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Epicardial adipose tissue is involved in the pathophysiology of atrial fibrillation (AF). This study aimed to analyze its relevance as a stroke etiology marker. A retrospective study of acute ischemic stroke patients with large vessel occlusion was conducted, periatrial epicardial adipose tissue thickness (pEATT) on admission computed tomography angiography was measured. One hundred and twenty-one patients with AF-related stroke and 94 patients with noncardioembolic stroke were included. Patients with AF-related stroke had increased pEATT. CT-measured left-sided pEATT was an independent predictor of AF-related stroke (adjusted odds ratio per 1 mm increase = 1.27, 95% CI = 1.05-1.53, p = 0.012). pEATT is an independent marker of AF-related stroke.

Journal of neurology (2022). doi:10.1007/s00415-022-11340-3, Published by Springer, Berlin ; Heidelberg

Background and purpose: A primary admission of patients with suspected acute ischemic stroke and large vessel occlusion (LVO) to centers capable of providing endovascular stroke therapy (EVT) may induce shorter time to treatment and better functional outcomes. One of the limitations in this strategy is the need for accurately identifying LVO patients in the prehospital setting. We aimed to study the feasibility and diagnostic performance of point-of-care ultrasound (POCUS) for the detection of LVO in patients with acute stroke. Methods: We conducted a proof-of-concept study and selected 15 acute ischemic stroke patients with angiographically confirmed LVO and 15 patients without LVO. Duplex ultrasonography (DUS) of the common carotid arteries was performed, and flow profiles compatible with LVO were scored independently by one experienced and one junior neurologist. Results: Among the 15 patients with LVO, 6 patients presented with an occlusion of the carotid-T and 9 patients presented with an M1 occlusion. Interobserver agreement between the junior and the experienced neurologist was excellent (kappa = 0.813, p < 0.001). Flow profiles of the CAA allowed the detection of LVO with a sensitivity of 73%, a positive predictive value of 92 and 100%, and a c-statistics of 0.83 (95%CI = 0.65–0.94) and 0.87 (95%CI = 0.69–0.94) (experienced neurologist and junior neurologist, respectively). In comparison with clinical stroke scales, DUS was associated with better trade-off between sensitivity and specificity. Conclusion: POCUS in acute stroke setting is feasible, it may serve as a complementary tool for the detection of LVO and is potentially applicable in the prehospital phase.

Randomized controlled trials of secukinumab have shown sustained efficacy and a favourable safety profile in multiple manifestations of psoriatic disease.To assess the long-term, real-world retention, effectiveness and safety of secukinumab in routine clinical practice for the treatment of moderate-to-severe plaque-type psoriasis (PsO).SERENA (CAIN457A3403) is a large, ongoing, longitudinal, observational study conducted at 438 sites and 19 countries for an expected duration of up to 5 years in adult patients with moderate-to-severe PsO, psoriatic arthritis and ankylosing spondylitis. Patients received ≥16 weeks of secukinumab treatment before enrolment. This interim analysis presents data from PsO patients, who were enrolled in the study between October-2016 and October-2018 and were observed for ≥2 years.In total, 1756 patients (67.3% male) with a mean age of 48.4 years and body mass index of 28.8 kg/mSecukinumab showed high treatment persistence, sustained effectiveness and a favourable safety profile up to 3 years of follow-up in the real-world population of PsO patients observed in SERENA.

Serine 129 and, to a lesser extent, serine 87 can appear phosphorylated in the intrinsically disordered protein humanα-synuclein (AS), a key player in Parkinson’s disease, where it accumulates in proteinaceous aggregates. Intriguingly, both phosphorylations are located in a highly negative potential region of the protein. Here we used molecular simulation to provide insight in the selective phosphorylation by polo-like kinase 2 (PLK2), in both monomeric and fibrillar forms of AS. We suggest that phosphorylation does not impact on the structural determinants of the physiological AS conformational ensemble, as the phosphate group is mostly solvated. Our findings are consistent with experimental data on the non-acetylated, non-physiological form of the protein. The phosphate groups of pAS may be solvated also in the aggregated form.

Purpose To test the reliability, validity and utility of the TEARS score, a scale of clinical and patient-reported severity in patients with epiphora, comprising 4 subscales: Times wiping (T), clinical Effects (E), Activity limitation (A), and symptoms of Reflex epiphora (R). Methods The TEARS score was completed by 136 patients with epiphora (78 treated surgically, and 51 non-surgically). Inter-rater reliability was evaluated using Cohen's Kappa and Bland-Altman analysis. 129 (95%) participants were followed up 2–6 months after baseline (non-surgical patients) or 3–6 months post-operatively (surgical patients). For each TEARS subscale, differences in scores were compared. Convergent validity was evaluated by testing correlation between TEARS and both The Lacrimal Symptom Questionnaire (Lac-Q) and The Watery Eye Quality of Life Score (WEQOL). Results Inter-rater reliability (Cohen's K) ranged from 0.5 for ‘A’ and ‘R’ to 0.8 for ‘T’ and ‘E’ subscales. Scores were lower post-operatively in surgical patients (p Conclusion The TEARS score is quickly and easily implemented in a busy clinical setting. It provides an overview of both subjective and objective clinical severity in patients with epiphora, with appropriate reliability, post-operative responsiveness and convergent validity for this purpose and in this setting. It is a valuable template to be used alongside individualised symptomology.

Purpose To provide first evidence of lymph node (LN) staging using CT scan and its prognostic value in variant histologies of bladder cancer. This knowledge may optimize patient management with variant histologies based on CT morphological findings. Methods Preoperative CT scans of patients with variant histologies who underwent RC between 2004 and 2019 were reanalyzed by two independent radiologists in a blinded review process. Specificity, sensitivity, and accuracy for LN staging as well as LN characteristics were evaluated. Correlation with survival was investigated by Kaplan–Meier method, log-rank test and multivariate analysis. Results 1361 patients with primary tumor of the bladder underwent RC, of which 163 (12%) patients revealed variant histologies. 65 (47.8%) patients have shown an urothelial variant (UV) and 71 (52.2%) a non-urothelial variant (NUV). LN metastases were found in 18 (27.7%) patients with UV and 21 (29.6%) patients with NUV. The accuracy to detect LN metastasis for all variant histologies was 62% with a sensitivity of 46% and a specificity of 70%. Subgroups of UV and NUV revealed an accuracy of 67% and 57%. An increased number of regional LN (HR 2.8; 1.34–6.18) and the loss of fatty hilum (HR 0.36, 0.17–0.76) were prognostic parameters. In multivariate analysis, a fatty hilum (HR 0.313, 0.104–0.945) and the presence of lymph node metastases (HR 2.866, 1.140–7.207) were prognostic. Conclusion This first study on CT morphological behavior of variant histologies revealed an accuracy of UV and NUV comparable to UC with low specificity for all variant histologies. CT scan prior RC should be interpreted in regard to histological subtypes.

ZUSAMMENFASSUNG Gegenstand und Ziel Viele Patienten mit posturalem Tachykardie-Syndrom (PoTS) erhalten eine Hautbiopsie, um eine mögliche Small Fiber Neuropathie (SFN) zu erkennen. Ziel der Fragebogenstudie war es, mögliche Nebenwirkungen nach Lokalanästhesie mit Adrenalinzusatz zu erkennen. Material und Methoden 52 Patienten (29 PoTS, 23 SFN) füllten die retrospektive Befragung aus. Es wurde eine qualitative deskriptive und quantitative Datenanalyse mit Zwischensubjektdesign durchgeführt. Ergebnisse Alle Nebenwirkungen wurden bei PoTS (32 Items, relative Häufigkeit 15,8 %) häufiger als bei SFN-Patienten (8 Items, 5,0 %), entweder während oder nach der Biopsie (p = 0,027) beschrieben. Nur Patienten mit PoTS beschrieben Hämatome und verlängerte Blutung. Schlussfolgerung In der klinischen Routine besteht Unsicherheit bei Patienten, ob die Hautbiopsie unter Lokalanästhesie mit Adrenalinzusatz Nebenwirkungen haben kann. In dieser Pilotstudie zeigten sich keine schwerwiegenden Nebenwirkungen, die die Durchführung der Hautbiopsien in der klinischen Diagnostik bei PoTS einschränken könnten. Klinische Relevanz Auf Basis dieser Daten wird eine prospektive Studie durchgeführt.

Neurological research and practice 4(1), 5 (2022). doi:10.1186/s42466-022-00169-w, Published by BioMed Central, [London]

Neurotherapeutics 18(4), 2425-2435 (2021). doi:10.1007/s13311-021-01141-3, Published by Springer, New York, NY

Introduction The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) is a renowned cognitive test battery, which has been extended in its German version to the CERAD-Plus including tests of executive functions and processing speed. The most commonly used total score (TS) is based on the restricted CERAD version and reflects the sum of selected raw-values (Chandler et al., 2005). The CERAD-Plus extensions might be of particular diagnostic utility for cognitive assessments in Parkinson's Disease (PD), as executive functions and processing speed belong to the most vulnerable domains in PD. Objective The aim was to develop a CERAD-TS based on the extended CERAD-Plus' age-, gender-, and education-corrected z-scores and to evaluate its diagnostic accuracy compared to the established CERAD-Chandler-TS. Methods Baseline data of n = 679 patients with PD (69% male, n = 277 PD without cognitive impairment, n = 307 PD-MCI, n = 95 PD-D) from the multicenter, prospective DEMPARK/LANDSCAPE study were analyzed. ROC-analyses were conducted for four different TS that were either based on the original CERAD or CERAD-Plus, on raw-values or z-scores, and equally-weighted or based on factor scores. AUC-comparisons were conducted to determine the best yet most parsimonious TS. Results The newly designed CERAD-Plus-TS based on equally-weighted z-scores outperformed both the CERAD-Chandler-TS and cognitive screening instruments when differentiating between individuals with PD of varying cognitive impairment (0.78 ≤ AUC ≤ 0.98). Conclusion Results suggest a high relevance of non-amnestic subscales for the cognitive assessment in PD populations. The proposed CERAD-Plus-TS needs further validation. The extensions might offer diagnostic potential for non-PD populations as well.

European journal of neurology 30(2), 719-728 (2022). doi:10.1111/ene.15649, Published by Wiley-Blackwell, Oxford [u.a.]

Tremor is one of the common symptoms of Parkinson’s disease (PD). Thanks to the recent evolution of digital technologies, monitoring of PD patients’ hand movements employing contactless methods gained momentum. Objective: We aimed to quantitatively assess hand movements in patients suffering from PD using the artificial intelligence (AI)-based hand-tracking technologies of MediaPipe. Method: High-frame-rate videos and accelerometer data were recorded from 11 PD patients, two of whom showed classical Parkinsonian-type tremor. In the OFF-state and 30 Minutes after taking their standard oral medication (ON-state), video recordings were obtained. First, we investigated the frequency and amplitude relationship between the video and accelerometer data. Then, we focused on quantifying the effect of taking standard oral treatments. Results: The data extracted from the video correlated well with the accelerometer-based measurement system. Our video-based approach identified the tremor frequency with a small error rate (mean absolute error 0.229 (±0.174) Hz) and an amplitude with a high correlation. The frequency and amplitude of the hand movement before and after medication in PD patients undergoing medication differ. PD Patients experienced a decrease in the mean value for frequency from 2.012 (±1.385) Hz to 1.526 (±1.007) Hz and in the mean value for amplitude from 8.167 (±15.687) a.u. to 4.033 (±5.671) a.u. Conclusions: Our work achieved an automatic estimation of the movement frequency, including the tremor frequency with a low error rate, and to the best of our knowledge, this is the first paper that presents automated tremor analysis before/after medication in PD, in particular using high-frame-rate video data.

Defined by dysfunction or degeneration of Aδ and C fibers, small fiber neuropathies (SFNs) entail a relevant health burden. In 50% of cases, the underlying cause cannot be identified or treated. In 100 individuals (70% female individuals; mean age: 44.8 years) with an idiopathic, skin biopsy-confirmed SFN, we characterized the symptomatic spectrum and measured markers of oxidative stress (vitamin C, selenium, and glutathione) and inflammation (transforming growth factor beta, tumor necrosis factor alpha), as well as neurotoxic 1-deoxy-sphingolipids. Neuropathic pain was the most abundant symptom (95%) and cause of daily life impairment (72%). Despite the common use of pain killers (64%), the painDETECT questionnaire revealed scores above 13 points in 80% of patients. In the quantitative sensory testing (QST), a dysfunction of Aδ fibers was observed in 70% and of C fibers in 44%, affecting the face, hands, or feet. Despite normal nerve conduction studies, QST revealed Aβ fiber involvement in 46% of patients' test areas. Despite absence of diabetes mellitus or mutations in SPTLC1 or SPTLC2 , plasma 1-deoxy-sphingolipids were significantly higher in the sensory loss patient cluster when compared with those in patients with thermal hyperalgesia ( P0.01) or those in the healthy category ( P0.1), correlating inversely with the intraepidermal nerve fiber density (1-deoxy-SA: P0.05, 1-deoxy-SO: P0.01). Patients with arterial hypertension, overweight (body mass index25 kg/m 2 ), or hyperlipidemia showed significantly lower L-serine (arterial hypertension: P0.01) and higher 1-deoxy-sphingolipid levels (arterial hypertension: P0.001, overweight: P0.001, hyperlipidemia: P0.01). Lower vitamin C levels correlated with functional Aβ involvement ( P0.05). Reduced glutathione was lower in patients with Aδ dysfunction ( P0.05). Idiopathic SFNs are heterogeneous. As a new pathomechanism, plasma 1-deoxy-sphingolipids might link the metabolic syndrome with small fiber degeneration.

Background Whether thrombectomy alone is equally as effective as intravenous alteplase plus thrombectomy remains controversial. We aimed to determine whether thrombectomy alone would be non-inferior to intravenous alteplase plus thrombectomy in patients presenting with acute ischaemic stroke. Methods In this multicentre, randomised, open-label, blinded-outcome trial in Europe and Canada, we recruited patients with stroke due to large vessel occlusion confirmed with CT or magnetic resonance angiography admitted to endovascular centres. Patients were randomly assigned (1:1) via a centralised web server using a deterministic minimisation method to receive stent-retriever thrombectomy alone or intravenous alteplase plus stent-retriever thrombectomy. In both groups, thrombectomy was initiated as fast as possible with any commercially available Solitaire stent-retriever revascularisation device (Medtronic, Irvine, CA, USA). In the combined treatment group, intravenous alteplase (0.9 mg/kg bodyweight, maximum dose 90 mg per patient) was administered as early as possible after randomisation for 60 min with 10% of the calculated dose given as an initial bolus. Personnel assessing the primary outcome were masked to group allocation; patients and treating physicians were not. The primary binary outcome was a score of 2 or less on the modified Rankin scale at 90 days. We assessed the non-inferiority of thrombectomy alone versus intravenous alteplase plus thrombectomy in all randomly assigned and consenting patients using the one-sided lower 95% confidence limit of the Mantel-Haenszel risk difference, with a prespecified non-inferiority margin of 12%. The main safety endpoint was symptomatic intracranial haemorrhage assessed in all randomly assigned and consenting participants. This trial is registered with ClinicalTrials.gov, NCT03192332, and is closed to new participants. Findings Between Nov 29, 2017, and May 7, 2021, 5215 patients were screened and 423 were randomly assigned, of whom 408 (201 thrombectomy alone, 207 intravenous alteplase plus thrombectomy) were included in the primary efficacy analysis. A modified Rankin scale score of 0-2 at 90 days was reached by 114 (57%) of 201 patients assigned to thrombectomy alone and 135 (65%) of 207 patients assigned to intravenous alteplase plus thrombectomy (adjusted risk difference -7 .3%, 95% CI -16.6 to 2.1, lower limit of one-sided 95% CI -15.1%, crossing the non-inferiority margin of - 12%). Symptomatic intracranial haemorrhage occurred in five (2%) of 201 patients undergoing thrombectomy alone and seven (3%) of 202 patients receiving intravenous alteplase plus thrombectomy ( risk difference -1.0%, 95% CI -4.8 to 2 .7). Successful reperfusion was less common in patients assigned to thrombectomy alone (182 [ 91%] of 201 vs 199 [96%] of 207, risk difference -5.1%, 95% CI -10.2 to 0. 0, p=0.047). Interpretation Thrombectomy alone was not shown to be non-inferior to intravenous alteplase plus thrombectomy and resulted in decreased reperfusion rates. These results do not support omitting intravenous alteplase before thrombectomy in eligible patients. Copyright (C) 2022 Elsevier Ltd. All rights reserved.

OBJECTIVE OR PURPOSE: To develop and test a patient-reported outcome measure for assessing health-related quality of life (HRQOL) in surgically amenable epiphora. DESIGN: Questionnaire development and validation study. PARTICIPANTS: 201 patients with a cause of epiphora amenable to surgical intervention, recruited across three independent centres. METHODS, INTERVENTION OR TESTING: The watery eye quality of life (WEQOL) questionnaire was developed and refined according to defined psychometric standards. Both surgical and non-surgical participants completed WEQOL at baseline and follow-up (>3 months), along with the Lacrimal Symptom Questionnaire (Lac-Q), RAND Short Form Health Survey (SF-36) and Glasgow Benefit Inventory (GBI). Convergent validity of WEQOL was evaluated according to correlation (R > 0.40) with each of these additional tests. Responsiveness of WEQOL to intervention was evaluated according to patient-reported success. Test-retest reliability was assessed by the Bland–Altman method and intraclass correlation (ICC) in a subset of 64 participants at baseline. MAIN OUTCOME MEASURES: WEQOL construct validity, responsiveness and test-retest reliability. RESULTS: WEQOL was moderately correlated (R > 0.4) with the Lac-Q and several subscales of the SF-36 (physical role limitation, social, emotional role limitation and emotional well-being). A stronger correlation was found between the change in WEQOL at follow-up and GBI (R = 0.61). An appropriate graded response was found with a significant change in WEQOL score being observed in patients reporting successful (−28%, p

PCDH19 is a nonclustered protocadherin molecule involved in axon bundling, synapse function, and transcriptional coregulation. Pathogenic variants in PCDH19 cause infantile-onset epilepsy known as PCDH19-clustering epilepsy or PCDH19-CE. Recent advances in DNA-sequencing technologies have led to a significant increase in the number of reported PCDH19-CE variants, many of uncertain significance. We aimed to determine the best approaches for assessing the disease relevance of missense variants in PCDH19. The application of the American College of Medical Genetics and Association for Molecular Pathology (ACMG-AMP) guidelines was only 50% accurate. Using a training set of 322 known benign or pathogenic missense variants, we identified MutPred2, MutationAssessor, and GPP as the best performing in silico tools. We generated a protein structural model of the extracellular domain and assessed 24 missense variants. We also assessed 24 variants using an in vitro reporter assay. A combination of these tools was 93% accurate in assessing known pathogenic and benign PCDH19 variants. We increased the accuracy of the ACMG-AMP classification of 45 PCDH19 variants from 50% to 94%, using these tools. In summary, we have developed a robust toolbox for the assessment of PCDH19 variant pathogenicity to improve the accuracy of PCDH19-CE variant classification. Refereed/Peer-reviewed

Introduction Frailty is a disorder of multiple physiological systems impairing the capacity of the organism to cope with insult or stress. It is associated with poor outcomes after acute illness. Our aim was to study the impact of frailty on the functional outcome of patients with acute ischemic stroke (AIS) submitted to endovascular stroke treatment (EST). Methods We performed a retrospective study of patients with AIS of the anterior circulation submitted to EST between 2012 and 2017, based on a prospectively collected local registry of consecutive patients. The Hospital Frailty Risk Score (HFRS) at discharge was calculated for each patient. We compared groups of patients with and without favourable 3-month outcome after index AIS (modified Rankin Scale 0–2 and 3–6, respectively). A multivariable logistic regression model was used to identify variables independently associated with favourable 3-month outcome. Diagnostic test statistics were used to compare HFRS with other prognostic scores for AIS. Results We included 489 patients with median age 75.6 years (interquartile range [IQR] = 65.3–82.3) and median NIHSS 15 (IQR = 11–19). About 29.7% presented a high frailty risk (HFRS >15 points). Patients with favourable 3-month outcome presented lower HFRS and lower prevalence of high frailty risk. High frailty risk was independently associated with decreased likelihood of favourable 3-month outcome (adjusted odds ratio = 0.48, 95% confidence interval = 0.26–0.89). Diagnostic performances of HFRS and other prognostic scores (THRIVE and PRE scores, SPAN-100 index) for outcome at 3-months were similar. Discussion Frailty is an independent predictor of outcome in AIS patients submitted to EST.

Movement disorders 38(1), 45-56 (2023). doi:10.1002/mds.29261, Published by Wiley, New York, NY

Seizure Related 6 Homolog Like 2 (SEZ6L2) protein has been shown to have implications in neuronal and especially motor function development. In oncology, overexpression of SEZ6L2 serves as a negative prognostic marker in several tumor entities. Recently, few cases of anti-SEZ6L2 antibody mediated cerebellar syndromes were reported. In this article, we present a case of a 70-year-old woman with subacute onset of gait disturbance, dysarthria and limb ataxia. Serum anti-SEZ6L2 antibodies were markedly increased, and further diagnostic workup revealed left sided breast cancer. Neurological symptoms and SEZ6L2 titer significantly improved after curative tumor therapy. This is a very rare and educationally important report of anti-SEZ6L2 autoimmune cerebellar syndrome with a paraneoplastic etiology. Additionally, we performed a review of the current literature for SEZ6L2, focusing on comparing the published cases on autoimmune cerebellar syndrome.

Orphanet journal of rare diseases : OJRD 17, 415 (2022). doi:10.1186/s13023-022-02568-3, Published by BioMed Central, London

Dementias are expensive diseases: the net annual cost in European healthcare is about € 28.000 per case with a strong stage dependency, of which medical care accounts for about 19%. Diagnostic costs, on the other hand, account for only a small proportion of the total costs. With changes in the guidelines, biomarker tests are becoming increasingly important. At present, the concrete economic impact of biomarker-based diagnosis is largely unknown. To determine the actual costs of diagnostic procedures based on guidelines, we conducted a survey among the members of the German Memory Clinic Network (DNG). From 15 expert centres, the staff engagement time for all procedures was collected. Based on the individual engagement times of the different professions, the total of personnel costs for diagnostics was calculated using current gross personnel costs. The total sum of diagnostic costs (personnel plus procedures) was calculated for three different scenarios e. g. € 633,97 for diagnostics without biomarkers, € 1.214,90 for diagnostics with CSF biomarkers and € 4.740,58 € for diagnostics with FDG- plus Amyloid-PET. In addition, the actual diagnostic costs of the current practice in expert memory clinics were estimated, taking into account personnel costs, costs for the different procedures and the frequency of their use across all patients. This results in total average costs of € 1.394,43 per case as the mean across all centres (personnel costs € 351,72, costs for diagnostic procedures € 1.042,71). The results show that state-of-the-art diagnosis of dementia and pre-dementia states, such as mild cognitive impairment (MCI) requires financial resources, which are currently not fully reimbursed in Germany. The need for a biomarker-based etiological diagnosis of dementia and pre-dementia states will increase, due to availability of disease-modifying treatments. Therefore, the current gap of reimbursement must be filled by new models of compensation.Demenzen sind teure Erkrankungen: die jährlichen Kosten betragen in europäischen Versorgungssystemen etwa 28.000 €/Fall mit einer starken Stadien-Abhängigkeit, davon entfallen etwa 19% auf die medizinische Versorgung. Die diagnostischen Kosten hingegen verursachen davon nur einen geringen Teil. Mit Wandel des konzeptuellen Verständnisses von Demenzerkrankungen, der Behandlungsmöglichkeiten und der Leitlinien spielen zunehmend auch Biomarker-Untersuchungen eine wichtige Rolle. Die ökonomischen Auswirkungen der Biomarker-basierten Diagnostik sind derzeit nicht sicher abschätzbar. Zur Erhebung der Kosten einer leitlinien-orientierten ätiologischen Erst-Diagnostik von kognitiven Störungen wurde eine Umfrage im Deutschen Netzwerk Gedächtnisambulanzen (DNG) durchgeführt. An 15 Expertenzentren des DNG wurden systematisch die Personalbindungszeiten für alle Prozeduren und alle beteiligten Berufsgruppen erhoben und die Personalkosten basierend auf den tarifvertraglichen Arbeitgeberkosten berechnet. Zusammen mit den Kosten für technische Untersuchungen wurden Gesamtkosten der Diagnostik für drei Szenarien abgeschätzt: Diagnostik ohne Biomarker € 633,97 €, Diagnostik mit Liquoruntersuchungen € 1.214,90 und Diagnostik mit FDG- plus Amyloid-PET € 4.740,58. Zusätzlich erfolgte eine Analyse der derzeitigen realen Kostensituation in Gedächtnisambulanzen, wobei die Personalbindungszeiten für einzelne Leistungen und die apparativen Kosten ins Verhältnis zur Häufigkeit ihrer Anwendung gesetzt wurden. Als Mittelwert aller Zentren ergeben sich dabei Gesamtkosten von € 1.394,43/Fall (Mittelwert der Personalkosten € 351,72, Mittelwert der Kosten für apparative Diagnostik € 1.042,71). Die Ergebnisse zeigen, dass eine ätiologische Diagnostik von kognitiven Störungen (Demenzen und leichte kognitive Störung) einen Ressourceneinsatz erfordert, welcher derzeit weder durch die Vergütungssysteme von Ambulanzen noch durch die vertragsärztliche Vergütung kostendeckend erstattet wird. Die Biomarker-gestützte Diagnostik dementieller und prädementieller Syndrome wird häufiger werden, wenn sie zur Indikationsstellung vor einer krankheits-modifizierenden Therapie erforderlich ist. Deshalb müssen neue Finanzierungsmodelle entwickelt werden, um die gegenwärtige Lücke in der Kostenerstattung für die ätiologische Diagnostik kognitiver Störungen zu schließen.

Scientific reports 12, 19173 (2022). doi:10.1038/s41598-022-23666-z, Published by Macmillan Publishers Limited, part of Springer Nature, [London]