The subjective burden of informal caregivers of persons with dementia: extended validation of the German language version of the Burden Scale for Family Caregivers (BSFC)

OBJECTIVE

In research as well as in the practice of caregiver counselling, the subjective burden of family caregivers is considered an important characteristic of home care. The objective of the present study was to provide an extended validation of the German language version of the Burden Scale for Family Caregivers (BSFC) published in 2001.

METHODS

Extended validation was performed using medical, interview, and health insurance data of 351 informal caregivers and their relatives who had dementia. Cronbach's alpha was calculated to assess the internal consistency of the items, and an exploratory factor analysis was conducted to determine the structure of the BSFC. The discriminatory power and item difficulties of the 28 BSFC items were examined. Five research questions addressed construct validity. Question six addressed the BSFC score as a potential predictor of institutionalization at a follow-up time of 2.5 years (predictive validity).

RESULTS

Exploratory factor analysis indicated that the BSFC had a single-factor structure. Cronbach's alpha for the total scale was 0.93. A significant increase in the BSFC score was observed when the severity of cognitive impairment increased, persons with dementia showed disturbing behaviour, caregivers were diagnosed with depression, care requirements increased, or the family caregiver and the person with dementia lived together. Caregiver burden emerged as a significant predictor of institutionalization. The validity of the BSFC was confirmed by the results.

CONCLUSION

The BSFC score allows for a valid assessment of the total caregiver burden in both research and practice. The BSFC is available for free in 20 languages ( http://www.caregiver-burden.eu ).

["As Good as it Gets at Home" - Reasons for Institutionalisation in Dementia]

AIM

What are the reasons for institutionalising community-dwelling persons with dementia?

METHOD

A written survey of family caregivers and general practitioners was undertaken.

RESULTS

Within 2 years 47 of 351 people with dementia (13%) were institutionalised. The person with dementia was involved in the decision in only 1/3 of the cases. The 3 most common reasons were: ensuring the best possible care, high expenditure of care-giving time at home, deterioration of the health of the care-receiver.

CONCLUSIONS

From the ethical point of view the exclusion of the persons with dementia from the decision-making with regard to institutionalisation has to be examined critically. The often given reason of ensuring the best possible care through institutionalisation could be counteracted by the improvement of community-based care.

Mammalian Sec61 is associated with Sec62 and Sec63

In yeast, efficient protein transport across the endoplasmic reticulum (ER) membrane may occur co-translationally or post-translationally. The latter process is mediated by a membrane protein complex that consists of the Sec61p complex and the Sec62p-Sec63p subcomplex. In contrast, in mammalian cells protein translocation is almost exclusively co-translational. This transport depends on the Sec61 complex, which is homologous to the yeast Sec61p complex and has been identified in mammals as a ribosome-bound pore-forming membrane protein complex. We report here the existence of ribosome-free mammalian Sec61 complexes that associate with two ubiquitous proteins of the ER membrane. According to primary sequence analysis both proteins display homology to the yeast proteins Sec62p and Sec63p and are therefore named Sec62 and Sec63, respectively. The probable function of the mammalian Sec61-Sec62-Sec63 complex is discussed with respect to its abundance in ER membranes, which, in contrast to yeast ER membranes, apparently lack efficient post-translational translocation activity.

Effects of environmental conditions on microbial proteolysis in a pork myofibril model system

A number of bacterial strains used for meat fermentations were screened for proteolytic activity. A strain of Micrococcus which was found to be proteolytic was evaluated for the effects of environmental conditions on its proteolytic activity against pork myofibrillar proteins using response surface methodology. Three strains of micrococci were also tested for the ability to produce free amino acids from pork myofibrils. Analysis of the effects of environmental conditions showed that proteolytic activity would be minimal under conditions normally found in fermented sausages, thereby suggesting that proteolysis in these products is largely due to endogenous meat enzymes. The three strains of micrococci were shown to produce free amino acids from pork myofibrils, thereby demonstrating the presence of peptidase activity in these strains.

[A modified technique of ridge reconstruction in extreme maxillary atrophy]

A ridge augmentation procedures for extremely atrophied upper jaws is presented. Compared with the use of a bone graft alone, the permanent integration of a titanium mesh reduces the loss of vertical dimension by resorption to a minimum. This is confirmed by the results of three reconstructed ridges that were followed up for 3 years. The indications and the technical procedure are discussed in detail.

On the edema-preventing effect of the calf muscle pump

During motionless standing an increased hydrostatic pressure leads to increased transcapillary fluid filtration into the interstitial space of the tissues of the lower extremities. The resulting changes in calf volume were measured using a mercury-in-silastic strain gauge. Following a change in body posture from lying to standing or sitting a two-stage change in calf volume was observed. A fast initial filling of the capacitance vessels was followed by a slow but continuous increase in calf volume during motionless standing and sitting with the legs dependent passively. The mean rates of this slow increase were about 0.17%.min-1 during standing and 0.12%.min-1 during sitting, respectively. During cycle ergometer exercise the plethysmographic recordings were highly influenced by movement artifacts. These artifacts, however, were removed from the recordings by low-pass filtering. As a result the slow volume changes, i.e. changes of the extravascular fluid were selected from the recorded signal. Contrary to the increases during standing and sitting the calf volumes of all 30 subjects decreased during cycle ergometer exercise. The mean decrease during 18 min of cycling (2-20 min) was -1.6% at 50 W work load and -1.9% at 100 W, respectively. This difference was statistically significant (p less than or equal to 0.01). The factors which may counteract the development of an interstitial edema, even during quiet standing and sitting, are discussed in detail. During cycling, however, three factors are most likely to contribute to the observed reduction in calf volume: (1) The decrease in venous pressure, which in turn reduces the effective filtration pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Technic and results of spinal computed tomography in the diagnosis of cervical disk disease]

We give a description of a technique of the patient's positioning with traction of the arms during the cervical spinal computed tomography which allows to draw the shoulders downwards by about one to three cervical segments. By this method the quality of the images can be improved in 96% in the cervical segment 6/7 and in 81% in the cervical/thoracal segment 7/1 to such a degree that a reliable judgement of the soft parts in the spinal canal becomes possible. The diagnostic reliability of the computed tomography of the cervical disc herniation is thus improved so that the necessity of a myelography is decreasing. The results of 396 cervical spinal computed tomographies are presented.

Reversible and non-reversible enlargement of cerebrospinal fluid spaces in anorexia nervosa

Brain CT studies of 35 patients with anorexia nervosa confirmed the observations of other authors: cerebral dystrophic changes correlate with weight loss and the reversibility of these changes also correlates with the normalization of body weight. Other corroborated facts are: the most numerous and most pronounced enlargements are of the cortical sulci and the interhemispheric fissure, moderate widening affects the ventricles and the rarest and most insignificant changes are those of the cerebellum. The reversibility of the changes showed a parallel to the extent of the changes themselves and to the duration of improvement of the body weight. The reversibility of the enlargement of the cortical sulci and of the distances between the frontal horns of the lateral ventricles was more often significant than that of the abnormal measurements of the cella media. This difference is based on minimal early acquired brain damage which occurs in 60% of our patients. This high incidence of early acquired minimal brain disease in patients with anorexia nervosa is here discussed as a nonspecific predisposing factor. Although there is no exact explanation of the etiology of the reversible enlargement of cerebrospinal fluid (CSF) spaces in anorexia nervosa, the changes resemble those in alcoholics. The mechanisms of brain changes in alcoholism, as shown experimentally, seem to us to throw light on the probable mechanism of reversible dystrophic brain changes in anorexia nervosa.

[Effect of methylprednisolone and dexamethasone on the prognosis and EEG in severe craniocerebral injuries]

In a prospective investigation, the effect of dexamethasone in severe head injuries is compared with methylprednisolone. Twenty patients were examined by computer-tomography and electroencephalography. The EEG was evaluated by frequency analysis; a statistically significant difference could not be demonstrated between the dexamethasone and methylprednisolone group.

Neuroradiologic and neuropathologic findings with growing giant intracranial aneurysm. Review of the literature

The neuroradiologic observations on a case of growing giant intracranial aneurysm originating from a small saccular aneurysm are described in detail. The reports in the literature of growing giant aneurysms are reviewed. The computed tomographic and angiographic findings are described and special diagnostic difficulties analyzed. A correlation between the computed tomographic and neuropathologic findings is made, and the pathogenetic mechanisms of enlargement of aneurysms are discussed.

Direct visualization of intracranial aneurysms by multiplane dynamic CT

Using an intravenous injection of 100-150 ml contrast medium (flow, 1-1.5 ml/sec) adjacent 2-mm-thick cuts are scanned at the level of the circle of Willis. After highlighting and multilevel image summation a complete picture of the vascular anatomy of the base of the brain is obtained. In this way aneurysms as small as 2-3 mm in diameter can be detected. The method has high reliability, as indicated by the results in 31 cases.

[Traumatic carotid artery thrombosis in the area of the base of the skull. 2 case reports]

The authors describe two cases with a carotid thrombosis at the level of the skull base. The clinical course and the pathogenesis are discussed with reference to 15 similar cases in the literature. It is considered that a direct injury to the vessel wall is the cause of the carotid thrombosis. To assist in the diagnosis angiography should be undertaken as early as possible. A good collateral supply is the prerequisite for a favourable result.

[Alpha activity and spindles in comatose patients after brain damage in reference to CT-results (author's transl)]

We observed seven comatose patients after various brain injuries who showed an alpha- or spindle-activity in the EEG. All patients were systematically examined by EEG and Computer-Tomography (CT). In all these cases a brain stem lesion was visible in CT. Three times the CT-findings could be verified by autopsy. The CT-findings agree with the well known localization of the lesion in the phono-mesencephalic region in these patients.

The course of brain atrophy in Parkinson's disease

In 110 parkinsonian patients (53 men, 57 woman) aged 38--81 years, computer-tomographic follow-up investigations were done to assess the development of brain atrophy. The control examinations were done after an average of 28 months. At that time an increase in brain atrophic changes of different localization could be observed in 23% of the patients. In addition, it could be demonstrated that the increase in pathologic CT findings is to be observed especially in patients with higher age, a more marked impairment in psycho-organic capacity, more pronounced handicaps in the fine-motorial performances at the beginning of the study. From the neuroradiological point of view, patients with more marked pathologic CT findings upon the first examination, be these ventricular enlargement and/or cortical atrophy, more often showed a progression of brain atrophy.

Analysis of cerebral defective states acquired in early life

The clinical and radiographic data provided by CT of 34 patients with cerebral defects acquired in early life were analyzed. Seventeen patients showed porus-like defects due to vascular thrombosis. Volume measurements were made in 26 patients to determine tissue loss and volume shifting by ROI. CT is the most effective means of detecting the cause of the lesion.

The base of the skull: a comparison of computed and conventional tomography

The diagnostic information obtained from 35 examinations of the skull base by computed tomography (CT) was compared with the findings furnished by conventional or blurring tomography (BT). Computed tomography yielded diagnostically valuable information not only on the soft tissues but also on the bony structures. Compared with BT, CT was superior in 40%, equivalent in 40%, and inferior in 20% of the cases in assessing pathological findings involving the bony structures of the skull base. Obviously, CT's additional capability of accurate display of soft tissue changes represents a fundamental diagnostic advantage.

Sarcoidosis of the pineal gland. Case report

The authors report a case of sarcoidosis of the pineal gland with no other organ manifestation of the disease. The tumor was successfully removed by a direct surgical approach.

[Demonstration of the skull base by computed tomography (author's transl)]

In addition to showing the structures of the brain, it is possible with computed tomography to demonstrate the bone of the skull. For this the window width has to be increased, or one has to use additive photographic manipulation (integral photography). The clinical value of views of the skull base is illustrated. The advantages of computed tomography compared with conventional radiographic technique are stressed.

[Intracranial calcification on computer tomography a comparison with radiography (author's transl)]

It is possible to demonstrate extremely fine calcification by computer tomography which cannot be shown by skull radiographs. A value of + 70 CT units was found to be the limit below which calcification visible on the CT could no longer be demonstrated radiographically. The incidence of calcification of the falx and of the choroid plexus is considerably greater on the CT than on radiographs, although no difference was found for calcification of the pineal body. Since it is possible to demonstrate cerebral substance and CSF pathways simultaneously, it is possible to obtain an exact anatomical localisation of any calcification. CT is the method of choice for the demonstration and investigation of intracranial calcification.

[Diagnosis and therapy of the nasoethmoidal encephaloceles (author's transl)]

Two typical cases of nasoethmoidal encephaloceles with liquorrhoea, which were operated on by neurosurgeons, are demonstrated. In one case, polyposis of the nose had been operated on twice in childhood, due to the ignorance of the cause with the result of a liquorrhoea. The second patient showed recurrent meningitis with nasal liquorrhoea and turricephaly. The tentative diagnosis of a nasoethmoidal enceplaocele which was suspected by x-ray-tomography and radio-isotopetest could be certified by the aid of detail-angiography. The neurosurgical technique of intracranial, intradural resection of the encephalocele and closure of the liquor fistual with an acrylic flap is shown.