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Fröhlich S, Kutz DF, Müller K, Voelcker-Rehage C. Cardiorespiratory fitness is associated with cognitive performance in 80 + -year-olds: Detangling processing levels. GeroScience 2024; 46:3297-3310. [PMID: 38261111 PMCID: PMC11009210 DOI: 10.1007/s11357-024-01065-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Cardiorespiratory fitness is known to protect against cognitive decline in older adults. Specifically, it has been shown that physical activity and fitness are beneficial for executive functions that are crucial for independent living up to old age. In this study, 115 individuals aged 80 years and older underwent a cardiorespiratory fitness assessment using the two-minute step test and had their electroencephalogram recorded during a colored flanker task in order to measure executive function performance. Cardiorespiratory fitness was related to quicker responses during the flanker task. A mediation analysis was carried out to determine whether these positive effects were mediated through event-related potentials (N1, N2, or P3) or motor-related cortical potentials (MRCP). Cardiorespiratory fitness was related to better visual discriminative processing as indicated by larger occipital N1 amplitudes. In addition, fitness was associated with larger MRCP amplitudes, which are a correlate of the response generation process. Fitness was not found to have a significant effect on fronto-central N2 or parietal P3, which are thought to capture cognitive control processes such as conflict detection and response inhibition. Moreover, all effects reported were present in all three flanker trial conditions (congruent, neutral, and incongruent). Thus, these results indicate that the quicker response times in fitter people were related to visual processing and motor response generation rather than cognitive control.
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Affiliation(s)
- Stephanie Fröhlich
- Department of Neuromotor Behavior and Exercise, University of Münster, Wilhelm-Schickard-Str. 8, 48149, Münster, Germany
| | - Dieter F Kutz
- Department of Neuromotor Behavior and Exercise, University of Münster, Wilhelm-Schickard-Str. 8, 48149, Münster, Germany
| | - Katrin Müller
- Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Claudia Voelcker-Rehage
- Department of Neuromotor Behavior and Exercise, University of Münster, Wilhelm-Schickard-Str. 8, 48149, Münster, Germany.
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Bohlken J, Riedel-Heller SG, Kostev K, Michalowsky B. [Comparison of the Documented Dementia Diagnoses in German Primary Care with the Prevalence Estimate for 2021]. PSYCHIATRISCHE PRAXIS 2024; 51:45-48. [PMID: 37813361 DOI: 10.1055/a-2160-2864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND A current prevalence estimate predicted the number of people with dementia (PwD) with 1.8 million in 2021. This estimation is based on data from different sources especially from field studies and does not reflect the recognized and documented cases in primary care. We, therefore, aim to compare the prevalence of diagnosed PwD in general practitioner (GP) practices with these estimates of the general population. METHODS The number of diagnosed PwD in 946 GP practices with 2.8 million patients in 2021 was compared with the prevalence estimate of the German Alzheimer Society for 83 million inhabitants in Germany. RESULTS Dementia diagnoses were documented less frequently in GP practices compared to the prevalence estimate (1.88% vs 2.16%), especially the age groups 80+years were less likely present in GP practices prevalence. DISCUSSION There is still potential for optimizing dementia diagnostics in primary care, especially in patients 80 or older.
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Affiliation(s)
- Jens Bohlken
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig Medizinische Fakultät, Leipzig
| | - Steffi G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig Medizinische Fakultät, Leipzig
| | | | - Bernhard Michalowsky
- Deutsches Zentrum fur Neurodegenerative Erkrankungen, German Center for Neurodegenerative Diseases Site Rostock/Greifswald, Greifswald
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Gollop C, Zingel R, Jacob L, Smith L, Koyanagi A, Kostev K. Incidence of Newly-Diagnosed Dementia After COVID-19 Infection versus Acute Upper Respiratory Infection: A Retrospective Cohort Study. J Alzheimers Dis 2023:JAD221271. [PMID: 37212106 DOI: 10.3233/jad-221271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND There is emerging evidence that coronavirus disease 2019 (COVID-19) is giving rise to seemingly unrelated clinical conditions long after the infection has resolved. OBJECTIVE The aim of this study is to examine whether COVID-19 is associated with an increased risk of dementia including Alzheimer's disease. METHODS This retrospective cohort study is based on longitudinal data from the IQVIATM Disease Analyzer database and included patients aged≥65 with an initial diagnosis of COVID-19 or acute upper respiratory infection (AURI) from 1,293 general practitioner practices between January 2020 and November 2021. AURI patients were matched 1 : 1 with COVID-19 patients using propensity scores based on sex, age, index quarter, health insurance type, the number of doctor visits, and comorbidities associated with dementia risk. Incidence rates of newly-diagnosed dementia were calculated using the person-years method. Poisson regression models were used to compute the incidence rate ratios (IRR). RESULTS The present study included 8,129 matched pairs (mean age 75.1 years, 58.9% females). After 12 months of follow-up, 1.84% of the COVID-19 patients and 1.78% of the AURI patients had been diagnosed with dementia. The Poisson regression model resulted in an IRR of 1.05 (95% CI: 0.85-1.29). CONCLUSION This study did not find any association between COVID-19 infection and one-year dementia incidence after controlling for all common risk factors for dementia. Because dementia is a progressive disease, which can be difficult to diagnose, a longer follow-up period might offer a better insight into a possible association between COVID-19 infection and an increased incidence of dementia cases in the future.
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Affiliation(s)
| | | | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, Barcelona, Spain
- Department of Physical Medicine and Rehabilitation, Lariboisière-Fernand Widal Hospital, AP-HP, University Paris Cité, Paris, France
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, United Kingdom
| | - Lee Smith
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Dr. Antoni Pujadas, Barcelona, Spain
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Weidung B, Lövheim H, Littbrand H, Wahlin J, Olofsson B, Gustafson Y. Temporal Dementia and Cognitive Impairment Trends in the Very Old in the 21st Century. J Alzheimers Dis 2023; 93:61-74. [PMID: 36938733 DOI: 10.3233/jad-220915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
BACKGROUND Long-increasing dementia incidence and prevalence trends may be shifting. Whether such shifts have reached the very old is unknown. OBJECTIVE To investigate temporal trends in the incidence of dementia and cognitive impairment and prevalence of dementia, cognitive impairment, Alzheimer's disease, vascular dementia, and unclassified dementia among 85-, 90-, and ≥ 95-year-olds in Sweden during 2000-2017. METHODS This study was conducted with Umeå 85 + /Gerontological Regional Database data from 2182 85-, 90-, and ≥ 95-year-olds in Sweden collected in 2000-2017. Using logistic regression, trends in the cumulative 5-year incidences of dementia and cognitive impairment; prevalences of dementia, cognitive impairment, Alzheimer's disease, and vascular dementia; and Mini-Mental State Examination thresholds for dementia diagnosis were estimated. RESULTS Dementia and cognitive impairment incidences decreased in younger groups, which generally showed more-positive temporal trends. The prevalences of overall dementia, cognitive impairment, and Alzheimer's disease were stable or increasing; longer disease durations and increasing dementia subtype classification success may mask positive changes in incidences. Vascular dementia increased while unclassified dementia generally decreased. CONCLUSION The cognitive health of the very old may be changing in the 21st century, possibly indicating a trend break.
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Affiliation(s)
- Bodil Weidung
- Department of Public Health and Caring Sciences, Section of Geriatrics, Uppsala University, Uppsala, Sweden
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Division of Geriatic Medicine, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Håkan Littbrand
- Department of Community Medicine and Rehabilitation, Division of Geriatic Medicine, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Johanna Wahlin
- Department of Community Medicine and Rehabilitation, Division of Geriatic Medicine, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Birgitta Olofsson
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Surgical andPerioperative Sciences, Division of Orthopedics, UmeåUniversity, Umeå, Sweden
| | - Yngve Gustafson
- Department of Community Medicine and Rehabilitation, Division of Geriatic Medicine, Geriatric Medicine, Umeå University, Umeå, Sweden
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Bohlken J, Riedel-Heller S, Kramer A, Kostev K, Schrag A. [Trends in Prevalence of Parkinson's Disease in German General and Neurological Practices from 2010 to 2019]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:19-23. [PMID: 35724681 DOI: 10.1055/a-1838-4963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Zusammenfassung
Hintergrund Bis 2040 wird mit einer erheblichen Prävalenzzunahme
der Parkinson-Erkrankung und damit einhergehend mit einer erheblichen Belastung
der Versorgungssysteme gerechnet. Ziel der Studie war es deshalb, eine
Veränderung der Anzahl an Parkinson-Patienten bereits im Zeitraum 2010
bis 2019 in deutschen Haus- und neurologischen Facharztpraxen zu
untersuchen.
Methode Die vorliegende Querschnittstudie basiert auf den Daten von 411
Hausarzt- (HA) und 56 neurologischen Facharzt-Praxen (FA) aus der IQVIA Disease
Analyzer Datenbank. Die Anzahl der etablierten und neu diagnostizierten
Patienten mit Parkinson-Erkrankung wurde in den Jahren 2010 und 2019 mit Alters-
und Geschlechtsstruktur und der Anteil therapierten Patienten
untersucht.Ergebnisse Die Zahl der Parkinson-Patienten
veränderte sich geringfügig zwischen 2010 bis 2019 von 3352
(0,36% aller Patienten) auf 3541 (0,33%) in den HA-Praxen und
von 4976 (3,48%) auf 4826 (3,34%) in den FA-Praxen. Die Anzahl
der neu diagnostizierten Fälle fiel bei den HA-Praxen leicht von 862
(0,09% aller Patienten) auf 836 (0,08%) und bei den FA-Praxen
von 1818 (1,27%) auf 1372 (0,95% aller Patienten). Der Anteil an
Frauen unter allen Parkinson-Erkrankten sank sowohl in HA- und FA- Praxen von
52,0% bzw. 50,2% auf 47,3% bzw. 46,0%. Das
Durchschnittsalter stieg bei den HA-Praxen von 77,1 (SD 10,4) im Jahr 2010 auf
77,7 (SD 9,3) Jahre im Jahr 2019 und in FA-Praxen von 74,6 (SD 9,9) auf 75,8 (SD
9,9) Jahre.
Diskussion Die prognostizierte Zunahme von Parkinson-Patienten in der
ambulanten Versorgung lässt sich für den Zeitraum 2010 bis 2019
nicht bestätigen. Es gab jedoch eine Verschiebung der Altersstruktur zu
höheren Altersgruppen und eine Verringerung des Anteils an Frauen mit
einer Parkinson-Erkrankung. Neben ätiologischen Erklärungen
sollten Besonderheiten des Versorgungssystems und methodische Limitationen
berücksichtigt werden.
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Affiliation(s)
| | - Steffi Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Germany
| | - Antje Kramer
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Medizinische Fakultät, Leipzig, Germany
| | | | - Anette Schrag
- Neurology, University College London, London, United Kingdom of Great Britain and Northern Ireland
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Bohlken J, Weber K, Riedel Heller S, Michalowsky B, Kostev K. Mild Cognitive Disorder in Post-COVID-19 Syndrome: A Retrospective Cohort Study of 67,000 Primary Care Post-COVID Patients. J Alzheimers Dis Rep 2022; 6:297-305. [PMID: 35891640 PMCID: PMC9277697 DOI: 10.3233/adr-220020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background: Little is known about the impact of COVID-19 on mild cognitive disorder. Objective: The aim of this retrospective cohort study was to investigate whether COVID-19 diagnosis is associated with subsequent mild cognitive disorder (MCD) compared to acute upper respiratory infections (AURI). Methods: This retrospective cohort study used data from the Disease Analyzer database (IQVIA) and included 67,046 patients with first-time symptomatic or asymptomatic COVID-19 diagnoses in 1,172 general practices in Germany between March 2020 and September 2021. Diagnoses were based on ICD-10 codes. Patients diagnosed with AURI were matched to 67,046 patients with COVID-19 using propensity scores based on sex, age, index month, and comorbidities. The index date was the diagnosis date for either COVID-19 or AURI. Associations between the COVID-19 and MCD were studied using conditional Poisson regression models. Results: The incidence of MCD was 7.6 cases per 1,000 person-years in the COVID-19 group and 5.1 cases per 1,000 person-years in the AURI group (IRR = 1.49, 95% CI = 1.22–1.82). The incidence rate ratio decreased strongly with increasing age from 10.08 (95% CI = 4.00–24.42) in the age group≤50 to 1.03 (95% CI = 0.81–1.31) in the age group > 70. In addition, the association between COVID-19 and MCD was significant in women (IRR: 1.70, 95% CI: 1.34–2.16) but not in men (IRR: 1.08, 95% CI: 0.75–1.56). Conclusion The incidence of MCD was low but significantly higher in COVID-19 than in AURI patients, especially among younger patients. If a cognitive disorder is suspected, referral to a specialist is recommended.
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Affiliation(s)
- Jens Bohlken
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig, Germany
| | | | - Steffi Riedel Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig, Germany
| | - Bernhard Michalowsky
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald site, Greifswald, Germany
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Bohlken J, Peters O, Kostev K. Association Between Ginkgo Biloba Extract Prescriptions and Dementia Incidence in Outpatients with Mild Cognitive Impairment in Germany: A Retrospective Cohort Study. J Alzheimers Dis 2022; 86:703-709. [PMID: 35124648 PMCID: PMC9028600 DOI: 10.3233/jad-215348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Clinical trials have demonstrated a significant effectiveness of Ginkgo biloba therapy versus placebo in patients with dementia. Objective: The present study aims to analyze the impact of Ginkgo biloba drug prescriptions on dementia incidence in patients with mild cognitive impairment (MCI) in a real-world setting. Methods: This retrospective study was based on the IQVIA Disease Analyzer database and included patients aged 65 or older with a first diagnosis of MCI from January 2000 to December 2019. Each patient was followed for up to 20 years after MCI diagnosis until February 2021. Date of the first diagnosis of dementia or loss to follow-up, whichever occurred first, was noted. To estimate the association between Ginkgo biloba prescriptions during the follow-up and dementia incidence, a multivariable Cox regression analysis was performed, adjusted for age, sex, health insurance, documented co-diagnoses, and prescription of cholinesterase inhibitors. Results: Overall, 24,483 MCI patients (mean age: 77.0 years, 56.3% women) were included. It was found that > 2 prescriptions of Ginkgo biloba were significantly associated with a reduced dementia incidence (HR: 0.71 (95% CI: 0.55–0.91), p = 0.007), as compared with no Ginkgo biloba prescription. The effect of receiving > 3 Ginkgo biloba prescriptions was even stronger, with an HR of 0.64 (95% CI: 0.48–0.86), p = 0.003), while for > 4 prescriptions the HR was 0.58 (95% CI: 0.41–0.82) (p = 0.002). Conclusion: All-cause dementia incidence decreased with higher numbers of Ginkgo biloba prescriptions in MCI patients.
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Affiliation(s)
- Jens Bohlken
- Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) of the Medical Faculty at the University of Leipzig, Germany
| | - Oliver Peters
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
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Ribeiro FS, de Oliveira Duarte YA, Santos JLF, Leist AK. Changes in prevalence of cognitive impairment and associated risk factors 2000-2015 in São Paulo, Brazil. BMC Geriatr 2021; 21:609. [PMID: 34706666 PMCID: PMC8554830 DOI: 10.1186/s12877-021-02542-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Decreases in prevalence of cognitive impairment and dementia over the last two decades have been observed in different countries for cohorts entering older age. This study aimed to assess the cognitive impairment prevalence and explore associated factors among subjects aged >60 living in São Paulo, Brazil. METHOD Data came from a population-based Health, Welfare and Aging survey conducted in 2000, 2006, 2010, and 2015. Cognitive impairment was detected using the abbreviated Mini-Mental State Exam corrected by formal education years. In total, there were 5922 respondents in the statistical analyses. RESULTS Logistic regression models adjusted for age group, income, race, cardiovascular risk factors, and depression were used to estimate cognitive impairment prevalence. Between 2015 and 2000, respondents were more likely to report formal education, hypertension, diabetes, and overweight/obesity. Moreover, the weighted analyses showed that cognitive impairment prevalence was higher in 2015, even adjusting for sociodemographic and socioeconomic characteristics, cardiovascular risk factors, and depression. CONCLUSION In contrast to decreases in cognitive impairment prevalence in other countries and despite increases in educational years, our findings suggest no secular improvements in cognitive health for the 2015 wave of older adults residing in São Paulo.
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Affiliation(s)
- Fabiana Silva Ribeiro
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg.
| | | | | | - Anja K Leist
- Department of Social Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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Wehrmann H, Michalowsky B, Lepper S, Mohr W, Raedke A, Hoffmann W. Priorities and Preferences of People Living with Dementia or Cognitive Impairment - A Systematic Review. Patient Prefer Adherence 2021; 15:2793-2807. [PMID: 34934309 PMCID: PMC8684431 DOI: 10.2147/ppa.s333923] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Knowledge about the priorities and preferences of people living with dementia (PwD) might help to individualize treatment, care, and support, which could improve patient-related outcomes. This study aimed to summarize preferences of PwD or people with mild cognitive impairment (MCI), considering all relevant aspects of health care and everyday life. METHODS We conducted a systematic literature review and included studies about patient preferences published in English between January 1, 1990 and October 28, 2019. The inclusion criteria were that preferences were elicited directly by PwD or patients with MCI. We used the International Consortium for Health Outcomes Management value set for dementia to categorize the preferences into the following topics: a) clinical status, b) symptoms, functioning, and quality of life, and c) sustainability of care. RESULTS Of 578 initially identified studies, 45 met the inclusion criteria. Patients preferred to be informed about the diagnosis as early as possible, especially for anticipatory care planning. They ranked caregiver quality of life as their highest priority. They preferred not to be a burden to others more than their caregivers' mood, their own functional status, or their own distressing behaviors. Furthermore, PwD are eager to participate in medical decisions, especially in those about creating an everyday life routine. PwD preferred their own quality of life, self-efficacy, and emotional well-being. Institutionalized PwD preferred individualized and person-centered care. According to the sustainability of care, PwD preferred to maintain close bonds with their family at the end of their life and wanted to be treated with empathy. CONCLUSION This systematic review provides essential insights into cognitively impaired patients' preferences, which are rarely considered in treatment, care, and support services. Further studies should evaluate whether considering preferences in treatment and care or daily living can improve patient-reported outcomes.
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Affiliation(s)
- Hannah Wehrmann
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Bernhard Michalowsky
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
- Correspondence: Bernhard Michalowsky Tel +49 3834 86 75 07 Email
| | - Simon Lepper
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Wiebke Mohr
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Anika Raedke
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
| | - Wolfgang Hoffmann
- Translational Health Care Research, German Center for Neurodegenerative Diseases (DZNE) Site Rostock/Greifswald, Greifswald, Germany
- Epidemiology of Health Care and Community Health, Institute for Community Medicine & University Medicine Greifswald (UMG), Greifswald, Germany
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