[Consensus statement "Dementia 2010" of the Austrian Alzheimer Society]

The Austrian Alzheimer Society developed evidence-based guidelines based on a systematic literature search and criteria-guided assessment with subsequent transparent determination of grades of clinical recommendation. The authors evaluated currently available therapeutic approaches for the most common forms of dementia and focused on diagnosis and pharmacological intervention, taking into consideration the situation in Austria. The purpose of these guidelines is the rational and cost-effective use of diagnostic and therapeutic measures in dementing illnesses. Users are physicians and all other providers of care for patients with dementia in Austria.

Effizienz spezifischer neuropsychologischer und klinisch-psychologischer Interventionen im Alter

Most of the time, the effect of neuropsychological and clinical-psychological interventions for older people with cognitive deficits compared with the medical treatment is underestimated. Most times the effect of neuropsychological and clinical-psychological interventions in old aged people with cognitive deficits is seen lower than those of medical treatment. The aim of the present paper is to point out the possibilities and scope of those nonpharmacologic interventions by discussing new literature. All interventions have to be based on a specific geriatric assessment including neuropsychological testing, which defines the structure of the treatment. In the progress of dementia all interventions have to be changed from training of cognitive functions to social and emotional aspects. A combination with physical activities seems to be more effective. From this point of view psychological interventions can be seen as effective as medical treatment and have to be combined with them but further research has to be done.

Oxidative stress related markers in the “VITA” and the centenarian projects

Oxidative stress seems to play an important role in the pathophysiology of Alzheimer's disease (AD). At present there are no easily accessible biochemical markers for AD. We performed activity assays for platelet MAO-B and erythrocyte Cu/Zn-SOD as well as Western blotting for these two proteins. Moreover, we assessed plasma lactoferrin and performed RFLP-analysis for the MAO-B-intron-13-polymorphism in patients from the Vienna-Transdanube Aging (VITA) and from the so called centenarian project. The first one, VITA, is a community-based cohort study of all 75 years old inhabitants of a geographical region of Vienna. The centenarian project investigates chronic care in-old patients suffering from AD. In both sexes platelet MAO-B activity increased significantly in the AD group, and Cu/Zn-SOD activity decreased, but the latter effect was significant only in females. No significant difference was found regarding plasma lactoferrin. No correlation was found between MAO-Bi13 and MAO-B platelet activity or allele MAO-Bi13 and disease frequency. These results point to the possibility that a combination of MAO-B and SOD activity levels might be useful tools for an early diagnosis of AD.

[Geriatric assessment--the Vienna model]

Geriatric Assessment is a structured interdisciplinary process for the diagnosis of the functional status and potential for rehabilitation of geriatric inpatients. This paper describes the possibilities and scope of the Vienna Model of Geriatric Assessment oriented in terms of practicability and focused implementation of resources. By using this multidimensional proceeding the rehabilitation-quotient of patients has increased more than 39%. From this point of view Geriatric Assessment in a geriatric hospital is a practical instrument to prevent hospitalization, to increase survival at home, and to improve functional status in elderly patients.

Olfactory functions in Parkinson's disease and Alzheimer's disease

The aim of this investigation was to compare olfactory functions of patients suffering from Parkinson's disease (PD) and Alzheimer's disease (AD). Olfactory threshold, odor identification ability and odor memory performance were assessed in 21 non-demented PD patients and in 22 AD patients. Both patient groups were impaired in relation to an age-matched control group for the measure of odor identification. AD patients showed a higher olfactory threshold and poorer odor memory performance.

[Nonpharmacologic and rehabilitation aspects in inpatient settings]

Dementia is one of the most psychic diseases of people over the age of 65 years and are often the reason or consequence of a hospitalization or need for commitment to rest homes. However, this disease should not lead to therapeutic nihilism, it should be a challenge for the development of new ideas and care concepts. The present publication shows the possibilities of non-pharmacological rehabilitative measures in the stationary field, whereby the priorities are on psychological and psychotherapeutical and also milieu therapeutical aspects. Additional well known intervention measures (e.g. physicotherapy, ergotherapy, logopedia, care) are summarized. Especially new concepts in stationary care can help to improve quality of life of geriatric patients with dementia in stationary fields: therefore they should be promoted and integrated to a greater amount into the total rehabilitative concept.

Prospective neuropathological validation of Hachinski's Ischaemic Score in dementias

The sensitivity and specificity of Hachinski's Ischaemic Score (IS) in the diagnosis of the vascular aetiology of dementia was studied in a series of 32 demented patients, dementia of the Alzheimer type (16), multi-infarct dementia (7), mixed dementia (6), Pick's disease (3), with neuropathological diagnosis as the point of reference. The IS distinguished between primary degenerative dementia and multi-infarct or mixed dementia. As single features of the IS "a positive history of stroke" and "a fluctuating course" showed differing prevalences in the latter two diagnostic categories. The IS labelled 21% of patients with primary degenerative dementia as having a vascular aetiology. The uncritical application of the IS to large samples in epidemiological studies may cause incorrect labelling of a significant proportion of patients with primary degenerative dementia as vascular dementia. These results are based on observations of long-term inpatients and depend on neuropathological criteria. While the definite diagnosis of DAT by threshold criteria concerning plaque and tangle counts is well established, neither clinical nor pathological evidence of stroke necessarily means that cerebrovascular disease has anything to do with a patient's dementia.

[Differential diagnosis of dementia diseases. A prospective clinical study with neuropathologic diagnostic verification]

We present clinico-pathological correlations for a consecutive series of 44 demented patients in the Vienna longitudinal study on dementia. Prospective clinical diagnosis used the DSM-III-R and the NINCDS-ADRDA criteria. Not only the clinical, but also the neuropathological diagnosis of DAT is based on exclusion criteria, and depends on the interpretation of minimal vascular lesions. Although we did not exclude atypical cases from the study, 80% of diagnoses could be validated at autopsy. Nevertheless, our set of clinical criteria needs further validation in patients in the earliest stages of dementia.

Course characteristics in the differentiation of dementia of the Alzheimer type and multi-infarct dementia

Clinico-pathological studies have shown that the clinical diagnosis of multi-infarct dementia (MID) is even more difficult than that of dementia of the Alzheimer type (DAT). The study evaluated the significance of course characteristics for the diagnosis of MID and DAT. Course characteristics were rated when 57 demented patients were admitted to our neurogeriatric department. Diagnosis of MID and DAT, respectively, was established after a follow-up study with repeated neurological, psychiatric and neuropsychological investigations. In 21 cases diagnosis was confirmed by postmortem neuropathology. MID lacked the typical course of the disease in about two thirds of patients, while most DAT patients presented with the typical course of primary degenerative dementia. Features of the "typical" clinical course of MID (abrupt onset, stepwise deterioration) helped to exclude DAT, whereas MID could not be excluded on the basis of a history of insidious onset and gradual decline.

Memory deficits in advanced Parkinson's disease

Apart from global dementia various isolated cognitive deficits have been described in Parkinson's disease (PD). We investigated 31 non-demented Parkinsonian patients in their late stages of disease and 50 control subjects with regard to verbal memory. Eleven patients suffered from an isolated verbal memory deficit as defined by two list learning tasks using the Buschke selective reminding procedure. The isolated memory impairment did not depend on depression but was associated with longer duration of PD. Twelve demented PD patients were comparable to PD patients with isolated memory impairment with regard to age at onset and duration of PD. We speculate that the isolated memory impairment in PD is associated with isolated neuronal loss in the nucleus basalis of Meynert, without cortical or limbic pathology of the Alzheimer's type.

The A-K-T ("Alters-Konzentrations-Test") a new psychometric test for geriatric patients

The A-K-T is a newly developed concentration test for geriatric patients. First results in demented patients show the test to be a good indicator of severity of dementia. Since the method is non-verbal, it can be applied to aphatic patients too. But, comparing results of patients suffering either from dementia of Alzheimer's type, multi-infarct dementia or Parkinson's disease with dementia, we are not able to objectify specific deficits of a certain dementing disease.

Nonspecificity of semantic impairment in dementia of Alzheimer's type

Two psychometric tests designed to evaluate "verbal fluency" and "naming" as a measure of semantic memory were presented to 18 patients with Alzheimer's-type dementia, 16 other patients with multi-infarct dementia, and 14 age-matched control subjects. The diagnosis of multi-infarct dementia and Alzheimer's-type dementia was based on the commonly accepted criteria of the Diagnostic and Statistical Manual of Mental Disorders, ed 3. Although the patients with Alzheimer and multi-infarct dementias, respectively, suffered from a comparable degree of dementia (as determined by the Mini-Mental State examination), semantic memory was not specifically impaired in Alzheimer's-type dementia as opposed to multi-infarct dementia. In contrast semantic memory was correlated with the degree of dementia in both disease entities.

Semantic memory in DAT, MID and parkinsonism

Previous studies found the semantic system particularly affected in Dementia of Alzheimer's Type (DAT), which would have important implications for the clinical diagnosis of this disease. We compared 14 non-demented parkinsonian patients and 14 controls on one hand and demented patients suffering from multi-infarct dementia (n = 17), DAT (n = 18) and Parkinsonism + dementia (n = 7) on the other. Demented groups were well matched regarding severity of dementia. Two tasks of semantic memory (naming, word fluency) did not differentiate within demented groups, but were correlated with severity of dementia.

[The Geriatric Concentration Test and correlations with intelligence, memory ability, orientation and professional assessment in geriatric patients between 60 and 85 years of age in a nursing home]

In view of the lack of standardised psychometric procedures in establishing the cerebral efficiency of geriatric patients, it was attempted to develop an aptitude test for this group of patients. The "AUT" was tested on 140 patients at the 1st Medical Department of the Vienna-Lainz nursing home. The values examined, such as completion time, number of correctly cancelled figures, mistakes, as well as the combined result total amount and error percentage correspond, with regard to objectivity and reliability, with the requirements of psychometric procedures. Initial findings show the test to be a good indicator of "general cerebral efficiency" of those questioned, but it is to be noted that most of all the varying ability to concentrate, ability to remember, intelligence, orientation, activity and independence have an influence on the test results.

[Panic attacks and cardiac phobia]

In this study 36 patients with cardiac phobia were examined prior to hospitalisation and 29 of them were re-examined after 2.5 years. An analysis of the clinical pictures showed that all of the patients met the DSM III criteria for panic disorder. The follow-up results indicated that the anxiety attacks often recurred despite treatment; on the other hand, the patients felt significantly less threatened by the symptoms and consequently showed less help-seeking behaviour. The attack symptomatology was characterized by a uniform picture and thus played, at best, a limited role in predicting the course of the illness. According to DSM III cardiac phobia is listed under the somatoform disorders as hypochondriasis; this seems to be an unfortunate decision and ought to be revised.

[Behavior medicine intervention strategies in nursing home patients with manifestations of dementia of multiple origins]

The present study is an attempt to throw light on the possibilities and scope of different therapeutic applications concerning geriatric patients. Guide-lines are presented for the absolving of general animation programmes as well as also a specific "training in realism, orientation and memory" to modify the symptoms of chronic brain syndromes. First results show that with both intervention strategies a better integration of demented patients is possible in the department. Furthermore some improvements in the cognitive area can be attained by means of selective training.

[Management of breech delivery in primiparas - on the incidence of cerebral lesions. (author's transl)]

The investigation comprises a group of infants of primiparae with breech presentation after caesarean section and a group of infants delivered by means of manual aid. The school age children were examined on the incidence of brain injury. The investigation consisted of four parts; anamnesis, neurological status, EEG, psychological examination. Between these two groups there is not statistically-significant difference in the incidence of brain injury. The result of the investigation advocates the maintenance of selective sectioindication in case of primiparae and points to a possibly existing brain injury of infants with breech presentation before delivery.