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Psychiatr Prax 2010; 37(2): 78-83
DOI: 10.1055/s-0029-1223473
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

MMST zur Überlebensprognostik bei Demenz

8-Jahre-Follow-up-Studie bei 145 ambulanten DemenzpatientenMMSE for Survival Prognostics in DementiaAn 8-Year Follow-Up Study in 145 OutpatientsSebastian  Dirk  Hötte1 , Daniel  Lankers1 , Sebastian  Kissler1 , Harald-Jürgen  Freyberger1 , Stefan  Georg  Schröder1
  • 1Ernst-Moritz-Arndt-Universität Greifswald und LWL-Universitätsklinik Bochum der Ruhr-Universität Bochum
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Publication History

Publication Date:
24 February 2010 (online)

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Zusammenfassung

Anliegen Inwieweit lassen sich Überlebenszeiten bei Demenz aus dem Punktwert des Mini-Mental-Status-Tests berechnen? Methode Bei 145 Demenzpatienten wurde anhand von Cox-Regressionsanalysen das Sterberisiko für Demenzschweregrade und MMST-Einzelwerte berechnet. Ergebnisse Gemäß Cox-Regression erhöht sich das relative Sterberisiko pro Stufe im Demenzschweregrad (leicht / mittel / schwer) je um 36,2 % (p = 0,023), pro abnehmendem MMST-Punkt um 4,1 % (p = 0,005). Schlussfolgerung Der MMST-Punktwert kann als Prognosefaktor im Rahmen individueller Beratung und Planung sowie für gesundheits- und sozialpolitisches Management herangezogen werden.

Abstract

Objective Evaluation of the predictive power of the Mini-Mental State Examination (MMSE) for survival analyses of dementia patients. Methods In an 8-year follow-up study for 145 dementia outpatients the survival and relative death risks (hazard ratios) were calculated with Kaplan Meier and Cox-regression analyses. Results Following Cox-regression the relative death risk increases by 36.2 % per severity level of dementia (mild / moderate / severe), p = 0.023. Per single MMSE point lost, the relative death risk rises by 4.1 % (p = 0.005). Kaplan Meier analysis supports the result. Conclusions MMSE scores may in fact be used for dementia survival prognoses in counseling family and professional caregivers of dementia patients, but also for socioeconomic management of the increasing dementia burden for society.

Schlüsselwörter

Demenz - MMST - Überlebenszeit - Prognose - Hazard Ratio

Keywords

dementia - MMSE - survival - prognosis - hazard ratio

Literatur

  • 1 Bundesministerium für Familien, Senioren, Frauen und Jugend (BMFSFJ) .Fünfter Bericht zur Lage der älteren Generation. Bundesministerium für Familien, Senioren, Frauen und Jugend 2005: 35-80
    PubMedGoogle Scholar
  • 2 Hux M J, O'Brien B J, Iskedjian M. et al . Relation between severity of Alzheimer's disease and costs of caring.  CMAJ. 1998;  159 457-465
    PubMedGoogle Scholar
  • 3 Wolstenholme J, Fenn P, Gray A. et al . Estimating the relationship between disease progression and cost of care in dementia.  Br J Psychiatry. 2002;  181 36-42
    CrossrefPubMedGoogle Scholar
  • 4 Caro J, Ward A, Ishak K. et al . To what degree does cognitive impairment in Alzheimer's disease predict dependence of patients on caregivers?.  BMC Neurol. 2002;  2 6
    CrossrefPubMedGoogle Scholar
  • 5 Rainer M, Jungwirth S, Kruger-Rainer C. et al . Family caregivers of patients with dementia: impact of factors of burden.  Psychiat Prax. 2002;  29 142-147
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Andersen C K, Wittrup-Jensen K U, Lolk A. et al . Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia.  Health Qual Life Outcomes. 2004;  2 52
    CrossrefPubMedGoogle Scholar
  • 7 Waring S C, Doody R S, Pavlik V N. et al . Survival among patients with dementia from a large multi-ethnic population.  Alzheimer Dis Assoc Disord. 2005;  19 178-183
    CrossrefPubMedGoogle Scholar
  • 8 Artaz M A, Boddaert J, Heriche-Taillandier E. et al . Medical comorbidity in Alzheimer's disease: baseline characteristics of the REAL.FR Cohort.  Rev Med Interne. 2006;  27 91-97
    PubMedGoogle Scholar
  • 9 Foley D J, Brock D B, Lanska D J. Trends in dementia mortality from two National Mortality Followback Surveys.  Neurology. 2003;  60 709-711
    PubMedGoogle Scholar
  • 10 Nitrini R, Caramelli P, Herrera Jr E. et al . Mortality from dementia in a community-dwelling Brazilian population.  Int J Geriatr Psychiatry. 2005;  20 247-253
    CrossrefPubMedGoogle Scholar
  • 11 Boersma F, Van Den B W, Deeg D J. et al . Survival in a population-based cohort of dementia patients: predictors and causes of mortality.  Int J Geriatr Psychiatry. 1999;  14 748-753
    CrossrefPubMedGoogle Scholar
  • 12 Barton C, Miller B, Yaffe K. Improved evaluation and management of cognitive impairment: results of a comprehensive intervention in long-term care.  J Am Med Dir Assoc. 2006;  7 84-89
    CrossrefPubMedGoogle Scholar
  • 13 Perneczky R, Wagenpfeil S, Komossa K. et al . Mapping scores onto stages: mini-mental state examination and clinical dementia rating.  Am J Geriatr Psychiatry. 2006;  14 139-144
    CrossrefPubMedGoogle Scholar
  • 14 Walsh J S, Welch H G, Larson E B. Survival of outpatients with Alzheimer-type dementia.  Ann Intern Med. 1990;  113 429-434
    PubMedGoogle Scholar
  • 15 Berg S, Jeppson L. Cognitive functioning and survival in psychogeriatric patients.  Acta Psychiatr Scand. 1991;  84 160-162
    CrossrefPubMedGoogle Scholar
  • 16 Wolf R, Weber S. Factors affecting delayed initial diagnosis of dementing diseases.  Z Gerontol Geriatr. 1998;  31 209-221
    CrossrefPubMedGoogle Scholar
  • 17 Perneczky R, Wagenpfeil S, Komossa K. et al . Mapping scores onto stages: mini-mental state examination and clinical dementia rating.  Am J Geriatr Psychiatry. 2006;  14 139-144
    CrossrefPubMedGoogle Scholar
  • 18 Tierney M C, Charles J, Naglie G. et al . Risk factors for harm in cognitively impaired seniors who live alone: a prospective study.  J Am Geriatr Soc. 2004;  52 1435-1441
    CrossrefPubMedGoogle Scholar
  • 19 Larson E B, Shadlen M F, Wang L. et al . Survival after initial diagnosis of Alzheimer disease.  Ann Intern Med. 2004;  140 501-509
    CrossrefPubMedGoogle Scholar
  • 20 Aguero-Torres H, Fratiglioni L, Guo Z. et al . Prognostic factors in very old demented adults: a seven-year follow-up from a population-based survey in Stockholm.  J Am Geriatr Soc. 1998;  46 444-452
    PubMedGoogle Scholar
  • 21 Bowen J D, Malter A D, Sheppard L. et al . Predictors of mortality in patients diagnosed with probable Alzheimer's disease.  Neurology. 1996;  47 433-439
    PubMedGoogle Scholar
  • 22 Tschanz J T, Corcoran C, Skoog I. et al . Dementia: the leading predictor of death in a defined elderly population: the Cache County Study.  Neurology. 2004;  62 1156-1162
    PubMedGoogle Scholar
  • 23 Ganguli M, Dodge H H, Shen C. et al . Alzheimer disease and mortality: a 15-year epidemiological study.  Arch Neurol. 2005;  62 779-784
    CrossrefPubMedGoogle Scholar
  • 24 Bonaiuto S, Mele M, Galluzzo L. et al . Survival and dementia: a 7-year follow-up of an Italian elderly population.  Arch Gerontol Geriatr. 1995;  20 105-113
    CrossrefPubMedGoogle Scholar
  • 25 Frisoni G B, Fratiglioni L, Fastbom J. et al . Mortality in nondemented subjects with cognitive impairment: the influence of health-related factors.  Am J Epidemiol. 1999;  150 1031-1044
    PubMedGoogle Scholar
  • 26 Noale M, Maggi S, Minicuci N. et al . Dementia and disability: impact on mortality. The Italian Longitudinal Study on Aging.  Dement Geriatr Cogn Disord. 2003;  16 7-14
    CrossrefPubMedGoogle Scholar
  • 27 Bhargava D, Weiner M F, Hynan L S. et al . Vascular disease and risk factors, rate of progression, and survival in Alzheimer's disease.  J Geriatr Psychiatry Neurol. 2006;  19 78-82
    CrossrefPubMedGoogle Scholar
  • 28 Bracco L, Gallato R, Grigoletto F. et al . Factors affecting course and survival in Alzheimer's disease. A 9-year longitudinal study.  Arch Neurol. 1994;  51 1213-1219
    PubMedGoogle Scholar
  • 29 Wolfson C, Wolfson D B, Asgharian M. et al . A reevaluation of the duration of survival after the onset of dementia.  N Engl J Med. 2001;  344 1111-1116
    CrossrefPubMedGoogle Scholar
  • 30 Karlawish J H, Casarett D, Propert K J. et al . Relationship between Alzheimer's disease severity and patient participation in decisions about their medical care.  J Geriatr Psychiatry Neurol. 2002;  15 68-72
    CrossrefPubMedGoogle Scholar
  • 31 Luck T, Busse A, Hensel A. et al . Leichte kognitive Beeinträchtigungen und Demenzentwicklung. Ergebnisse einer bevölkerungsrepräsentativen Längsschnittstudie (LEILA 75+).  Psychiat Prax. 2008;  35 331-336
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Aurich C, Riedel-Heller S G, Becker T. Does education prevent dementia?.  Psychiat Prax. 1999;  26 112-115
    PubMedGoogle Scholar
  • 33 Kissler S, Hötte S D, Lankers D. et al . Welchen Einfluss haben zerebrale Durchblutungsstörungen auf die Überlebenszeit Demenzerkrankter?.  Z Gerontol Geriatr. 2008;  41 51-55
    CrossrefPubMedGoogle Scholar
  • 34 Lankers D, Kissler S, Hötte S D. et al . Welchen Einfluss hat die Wohnform auf die Überlebenszeit Demenzerkrankter?.  Z Gerontol Geriatr . 2010 angenommen; 
    PubMedGoogle Scholar
  • 35 Riedel-Heller S, Bramesfeld A, Roick C. et al . Der Ruf nach mehr Versorgungsforschung.  Psychiat Prax. 2008;  35 157-159
    Article in Thieme ConnectPubMedGoogle Scholar

Priv.-Doz. Dr. med. habil. Stefan Georg Schröder

Ernst-Moritz-Arndt-Universität Greifswald, Arbeitsgruppe Gerontopsychiatrie, Chefarzt der Klinik für Psychiatrie, Psychotherapie und Psychosomatik, KMG Klinikum Güstrow

Friedrich-Trendelenburg-Allee 1

18273 Güstrow

Email: s.schroeder@kmg.ag

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