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DOI: 10.1055/s-2008-1080910
© Georg Thieme Verlag KG Stuttgart · New York
DEGAM-Leitlinie Demenz – Teil 1: Diagnostik
DEGAM-Guideline Dementia – Part 1: DiagnosisPublication History
eingereicht: 07.05.2008
akzeptiert: 27.05.2008
Publication Date:
18 July 2008 (online)
![](https://www.thieme-connect.de/media/zfa/200807/lookinside/thumbnails/10.1055-s-2008-1080910-1.jpg)
Lernziele
Dieser Artikel soll den in der Primärversorgung tätigen Ärzten wissenschaftlich begründete Hinweise für das Erkennen einer Demenz und Empfehlungen für die Versorgung von Menschen mit Demenz geben. Zu den therapeutischen Optionen wird es einen Folgebeitrag geben. Es ist wichtig, adäquate Instrumentarien zu entwickeln und zu evaluieren, die Wissen, Einstellungen und Handlungskompetenz bei Hausärzten im Umgang mit dem Krankheitsbild „Demenz” nachhaltig fördern. Um diese Ziele zu erreichen, werden im folgenden Beitrag die Kernaussagen einer hausärztlichen Leitlinie zur Demenz dargestellt. Um den Zusammenhang zur Leitlinie transparent zu machen, werden die Empfehlungen am Rand mit den Empfehlungsstärken der Leitlinie dargestellt: A basiert auf wissenschaftlichen Studien hoher Qualität, B auf sonstigen Studien und C auf Konsensusaussagen oder Expertenurteilen.
Die DEGAM-Leitlinie Demenz erscheint 2008. |
References
- 1 Bundesministerium für Familie Senioren Frauen und Jugend . Vierter Altenbericht zur Lage der älteren Generation in der Bundesrepublik Deutschland: Risiken, Lebensqualität und Versorgung Hochaltriger – unter besonderer Berücksichtigung demenzieller Erkrankungen. 2002;
- 2 Wagner G, Abholz H. Diagnose und Therapiemanagement der Demenz in der Hausarztpraxis. Zeitschrift für Allgemeinmedizin. 2002; 78 239-244
-
3 Vollmar HC, Mand P, Butzlaff M.
DEGAM-Leitlinie Demenz . Düsseldorf: Omikron publishing 2008 - 4 Bickel H. Dementia in advanced age: estimating incidence and health care costs]. Z Gerontol Geriatr. 2001; 34 ((2)) 108-115
- 5 Hout H van, Vernooij-Dassen M, Bakker K, Blom M, Grol R. General practitioners on dementia: tasks, practices and obstacles. Patient Educ Couns. 2000; 39 ((2–3)) 219-225
- 6 Kaduszkiewicz H, Bussche H van den. Die hausärztliche Versorgung von Patienten mit kognitiven Störungen und Demenz. Psychoneuro. 2003; 29 ((6)) 275-281
- 7 Drickamer MA, Lachs MS. Should patients with Alzheimer's disease be told their diagnosis?. N Engl J Med. 1992; 326 ((14)) 947-951
- 8 Kaduszkiewicz H, Sperber S, Busche H van den. Kompetenz bei Demenz. Möglichkeiten und Grenzen der hausärztlichen Versorgung von Patienten mit kognitiven Störungen und Demenzen. Niedersächsisches Ärzteblatt. 2005; ((4)) 7
-
9 Alex K. Angehörigenbericht. In: Gesellschaft DA ed
Fortschritte und Defizite im Problemfeld Demenz . Berlin: Deutsche Alzheimer Gesellschaft 2000: 105-110 - 10 Carpenter BD, Xiong C, Porensky EK, Lee MM, Brown PJ, Coats M. et al . Reaction to a dementia diagnosis in individuals with Alzheimer's disease and mild cognitive impairment. J Am Geriatr Soc. 2008; 56 ((3)) 405-412
- 11 Frenette G, Beauchemin P. It is sad, but it is true: yes, your father has dementia. Rev Med Suisse Romande. 2003; 123 ((7)) 437-443
- 12 Adler G, Kuskowski M. Driving Cessation in Older Men With Dementia. Alzheimer Disease & Associated Disorders April/June. 2003; 17 ((2)) 68-71
- 13 Lundberg C, Johansson K, Ball K, Bjerre B, Blomqvist C, Braekhus A. et al . Dementia and driving: an attempt at consensus. Alzheimer Dis Assoc Disord. 1997; 11 ((1)) 28-37
- 14 Abholz H, Pentzek M. Hausärztliche Versorgung von Patienten mit einer Demenz – Gedanken auf Basis von Alltagserfahrung und empirischen Befunden. Zeitschrift für Allgemeinmedizin. 2007; 83 61-65
- 15 Hensler S, Engeser P, Kaduszkiewicz H. Screening bei der hausärztlichen Versorgung der chronische Erkrankungen Depression, pAVK und Demenz. Zeitschrift für Allgemeinmedizin. 2006; 82 ((5)) 199-204
- 16 Black SE, Patterson C, Feightner J. Preventing dementia. Can J Neurol Sci. 2001; 28 ((Suppl. 1)) S56-S66
- 17 Fratiglioni L, Grut M, Forsell Y, Viitanen M, Grafstrom M, Holmen K. et al . Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education. Neurology. 1991; 41 ((12)) 1886-1892
- 18 Bickel H. Dementia syndrome and Alzheimer disease: an assessment of morbidity and annual incidence in Germany]. Gesundheitswesen. 2000; 62 ((4)) 211-218
- 19 Zhang MY, Katzman R, Salmon D, Jin H, Cai GJ, Wang ZY. et al . The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education. Ann Neurol. 1990; 27 ((4)) 428-437
- 20 Knopman DS, Edland SD, Cha RH, Petersen RC, Rocca WA. Incident dementia in women is preceded by weight loss by at least a decade. Neurology. 2007; 69 ((8)) 739-746
- 21 Fratiglioni L, Ahlbom A, Viitanen M, Winblad B. Risk factors for late-onset Alzheimer's disease: a population-based, case-control study. Ann Neurol. 1993; 33 ((3)) 258-266
- 22 Blacker D, Tanzi RE. The genetics of Alzheimer disease: current status and future prospects. Arch Neurol. 1998; 55 ((3)) 294-296
- 23 Duijn CM van, Clayton D, Chandra V, Fratiglioni L, Graves AB, Heyman A. et al . Familial aggregation of Alzheimer's disease and related disorders: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. Int J Epidemiol. 1991; 20 ((Suppl 2)) S13-S20
- 24 Jayadev S, Steinbart EJ, Chi YY, Kukull WA, Schellenberg GD, Bird TD. Conjugal Alzheimer disease: risk in children when both parents have Alzheimer disease. Arch Neurol. 2008; 65 ((3)) 373-378
- 25 Mortimer JA, Duijn CM van, Chandra V, Fratiglioni L, Graves AB, Heyman A. et al . Head trauma as a risk factor for Alzheimer's disease: a collaborative re-analysis of case-control studies. EURODEM Risk Factors Research Group. Int J Epidemiol. 1991; 20 ((Suppl 2)) S28-S35
- 26 Letenneur L, Gilleron V, Commenges D, Helmer C, Orgogozo JM, Dartigues JF. Are sex and educational level independent predictors of dementia and Alzheimer's disease? Incidence data from the PAQUID project. J Neurol Neurosurg Psychiatry. 1999; 66 ((2)) 177-183
- 27 Jorm AF, Henderson AS, Scott R, Korten AE, Christen H, Mackinnon AJ. et al . Does education protect against cognitive impairment? A comparison of the elderly in two australian cities. International Journal of Geriatric Psychiatry. 1994; 9 ((5)) 357-363
- 28 Petersen RC, Stevens JC, Ganguli M, Tangalos EG, Cummings JL, DeKosky ST. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001; 56 ((9)) 1133-1142
- 29 Bischkopf J, Busse A, Angermeyer M. Mild cognitive impairment: A review of prevalence, incidence and outcome according to current approaches. Acta Psychiatrica Scandinavica. 2002; 106 ((6)) 403-414
- 30 Grundman M, Petersen RC, Ferris SH, Thomas RG, Aisen PS, Bennett DA. et al . Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol. 2004; 61 ((1)) 59-66
- 31 Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H. Abnormality of gait as a predictor of non-Alzheimer's dementia. N Engl J Med. 2002; 347 ((22)) 1761-1768
- 32 Whitmer RA, Sidney S, Selby J, Johnston SC, Yaffe K. Midlife cardiovascular risk factors and risk of dementia in late life. Neurology. 2005; 64 ((2)) 277-281
- 33 Saunders PA, Copeland JR, Dewey ME, Davidson IA, McWilliam C, Sharma V. et al . Heavy drinking as a risk factor for depression and dementia in elderly men. Findings from the Liverpool longitudinal community study. Br J Psychiatry. 1991; 159 213-216
- 34 Anttila T, Helkala EL, Viitanen M, Kareholt I, Fratiglioni L, Winblad B. et al . Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: a prospective population based study. BMJ. 2004; 329 ((7465)) 539
- 35 Kivipelto M, Helkala E-L, Laakso MP, Hanninen T, Hallikainen M, Alhainen K. et al . Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study. BMJ. 2001; 322 ((7300)) 1447-1451
- 36 Seshadri S, Beiser A, Selhub J, Jacques PF, Rosenberg IH, D’Agostino RB. et al . Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. N Engl J Med. 2002; 346 ((7)) 476-483
- 37 Ott A, Slooter AJ, Hofman A, Harskamp F van, Witteman JC, Broeckhoven C van. et al . Smoking and risk of dementia and Alzheimer's disease in a population- based cohort study: the Rotterdam Study. Lancet. 1998; 351 ((9119)) 1840-1843
- 38 Ruitenberg A, Skoog I, Ott A, Aevarsson O, Witteman JC, Lernfelt B. et al . Blood pressure and risk of dementia: results from the Rotterdam study and the Gothenburg H-70 Study. Dement Geriatr Cogn Disord. 2001; 12 ((1)) 33-39
- 39 Ruitenberg A, Skoog I, Ott A, Aevarsson OP, Lernfelt B, Hofman A. et al . Blood Pressure and the Risk of Dementia: Results from the Gothenburg H-70 Study and the Rotterdam Study. Neurology. 1999; 52 ((6) (Suppl. 2)) A297
- 40 Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. Jama. 2003; 290 ((7)) 932-940
- 41 Honig LS, Tang MX, Albert S, Costa R, Luchsinger J, Manly J. et al . Stroke and the risk of Alzheimer disease. Arch Neurol. 2003; 60 ((12)) 1707-1712
- 42 Langa KM, Foster NL, Larson EB. Mixed dementia: emerging concepts and therapeutic implications. JAMA. 2004; 292 ((23)) 2901-2908
- 43 Oijen M van, Witteman JC, Hofman A, Koudstaal PJ, Breteler MM. Fibrinogen is associated with an increased risk of Alzheimer disease and vascular dementia. Stroke. 2005; 36 ((12)) 2637-2641
- 44 Qiu C, Winblad B, Marengoni A, Klarin I, Fastbom J, Fratiglioni L. Heart failure and risk of dementia and Alzheimer disease: a population-based cohort study. Arch Intern Med. 2006; 166 ((9)) 1003-1008
- 45 Patterson C, Feightner JW, Garcia A, Hsiung GY, MacKnight C, Sadovnick AD. Diagnosis and treatment of dementia: 1. Risk assessment and primary prevention of Alzheimer disease. CMAJ. 2008; 178 ((5)) 548-556
- 46 Alzheimer's Disease and Related Dementias Guideline Panel. Recognition and Initial Assessment of Alzheimer's Disease and Related Dementias . Rockville, Maryland: U.S. Department of Health and Human Services. Agency for Health Care Policy and Research (AHCPR). 1996;
- 47 Reding M, Haycox J, Blass J. Depression in patients referred to a dementia clinic. A three-year prospective study. Arch Neurol. 1985; 42 ((9)) 894-896
- 48 Reifler BV, Larson E, Teri L, Poulsen M. Dementia of the Alzheimer's type and depression. J Am Geriatr Soc. 1986; 34 ((12)) 855-859
- 49 Teri L, Larson EB, Reifler BV. Behavioral disturbance in dementia of the Alzheimer's type. J Am Geriatr Soc. 1988; 36 ((1)) 1-6
- 50 Knopman DS, DeKosky ST, Cummings JL, Chui H, Corey-Bloom J, Relkin N. et al . Practice parameter: Diagnosis of dementia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001; 56 ((9)) 1143-1153
- 51 Leys D, Henon H, Mackowiak-Cordoliani MA, Pasquier F. Poststroke dementia. Lancet Neurol. 2005; 4 ((11)) 752-759
-
52 Rebhandl E, Rabady S, Mader F. 36.31 Hirninfarkt, 36.32 Subarachnoidalblutung (SAB), 36.33 Intrazerebralle Blutung, 36.34 Rehabilitation nach Schlaganfall. In: Kunnamo I ed
Evidence based Medicine – Guidelines für Allgemeinmedizin . Köln: Deutscher Ärzte-Verlag 2005: 1264-1274 -
53 Hensler S, Hoidn S, Jork K.
Leitlinie Schlaganfall . Düsseldorf: Omikron publishing 2006 - 54 Freter S, Bergman H, Gold S, Chertkow H, Clarfield AM. Prevalence of potentially reversible dementias and actual reversibility in a memory clinic cohort. CMAJ. 1998; 159 ((6)) 657-662
- 55 Rizzo M, McGehee DV, Dawson JD, Anderson SN. Simulated car crashes at intersections in drivers with Alzheimer disease. Alzheimer Dis Assoc Disord. 2001; 15 ((1)) 10-20
- 56 Viitanen M, Johansson K, Bogdanovic N, Berkowicz A, Druid H, Eriksson A. et al . Alzheimer changes are common in aged drivers killed in single car crashes and at intersections. Forensic Sci Int. 1998; 96 ((2–3)) 115-127
- 57 Weibler-Villalobos U. Ernährungsstörungen bei Demenz – Sondenernährung und alternative Versorgungskonzepte. Zeitschrift für Allgemeinmedizin. 2005; 81 71-76
- 58 Ueki A, Shinjo H, Shimode H, Nakajima T, Morita Y. Factors associated with mortality in patients with early-onset Alzheimer's disease: a five-year longitudinal study. Int J Geriatr Psychiatry. 2001; 16 ((8)) 810-815
- 59 Wada H, Nakajoh K, Satoh-Nakagawa T, Suzuki T, Ohrui T, Arai H. et al . Risk factors of aspiration pneumonia in Alzheimer's disease patients. Gerontology. 2001; 47 ((5)) 271-276
- 60 Hesdorffer DC, Hauser WA, Annegers JF, Kokmen E, Rocca WA. Dementia and adult-onset unprovoked seizures. Neurology. 1996; 46 ((3)) 727-730
- 61 Cummings JL, Frank JC, Cherry D, Kohatsu ND, Kemp B, Hewett L. et al . Guidelines for managing Alzheimer's disease: part I. Assessment. Am Fam Physician. 2002; 65 ((11)) 2263-2272
- 62 Doody RS, Stevens JC, Beck C, Dubinsky RM, Kaye JA, Gwyther L. et al . Practice parameter: Management of dementia (an evidence-based review): Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001; 56 ((9)) 1154-1166
- 63 CMA Association CM . The recognition, assessment and management of dementing disorders: conclusions from the Canadian Consensus Conference on Dementia. Canad Med Assoc Journ. 1999; 160 ((12 Suppl.))
-
64 DGN DGfN .Wallesch C-W, Förstl H, Herholz K, Lang C, Schmidtke K. Diagnose und Therapie der Alzheimer-Demenz (AD) und der Demenz mit Lewy-Körperchen (DLB). In: Diener HC, ed.
Leitlinien für Diagnostik und Therapie in der Neurologie . Stuttgart: Georg Thieme Verlag 2003 - 65 Koss E, Patterson MB, Ownby R, Stuckey JC, Whitehouse PJ. Memory evaluation in Alzheimer's disease. Caregivers’ appraisals and objective testing. Arch Neurol. 1993; 50 ((1)) 92-97
- 66 McGlone J, Gupta S, Humphrey D, Oppenheimer S, Mirsen T, Evans DR. Screening for early dementia using memory complaints from patients and relatives. Arch Neurol. 1990; 47 ((11)) 1189-1193
- 67 Feher EP, Larrabee GJ, Sudilovsky A, Crook 3rd TH. Memory self-report in Alzheimer's disease and in age-associated memory impairment. J Geriatr Psychiatry Neurol. 1994; 7 ((1)) 58-65
- 68 Tobiansky R, Blizard R, Livingston G, Mann A. The Gospel Oak Study stage IV: the clinical relevance of subjective memory impairment in older people. Psychol Med. 1995; 25 ((4)) 779-786
- 69 Holsinger T, Deveau J, Boustani M, Williams Jr JW. Does this patient have dementia?. JAMA. 2007; 297 ((21)) 2391-2404
- 70 Kurz A, Gertz HJ, Monsch A, Adler G. Dementias: communication between doctor, patient and relatives]. Dtsch Med Wochenschr. 2004; 129 ((5)) 199-203
- 71 Connell CM, Boise L, Stuckey JC, Holmes SB, Hudson ML. Attitudes toward the diagnosis and disclosure of dementia among family caregivers and primary care physicians. Gerontologist. 2004; 44 ((4)) 500-507
- 72 Johnson JC, Kerse NM, Gottlieb G, Wanich C, Sullivan E, Chen K. Prospective versus retrospective methods of identifying patients with delirium. J Am Geriatr Soc. 1992; 40 ((4)) 316-319
- 73 Pentzek M. Der Mini-Mental-Status-Test (MMST) als Demenz-Screening. Methodische Überlegungen zur Eignung in der Hausarzt-Praxis. Zeitschrift für Allgemeinmedizin. 2005; 81 ((5)) 203-204
- 74 Chodosh J, Petitti DB, Elliott M, Hays RD, Crooks VC, Reuben DB. et al . Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc. 2004; 52 ((7)) 1051-1059
- 75 Monnot M, Brosey M, Ross E. Screening for dementia: family caregiver questionnaires reliably predict dementia. J Am Board Fam Pract. 2005; 18 ((4)) 240-256
- 76 Cooper B, Bickel H, Schaufele M. The ability of general practitioners to detect dementia and cognitive impairment in their elderly patients. A study in Mannheim. International Journal of Geriatric Psychiatry. 1992; 7 ((8)) 591-598
- 77 O’Connor DW, Fertig A, Grande MJ, Hyde JB, Perry JR, Roland MO. et al . Dementia in general practice: the practical consequences of a more positive approach to diagnosis. Br J Gen Pract. 1993; 43 ((370)) 185-188
- 78 Kessler J, Calabrese P, Kalbe E, Berger F. DemTect: A new screening method to support diagnosis of dementia. Psycho. 2000; 26 ((6)) 343-347
- 79 Perneczky R. The appropriateness of short cognitive tests for the identification of mild cognitive impairment and mild dementia. Aktuelle Neurologie. 2003; 30 ((3)) 114-117
- 80 Kalbe E, Kessler J, Calabrese P, Smith R, Passmore AP, Brand M. et al . DemTect: a new, sensitive cognitive screening test to support the diagnosis of mild cognitive impairment and early dementia. Int J Geriatr Psychiatry. 2004; 19 ((2)) 136-143
- 81 Grass-Kapanke B, Brieber S, Pentzek M, Ihl R. Der TFDD – Test zur Früherkennung von Demenzen mit Depressionsabgrenzung Zeitschrift für Gerontopsychologie & -psychiatrie. 2005; 18 ((3))
- 82 Brinkmeyer J, Grass-Kapanke B, Ihl R. EEG and the Test for the Early Detection of Dementia with Discrimination from Depression (TE4D): a validation study. Int J Geriatr Psychiatry. 2004; 19 ((8)) 749-753
- 83 Mahoney R, Johnston K, Katona C, Maxmin K, Livingston G. The TE4D-Cog: a new test for detecting early dementia in English-speaking populations. Int J Geriatr Psychiatry. 2005; 20 ((12)) 1172-1179
- 84 Kasa M, Bierma TJ, Waterstraat Jr F, Corsaut M, Singh SP. Routine blood chemistry screen: a diagnostic aid for Alzheimer's disease. Neuroepidemiology. 1989; 8 ((5)) 254-261
- 85 Larson EB, Reifler BV, Sumi SM, Canfield CG, Chinn NM. Diagnostic tests in the evaluation of dementia. A prospective study of 200 elderly outpatients. Arch Intern Med. 1986; 146 ((10)) 1917-1922
-
86 AKDÄ, Arzneimittelkommission der deutschen Ärzteschaft, .Höffler D, Lasek R, Berthold HK.
Demenz . Köln: Arzneimittelkommission der deutschen Ärzteschaft 2004 - 87 Nagy Z, Hindley NJ, Braak H, Braak E, Yilmazer-Hanke DM, Schultz C. et al . Relationship between clinical and radiological diagnostic criteria for Alzheimer's disease and the extent of neuropathology as reflected by ‘stages’: a prospective study. Dement Geriatr Cogn Disord. 1999; 10 ((2)) 109-114
- 88 Zakzanis KK, Graham SJ, Campbell Z. A meta-analysis of structural and functional brain imaging in dementia of the Alzheimer's type: a neuroimaging profile. Neuropsychol Rev. 2003; 13 ((1)) 1-18
- 89 Chui H, Zhang Q. Evaluation of dementia: a systematic study of the usefulness of the American Academy of Neurology's practice parameters. Neurology. 1997; 49 ((4)) 925-935
- 90 Clarfied. Assessing dementia: the Canadian consensus. Organizing Committee, Canadian Consensus Conference on the Assessment of Dementia. CMAJ. 1991; 144 ((7)) 851-853
- 91 Verhey FR, Jolles J, Ponds RW, Rozendaal N, Plugge LA, Vet RC de. et al . Diagnosing dementia: a comparison between a monodisciplinary and a multidisciplinary approach. J Neuropsychiatry Clin Neurosci. 1993; 5 ((1)) 78-85
Korrespondenzadresse
Dr. H. C. VollmarMPH
Uni Witten/Herdecke
Institut für Allgemeinmedizin und Familienmedizin
Alfred-Herrhausen-Str. 50
58448 Witten
Email: vollmar@uni-wh.de