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Articles by S. G Riedel Heller
Total Records ( 2 ) for S. G Riedel Heller
  F Jessen , B Wiese , C Bachmann , S Eifflaender Gorfer , F Haller , H Kolsch , T Luck , E Mosch , H van den Bussche , M Wagner , A Wollny , T Zimmermann , M Pentzek , S. G Riedel Heller , H. P Romberg , S Weyerer , H Kaduszkiewicz , W Maier , H Bickel and Cognition and Dementia in Primary Care Patients Study Group for the German Study on Aging
 

Context  Subjective memory impairment (SMI) is receiving increasing attention as a pre-mild cognitive impairment (MCI) condition in the course of the clinical manifestation of Alzheimer disease (AD).

Objectives  To determine the risk for conversion to any dementia, dementia in AD, or vascular dementia by SMI, graded by the level of SMI-related worry and by the temporal association of SMI and subsequent MCI.

Design  Longitudinal cohort study with follow-up examinations at 11/2 and 3 years after baseline.

Setting  Primary care medical record registry sample.

Participants  A total of 2415 subjects without cognitive impairment 75 years or older in the German Study on Aging, Cognition and Dementia in Primary Care Patients.

Main Outcome Measures  Conversion to any dementia, dementia in AD, or vascular dementia at follow-up 1 or follow-up 2 predicted by SMI with or without worry at baseline and at follow-up 2 predicted by different courses of SMI at baseline and MCI at follow-up 1.

Results  In the first analysis, SMI with worry at baseline was associated with greatest risk for conversion to any dementia (hazard ratio [HR], 3.53; 95% confidence interval [CI], 2.07-6.03) or dementia in AD (6.54; 2.82-15.20) at follow-up 1 or follow-up 2. The sensitivity was 69.0% and the specificity was 74.3% conversion to dementia in AD. In the second analysis, SMI at baseline and MCI at follow-up 1 were associated with greatest risk for conversion to any dementia (odds ratio [OR], 8.92; 95% CI, 3.69-21.60) or dementia in AD (19.33; 5.29-70.81) at follow-up 2. Furthermore, SMI at baseline and amnestic MCI at follow-up 1 increased the risk for conversion to any dementia (OR, 29.24; 95% CI, 8.75-97.78) or dementia in AD (60.28; 12.23-297.10), with a sensitivity of 66.7% and a specificity of 98.3% for conversion to dementia in AD.

Conclusion  The prediction of dementia in AD by SMI with subsequent amnestic MCI supports the model of a consecutive 3-stage clinical manifestation of AD from SMI via MCI to dementia.

  H. H Konig , A Born , D Heider , H Matschinger , S Heinrich , S. G Riedel Heller , D Surall , M. C Angermeyer and C. Roick
 

Background

Individuals with anxiety disorders often do not receive an accurate diagnosis or adequate treatment in primary care.

Aims

To analyse the cost-effectiveness of an optimised care model for people with anxiety disorders in primary care.

Method

In a cluster randomised controlled trial, 46 primary care practices with 389 individuals positively screened with anxiety were randomised to intervention (23 practices, 201 participants) or usual care (23 practices, 188 participants). Physicians in the intervention group received training on diagnosis and treatment of anxiety disorders combined with the offer of a psychiatric consultation–liaison service for 6 months. Anxiety, depression, quality of life, service utilisation and costs were assessed at baseline, 6-month and 9-month follow-up.

Results

No significant differences were observed between intervention and control group on the Beck Anxiety Inventory, Beck Depression Inventory and EQ–5D during follow-up. Total costs were higher in the intervention group (4911 v. 3453, P = 0.09). The probability of an incremental cost-effectiveness ratio <50 000 per quality-adjusted life year was below 10%.

Conclusions

The optimised care model did not prove to be cost-effective.

 
 
 
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