Biomedical subjects

Horst Bickel

Publications and source records attributed to Horst Bickel.

7 recordsLinked to original sources

PubMed2006

[Associations between dementia and head circumference as a measure of brain reserve--results from the Bavarian School sisters study].

OBJECTIVE: The aim of the study was to examine the relationship of head circumference as a marker of maximal attained brain size to late-life cognitive impairment and dementia. METHODS: Cognitive performance was assessed and the presence of dementia was diagnosed in a cross-sectional study of 442 Catholic sisters aged 65 years and over. RESULTS: A head circumference below average was significantly associated with the presence of dementia even after adjustment for age, body mass index and presence of one or two apolipoprotein E epsilon4 alleles (OR = 2.0; 95% CI: 1.1-3.6). The combination of small head circumference and apolipoprotein E epsilon4 strongly increased the risk of dementia (OR = 3.59; 95% CI: 1.44-8.97). CONCLUSIONS: The findings support the hypothesis that a larger head size reduces the risk of cognitive decline and dementia in old age.

Age Factors↗

PubMed2005

Combined effects of hemoglobin A1c and C-reactive protein on the progression of subclinical carotid atherosclerosis: the INVADE study.

BACKGROUND AND PURPOSE: Glycohemoglobin (hemoglobin A1c [HbA1c]) and high-sensitivity C-reactive protein (hsCRP) are risk indicators for atherosclerosis. Limited information exists regarding the combined effects of inflammation and hyperglycemia. We investigated the joint effects of both parameters on early carotid atherosclerosis progression and major vascular events in diabetic and nondiabetic subjects. METHODS: We analyzed the data of INVADE (Intervention Project on Cerebrovascular Diseases and Dementia in the Community of Ebersberg, Bavaria), a prospective, population-based study conducted in 3534 subjects (mean age, 69 years). In addition to common risk factors, measurements of carotid intima-media thickness (IMT), hsCRP, and HbA1c were performed at baseline and after 2 years of follow-up. RESULTS: For the entire population, IMT progression was significantly related to HbA1c (P=0.003) but not to hsCRP (P=0.06) after risk factor adjustment. The interaction hsCRPxHbA1c was highly significant (P=0.001), and the most pronounced IMT progression was seen in subjects with both parameters in the fourth quartiles compared with subjects with both parameters in the first quartiles (0.028 [0.025, 0.031] versus 0.012 mm/year [0.007, 0.019]; P=0.0013). We observed a significant joint effect of HbA1c and hsCRP on IMT progression in the diabetic (n=882) as well as the nondiabetic subgroup (n=2652). Subjects with HbA1c and hsCRP in the upper 2 quartiles had an increased risk for new vascular events (adjusted hazard ratio in diabetics: 4.3 [1.8, 7.3]; P=0.001; nondiabetics: 2.9 [1.6, 4.7]; P=0.001). CONCLUSIONS: The combination of hyperglycemia and inflammation is associated with an advanced early carotid atherosclerosis progression and an increased risk of new vascular events in diabetic as well as nondiabetic subjects.

Aged↗

PubMed2004

[Incidence and risk factors of delirium after hip surgery].

OBJECTIVE: Postoperative delirium is common among elderly hip surgery patients. The objective of the current study was to determine the incidence of delirious states and to identify possible risk factors. METHOD: The sample consisted of 200 consecutive patients, age 60 years and older, who underwent hip surgery because of acute hip fracture or elective hip replacement. Patients were prospectively assessed preoperatively and on a daily basis postoperatively using the Confusion Assessment Method (CAM). Associations between risk factors and delirium were analysed by means of multiple logistic regression models. RESULTS: 20.5 % of the sample were diagnosed with postoperative delirium. Statistically significant risk factors for the development of delirium were higher age, lower preoperative cognitive test performance and severe physical comorbidity. Some other putative risk factors tended to be associated with postoperative delirium, but failed to reach statistical significance. CONCLUSIONS: The study confirmed a high incidence of delirium among hip surgery patients. Apart from established risk factors like old age, low cognitive test performance, and comorbidity, no other significant risk factors could be identified.

Aged↗

PubMed2003

Psychiatric morbidity and low self-attentiveness in patients with environmental illness.

Controversy surrounds the origin of symptoms attributed to environmental pollutants or widely used chemicals, and the authors believed that a psychiatric evaluation could advance understanding of this contentious condition. They assessed psychiatric morbidity, somatization, and self-attentiveness in patients seen in their Environmental Clinic. Two hundred ninety-five consecutive patients underwent SCID-I and -II interviews and were investigated with self-rating scales for self-attentiveness and somatization. The authors found a high prevalence of mental disorders (66% had a current SCID diagnosis, and 75% had a lifetime SCID diagnosis) and a low level of self-attentiveness, which was not necessarily associated with psychiatric disease. Among patients visiting an Environmental Clinic, mental disorders were common and needed to be diagnosed and treated by standard interventions. Patients who did not meet diagnostic criteria for a psychiatric disorder had relatively low somatization scores and low private self-attentiveness. These "externalizers" could benefit from an intervention that teaches them to focus on their internal and emotional lives. In these patients, the authors consider low self-attentiveness a major feature that may act as a pathogenic factor for environmental illness.

Adolescent↗

PubMed2003

Mild cognitive impairment: making headway by stepping backwards.

Mild cognitive impairment (MCI) is a prevalent medical problem and the concept and term have become a catch-phrase for research and clinical practice. However, little is known about the most effective tools for a clinical diagnosis of MCI, its potential significance for individual patients and the best possible intervention--at least as long as MCI is considered as a diagnostic entity. We propose a simplified diagnostic and interventional algorithm for the detection and management of patients with MCI. We argue that MCI is so important, because it represents the closest call for an identification of treatable diseases or risk factors before the final manifestation of irreversible brain changes. Stepping backward by focussing on underlying disease processes and attempting causal interventions must be preferred to a mere symptomatic treatment of MCI as a preclinical form of Alzheimer's disease.

Age of Onset↗

PubMed2002

The clock drawing test and questionable dementia: reliability and validity.

OBJECTIVES: In order to evaluate the suitability of the clock drawing test (CDT) for the detection of questionable dementia (QD), we assessed the inter-rater reliabilities and intercorrelations of four common scoring methods of the CDT in a sample of non-demented subjects and determined the concurrent validity. METHODS: The study sample consisted of 253 discharged general hospital patients, aged between 65 and 85 years. Subjects were screened for cognitive impairment during their hospital stay. Four to six weeks after discharge each non-demented patient was visited at home and interviewed by a trained psychologist. The interview procedure included a cognitive test battery incorporating the CDT, the Mini-Mental State Examination (MMSE), the Syndrome Short Test (SKT), and a verbal fluency test (VF). The criteria of the Clinical Dementia Rating (CDR) were used to differentiate between cognitively normal subjects and those with QD. Clock drawings were scored independently and blindly by two raters according to four different methods. The agreement between raters was assessed, as well as the agreement between the different scoring methods. The association of gender, education, age, test performance and CDR-rating with CDT scores was examined. Accuracy of the CDT for the detection of QD was calculated. RESULTS: Inter-rater reliabilities were high for all four scoring methods. However, substantial differences among the scoring methods were observed, the proportion of abnormal test results varying between 9% and 50%. The CDT correlated significantly with MMSE, SKT and VF, but correlation coefficients were low (r = 0.13 to r = 0.32). Furthermore, CDT scores were influenced by age, gender, and education. Sensitivity of the CDT for QD was 66%, specificity was 65%; the negative predictive value was 73%, the positive predictive value 58%. CONCLUSION: In a sample of non-demented elderly, the reliability of the CDT was sufficiently high, but the different scoring methods were not equivalent. When established cut-off scores were used, the proportion of abnormal CDTs were significantly different. Concurrent validity with other common cognitive tests was unsatisfactory. The CDT lacks sufficient sensitivity and specificity for the identification of QD and should not be used alone to screen for possible prodromal stages of dementing illnesses. The association of age, gender and level of education with CDT scores should be taken into account by clinicians using the CDT.

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PubMed2002

Which factors influence cognitive decline in older adults suffering from dementing disorders?

BACKGROUND: Although extensive research has been done on dementing disorders in recent decades, their natural course and prognosis are not yet well understood. The aim of our study was to assess cognitive decline in a representative sample of demented elderly and to analyse the predictive value of a broad spectrum of sociodemographic, neurological and clinical variables. METHODS: A random sample of elderly patients in primary care (n = 407) was drawn from a total of 3721 patients. The sample has been stratified according to the degree of cognitive impairment as assessed by their GPs. The patients were examined by means of a standardized research interview, including comprehensive cognitive testing (Hierarchic Dementia Scale) and the assessment of neurologic and physical impairments as well as of mental state (CAMDEX criteria). After a mean interval of 28 months, a follow-up study was conducted using essentially the same instruments. RESULTS: At baseline, 117 of the 407 patients were identified as suffering from mild, moderate, or severe dementia. The two-year follow-up of those patients revealed high mortality rates (53/117). The surviving patients showed significant cognitive decline, although the rate varied considerably between individuals. The rate of progression was strongly related to the initial degree of severity, but also to the use of psychotropic medication, which was associated with a more rapid deterioration. CONCLUSIONS: There are some prognostic indicators that can help to establish the prognosis for dementia patients. The best indicator for both--the rate of cognitive decline and the probability of survival--is the severity of dementia.

Aged↗