Search PubMed⌕ Search

Biomedical subjects

H Bickel

Publications and source records attributed to H Bickel.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence and persistence of mild cognitive impairment among elderly patients in general hospitals.

The aim of the present study was to determine the prevalence of mild cognitive impairment (MCI) in elderly patients in general hospitals and to investigate the persistence of the cognitive deficits after discharge from the hospital. In a sample consisting of 794 non-demented patients in general hospitals aged 65-85 years, we found an MCI prevalence of 36.1%. The positive predictive value for cognitive impairment 3.5 months after hospital discharge was 61.0%. The deficits in multiple-domain MCI proved to be particularly stable with a positive predictive value of 82.9%. Elderly patients in general hospitals represent a high-risk group for MCI. These results indicate that general hospitals offer an opportunity for the early detection of incipient dementia.

Aged↗
PubMed2006

[Presenile dementia in memory clinics--incidence rates and clinical features].

This study describes the clinical features of presenile dementia diagnosed in memory clinics. It further gives an estimate of the declared incidence for the German city of Munich and surrounding counties. Twelve memory clinics in Switzerland and Germany were considered, among them all of the four in Munich. A total of 267 patients with onset of illness under the age of 65 were included. Only 16 patients (6%) were younger than 50. Men and women were affected about equally often. The most common cause of dementia was Alzheimer's disease (67%), followed by frontotemporal degeneration (13.5%) and vascular (5.6%) dementia. The declared incidence was estimated at 8.3 new cases of dementia per year among 100,000 persons in the 50-64 age range, with an incidence rate of Alzheimer's disease at 6.3/100,000. It can be concluded that memory clinics fulfill an important function in the care of patients with presenile dementia, since they are highly utilized by younger patients in early stages of the illness.

Adult↗
PubMed2005

Postoperative acute confusional state in typical urologic population: incidence, risk factors, and strategies for prevention.

OBJECTIVES: To determine the incidence of, and predictors for, the acute confusional state (ACS) in older patients after urologic surgery. ACS is among the most common complications after surgery in older patients. It is associated with increased postoperative morbidity, longer hospital stays, and greater mortality. Agitation caused by ACS might have deleterious consequences in a large proportion of older patients, especially after urologic surgery. Only a few studies, of highly selected urologic procedures, have been reported, and all showed an astonishingly low percentage of patients with this distressing condition. METHODS: We examined 100 consecutive, older patients (age 60 years or older), prospectively, before and after urologic surgery, to determine both the incidence of, and the predictors for, ACS. RESULTS: Only 7 of the 100 patients developed postoperative ACS. The risk factors identified were preoperative cognitive deficits, pre-existing depression, impaired vision, and the operative time. CONCLUSIONS: These results suggest that postoperative ACS is relatively rare after urologic surgical procedures; however, patients who are likely to develop ACS can be identified, prompting consideration for prophylactic antidelirium care.

Acute Disease↗
PubMed2002

[Intervention project on cerebrovascular diseases and dementia in the Ebersberg district (INVADE): rationale and design].

The aim of INVADE (Intervention project on cerebrovascular diseases and dementia in the district of Ebersberg) is to analyse the effect of risk factor evaluation and modification (arterial hypertension, dyslipoproteinaemia, diabetes mellitus,hyperhomocysteinaemie, smoking, adipositas, alcohol abuse, lack of movement and depression) on the incidence of stroke and dementia in a population based sample. Stroke represents the third-common cause of death in the industrialized countries and is together with dementia one of the main causes for dependency in the activities of daily living. The project was performed in an area near to Munich, the district of Ebersberg. Risk factors were evaluated and if necessary modified by means of the primary care concept. INVADE was performed in cooperation with the health insurance company AOK and most of the general practitioners (n=65) of the district. All inhabitants of the district born 1946 and earlier who were also member of the AOK (10548 persons) are able to participate.

Aged↗
PubMed2001

[Forgetfulness and light cognitive impairment. What can the physician still tolerate?].

Forgetfulness is defined as a subjectively bothersome impairment of the ability to recall facts that are unequivocally known to be stored in the memory. Objectifiable memory deficits may accompany numerous physical and neurological illnesses, but may also be seen in depressive states. Below average-for-age cognitive performances that do not reach the level of dementia are referred to as mild cognitive impairment, which in some cases represents a pre-dementia stage of Alzheimer's disease. Its recognition and differentiation from age-related performance deficits is now possible using simple, but sensitive neuropsychological tests. An important aim of the diagnostic work-up is the recognition of potentially reversible causes. For this purpose, physical examination and laboratory investigations are helpful. Structural and functional imaging procedures can provide information about cerebral causes. Biochemical indicators of neurogenerative processes are currently being developed. Cognitive training measures possibly have only a small and temporary effect. In patients with mild cognitive impairment, nootropic agents apparently have a symptomatic effect. Whether antidementia agents are capable of stopping the progress of mild cognitive impairment to full-blown dementia is currently being investigated in ongoing trials.

Aged↗
PubMed2001

Acute confusional state in the elderly following hip surgery: incidence, risk factors and complications.

OBJECTIVE: To determine incidence and risk factors for the development of postoperative acute confusional state (ACS) in the elderly. DESIGN: A prospective cohort study. SETTING: University hospital. PATIENTS: One hundred and five consecutive patients without ACS at baseline who underwent hip surgery because of hip fracture or elective hip replacement. All patients were 60 years or older. MEASUREMENTS: All patients underwent preoperative and daily postoperative evaluation by a research psychiatrist. Standardized instruments were used for cognitive screening, baseline assessment of depression, screening for alcohol abuse, comorbidity, and functional status. ACS was diagnosed by using the Confusion Assessment Method (CAM). Additional medical data were taken from patients' charts and anaesthetic records. RESULTS: Postoperative ACS developed in 23.8% of the study sample, in 40.5% of the hip fracture group and in 14.7% of the hip joint replacement group. The prevalence was highest between postoperative days 2 and 5. Multiple logistic regression analysis demonstrated the following risk factors of ACS: higher age (OR = 1.14, 95% CI 1.07-1.22), prior cognitive impairment as measured by Mini-Mental State Examination (OR = 1.32 for each point less, 95% CI 1.06-1.64), depression (OR = 3.67, 95% CI 1.12-12.02), low educational level (OR = 3.59, 95% CI 1.14-11.25), and preoperative abnormal sodium (OR = 4.32, 95% CI 1.01-18.38). Other risk factors showing statistically significant differences in the univariate analyses were: living in nursing home, vision or hearing impairment, higher comorbidity, regular use of psychotropic drugs before admission, fracture on admission, preoperative leucocytosis. A considerable proportion of patients with ACS showed self-destructive behaviour postoperatively, whereas self-destructive behaviour was not observed among non-delirious patients. CONCLUSIONS: ACS is common among elderly hip surgery patients. The occurrence of ACS is influenced by several predisposing and precipitating factors. Further knowledge of these risk factors will contribute to the early identification of high risk patients and to the development of preventive measures.

Acute Disease↗
PubMed2001

[Dementia in advanced age: estimating incidence and health care costs].

Based on results from large-scale epidemiological field studies in the western industrial countries, 930,000 elderly people in Germany were estimated to suffer from a dementing disorder at the end of 1996. Following the most recent population projection, a population increase of the number of elderly people (65 yrs. and above) from 12.9 million (mio.) in 1996 to more than 20 mio. in 2030 is anticipated. Based on the assumption that age-specific prevalence rates of dementia will remain stable, a steep rise in patient numbers by an average of 20,000 per year can thus be expected, reaching 1.56 mio. in 2030 and more than 2 mio. in 2050. Studies on the cost of illness point to an enormous economic burden caused by dementia. The unpaid informal care provided by relatives and the high expenses for long-term institutional care can be considered as the most significant components of total costs. Currently, the medical costs associated with diagnosis and treatment, however, appear as an almost negligible fraction of the total costs.

Aged↗
PubMed2001

[Life expectancy and the need for nursing care in Germany].

Effects of further gains in life expectancy on the health and autonomy of the elderly population are a matter of controversy. Health indicators, which integrate information on both mortality and morbidity could help to clarify whether the additional years are spent in health or disease. Since the introduction of a statutory long-term care insurance in Germany, national data on the prevalence of dependency are available. These data were used for the calculation of dependency-free life expectancy and life expectancy in a state of dependency according to Sullivans method. The calculations are based on 71.5 million insured at mid-year 1999 and on the period life-table for the years 1995/97. At the age of 65 the average duration of dependency is 15.4 months for men and 29.4 months for women. Men can expect to spend 91.4% of their remaining lifetime dependency-free, whereas the dependency-free proportion among women is only 86.9%. The distribution of severity grades of dependency is similar for both sexes. Women, however, spend 35.4% of the total duration of dependency in institutional care (10.4 months), men only 22.1% (3.5 months). Information from long-term care insurance appears suitable for the monitoring of time trends in the health of the elderly population and for projections of future needs for health and social services.

Aged↗
PubMed2000

[Psychiatric and somatic morbidity of patients with suspected multiple chemical sensitivity syndrome (MCS)].

Multiple chemical sensitivity (MCS) or idiopathic environmental intolerance (IEI) is understood as an acquired disorder with multiple recurrent symptoms that cannot be traced to any well-known medical or psychiatric condition and is associated with diverse environmental influences that are well tolerated by the majority of people. In a prospective study, we investigated 120 consecutive patients admitted a university-based outpatient department for environmental medicine during 1 year. Apart from routine medical examination and special toxicological diagnostic procedures, a structured clinical interview for DSM-IV psychiatric disorders was performed with every patient. At least one psychiatric diagnosis was found in 100 patients. The diagnostic criteria for somatoform disorders were filled by 53 patients. We found lifetime or current affective disorders in 39 patients, anxiety disorders in 29, and substance dependency or abuse in 25. In 16 patients, personality disorders were diagnosed. Nine suffered from psychotic disorders. This is the largest prospective study with standardized psychiatric diagnostic methods concerning psychiatric morbidity and MCS. The data show that many patients with environmental health problems obviously suffer from somatoform disorders but also from other, well-known psychiatric conditions.

Adolescent↗
PubMed2000

[Dementia syndrome and Alzheimer disease: an assessment of morbidity and annual incidence in Germany].

Due to the increasing life expectancy and the growing number of elderly people, dementia is emerging as a major health problem. There is, however, a lack of consistent data on the number of prevalent and incident cases of dementia in Germany. The aim of the present study was to estimate the prevalence and the incidence of dementing disorders in general as well as Alzheimer's disease in particular on the basis of disease rates based on large-scale epidemiological field studies and meta-analyses, which were standardized according to the age structure of the German population. The results show that probably more than 900,000 persons in Germany suffer from a dementing illness, 650,000 among them from Alzheimer's disease. About 200,000 new cases of dementia develop during one year, among them 120,000 new cases of Alzheimer's disease. Due to the higher life expectancy of women as compared to men 70% of the patients are of female gender. As a consequence of the steep increase of disease rates with age, two-thirds of the prevalent cases and 60% of the incident cases are found among people in the age bracket of 80 and over, whereas only 3% are found among persons younger than 65 years of age. Additionally, an estimate of the distribution of cases by the 16 Federal states of Germany is given.

Aged↗
PubMed1999

Predictors of mortality among demented elderly in primary care.

OBJECTIVES: To evaluate a wide range of sociodemographic, neurological and clinical variables as to whether they predict mortality in a representative sample of demented elderly. DESIGN: A three-stage community survey was conducted, based on a total of 3721 elderly patients whose cognitive status was assessed by their general practitioners (stage I). A stratified random sample of patients underwent a standardized research interview, including cognitive testing and the assessment of mental status, physical illness, sensory impairment and motor disability (stage II). After a mean interval of 28 months, all patients were recontacted. For deceased patients a close reference person was interviewed and the exact date of death was recorded (stage III). The influence of the predictor variables on mortality was determined by using the Cox proportional hazards model. SUBJECTS: A stratified random sample of 117 patients in primary care (mean age 82 years) suffering from mild, moderate or severe dementia (Alzheimer type, vascular or mixed dementia). MATERIALS: Hierarchical Dementia Scale (HDS), a modified version of the Hamilton Depression Scale, other clinical rating scales and CAMDEX criteria for clinical diagnosis and a degree of severity of dementia. RESULTS: Fifty-three of the 117 demented patients had died during the follow-up interval. The mortality risk increased steeply with the degree of severity of dementia. By controlling for this variable, only age and motor disability contributed significantly to the prediction of mortality, whereas gender, social class, type of dementia, extrapyramidal signs and other clinical features showed no or only a weak effect on the outcome. CONCLUSION: The remaining life expectancy of the demented elderly depends primarily on the severity of the dementia, the patients' age and their general physical health. The influence of other clinical features which often have been hypothesized as indicators of specific subgroups of dementia was mainly due to their relationship to the disease severity.

Aged↗
PubMed1998

[The last year of life: a representative study of deceased patients. Living arrangement, place of death and utilization of health resources].

The aim of the present study was to describe the pattern of service use (hospitals, homes, ambulatory services) in the year before death. The results are based on administrative data for the elderly inhabitants of the city of Mannheim, who died during one year (n = 2507), as well as on a survey of the next of kin of a 40% random sample of the decedents (n = 958). Deaths occurred most frequently in hospitals (49.7%), followed by deaths outside of institutions (29.1%) and deaths in residential or nursing homes (21.2%). 79.6% of the deceased had been admitted to hospitals in the last year of their lives, 28.6% were cared for in homes, and almost 40% were receiving care from home-help services. 9.3% of the last year of life were spent on average in hospitals and 20.5% in residential or nursing homes. Utilization of care was influenced by age at death, family conditions, living arrangements, and level of dependency. Hospital and nursing care use showed an opposite pattern. With increasing age at death, the utilization of homes and ambulatory services rose steeply, whereas the probability of hospital treatment decreased with more advancing age. Obviously a substantial proportion of the resources of the care system is spent for care at the end of life. Future gains in life expectancy will probably have a greater impact on nursing care than on hospital care.

Aged↗
PubMed1996

Early development and progression of dementing illness in the elderly: a general-practice based study.

In a study carried out in 21 general practices in Mannheim, Germany, a stratified random sample (N = 507) of patients over the age of 65 years was drawn from the total of nearly 4000 who were medically documented. Eighty per cent of the sample were examined, using the Hierarchic Dementia Scale to test cognitive functioning and the CAMDEX criteria to assess global clinical severity. Repeat assessment after a mean interval of 27 months showed that all new cases of clinical dementia had arisen in persons with mild deficits initially and represented one-fifth of this group. The first-assessment ratings of cognitive function proved to be strongly predictive of risks for age-corrected mortality, admission to long-term care and dependency at follow-up, as well as of further progressive cognitive decline.

Activities of Daily Living↗
PubMed1996

The Hierarchic Dementia Scale: usage.

The reliability, validity, and sensitivity to change of the Hierarchic Dementia Scale (HDS) were tested in two cross-sectional studies and one longitudinal study. Results prove the HDS to be a simple-to-conduct method, economical in terms of time, and possessing high reliability and high concurrent and criterion-related validity. The HDS appears capable of use at all stages of dementia and capable of permitting studies of the course well into the advanced stages of the illness.

Activities of Daily Living↗
PubMed1996

Cross-national interrater reliability of dementia diagnosis in the elderly and factors associated with disagreement.

Thirteen researchers from five centers in Australia, Germany, the Netherlands, United Kingdom, and United States applied DSM-III-R and Clinical Dementia Rating (CDR) syndrome-level dementia criteria to written vignettes of 100 elderly people identified in clinics or community surveys. Subjects ranged in type from cognitively intact to severely demented and many were also frail, partially sighted, or deaf. This paper concerns reliability within and between centers, and the relationship between reliability and factors such as diagnostic criteria, dementia severity, and respondents' clinical characteristics. Within-center interrater reliability was high, more so for "yes-no" DSM-III-R diagnoses than the multi-level CDR. Between-center rates were lower but still moderate to good. Concordance was lower for intermediate dementia levels than for no dementia and severe dementia. Physical disability made an additional contribution to uncertainty but deafness, poor vision, anxiety, and depression had no discernible effects. Reliability levels are likely to be lower in representative aged populations than in carefully selected clinical groups.

Aged↗
PubMed1996

[Need for nursing care by the elderly: results of a population based retrospective longitudinal study].

Results of a population-based Study: The purpose of the study was to estimate the prevalence, incidence, and duration of dependency at an advanced age and to examine the extent to which dementias contribute to prevalence and causation of dependence. The study was based on a random sample of all inhabitants of the city of Mannheim over 65 years of age, who died during one year. The data were gathered retrospectively by means of a standardized informant interview conducted with close relatives of the deceased. The estimated prevalence of severe dependency (round-the-clock care) was 7.3%-4% among the elderly living in private households and 51% among the institutionalised elderly. The annual incidence was 2.9%, the mean duration was 32 months. Prevalence and incidence increased steeply with age. The results suggested that dementias were present in 73% of the prevalent cases of dependence. In 47% of all cases dementia was regarded as the main cause. It appears that severe disability and high levels of need for care in elderly people are largely determined by a dementia or a related disorder. The outstanding importance of dementia should be adequately reflected in the planning and provision of services.

Aged↗
PubMed1994

Neuropsychological and biochemical investigations in heterozygotes for phenylketonuria during ingestion of high dose aspartame (a sweetener containing phenylalanine).

Aspartame, a high intensity sweetener, is used extensively worldwide in over 5,000 products. Upon ingestion, aspartame is completely metabolized to two amino acids and methanol (approximately 50% phenylalanine, 40% aspartic acid, and 10% methanol). The effects of aspartame on cognitive function, electroencephalograms (EEGs) and biochemical parameters were evaluated in 48 adult (21 men, 27 women) heterozygotes for phenylketonuria (PKUH), PKUH subjects whose carrier status had been proven by DNA analysis ingested aspartame (either 15 or 45 mg/kg/day) and placebo for 12 weeks on each treatment using a randomized, double-blind, placebo-controlled, crossover study. A computerized battery of neuropsychological tests was administered at baseline weeks -2 and -1, and during treatment at weeks 6, 12, 18, and 24. Samples for plasma amino acids and urinary organic acids were also collected during these visits. EEGs were evaluated by conventional and spectral analysis at baseline week -1 and treatment weeks 12 and 24. The results of the neuropsychological tests demonstrated that aspartame had no effect on cognitive function. Plasma phenylalanine significantly increased, within the normal range for PKUH, at 1 and 3 h following the morning dose of aspartame in the group receiving the 45 mg/kg per day dose only. There were no significant differences in the conventional or spectral EEG analyses, urinary organic acid concentrations, and adverse experiences when aspartame was compared with placebo. This study reaffirms the safety of aspartame in PKUH and refutes the speculation that aspartame affects cognitive performance, EEGs, and urinary organic acids.

Adolescent↗