Prof. Dr. Johannes Schröder
Interview of May 9, 2007 with Dr. Birgit Teichmann
Professor Schröder, you are heading the section Gerontopsychiatry of the University Clinic, Heidelberg. One of your focal points is early diagnosis of dementia. Which warning signals appear at the beginning of dementia?
Principally, there are a number of warning signs at that point, which may be an indication, but not necessarily for dementia. This is very important because in all phases of life, particular with the aging person, there are fluctuations of fitness and capabilities.
These restrictions, I would say, that the most important sign is the ability to memorize and an impairment of the memory, providing it is not just temporary and intensifies with time. This we must clarify with physical tests and neuropsychological testing. Aside from that, there are other early symptoms such as impairment of flexibility, cognitive flexibility, the ability to adjust to changes, but also impairment of the spatial imaginative ability, the orientation. This may point to the beginning of dementia, but not in all cases.
How do you diagnose dementias at the present time?
One has to differentiate between the situation here in the Heidelberg area and in other parts of the country. Since the beginning of the nineties, to be exact since 1994, we have established a memory ambulance, meaning a special consultation for patients, usually for the elderly, where they can present their problems and find out if their condition is only of temporary nature or if there are indeed valid symptoms, in which case further testing would be necessary. To identify the problem a physical and a neuropsychological test is done. If there should be a positive result, then a magnetic resonance tomography of the brain is done. After this a diagnosis is made if further tests are necessary, mainly a determination of the molecular biological disease markers.
Why is it necessary to develop new diagnostic methods?
It is our goal to diagnose these diseases as early as possible and this with the greatest possible precision. The patients come to us with the question:
"Is there something, could there be something, is there a possible threat or is it just a temporary situation, which will pass again?" In order to answer this question with certainty, we need further diagnostic methods.
The most common form of dementia, the Alzheimer dementia, is said to be incurable. What value has early diagnosis here?
Early diagnosis has two reasons: One, it is important to the patient if there might be a problem or not. This is understandable and we in Heidelberg take it very serious. On top of that, it is possible today with the presently available treatments, to reduce the effects of AD. Meaning not only the use of certain medication, which influence the symptoms positively or slow down the progress, but also things like cognitive training, exercising treatment, but also question of housing environment, which is an essential point, or the question on how to organize the future.
Does it make sense to participate in early diagnostics, when a close relative has AD, even if one does not have any symptoms?
In principle I would not answer this with yes. Age is a determining factor, one speaks of hereditary tendency. If many relatives are affected, in particular at a young age, before age 60, then it would make sense to visit the memory consultation. If the disease appears only sporadic in the family, relatives of the second grade, at age 80 or 90, then this can be viewed differently. But also in this case we are available for help.
In Heidelberg the Network Aging Research was founded with scientists from areas of biology, medicine, gerontology, psychology and economics. What do you hope to gain from cooperation with the Network in regard to the research on dementia?
Most of all I hope to intensify the cooperation. We know each other since a long time and have on occasions worked together already, I am thinking of the team around Professor Beyreuther, but also the teams at the DKFZ. However, now we have a platform, a basis from which we can systematically summarize our efforts and intensify them.I believe and am convinced of it, that this will be mutually beneficial.
Johannes Schröder was born in 1957. Since 1994 he is heading the Department of Geriatric Psychiatry and since 1999 he is head of the Clinical Psychiatry. His focal point is the development of cognitive impairment and dementia. He has been using magnetic resonance tomography as early as 1992, together with his colleagues of the Cancer Research Institute. His research on psychological illnesses and their treatment has gained him many awards and prizes – as in 2006 the "Alois Alzheimer-Prize" together with Tobias Hartmann of the University of Saarland.
He is an enthusiastic yachtsman from Oldenburg and has been engaged a number of years as an environmental protectionist.