Hintergrund: Impulsiv-zwanghafte Verhaltensstörungen (Impulsive Compulsive Behaviours, ICBs) sind häufige, therapiebedingte Komplikationen beim idiopathischen Parkinsonsyndrom (IPS). Sie umfassen Impulskontrollstörungen (Impulsive Compulsive Disorders, ICDs), repetitive Verhaltensstörungen (Repetitive Behaviour, RB) und das Dopamin-Dysregulations-Syndrom (DDS). Methoden: In einer multizentrischen, prospektiven Longitudinalstudie an n = 739 Patienten mit IPS wurde eine Teilstichprobe (n = 72) mit dem Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP) untersucht. Die Ergebnisse wurden mit soziodemografischen, klinischen und neuropsychologischen Parametern in Verbindung gesetzt. Ergebnisse: Bei 60 % der Stichprobe lag mindestens eine ICB vor, am häufigsten waren RBs (47 %). Patienten mit ICB wiesen höhere Dopaminagonisten-Dosen auf (343 ± 177 mg vs. 390 ± 153 mg; p < 0,01). Bei einer Subgruppenanalyse zeigte sich eine Assoziation zwischen RBs, nicht aber ICDs und Pramipexol (Levodopa-Äquivalenzdosis: 273 ± 225 mg bzw. 53 ± 106 mg vs. 151 ± 209 mg bei Pat. ohne ICBs). Patienten mit ICDs wiesen stärkere Dyskinesien auf (UPDRS IV: 1,8 ± 1,6 vs. 0,6 ± 1,1 Punkte; p = 0,012) und Patienten mit multiplen ICBs eine höhere Erkrankungsdauer (9,3 ± 5,0 vs. 6,2 ± 4,0 Jahre; p = 0,026) und geringere Lebensqualität (PDQ39: 29,9 ± 13,8 vs. 20,3 ± 13,4 Punkte; p = 0,036) als Patienten ohne ICB. Schlussfolgerungen: ICBs sind auch bei ambulant versorgten IPS-Patienten mit vergleichsweise geringer Erkrankungsdauer und -schwere häufig und mit der Dosis von Dopaminagonisten assoziiert. Da sie schwerwiegende psychosoziale Konsequenzen haben können, sind ihre Detektion und Therapie wichtig.
Der vorliegende Band dokumentiert die Aktivitäten der produktionstechnischen Institute aus Aachen (WZL/ IPT), Berlin (IWF/IPK) und Stuttgart (ISW) im Zusammenhang mit dem Thema „KI in der Produktion – Innovative Anwendungsfälle“ und gibt einen Ausblick auf mögliche Anwendungsfelder und Entwicklungsrichtungen dieses Themenbereichs. Im Rahmen der Entwicklungen von Anwendungen der Künstlichen Intelligenz in der industriellen Produktion werden Potentiale und aktuelle Grenzen aufgezeigt. Dabei wird insbesondere gezeigt, dass die Kombination von Expertenwissen mit Methoden der Künstlichen Intelligenz vielversprechende neue Ansätze bietet. Das reine Sammeln von Daten und die reine Anwendung von Algorithmen auf diese führt zu keinen hilfreichen Ergebnissen. Inhalt 1 Neuronale Netze für die Berechnung optimaler Geometrieparameter für das Polynomüberschleifen ....1 B. Kaiser, A. Lechler, A. Verl und O. Riedel 2 Divide and Conquer-Prinzip für die KI-basierte Wiedererkennung von Altteilen in der Kreislaufwirtschaft ... 15 C. Briese, M. Schlüter und J. Krüger 3 Strategien zur Integration datengetriebener Ansätze für die Dynamik-modellierung von Industrierobotern ...27 L. Gründel, S. St...
Parkinson's disease (PD) is associated with various non-motor symptoms, including cognitive deterioration.Here, we used data from the DEMPARK/LANDSCAPE cohort to describe the association between progression of cognitive profiles and the PD motor phenotypes: postural instability and gait disorder (PIGD), tremor-dominant (TR-D), and not-determined (ND).Demographic, clinical, and neuropsychological six-year longitudinal data of 711 PD-patients were included (age: M = 67.57; 67.4% males). We computed z-transformed composite scores for a priori defined cognitive domains. Analyses were controlled for age, gender, education, and disease duration. To minimize missing data and drop-outs, three-year follow-up data of 442 PD-patients was assessed with regard to the specific role of motor phenotype on cognitive decline using linear mixed modelling (age: M = 66.10; 68.6% males).Our study showed that in the course of the disease motor symptoms increased while MMSE and PANDA remained stable in all subgroups. After three-year follow-up, significant decline of overall cognitive performance for PIGD-patients were present and we found differences for motor phenotypes in attention (β= -0.08, SE = 0.003, p < 0.006) and memory functions showing that PIGD-patients deteriorate per months by -0.006 compared to the ND-group (SE = 0.003, p = 0.046). Furthermore, PIGD-patients experienced more often difficulties in daily living.Over a period of three years, we identified distinct neuropsychological progression patterns with respect to different PD motor phenotypes, with early executive deficits yielding to a more amnestic profile in the later course. Here, in particular PIGD-patients worsened over time compared to TR-D and ND-patients, highlighting the greater risk of dementia for this motor phenotype.
Large studies on cognitive profiles of patients with mild cognitive impairment (MCI) due to Alzheimer's disease (AD-MCI) compared to Parkinson's disease (PD-MCI) are rare.Data from two multicenter cohort studies in AD and PD were merged using a unified base rate approach for the MCI diagnosis. Cognitive profiles were compared using scores derived from the Consortium to Establish a Registry for Alzheimer's Disease battery.Patients with AD-MCI showed lower standardized scores on all memory test scores and a language test. Patients with PD-MCI showed lower standardized scores in a set-shifting measure as an executive task. A cross-validated logistic regression with test scores as predictors was able to classify 72% of patients correctly to AD-MCI versus PD-MCI.The applied test battery successfully discriminated between AD-MCI and PD-MCI. Neuropsychological test batteries in clinical practice should always include a broad spectrum of cognitive domains to capture any cognitive changes.
The attention deficit hyperactivity disorder (ADHD) is associated with substantial impairment and psychiatric comorbidities. Thus, an optimized treatment is essential. In 2011, a new multidisciplinary treatment strategy (so-called Versorgungsvertrag) was contracted for the model region of Bremerhaven, Germany. This manuscript describes the results of the feasibility testing, focusing on the effects of the Versorgungsvertrag on patients' ADHD symptoms and on the treatment satisfaction of patients' kins.Patients with ADHD (4-17 years) were assessed at baseline and at 9 months follow-up. Kins documented the current symptomatology using the FBB-ADHS questionnaire on both occasions, and rated their satisfaction with the Versorgungsvertrag at follow-up. The FBB-ADHS gives information on the severity of the ADHD core symptoms (0=normal, 3=very noticeable).69 patients (77 kins) were included. At follow-up, data from 59 patients (67 kins) were available. FBB-ADHS data of both occasions was available for 44 patients. Improvements regarding the ADHD total score (1.27 at follow-up vs. 1.59 at baseline, p=0.003) and the subdomains inattention (1.42 vs. 1.81, p=0.001) and hyperactivity (0.96 vs. 1.22, p=0.032) were documented. In the subgroup of boys (n=34), inattention (p=0.001), impulsivity (p=0.019) and the ADHD total score (p=0.002) improved, while no changes were observed in the subgroup of girls (n=10). The majority of kins (52.4 to 68.4%) rated the treatment as helpful.Our study shows improvements for the ADHD core symptoms after 9 months and a high satisfaction of kins with the treatment strategy. Due to the lack of a control group from routine care, no certain statement about the additional benefit of the treatment strategy can be made. The null effect in the subgroup of girls might be explained by the underrepresentation of girls, but the gender distribution observed in our study is commonly observed in patients with ADHD.The positive effects during the observation period should be confirmed in further studies including a control group from routine care.
A comprehensive small area description of regional variations in outpatient antibiotic prescribing in Germany is lacking. Using the German Pharmacoepidemiological Research Database (GePaRD), a claims database covering ~20% of the German population, we determined the age- and sex-standardized prescription rates of antibiotics (number of outpatient prescriptions per 1000 persons/year). We calculated these prescription rates overall and on the level of 401 German districts for the calendar years 2010 and 2018. In 2018, the standardized prescription rate of antibiotics in the total study population was 23% lower than in 2010 (442 vs. 575 per 1000 persons/year). Among 0-17-year-olds, prescription rates across districts ranged from 312 to 1205 in 2010 and from 188 to 710 in 2018 per 1000 persons/year; among adults (≥18 years), they ranged from 388 to 841 in 2010 and from 300 to 693 in 2018 per 1000 persons/year. Despite the overall decline in outpatient antibiotic prescribing between 2010 and 2018, regional variations at the district level remained high in all age groups in Germany. Identifying reasons that explain the persistently high prescription rates in certain regions will be helpful in designing effective and tailored measures to further improve antibiotic stewardship in these regions.
