Somatische Faktoren bei leichten kognitiven Störungen

T. Etgen; M. Brönner; D. Sander; H. Bickel; K. Sander; H. Förstl

doi:10.1055/s-0028-1109116

Fortschritte der Neurologie · Psychiatrie, Table of Contents

Fortschr Neurol Psychiatr 2009; 77(2): 72-82
DOI: 10.1055/s-0028-1109116

Originalarbeit

Somatische Faktoren bei leichten kognitiven Störungen

Somatic Factors in Cognitive ImpairmentT. Etgen^1, ² , M. Brönner² , D. Sander^3, ⁴ , H. Bickel² , K. Sander^3, ⁴ , H. Förstl²

¹Neurologische Klinik, Klinikum Traunstein (Chefarzt: Dr. T. Freudenberger)
²Klinik für Psychiatrie und Psychotherapie, Technische Universität München (Direktor: Prof. Dr. H. Förstl)
³Neurologische Klinik, Medical Park Loipl, Bischofswiesen (Chefarzt: Prof. Dr. D. Sander)
⁴Neurologische Klinik, Technische Universität München (Direktor: Prof. Dr. B. Hemmer)

Abstract

Zusammenfassung

Leichte kognitive Störungen beschreiben eine häufige, über dem Durchschnitt der entsprechenden Alters- und Ausbildungsstufe liegende Einschränkung von Merkfähigkeit, Aufmerksamkeit oder Denkvermögen ohne wesentliche Störung im Alltagsleben. Der Begriff „mild cognitive impairment (MCI)“ wurde in den letzten Jahren unterschiedlich definiert und als fragliches Vorstadium demenzieller Erkrankungen diskutiert. Die Ätiologie leichter kognitiver Störungen ist heterogen und kann durch unterschiedliche somatische Erkrankungen begünstigt oder hervorgerufen werden. Zu den relevanten somatischen Faktoren gehören Bluthochdruck, Diabetes mellitus, Herzinsuffizienz, chronisch-obstruktive Lungenerkrankung und Asthma bronchiale. Eine mögliche Rolle bei der Entstehung von leichten kognitiven Störungen besitzen ferner Hypercholesterinämie, chronische Niereninsuffizienz, subklinische Hypothyreose, Testosteronmangel, minimale hepatische Enzephalopathie, HIV- und Hepatitis-C-Infektion. Daher muss bei leichten kognitiven Störungen nach somatischen Risikofaktoren gesucht werden, um diese optimal zu behandeln, da dies zu einer Leistungsverbesserung führen oder eine Progredienz verhindern kann.

Abstract

Mild cognitive impairment describes a cognitive decline greater than expected for an individual’s age and education level that does not interfere significantly with activities of daily life. In the recent years concepts of “mild cognitive impairment” with divergent definitions have been discussed as potential preclinical forms of dementia. The etiology of cognitive impairment is heterogeneous and it can be promoted or caused by numerous somatic factors. Relevant somatic factors include hypertension, diabetes mellitus, heart failure, chronic obstructive airways disease and bronchial asthma. Cognitive impairment may be facilitated by hypercholesterolemia, chronic renal failure, hypothyroidism, testosterone deficiency, minimal hepatic encephalopathy, HIV- and hepatitis C-infection. Knowledge and diagnosis of these somatic factors is essential in cognitive impairment, as diligent treatment may lead to improve cognitive performance and postpone the manifestation of dementia.

Schlüsselwörter

leichte kognitive Störungen - Demenz - somatische Risikofaktoren - Ätiologie - Prävention

Key words

mild cognitive impairment - dementia - somatic risk factors - etiology - prevention

Full Text

References

Literatur

1 Gauthier S, Reisberg B, Zaudig M. et al . Mild cognitive impairment. Lancet. 2006; 367 1262-1270
2 Kurz A, Diehl J, Riemenschneider M. et al . Leichte kognitive Störung. Fragen zu Definition, Diagnose, Prognose und Therapie. Nervenarzt. 2004; 75 6-15
3 DeCarli C. Mild cognitive impairment: prevalence, prognosis, aetiology, and treatment. Lancet Neurol. 2003; 2 15-21
4 Winblad B, Palmer K, Kivipelto M. et al . Mild cognitive impairment – beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med. 2004; 256 240-246
5 Luck T, Riedel-Heller S G, Kaduszkiewicz H. et al . Mild cognitive impairment in general practice: age-specific prevalence and correlate results from the German study on ageing, cognition and dementia in primary care patients (AgeCoDe). Dement Geriatr Cogn Disord. 2007; 24 307-316
6 Graham J E, Rockwood K, Beattie B L. et al . Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet. 1997; 349 1793-1796
7 Förstl H, Bickel H, Frölich L. et al . Leichte kognitive Beeinträchtigung mit Vorzeichen rascher Verschlechterung. Dtsch Med Wochenschr. 2008; 133 431-436
8 Price J L, Morris J C. Tangles and plaques in nondemented aging and “preclinical” Alzheimer’s disease. Ann Neurol. 1999; 45 358-368
9 Riemenschneider M, Lautenschlager N, Wagenpfeil S. et al . Cerebrospinal fluid tau and beta-amyloid 42 proteins identify Alzheimer disease in subjects with mild cognitive impairment. Arch Neurol. 2002; 59 1729-1734
10 Morris J C, Storandt M, Miller J P. et al . Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol. 2001; 58 397-405
11 Linn R T, Wolf P A, Bachman D L. et al . The ‘preclinical phase’ of probable Alzheimer’s disease. A 13-year prospective study of the Framingham cohort. Arch Neurol. 1995; 52 485-490
12 DeCarli C, Miller B L, Swan G E. et al . Cerebrovascular and brain morphologic correlates of mild cognitive impairment in the National Heart, Lung, and Blood Institute Twin Study. Arch Neurol. 2001; 58 643-647
13 Seux M L, Forette F. Effects of hypertension and its treatment on mental function. Curr Hypertens Rep. 1999; 1 232-237
14 Birkenhager W H, Forette F, Seux M L. et al . Blood pressure, cognitive functions, and prevention of dementias in older patients with hypertension. Arch Intern Med. 2001; 161 152-156
15 Elias M F, Wolf P A, D’Agostino R B. et al . Untreated blood pressure level is inversely related to cognitive functioning: the Framingham Study. Am J Epidemiol. 1993; 138 353-364
16 Launer L J, Masaki K, Petrovitch H. et al . The association between midlife blood pressure levels and late-life cognitive function. The Honolulu-Asia Aging Study. J Am Med Assoc. 1995; 274 1846-1851
17 Tzourio C, Dufouil C, Ducimetiere P. et al . Cognitive decline in individuals with high blood pressure: a longitudinal study in the elderly. EVA Study Group. Epidemiology of Vascular Aging. Neurology. 1999; 53 1948-1952
18 Prince M J, Bird A S, Blizard R A. et al . Is the cognitive function of older patients affected by antihypertensive treatment? Results from 54 months of the Medical Research Council’s trial of hypertension in older adults. Brit Med J. 1996; 312 801-805
19 Applegate W B, Pressel S, Wittes J. et al . Impact of the treatment of isolated systolic hypertension on behavioral variables. Results from the systolic hypertension in the elderly program. Arch Intern Med. 1994; 154 2154-2160
20 Lithell H, Hansson L, Skoog I. et al . The Study on Cognition and Prognosis in the Elderly (SCOPE): principal results of a randomized double-blind intervention trial. J Hypertens. 2003; 21 875-886
21 Forette F, Seux M L, Staessen J A. et al . Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial. Lancet. 1998; 352 1347-1351
22 Tzourio C, Anderson C, Chapman N. et al . Effects of blood pressure lowering with perindopril and indapamide therapy on dementia and cognitive decline in patients with cerebrovascular disease. Arch Intern Med. 2003; 163 1069-1075
23 McGuinness B, Todd S, Passmore P. et al . The effects of blood pressure lowering on development of cognitive impairment and dementia in patients without apparent prior cerebrovascular disease. Cochrane Database Syst Rev. 2006 Apr 19; (2) CD004034
24 Poon I O. Effects of antihypertensive drug treatment on the risk of dementia and cognitive impairment. Pharmacotherapy. 2008; 28 366-375
25 Skoog I, Lernfelt B, Landahl S. et al . 15-year longitudinal study of blood pressure and dementia. Lancet. 1996; 347 1141-1145
26 Cardiogenic Dementia. Lancet. 1977; 1 27-28
27 Vogels R L, Scheltens P, Schroeder-Tanka J M. et al . Cognitive impairment in heart failure: a systematic review of the literature. Eur J Heart Fail. 2007; 9 440-449
28 Deshields T L, McDonough E M, Mannen R K. et al . Psychological and cognitive status before and after heart transplantation. Gen Hosp Psychiatry. 1996; 18 62S-69S
29 Koide H, Kobayashi S, Kitani M. et al . Improvement of cerebral blood flow and cognitive function following pacemaker implantation in patients with bradycardia. Gerontology. 1994; 40 279-285
30 Grant I, Heaton R K, McSweeny A J. et al . Neuropsychologic findings in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med. 1982; 142 1470-1476
31 Prigatano G P, Parsons O, Wright E. et al . Neuropsychological test performance in mildly hypoxemic patients with chronic obstructive pulmonary disease. J Consult Clin Psychol. 1983; 51 108-116
32 Grant I, Prigatano G P, Heaton R K. et al . Progressive neuropsychologic impairment and hypoxemia. Relationship in chronic obstructive pulmonary disease. Arch Gen Psychiatry. 1987; 44 999-1006
33 Hjalmarsen A, Waterloo K, Dahl A. et al . Effect of long-term oxygen therapy on cognitive and neurological dysfunction in chronic obstructive pulmonary disease. Eur Neurol. 1999; 42 27-35
34 Incalzi R A, Gemma A, Marra C. et al . Chronic obstructive pulmonary disease. An original model of cognitive decline. Am Rev Respir Dis. 1993; 148 418-424
35 Heaton R K, Grant I, McSweeny A J. et al . Psychologic effects of continuous and nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease. Arch Intern Med. 1983; 143 1941-1947
36 Krop H D, Block A J, Cohen E. Neuropsychologic effects of continuous oxygen therapy in chronic obstructive pulmonary disease. Chest. 1973; 64 317-322
37 Liesker J J, Postma D S, Beukema R J. et al . Cognitive performance in patients with COPD. Respir Med. 2004; 98 351-356
38 Fitzpatrick M F, Engleman H, Whyte K F. et al . Morbidity in nocturnal asthma: sleep quality and daytime cognitive performance. Thorax. 1991; 46 569-573
39 Weersink E J, Zomeren E H, Koeter G H. et al . Treatment of nocturnal airway obstruction improves daytime cognitive performance in asthmatics. Am J Respir Crit Care Med. 1997; 156 1144-1150
40 Gregg E W, Yaffe van K, Cauley J A. et al . Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group. Arch Intern Med. 2000; 160 174-180
41 Logroscino G, Kang J H, Grodstein F. Prospective study of type 2 diabetes and cognitive decline in women aged 70 – 81 years. Brit Med J. 2004; 328 548
42 Yaffe K, Blackwell T, Kanaya A M. et al . Diabetes, impaired fasting glucose, and development of cognitive impairment in older women. Neurology. 2004; 63 658-663
43 Okereke O I, Kang J H, Cook N R. et al . Type 2 Diabetes Mellitus and Cognitive Decline in Two Large Cohorts of Community-Dwelling Older Adults. J Am Geriatr Soc. 2008; 56 1028-1036
44 Brands A M, Biessels G J, Haan E H. et al . The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care. 2005; 28 726-735
45 Ryan C M. Diabetes, aging, and cognitive decline. Neurobiol Aging. 2005; 26 (Suppl 1) 21-25
46 Brownlee de M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001; 414 813-820
47 Pappolla M A, Bryant-Thomas T K, Herbert D. et al . Mild hypercholesterolemia is an early risk factor for the development of Alzheimer amyloid pathology. Neurology. 2003; 61 199-205
48 Roher A E, Esh C, Kokjohn T A. et al . Circle of willis atherosclerosis is a risk factor for sporadic Alzheimer’s disease. Arterioscler Thromb Vasc Biol. 2003; 23 2055-2062
49 Kivipelto M, Helkala E L, Hanninen T. et al . Midlife vascular risk factors and late-life mild cognitive impairment: A population-based study. Neurology. 2001; 56 1683-1689
50 Mielke M M, Zandi P P, Sjogren M. et al . High total cholesterol levels in late life associated with a reduced risk of dementia. Neurology. 2005; 64 1689-1695
51 Solfrizzi V, Panza F, Colacicco A M. et al . Vascular risk factors, incidence of MCI, and rates of progression to dementia. Neurology. 2004; 63 1882-1891
52 Panza F, Capurso C, D’Introno A. et al . Total cholesterol levels and the risk of mild cognitive impairment and Alzheimer’s disease. J Am Geriatr Soc. 2007; 55 133-135
53 Solomon A, Kareholt I, Ngandu T. et al . Serum cholesterol changes after midlife and late-life cognition: twenty-one-year follow-up study. Neurology. 2007; 68 751-756
54 Wirths O, Thelen K, Breyhan H. et al . Decreased plasma cholesterol levels during aging in transgenic mouse models of Alzheimer’s disease. Exp Gerontol. 2006; 41 220-224
55 Solomon A, Kareholt I, Ngandu T. et al . Serum total cholesterol, statins and cognition in non-demented elderly. Neurobiol Aging. 2007 Nov 15; Epub ahead of print
56 Heart Protection Study Collaborative Study Group . MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360 7-22
57 Madero M, Gul A, Sarnak M J. Cognitive function in chronic kidney disease. Semin Dial. 2008; 21 29-37
58 Kurella M, Yaffe K, Shlipak M G. et al . Chronic kidney disease and cognitive impairment in menopausal women. Am J Kidney Dis. 2005; 45 66-76
59 Seliger S L, Siscovick D S, Stehman-Breen C O. et al . Moderate renal impairment and risk of dementia among older adults: the Cardiovascular Health Cognition Study. J Am Soc Nephrol. 2004; 15 1904-1911
60 Teng E L, Chui H C. The Modified Mini-Mental State (3 MS) examination. J Clin Psychiatry. 1987; 48 314-318
61 Kurella M, Chertow G M, Fried L F. et al . Chronic kidney disease and cognitive impairment in the elderly: the health, aging, and body composition study. J Am Soc Nephrol. 2005; 16 2127-2133
62 Olichney J M, Taylor J R, Gatherwright J. et al . Patients with MCI and N 400 or P 600 abnormalities are at very high risk for conversion to dementia. Neurology. 2008; 70 1763-1770
63 Madan P, Kalra O P, Agarwal S. et al . Cognitive impairment in chronic kidney disease. Nephrol Dial Transplant. 2007; 22 440-444
64 Kurella M, Chertow G M, Luan J. et al . Cognitive impairment in chronic kidney disease. J Am Geriatr Soc. 2004; 52 1863-1869
65 Stewart C A, Smith G E. Minimal hepatic encephalopathy. Nat Clin Pract Gastroenterol Hepatol. 2007; 4 677-685
66 Weissenborn K, Ennen J C, Schomerus H. et al . Neuropsychological characterization of hepatic encephalopathy. J Hepatol. 2001; 34 768-773
67 McCrea M, Cordoba J, Vessey G. et al . Neuropsychological characterization and detection of subclinical hepatic encephalopathy. Arch Neurol. 1996; 53 758-763
68 Ferenci P, Lockwood A, Mullen K. et al . Hepatic encephalopathy – definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002; 35 716-721
69 Groeneweg M, Quero J C, De Bruijn I. et al . Subclinical hepatic encephalopathy impairs daily functioning. Hepatology. 1998; 28 45-49
70 Lockwood A H. “What’s in a name?” Improving the care of cirrhotics. J Hepatol. 2000; 32 859-861
71 Clarke R, Refsum H, Birks J. et al . Screening for vitamin B-12 and folate deficiency in older persons. Am J Clin Nutr. 2003; 77 1241-1247
72 Lindenbaum J, Healton E B, Savage D G. et al . Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis. N Engl J Med. 1988; 318 1720-1728
73 Hin H, Clarke R, Sherliker P. et al . Clinical relevance of low serum vitamin B 12 concentrations in older people: the Banbury B 12 study. Age Ageing. 2006; 35 416-422
74 Malouf R, Areosa S astre A. Vitamin B 12 for cognition. Cochrane Database Syst Rev. 2003; (3) CD004326
75 Kessler H, Bleich S, Falkai P. et al . Homozystein und Demenzerkrankungen. Fortschr Neurol Psychiatr. 2003; 71 150-156
76 Riggs K M, Spiro 3 rd A, Tucker K. et al . Relations of vitamin B-12, vitamin B-6, folate, and homocysteine to cognitive performance in the Normative Aging Study. Am J Clin Nutr. 1996; 63 306-314
77 Quadri P, Fragiacomo C, Pezzati R. et al . Homocysteine and B vitamins in mild cognitive impairment and dementia. Clin Chem Lab Med. 2005; 43 1096-1100
78 Tucker K L, Qiao N, Scott T. et al . High homocysteine and low B vitamins predict cognitive decline in aging men: the Veterans Affairs Normative Aging Study. Am J Clin Nutr. 2005; 82 627-635
79 Mooijaart S P, Gussekloo J, Frolich M. et al . Homocysteine, vitamin B-12, and folic acid and the risk of cognitive decline in old age: the Leiden 85-Plus study. Am J Clin Nutr. 2005; 82 866-871
80 Malouf M, Grimley E J, Areosa S A. Folic acid with or without vitamin B 12 for cognition and dementia. Cochrane Database Syst Rev. 2003; (4) CD004514
81 Janowsky J S. Thinking with your gonads: testosterone and cognition. Trends Cogn Sci. 2006; 10 77-82
82 Tirassa P, Thiblin I, Agren G. et al . High-dose anabolic androgenic steroids modulate concentrations of nerve growth factor and expression of its low affinity receptor (p75-NGFr) in male rat brain. J Neurosci Res. 1997; 47 198-207
83 Zitzmann M, Weckesser M, Schober O. et al . Changes in cerebral glucose metabolism and visuospatial capability in hypogonadal males under testosterone substitution therapy. Exp Clin Endocrinol Diabetes. 2001; 109 302-304
84 Azad N, Pitale S, Barnes W E. et al . Testosterone treatment enhances regional brain perfusion in hypogonadal men. J Clin Endocrinol Metab. 2003; 88 3064-3068
85 Beauchet O. Testosterone and cognitive function: current clinical evidence of a relationship. Eur J Endocrinol. 2006; 155 773-781
86 Nieschlag E, Swerdloff R, Behre H M. et al . Investigation, treatment and monitoring of late-onset hypogonadism in males. ISA, ISSAM, and EAU recommendations. Eur Urol. 2005; 48 1-4
87 Cooper D S. Clinical practice. Subclinical hypothyroidism. N Engl J Med. 2001; 345 260-265
88 Canaris G J, Manowitz N R, Mayor G. et al . The Colorado thyroid disease prevalence study. Arch Intern Med. 2000; 160 526-534
89 Osterweil D, Syndulko K, Cohen S N. et al . Cognitive function in non-demented older adults with hypothyroidism. J Am Geriatr Soc. 1992; 40 325-335
90 Volpato S, Guralnik J M, Fried L P. et al . Serum thyroxine level and cognitive decline in euthyroid older women. Neurology. 2002; 58 1055-1061
91 Badgio P C, Worden B L. Cognitive functioning and aging in women. J Women Aging. 2007; 19 13-30
92 Burmeister L A, Ganguli M, Dodge H H. et al . Hypothyroidism and cognition: preliminary evidence for a specific defect in memory. Thyroid. 2001; 11 1177-1185
93 Davis J D, Stern R A, Flashman L A. Cognitive and neuropsychiatric aspects of subclinical hypothyroidism: significance in the elderly. Curr Psychiatry Rep. 2003; 5 384-390
94 Vardy J, Rourke S, Tannock I F. Evaluation of cognitive function associated with chemotherapy: a review of published studies and recommendations for future research. J Clin Oncol. 2007; 25 2455-2463
95 Minisini A, Atalay G, Bottomley A. et al . What is the effect of systemic anticancer treatment on cognitive function?. Lancet Oncol. 2004; 5 273-282
96 Anderson-Hanley C, Sherman M L, Riggs R. et al . Neuropsychological effects of treatments for adults with cancer: a meta-analysis and review of the literature. J Int Neuropsychol Soc. 2003; 9 967-982
97 Jansen C E, Miaskowski C, Dodd M. et al . A metaanalysis of studies of the effects of cancer chemotherapy on various domains of cognitive function. Cancer. 2005; 104 2222-2233
98 Hopkins R O, Jackson J C. Long-term neurocognitive function after critical illness. Chest. 2006; 130 869-878
99 Jackson J C, Hart R P, Gordon S M. et al . Six-month neuropsychological outcome of medical intensive care unit patients. Crit Care Med. 2003; 31 1226-1234
100 Hopkins R O, Weaver L K, Pope D. et al . Neuropsychological sequelae and impaired health status in survivors of severe acute respiratory distress syndrome. Am J Respir Crit Care Med. 1999; 160 50-56
101 Rothenhausler H B, Ehrentraut S, Stoll C. et al . The relationship between cognitive performance and employment and health status in long-term survivors of the acute respiratory distress syndrome: results of an exploratory study. Gen Hosp Psychiatry. 2001; 23 90-96
102 Hopkins R O, Weaver L K, Collingridge D. et al . Two-year cognitive, emotional, and quality-of-life outcomes in acute respiratory distress syndrome. Am J Respir Crit Care Med. 2005; 171 340-347
103 Mullges W, Berg D, Schmidtke A. et al . Early natural course of transient encephalopathy after coronary artery bypass grafting. Crit Care Med. 2000; 28 1808-1811
104 Keith J R, Puente A E, Malcolmson K L. et al . Assessing postoperative cognitive change after cardiopulmonary bypass surgery. Neuropsychology. 2002; 16 411-421
105 Selnes O A, Grega M A, Borowicz L M. et al . Cognitive changes with coronary artery disease: a prospective study of coronary artery bypass graft patients and nonsurgical controls. Ann Thorac Surg. 2003; 75 1377-1384; discussion 1384 – 1376
106 Selnes O A, McKhann G M. Neurocognitive complications after coronary artery bypass surgery. Ann Neurol. 2005; 57 615-621
107 Newman M F, Kirchner J L, Phillips-Bute Jr B. et al . Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 2001; 344 395-402
108 Selnes O A, Royall R M, Grega M A. et al . Cognitive changes 5 years after coronary artery bypass grafting: is there evidence of late decline?. Arch Neurol. 2001; 58 598-604
109 Stygall J, Newman S P, Fitzgerald G. et al . Cognitive change 5 years after coronary artery bypass surgery. Health Psychol. 2003; 22 579-586
110 Mullges W, Babin-Ebell J, Reents W. et al . Cognitive performance after coronary artery bypass grafting: a follow-up study. Neurology. 2002; 59 741-743
111 Potter G G, Plassman B L, Helms M J. et al . Age effects of coronary artery bypass graft on cognitive status change among elderly male twins. Neurology. 2004; 63 2245-2249
112 Hlatky M A BC, Boothroyd D. et al . Cognitive function 5 years after randomization to coronary angioplasty or coronary artery bypass graft surgery. Circulation. 1999; 96 11-15
113 McKhann G M, Grega M A, Borowicz L M. et al . Is there cognitive decline 1 year after CABG? Comparison with surgical and nonsurgical controls. Neurology. 2005; 65 991-999
114 Selnes O A, Zeger S L. Coronary artery bypass grafting baseline cognitive assessment: essential not optional. Ann Thorac Surg. 2007; 83 374-376
115 Perry Jr W, Hilsabeck R C, Hassanein T I. Cognitive dysfunction in chronic hepatitis C: a review. Dig Dis Sci. 2008; 53 307-321
116 Forton D M, Taylor-Robinson S D, Thomas H C. Central nervous system changes in hepatitis C virus infection. Eur J Gastroenterol Hepatol. 2006; 18 333-338
117 Forton D M, Thomas H C, Murphy C A. et al . Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease. Hepatology. 2002; 35 433-439
118 Hilsabeck R C, Hassanein T I, Carlson M D. et al . Cognitive functioning and psychiatric symptomatology in patients with chronic hepatitis C. J Int Neuropsychol Soc. 2003; 9 847-854
119 McAndrews M P, Farcnik K, Carlen P. et al . Prevalence and significance of neurocognitive dysfunction in hepatitis C in the absence of correlated risk factors. Hepatology. 2005; 41 801-808
120 Cordoba J, Flavia M, Jacas C. et al . Quality of life and cognitive function in hepatitis C at different stages of liver disease. J Hepatol. 2003; 39 231-238
121 Lawson L J, Perry V H, Gordon S. Turnover of resident microglia in the normal adult mouse brain. Neuroscience. 1992; 48 405-415
122 Nomenclature and research case definitions for neurologic manifestations of human immunodeficiency virus-type 1 (HIV-1) infection. Report of a Working Group of the American Academy of Neurology AIDS Task Force. Neurology. 1991; 41 778-785
123 Heaton R K, Grant I, Butters N. et al . The HNRC 500 – neuropsychology of HIV infection at different disease stages. HIV Neurobehavioral Research Center. J Int Neuropsychol Soc. 1995; 1 231-251
124 Goodkin K, Wilkie F L, Concha M. et al . Aging and neuro-AIDS conditions and the changing spectrum of HIV-1-associated morbidity and mortality. J Clin Epidemiol. 2001; 54 (Suppl 1) S35-S43
125 White D A, Heaton R K, Monsch A U. Neuropsychological studies of asymptomatic human immunodeficiency virus-type-1 infected individuals. The HNRC Group. HIV Neurobehavioral Research Center. J Int Neuropsychol Soc. 1995; 1 304-315
126 Ances B M, Ellis R J. Dementia and neurocognitive disorders due to HIV-1 infection. Semin Neurol. 2007; 27 86-92
127 Valcour V G, Shikuma C M, Watters M R. et al . Cognitive impairment in older HIV-1-seropositive individuals: prevalence and potential mechanisms. Aids. 2004; 18 (Suppl 1) S79-S86
128 Hult B, Chana G, Masliah E. et al . Neurobiology of HIV. Int Rev Psychiatry. 2008; 20 3-13
129 Strachan M W, Price J F, Frier B M. Diabetes, cognitive impairment, and dementia. Brit Med J. 2008; 336 6

Dr. Thorleif Etgen

Neurologische Klinik, Klinikum Traunstein

Cuno-Niggl-Straße 3

83278 Traunstein

Email: thorleif.etgen@klinikum-traunstein.de