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ZFA (Stuttgart) 2008; 84(9): 404-417
DOI: 10.1055/s-0028-1085437
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© Georg Thieme Verlag KG Stuttgart · New York

DEGAM Leitlinie Demenz – Teil 2: Versorgung und Therapie

DEGAM Guideline dementia – Part 2: Medical Care and TherapyH. C. Vollmar 1 , 2 , P. Mand 3 , S. Wilm 1 , M. E. Butzlaff 4
  • 1Institut für Allgemeinmedizin und Familienmedizin, Universität Witten/Herdecke
  • 2Fraunhofer Institut für System- und Innovationsforschung (ISI), Karlsruhe
  • 3Abteilung für Allgemeinmedizin, Medizinische Hochschule Hannover
  • 4Fakultät für Medizin, Universität Witten/Herdecke
Further Information

Publication History

eingereicht: 13.07.2008

akzeptiert: 11.08.2008

Publication Date:
16 September 2008 (online)

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Schlüsselwörter

Leitlinie - Demenz - Alzheimer - Therapie - Versorgung

Key words

guideline - dementia - Alzheimer's disease - therapy - medical care

Literatur

  • 1 Vollmar HC, Mand P, Butzlaff M. DEGAM-Leitlinie Demenz. Düsseldorf: omikron publishing 2008
  • 2 Vollmar HC, Mandt P, Butzlaff ME. et al . DEGAM Leitlinie Demenz – Teil: 1 Diagnostik.  Zeitschrift für Allgemeinmedizin. 2008;  84 ((7)) 297-311
    PubMedSearch in Google Scholar
  • 3 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
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Cohen D. A primary care checklist for effective family management.  Med Clin North Am. 1994;  78 ((4)) 795-809
    PubMedSearch in Google Scholar
  • 5 Brauner DJ, Muir JC, Sachs GA. Treating nondementia illnesses in patients with dementia.  Jama. 2000 Jun 28;  283 ((24)) 3230-3235
    CrossrefPubMedSearch in Google Scholar
  • 6 Lichte T, Beyer M. Leitlinie Pflegende Angehörige. Düsseldorf: omikron publishing 2005
  • 7 Hallauer JF, Kurz A. Weißbuch Demenz. Stuttgart: Thieme Verlag 2002
  • 8 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; 
    PubMed
  • 9 Kitwood T. Demenz – Der personenzentrierte Ansatz im Umgang mit verwirrten Menschen. Bern: Verlag Hans Huber 2000
  • 10 Schrijnemaekers V, Rossum E van, Candel M. et al . Effects of emotion-oriented care on elderly people with cognitive impairment and behavioral problems.  Int J Geriatr Psychiatry. 2002 Oct;  17 ((10)) 926-937
    CrossrefPubMedSearch in Google Scholar
  • 11 Rovner BW, Steele CD, Shmuely Y. et al . A randomized trial of dementia care in nursing homes.  J Am Geriatr Soc. 1996 Jan;  44 ((1)) 7-13
    PubMedSearch in Google Scholar
  • 12 Reininghaus W, Engeser P. Indikation und Durchführung der enteralen Ernährung.  Z Allg Med. 2006;  82 ((4)) 168-177
    Thieme ConnectPubMedSearch in Google Scholar
  • 13 Teri L, Logsdon RG, Peskind E. et al . Treatment of agitation in AD: a randomized, placebo-controlled clinical trial.  Neurology. 2000 Nov 14;  55 ((9)) 1271-1278
    PubMedSearch in Google Scholar
  • 14 Cohen-Mansfield J. Nonpharmacologic interventions for inappropriate behaviors in dementia: a review, summary, and critique.  Am J Geriatr Psychiatry. 2001 Fall;  9 ((4)) 361-381
    PubMedSearch in Google Scholar
  • 15 Grasel E, Wiltfang J, Kornhuber J. Non-drug therapies for dementia: an overview of the current situation with regard to proof of effectiveness.  Dement Geriatr Cogn Disord. 2003;  15 ((3)) 115-125
    CrossrefPubMedSearch in Google Scholar
  • 16 Grossberg GT. The ABC of Alzheimer's disease: behavioral symptoms and their treatment.  Int Psychogeriatr. 2002;  14 ((Suppl 1)) 27-49
    CrossrefPubMedSearch in Google Scholar
  • 17 Forbes DA. Strategies for managing behavioural symptomatology associated with dementia of the Alzheimer type: a systematic overview.  Can J Nurs Res. 1998 Summer;  30 ((2)) 67-86
    PubMedSearch in Google Scholar
  • 18 Koss E, Patterson MB, Ownby R. et al . Memory evaluation in Alzheimer's disease. Caregivers’ appraisals and objective testing.  Arch Neurol. 1993 Jan;  50 ((1)) 92-97
    PubMedSearch in Google Scholar
  • 19 Schulz R, O’Brien AT, Bookwala J. et al . Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes.  Gerontologist. 1995;  35 ((6)) 771-791
    PubMedSearch in Google Scholar
  • 20 Schulz R, O’Brien A, Czaja S. et al . Dementia caregiver intervention research: in search of clinical significance.  Gerontologist. 2002;  42 ((5)) 589-602
    PubMedSearch in Google Scholar
  • 21 Doody RS, Stevens JC, Beck C. 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
    PubMedSearch in Google Scholar
  • 22 Wolfson C, Oremus M, Shukla V. et al . Donepezil and rivastigmine in the treatment of Alzheimer's disease: a best-evidence synthesis of the published data on their efficacy and cost-effectiveness.  Clin Ther. 2002;  24 ((6)) 862-886 , [discussion 37]
    CrossrefPubMedSearch in Google Scholar
  • 23 Cummings JL. Use of cholinesterase inhibitors in clinical practice: Evidence-based recommendations.  Am J Geriat Psychiat. 2003;  11 ((2)) 131-145
    PubMedSearch in Google Scholar
  • 24 Finucane TE. Cholinesterase inhibitors for Alzheimer disease.  Jama. 2003 May 14;  289 ((18)) 2359 , [author reply 60-1]
    CrossrefPubMedSearch in Google Scholar
  • 25 Fachbereich Evidenz-basierte Medizin . Ziegler S, Arndt C, Windeler J. Donepezil, Rivastigmin und Galantamin in der Therapie der Demenz vom Alzheimer-Typ: Medizinischer Dienst der Spitzenverbände der Krankenkassen e. V.. 2002;  , 13.03.2002.
    PubMed
  • 26 Lanctot KL, Herrmann N, Yau KK. et al . Efficacy and safety of cholinesterase inhibitors in Alzheimer's disease: a meta-analysis.  CMAJ. 2003 Sep 16;  169 ((6)) 557-564
    PubMedSearch in Google Scholar
  • 27 Ritchie CW, Ames D, Clayton T. et al . Metaanalysis of randomized trials of the efficacy and safety of donepezil, galantamine, and rivastigmine for the treatment of Alzheimer disease.  Am J Geriatr Psychiatry. 2004 Jul-Aug;  12 ((4)) 358-369
    PubMedSearch in Google Scholar
  • 28 Birks JS, Melzer D, Beppu H. Donepezil for mild and moderate Alzheimer's disease.  Cochrane Database Syst Rev. 2003;  2
    PubMedSearch in Google Scholar
  • 29 Olin J, Schneider L. Galantamine for Alzheimer's disease (Cochrane Review).  Cochrane Database Syst Rev. 2003;  2
    PubMedSearch in Google Scholar
  • 30 Birks J, Grimley Evans J, Iakovidou V. et al . Rivastigmine for Alzheimer's disease.  Cochrane Database Syst Rev. 2003;  2 3
    PubMedSearch in Google Scholar
  • 31 DGPPN, Deutsche Gesellschaft für Psychiatrie PuN .Behandlungsleitlinie Demenz. Darmstadt: Steinkopff Verlag 2000
  • 32 Cummings JL, Frank JC, Cherry D. et al . Guidelines for managing Alzheimer's disease: part I. Assessment.  Am Fam Physician. 2002;  65 ((11)) 2263-2272
    PubMedSearch in Google Scholar
  • 33 DGGPP . Gutzmann H, Haupt M. Empfehlungen zur Therapie dementieller Erkrankungen: Deutsche Gesellschaft für Gerontopsychiatrie und -psychotherapie. 2004; 
    PubMed
  • 34 Ärztliches Zentrum für Qualität in der Medizin (ÄZQ) .Leitlinien-Clearingbericht „Demenz”. Berlin: Ärztliches Zentrum für Qualität in der Medizin (Gemeinsame Einrichtung von BÄK und KBV) 2005
  • 35 DGN . Diagnose und Therapie der Alzheimer-Demenz (AD) und der Demenz mit Lewy-Körperchen (DLB). 2002;  , Zugriff unter: http://www.uni-duesseldorf.de/AWMF/ll/neur-029.htm
    PubMed
  • 36 Frankfort SV, Appels BA, Boer A de. et al . Identification of responders and reactive domains to rivastigmine in Alzheimer's disease.  Pharmacoepidemiol Drug Saf. 2007 May;  16 ((5)) 545-551
    CrossrefPubMedSearch in Google Scholar
  • 37 Courtney C, Farrell D, Gray R. et al . Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial.  Lancet. 2004 Jun 26;  363 ((9427)) 2105-2115
    CrossrefPubMedSearch in Google Scholar
  • 38 Kaduszkiewicz H, Zimmermann T, Beck-Bornholdt HP. et al . Cholinesterase inhibitors for patients with Alzheimer's disease: systematic review of randomised clinical trials.  BMJ. 2005 Aug 6;  33 ((7512)) 321-327
    PubMedSearch in Google Scholar
  • 39 N.N. Alzheimer-Mittel Donepezil (Aricept) ohne relevanten Nutzen.  Arznei-Telegramm. 2004;  35 ((7)) 67-68
    PubMedSearch in Google Scholar
  • 40 Kaduszkiewicz H, Beck-Bornholdt HP, Bussche H van den. et al . Doubtful evidence for the use of the cholinesterase inhibitor donepezil in patients with dementia – a systematic review.  Fortschr Neurol Psychiatr. 2004 Oct;  72 ((10)) 557-563
    Thieme ConnectPubMedSearch in Google Scholar
  • 41 Trinh NH, Hoblyn J, Mohanty S. et al . Efficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis.  Jama. 2003 Jan 8;  289 ((2)) 210-216
    CrossrefPubMedSearch in Google Scholar
  • 42 Whitehead A, Perdomo C, Pratt RD. et al . Donepezil for the symptomatic treatment of patients with mild to moderate Alzheimer's disease: a meta-analysis of individual patient data from randomised controlled trials.  Int J Geriatr Psychiatry. 2004 Jul;  19 ((7)) 624-633
    CrossrefPubMedSearch in Google Scholar
  • 43 Hogan DB, Patterson C. Progress in clinical neurosciences: Treatment of Alzheimer's disease and other dementias – review and comparison of the cholinesterase inhibitors.  Can J Neurol Sci. 2002;  29 ((4)) 306-314
    PubMedSearch in Google Scholar
  • 44 Areosa Sastre A, Sherriff F. Memantine for dementia (Cochrane Review). The Cochrane Library. Oxford: Update Software 2005
  • 45 IQWiG .Memantine bei Alzheimer Demenz. Berichtsplan. Auftrag A05-19C Version 2.0 Köln: Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) 2008 11.02.2008.
  • 46 AKDÄ, Arzneimittelkommission der deutschen Ärzteschaft .Höffler D, Lasek R, Berthold HK. Demenz. Köln: Arzneimittelkommission der deutschen Ärzteschaft 2004
  • 47 Winblad B, Poritis N. Memantine in severe dementia: results of the 9M-Best Study (Benefit and efficacy in severely demented patients during treatment with memantine).  Int J Geriatr Psychiatry. 1999;  14 ((2)) 135-146
    CrossrefPubMedSearch in Google Scholar
  • 48 Reisberg B, Doody R, Stoffler A. et al . Memantine in moderate-to-severe Alzheimer's disease.  N Engl J Med. 2003 Apr 3;  348 ((14)) 1333-1341
    CrossrefPubMedSearch in Google Scholar
  • 49 Kivipelto M, Helkala E-L, Laakso MP. et al . Midlife vascular risk factors and Alzheimer's disease in later life: longitudinal, population based study.  BMJ 2001 June 16. 2001;  322 ((7300)) 1447-1451
    CrossrefPubMedSearch in Google Scholar
  • 50 Vermeer SE, Prins ND, Heijer T den. et al . Silent brain infarcts and the risk of dementia and cognitive decline.  N Engl J Med. 2003 Mar 27;  348 ((13)) 1215-1222
    CrossrefPubMedSearch in Google Scholar
  • 51 Antiplatelet Trialists’ Collaboration. . Collaborative overview of randomised trials of antiplatelet therapy–I: Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists’ Collaboration.  BMJ. 1994 Jan 8;  308 ((6921)) 81-106
    PubMedSearch in Google Scholar
  • 52 Williams PS, Rands G, Orrel M. et al . Aspirin for vascular dementia (Cochrane Review).  Cochrane Database Syst Rev. 2003;  2
    PubMedSearch in Google Scholar
  • 53 Hensler S, Hoidn S, Jork K. Leitlinie Schlaganfall. Düsseldorf: omikron publishing 2006
  • 54 Forette F, Seux ML, Staessen JA. et al . Prevention of dementia in randomised double-blind placebo-controlled Systolic Hypertension in Europe (Syst-Eur) trial.  Lancet. 1998;  352 ((9137)) 1347-1351
    CrossrefPubMedSearch in Google Scholar
  • 55 MacGuinness 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;  ((2)) CD004034
    PubMedSearch in Google Scholar
  • 56 Peila R, White LR, Masaki K. et al . Reducing the risk of dementia: efficacy of long-term treatment of hypertension.  Stroke. 2006 May;  37 ((5)) 1165-1170
    CrossrefPubMedSearch in Google Scholar
  • 57 Gormley N, Lyons D, Howard R. Behavioural management of aggression in dementia: a randomized controlled trial.  Age Ageing. 2001;  30 ((2)) 141-145
    CrossrefPubMedSearch in Google Scholar
  • 58 MacKeith I, Cummings J. Behavioural changes and psychological symptoms in dementia disorders.  Lancet Neurol. 2005 Nov;  4 ((11)) 735-742
    CrossrefPubMedSearch in Google Scholar
  • 59 Ballard C, O’Brien J. Treating behavioural and psychological signs in Alzheimer's disease.  BMJ. 1999 Jul 17;  319 ((7203)) 138-139
    PubMedSearch in Google Scholar
  • 60 Steele C, Rovner B, Chase GA. et al . Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease.  Am J Psychiatry. 1990 Aug;  147 ((8)) 1049-1051
    PubMedSearch in Google Scholar
  • 61 Haupt M, Kurz A. Predictors of nursing home placement in patients with alzheimer's disease.  Int J Geriat Psychiatry. 1993;  8 741-746
    CrossrefPubMedSearch in Google Scholar
  • 62 Kurz A, Jendroska K. Therapie und Prävention. In: Beyreuther K, Einhäup KM, Förstl H, Kurz A (eds) Demenzen Grundlagen und Klinik. Suttgart, New York: Thieme Verlag 2002: 187-210
    Search in Google Scholar
  • 63 Herrmann N. Recommendations for the management of behavioral and psychological symptoms of dementia.  Can J Neurol Sci. 2001;  28 ((Suppl 1)) S96-S107
    PubMedSearch in Google Scholar
  • 64 Tariot PN. Treatment strategies for agitation and psychosis in dementia.  J Clin Psychiatry. 1996;  57 ((Suppl 14)) 21-29
    PubMedSearch in Google Scholar
  • 65 Howard R, Ballard C, O’Brien J. et al . Guidelines for the management of agitation in dementia.  Int J Geriatr Psychiatry. 2001;  16 ((7)) 714-717
    CrossrefPubMedSearch in Google Scholar
  • 66 Schneider LS, Pollock VE, Lyness SA. A metaanalysis of controlled trials of neuroleptic treatment in dementia.  J Am Geriatr Soc. 1990 May;  38 ((5)) 553-563
    PubMedSearch in Google Scholar
  • 67 Zeitler H-P, Gulich M. Leitlinie Ältere Sturzpatient. Düsseldorf: omikron publishing 2004
  • 68 MacShane R, Keene J, Gedling K. et al . Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up.  BMJ. 1997 Jan 25;  314 ((7076)) 266-270
    PubMedSearch in Google Scholar
  • 69 MacGrath AM, Jackson GA. Survey of neuroleptic prescribing in residents of nursing homes in Glasgow.  BMJ. 1996 Mar 9;  312 ((7031)) 611-612
    PubMedSearch in Google Scholar
  • 70 Deyn PP De, Rabheru K, Rasmussen A. et al . A randomized trial of risperidone, placebo, and haloperidol for behavioral symptoms of dementia.  Neurology. 1999 Sep 22;  53 ((5)) 946-955
    PubMedSearch in Google Scholar
  • 71 Katz IR, Jeste DV, Mintzer JE. et al . Comparison of risperidone and placebo for psychosis and behavioral disturbances associated with dementia: a randomized, double-blind trial. Risperidone Study Group.  J Clin Psychiatry. 1999 Feb;  60 ((2)) 107-115
    PubMedSearch in Google Scholar
  • 72 Brodaty H, Ames D, Snowdon J. et al . A randomized placebo-controlled trial of risperidone for the treatment of aggression, agitation, and psychosis of dementia.  J Clin Psychiatry. 2003 Feb;  64 ((2)) 134-143
    CrossrefPubMedSearch in Google Scholar
  • 73 Wooltorton E. Risperidone (Risperdal): increased rate of cerebrovascular events in dementia trials.  CMAJ. 2002 Nov 26;  167 ((11)) 1269-1270
    PubMedSearch in Google Scholar
  • 74 Bridges-Parlet S, Knopman D, Steffes S. Withdrawal of neuroleptic medications from institutionalized dementia patients: Results of a double-blind, baseline-treatment-controlled pilot study.  Journal of Geriatric Psychiatry & Neurology. 1997;  10 ((3)) 119-126
    PubMedSearch in Google Scholar
  • 75 NICE, SCIE .Dementia. The NICE-SCIE guideline on supporting people with dementia and their carers in health and social care: The British Psychological Society and Gaskell, NICE 2007
  • 76 Ballard C, Walker M. Neuropsychiatric aspects of Alzheimer's disease.  Curr Psychiatry Rep. 1999;  1 ((1)) 49-60
    CrossrefPubMedSearch in Google Scholar
  • 77 Small GW, Rabins PV, Barry PP. et al . Diagnosis and treatment of Alzheimer disease and related disorders. Consensus statement of the American Association for Geriatric Psychiatry, the Alzheimer's Association, and the American Geriatrics Society.  Jama. 1997 Oct 22–29;  278 ((16)) 1363-1371
    CrossrefPubMedSearch in Google Scholar
  • 78 Nyth AL, Gottfries CG, Lyby K. et al . A controlled multicenter clinical study of citalopram and placebo in elderly depressed patients with and without concomitant dementia.  Acta Psychiatr Scand. 1992 Aug;  86 ((2)) 138-145
    CrossrefPubMedSearch in Google Scholar
  • 79 Swartz M, Barak Y, Mirecki I. et al . Treating depression in Alzheimer's disease: integration of differing guidelines.  Int Psychogeriatr. 2000;  12 ((3)) 353-358
    CrossrefPubMedSearch in Google Scholar
  • 80 Petracca GM, Chemerinski E, Starkstein SE. A double-blind, placebo-controlled study of fluoxetine in depressed patients with Alzheimer's disease.  Int Psychogeriatr. 2001 Jun;  13 ((2)) 233-240
    PubMedSearch in Google Scholar

Korrespondenzadresse

Dr. H. C. VollmarMPH 

Uni Witten/Herdecke

Institut für Allgemeinmedizin und Familienmedizin

Alfred-Herrhausen-Str. 50

58448 Witten

Email: vollmar@uni-wh.de