Progression von leichter kognitiver Störung zur Demenz in deutschen Hausarztpraxen: Eine retrospektive, datenbankgestützte Auswertung

Zusammenfassung

Ziel der Studie Schätzung der Progressionsrate von der leichten kognitiven Störung (MCI) zur Demenz und Untersuchung möglicher Risikofaktoren in deutschen Hausarztpraxen.

Methodik 4057 Patienten über 40 Jahre aus 723 Hausarztpraxen, bei denen erstmals zwischen 2000 und 2014 eine MCI diagnostiziert wurde. Die wichtigste Zielvariable in der Studie war die zum ersten Mal dokumentierte Demenz-Diagnose, die zwischen dem Beobachtungsbeginn (erste MCI-Diagnose-Stellung) und dem Beobachtungsende (maximal 5 Jahre) gestellt wurde. Cox-Regression-Modelle wurden eingesetzt, um den Einfluss von Kovariablen (Alter, Geschlecht, Versicherungsstatus) auf das Risiko des Übergangs von MCI zur Demenz zu untersuchen.

Ergebnisse Das Durchschnittsalter betrug 73,9 Jahre, 43,9 % waren Männer, 5,2 % der Patienten waren privat versichert. 27,4 % Frauen und 25,7 % Männer entwickelten eine Demenz (P = 0,192.). Die Demenzrate stieg von 6,6 % in der Altersgruppe ≤ 60 Jahre auf 39,0 % in der Altersgruppe > 80 Jahre. Die Hazard Ratio wuchs mit jedem zusätzlichen Lebensjahr (HR = 1,06).

Schlussfolgerung Hausärzte dokumentieren die Diagnose „Leichte kognitive Störung“ (MCI). Einer von vier Patienten entwickelt in fünf Jahren eine Demenz. Alter, aber nicht Geschlecht oder Versicherungstyp war mit dem erhöhten Demenzrisiko assoziiert. Die Progressionsraten sind denen wissenschaftlicher Studien vergleichbar.

Abstract

Aim To estimate the rate of progression of mild cognitive impairment (MCI) to dementia and to identify potential risk factors in patients in German primary-care practices.

Methodology From those seen at 723 general physicians’ practices, this study included 4057 patients aged 40 years and above who were initially diagnosed with MCI between 2000 and 2014. The primary outcome was diagnosis of all-cause dementia recorded between the index date and the end of the five-year follow-up. Cox regression models were performed to examine MCI progression to dementia when adjusted for confounders (age, sex and health insurance type).

Results The mean age was 73.9 years. There were 43.9 % of men and 5.2 % of individuals with private health insurance coverage. There were 27.4 % of women and 25.7 % of men with dementia after the five-year follow-up (P = 0.192). The proportion of dementia increased with age from 6.6 % in the age group of ≤ 60 years to 39.0 % in the age group of > 80 years, with the hazard ratio increasing every additional year (HR = 1.06).

Conclusion About one out of four patients developed dementia in the five years following MCI diagnosis. Age but not sex or type of health insurance was associated with this higher risk.

Schlüsselwörter

leichte kognitive Störung - Demenz - Risikofaktoren - hausärztliche Versorgung - Hausarztpraxen

Key words

mild cognitive impairment - dementia - risk factors - primary care - primary care practices

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