Memory Clinics in Switzerland. Collaborative Group of Swiss Memory Clinics.

Currently, eleven Memory Clinics (MC) in Switzerland offer their services to patients, caregivers and family doctors. Their primary goal is the early diagnosis and management of dementia in elderly outpatients. Special emphasis is put on the detection of reversible causes of dementing disorders. Diagnoses and medical, pharmacological, neuropsychological and social treatment recommendations are established in a multidisciplinary consensus conference and communicated back to the referring physicians. The psychosocial therapies and supportive activities include counseling, memory training for patients, neuropsychological rehabilitation, caregiver groups, relaxation and biofeedback training, day care centers, Alzheimer's Tanzcafé, and special vacations for dementia patients. These activities vary from MC to MC according to the availability of resources. Research activities are an integral part of all MCs and range from the attempt to identify preclinical markers of Alzheimer's disease to studies of neuropathological correlates of cognitive disturbances. Moreover, patients are encouraged to participate in studies investigating new medications. MCs play an important role in the education and training of health care professionals and in raising awareness and support in the general population.

Category fluency is also predominantly affected in Swiss Alzheimer's disease patients.

OBJECTIVES: To establish the comparative efficacy to differentiate between Swiss patients with dementia of the Alzheimer type (DAT) and elderly normal control subjects (NC) on two different verbal fluency tasks: category fluency and letter fluency. MATERIAL AND METHODS: Fifty Swiss German DAT patients in the early stages of the disease and 50 matched normal control subjects were compared on letter and category fluency tasks. RESULTS: DAT patients exhibited an overproportional impairment on category fluency as compared with letter fluency. Receiver operating characteristic curves (ROC) showed that category fluency correctly classified a significantly higher number of DAT patients and NC subjects (84%) than letter fluency (70%). CONCLUSION: As similar findings have been described for English-speaking DAT patients, we conclude that deficiencies in category fluency are a general phenomenon, reflecting impaired structures of semantic knowledge occurring early in the course of Alzheimer's disease.

[Frontal lobe dementia: a case report]. / Frontal lobe dementia: eine Fallbeschreibung.

Frontal lobe dementia (FDL) is a disorder that has only been described in recent years. It is mainly characterized by language disturbances and personality changes. We describe the problems and the possible therapeutic approaches to FLD, using a single case which has been well documented for several years.

[Cardiovascular diseases, cognitive abilities and quality of life in old age]. / Herz-Kreislauf-Krankheiten, kognitive Fähigkeiten und Lebensqualität im Alter.

Dementia is the most important disorder endangering and impairing quality of life in old age. Cardiovascular diseases as well as cardiovascular risk factors raise the risk for dementia; therefore, a targeted primary and secondary prevention strategy is indicated, also in view of the maintenance of autonomy and quality of life. Consequent primary and secondary prevention comprises adequate therapy of risk factors, including pharmacotherapy, if necessary. Important general measures are regular physical and mental training, complemented by an alimentation with a favorable composition of lipids and rich in micronutrients (in particular antioxidants).

Improving the diagnostic accuracy of the Mini-Mental State Examination.

INTRODUCTION: We determined the diagnostic accuracy of the Mini-Mental State Examination (MMSE) for dementia of the Alzheimer type (DAT) in an outpatient geriatric referral center in Switzerland. MATERIAL & METHODS: DAT patients and elderly controls were assigned to two groups: a validation sample (70 DAT patients; 50 controls) and a cross-validation sample (133 DAT patients; 43 controls). A Receiver Operating Characteristic curve was generated to derive the optimal MMSE cut-off score in the validation sample. RESULTS: The optimal MMSE cut-off was < 26/30 (sensitivity of 74%, specificity of 100%). Adjustments for age and education were necessary. The cross-validation confirmed these findings. CONCLUSION: iN A clinical setting the MMSE cut-off should be increased to < 26/30. A thorough neurobehavioral assessment is still necessary for a complete evaluation.

[Memory training: an important constituent of milieu therapy in senile dementia]. / Gedächtnistraining: Wichtiger Bestandteil der Milieutherapie bei seniler Demenz.

At the Memory Clinic in Basel we provide long-term memory training as part of our "milieu therapy". Mildly demented elderly out-patients attend weekly group sessions of 60 min for a special semistructured memory training. The goal is to relearn and practice strategies which help to preserve or extend the phase of autonomy and thus life quality and self-esteem. In several studies we tested the efficiency of the training on mood, global mental status, short-term memory, cognitive flexibility, and quality of life by comparing the performance of groups of patients attending the memory training to nontreated matched control groups after 1 year. We found that depression scores improved in a treated group and worsened in a control group, independently of diagnosis. Global mental status as measured by Mini-Mental-State Examination and performance on a figural and verbal fluency task remained stable for the memory training groups and declined in the control groups. Short-term memory declined in both groups, however, significantly only in the nontreated groups. The individual quality of life schedule showed stable or improved scores for the treated group and lower scores for the control group. We conjecture from these results that memory training is effective in mildly demented out-patients in delaying the progression of cognitive deficits.

[Is prevention of dementia possible?]. / Gibt es eine Prävention der Demenz?

Dementia is a clinical syndrome with many causes. Dementia of the Alzheimer type and vascular dementia account alone or in combination for the vast majority of the dementia in the elderly population. Primary prevention depends on the knowledge of etiopathogenetic mechanisms and the possibility to change contributing factors. In the case of dementia of the Alzheimer type (DAT) contributing factors (risk factors) are emerging. However, they are not easily altered. The protective effect of certain micronutrients, such as antioxidants, remains speculative. The well-established cardiovascular risk factors such as hypertension, diabetes, and overweight are effective in the etiopathogenesis of vascular dementia. Their treatment by diet and drugs is therefore indicated. The protective role of antioxidants is better established in vascular dementia. Antioxidant micronutrients could be an important part of the primary preventive strategy. Whether mental training is effective in primary prevention or not remains controversial. Better training allows the individuals to optimize their resources. In secondary prevention, mental training was shown to be effective in mild dementia (MMS > or = 23), maintaining or even improving function (vascular dementia) and maintaining function for a given time in DAT. In the population with advanced age, mixed forms of dementia become increasingly common. Hence, patients with mild dementia should receive mental training as well as a vigorous treatment of established risk factors.

A new behavioral assessment scale for geriatric out- and in-patients: the NOSGER (Nurses' Observation Scale for Geriatric Patients).

Although a great number of psychometric tests and rating scales for the assessment of psychogeriatric patients is available, there is still an urgent need, in research and practice, for a clinical rating instrument that meets the following main requirements: (1) applicable to institutionalized and community patients and covering a wide range of behavioral pathology; (2) acceptable and easy to use for professionals and lay persons alike; (3) covering a wide range of behavior relevant to daily functioning but independent of sex or social status of the individual assessed. The NOSGER contains 30 items of behavior, each rated on a 5-point scale according to frequency of occurrence. Item scores are summarized into 6 Dimension scores (memory, instrumental activities of daily life, self-care, mood, social behavior, and disturbing behavior) which are clinically relevant in dementia, depression, and other psychiatric disorders of old age. Validation studies with a preliminary version of the NOSGER indicated good acceptance of the scale, high inter-rater and test-retest reliability, and high correlations of all NOSGER Dimension scores with results of a variety of established assessment instruments. The NOSGER is currently being used in a number of European and North American centers and should turn out to be a useful instrument for longitudinal studies in psychogeriatrics.

[The memory clinic]. / Die Memory-Klinik.

The aim of the Memory Clinic, in operation at Basel since 1986, is the early detection of dementing disorders in ambulatory elderly patients. Special emphasis is put on the differential diagnosis and detection of reversible mental disorders such as depression. Treatment comprises medical, psychological and social measures. For suitable patients, drug treatment with investigational compounds is offered. Memory training programs and therapeutic groups for patients with coexisting affective disorders as well as groups for relatives are held. By these means the Memory Clinic attempts to improve the situation of elderly patients with cognitive disturbances and to maintain them longer in the community. Experience with the first 180 patients is reported.