by age and gender. Analyses of a BASE first sample (N = 156) with 52 participants aged 90 years and older showed an exponential increase in dementia from age 70 up to age 94 years, but the group aged 95 years and older (N = 26) showed a plateau near 45%, with no further increase in dementia prevalence.
Age Factors↗