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Fremdbeurteilung kognitiver Veränderungen im Alter

Erste Vergleichswerte für den deutschen IQCODE

Informant report of cognitive changes in the elderly

A first evaluation of the German version of the IQCODE

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Zusammenfassung

Hintergrund

Da kognitive Defizite im Rahmen einer demenziellen Entwicklung vom Betroffenen häufig nicht berichtet werden, kommt der Auskunft einer engen Bezugsperson in der Früherkennung von Demenzen eine wichtige Bedeutung zu. Ein international verbreitetes und gut evaluiertes Fremdbeurteilungs-Screeningverfahren des kognitiven Abbaus ist der Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Er besitzt den Vorteil, kognitive Veränderungen direkt zu erfassen. Für den deutschen Sprachraum fehlen für den IQCODE bisher Vergleichswerte und psychometrische Untersuchungen.

Methodik

Es wurden Vergleichsdaten für die deutsche Version der IQCODE-Langform an 46 normal gesunden älteren Ehepaaren erhoben. Diese wurden hinsichtlich der konkurrenten und diskriminanten Validität mit Patientengruppen mit leichter kognitiver Störung (LKS, n=25), Alzheimer-Demenz bzw. Mischdemenz (AD, n=59) und frontotemporalen Lobärdegenerationen (FTLD, n=15) verglichen.

Ergebnisse

Der deutsche IQCODE zeigte gute psychometrische Eigenschaften und trennte am besten kognitiv unauffällige Probanden von AD-Patienten. Der mittels Receiver-operating-characteristic-Analyse errechnete Cut-off-Wert von 3,38 entsprach den Ergebnissen internationaler Studien. Auch wurden Patienten mit LKS und FTLD reliabel von normal-gesunden Probanden abgegrenzt, jedoch gelang mittels IQCODE keine überzufällige Unterscheidung zwischen Patienten mit AD und FTLD.

Schlussfolgerungen

Die deutsche Version des IQCODE trennt zuverlässig zwischen kognitiv unauffälligen Probanden und Patienten mit LKS bzw. kortikalen Demenzen, jedoch nicht zwischen verschiedenen kortikalen Demenzen wie AD und FTLD. Der IQCODE kann als ökonomisches Fremdbeurteilungs-Screening zur Früherkennung demenzieller Entwicklungen beitragen.

Summary

Background

Cognitive deficits occurring with dementia are frequently not reported by the affected subject. Therefore, informant reports from close relatives are especially important for the early diagnosis of dementia. Internationally, the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) has been evaluated with positive results and is a widely used informant-rated instrument for the diagnosis of cognitive decline. For the German speaking countries, norms and evaluation of the psychometric properties of the instrument are lacking.

Methods

Norms for the German long version of the IQCODE were established with 46 healthy elderly married couples. These were compared with respect to their concurrent and discriminative validity with groups of patients suffering from mild cognitive impairment (MCI, n=25), Alzheimer’s or mixed dementia (AD, n=59) and frontotemporal lobe degeneration (FTLD, n=15).

Results

The German version of the IQCODE exhibited good psychometric properties and was able to best discriminate between cognitively intact and demented subjects with AD. Receiver-operating characteristic analyses indicated a cut-off score of 3.38 which corresponds well with the value given in international literature. Patients with MCI and with FTLD were also reliably distinguished from cognitively intact subjects. However, the instrument did not distinguish AD from FTLD with any significant degree of confidence.

Discussion

The German version of the IQCODE reliably discriminates cognitively intact persons from those suffering from MCI or cortical dementia, but not between different types of cortical dementia, such as AD and FTLD. The IQCODE is an efficient informant-rated screening instrument for the early diagnosis of cognitive decline and dementia.

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Abb. 1

Notes

  1. Eine Liste aller verwendeten neuropsychologischen Verfahren kann bei der korrespondierenden Autorin angefordert werden.

  2. Der IQCODE wurde von damaligen Angehörigen der Universitätsklinik für Neurologie Magdeburg aus dem englischen Original ins Deutsche übersetzt (A. D. E.) und rückübersetzt (C.-W. W.). Dabei ergaben sich geringfügige lexikalische Unterschiede, welche lexikalischen Ambiguitäten zwischen deutscher und englischer Sprache entsprachen. Semantische Inhalte der Instruktion oder der Items waren unverändert.

  3. Der positive Vorhersagewert bezeichnet die Wahrscheinlichkeit des Vorliegens einer Erkrankung (hier: Demenz), falls das Screening-Instrument einen auffälligen Wert ergeben hat; der negative Vorhersagewert bezeichnet die Wahrscheinlichkeit des Nichtvorliegens der Erkrankung, falls das Screening einen unauffälligen Wert erbracht hat [1].

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Authors and Affiliations

  1. Institut für Klinische Psychologie, Bürgerhospital, Tunzhofer Straße 14–16, 70191, Stuttgart, Deutschland

    S.A. Wolf

  2. Medizinische Fakultät der Otto-von-Guericke-Universität, Magdeburg, Deutschland

    K. Kubatschek

  3. Klinik für Neurologie, Humboldt-Klinikum, Berlin, Deutschland

    M. Henry

  4. Bundesagentur für Arbeit, Berlin, Deutschland

    S. Harth

  5. Arbeitsgruppe Kognitive Neurologie, Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität, München, Deutschland

    A.D. Ebert

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  1. S.A. Wolf
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  2. K. Kubatschek
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  3. M. Henry
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  4. S. Harth
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  6. C.-W. Wallesch
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Correspondence to S.A. Wolf.

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Das Projekt wurde durch das Bundesministerium für Bildung und Forschung (Förderkennzeichen 01ZZ0407) gefördert.

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Wolf, S., Kubatschek, K., Henry, M. et al. Fremdbeurteilung kognitiver Veränderungen im Alter. Nervenarzt 80, 1176–1189 (2009). https://doi.org/10.1007/s00115-009-2794-1

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