Skip to main content
Erschienen in: Neurological Sciences 12/2014

01.12.2014 | Original Article

Sleep disturbance and cognitive disorder: epidemiological analysis in a cohort of 263 patients

verfasst von: Michele Pistacchi, Manuela Gioulis, Franco Contin, Flavio Sanson, Sandro Zambito Marsala

Erschienen in: Neurological Sciences | Ausgabe 12/2014

Einloggen, um Zugang zu erhalten

Abstract

The aim of this study was to investigate and describe frequency and characteristics of sleep disorders in a large cohort of community dwelling persons with several degrees and typologies of cognitive disorders. 236 patients (78 men and 158 women) were enrolled with different subtypes of dementia: Alzheimer’s disease (AD), vascular dementia (VaD), mixed dementia, mild cognitive impairment (MCI), dementia with Lewy bodies (DLB), parkinson’s disease dementia (PDD), and frontotemporal lobar degeneration (FTLD), respectively. The sleep disturbances evaluated were: insomnia, excessive daytime sleepiness (EDS), REM behavior disorder (RBD), restless legs syndrome (RLS), and nightmares. Every type of sleep disorder was present in each type of dementia but with significant differences. Insomnia is found to be more present and specific for AD; EDS was associated with the presence of dementia in the elderly with LBD or PDD; RLS and nightmares that were recognized mainly in FTD, LBD, and PDD patients scores; patients with MCI had a frequency of sleep disturbances of any type equal to that of patients with AD presenting mostly insomnia, nightmares or RLS more frequently; nightmares were more frequent among LBD and PDD patients. Frequency of RDB was more frequent in FTD, AD, and VaD. Our findings demonstrate that sleep disturbance was related to dementia. A careful clinical evaluation of sleep disorders should be performed routinely in the clinical setting of persons with cognitive decline.
Literatur
1.
Zurück zum Zitat Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV (2004) Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 27:1255–1273PubMed Ohayon MM, Carskadon MA, Guilleminault C, Vitiello MV (2004) Meta-analysis of quantitative sleep parameters from childhood to old age in healthy individuals: developing normative sleep values across the human lifespan. Sleep 27:1255–1273PubMed
2.
Zurück zum Zitat Vitiello MV (1997) Sleep disorders and aging: understanding the causes. J Gerontol A Biol Sci Med Sci 52:M189–M191PubMedCrossRef Vitiello MV (1997) Sleep disorders and aging: understanding the causes. J Gerontol A Biol Sci Med Sci 52:M189–M191PubMedCrossRef
3.
Zurück zum Zitat Ancoli-Israel S, Ayalon L (2006) Diagnosis and treatment of sleep disorders in older adults. Am J Geriatr Psychiatry 14:95–103PubMedCrossRef Ancoli-Israel S, Ayalon L (2006) Diagnosis and treatment of sleep disorders in older adults. Am J Geriatr Psychiatry 14:95–103PubMedCrossRef
5.
6.
Zurück zum Zitat Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG (1995) Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 18:425–432PubMed Foley DJ, Monjan AA, Brown SL, Simonsick EM, Wallace RB, Blazer DG (1995) Sleep complaints among elderly persons: an epidemiologic study of three communities. Sleep 18:425–432PubMed
7.
Zurück zum Zitat Bliwise DL (1996) Is sleep apnea a cause of reversible dementia in old age? J Am Geriatr Soc 44:1407–1409PubMed Bliwise DL (1996) Is sleep apnea a cause of reversible dementia in old age? J Am Geriatr Soc 44:1407–1409PubMed
8.
Zurück zum Zitat Redline S, Strauss ME, Adams N, Winters M, Roebuck T, Spry K et al (1997) Neuropsychological function in mild sleep-disordered breathing. Sleep 20:160–167PubMed Redline S, Strauss ME, Adams N, Winters M, Roebuck T, Spry K et al (1997) Neuropsychological function in mild sleep-disordered breathing. Sleep 20:160–167PubMed
9.
Zurück zum Zitat Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O (1991) Sleep-disordered breathing in community-dwelling elderly. Sleep 14:486–495PubMedCentralPubMed Ancoli-Israel S, Kripke DF, Klauber MR, Mason WJ, Fell R, Kaplan O (1991) Sleep-disordered breathing in community-dwelling elderly. Sleep 14:486–495PubMedCentralPubMed
10.
Zurück zum Zitat Décary A, Rouleau I, Montplaisir J (2000) Cognitive deficits associated with sleep apnea syndrome: a proposed neuropsychological test battery. Sleep 23:369–381PubMed Décary A, Rouleau I, Montplaisir J (2000) Cognitive deficits associated with sleep apnea syndrome: a proposed neuropsychological test battery. Sleep 23:369–381PubMed
11.
Zurück zum Zitat Merlino G, Piani A, Gigli GL et al (2010) Daytime sleepiness is associated with dementia and cognitive decline in older Italian adults: a population-based study. Sleep Med 11:372–377PubMedCrossRef Merlino G, Piani A, Gigli GL et al (2010) Daytime sleepiness is associated with dementia and cognitive decline in older Italian adults: a population-based study. Sleep Med 11:372–377PubMedCrossRef
12.
Zurück zum Zitat Nebes RD, Buysse DJ, Halligan EM, Houck PR, Monk TH (2009) Self-reported sleep quality predicts poor cognitive performance in healthy older adults. J Gerontol B Psychol Sci Soc Sci 64:180–187PubMedCrossRef Nebes RD, Buysse DJ, Halligan EM, Houck PR, Monk TH (2009) Self-reported sleep quality predicts poor cognitive performance in healthy older adults. J Gerontol B Psychol Sci Soc Sci 64:180–187PubMedCrossRef
13.
Zurück zum Zitat Ohayon MM, Vecchierini MF (2002) Daytime sleepiness and cognitive impairment in the elderly population. Arch Intern Med 162:201–208PubMedCrossRef Ohayon MM, Vecchierini MF (2002) Daytime sleepiness and cognitive impairment in the elderly population. Arch Intern Med 162:201–208PubMedCrossRef
14.
Zurück zum Zitat Schmutte T, Harris S, Levin R, Zweig R, Katz M, Lipton R (2007) The relation between cognitive functioning and self-reported sleep complaints in nondemented older adults: results from the Bronx aging study. Behav Sleep Med 5:39–56PubMedCrossRef Schmutte T, Harris S, Levin R, Zweig R, Katz M, Lipton R (2007) The relation between cognitive functioning and self-reported sleep complaints in nondemented older adults: results from the Bronx aging study. Behav Sleep Med 5:39–56PubMedCrossRef
15.
16.
Zurück zum Zitat Vitiello MV, Borson S (2001) Sleep disturbances in patients with Alzheimer’s disease: epidemiology, pathophysiology and treatment. CNS Drugs 15:777–796PubMedCrossRef Vitiello MV, Borson S (2001) Sleep disturbances in patients with Alzheimer’s disease: epidemiology, pathophysiology and treatment. CNS Drugs 15:777–796PubMedCrossRef
17.
18.
Zurück zum Zitat Boeve BF, Silber MH, Ferman TJ, Lucas JA, Parisi JE (2001) Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Movement Disord 16:622630CrossRef Boeve BF, Silber MH, Ferman TJ, Lucas JA, Parisi JE (2001) Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Movement Disord 16:622630CrossRef
19.
Zurück zum Zitat Harper DG, Stopa EG, McKee AC, Satlin A, Harlan PC, Goldstein R et al (2001) Differential circadian rhythm disturbances in men with Alzheimer disease and frontotemporal degeneration. Arch Gen Psychiatry 58:353–360PubMedCrossRef Harper DG, Stopa EG, McKee AC, Satlin A, Harlan PC, Goldstein R et al (2001) Differential circadian rhythm disturbances in men with Alzheimer disease and frontotemporal degeneration. Arch Gen Psychiatry 58:353–360PubMedCrossRef
20.
Zurück zum Zitat Grace JB, Walker MP, McKeith IG (2000) A comparison of sleep profiles in patients with dementia with Lewy bodies and Alzheimer disease. Int J Geriatr Psychiatry 15:1028–1033PubMedCrossRef Grace JB, Walker MP, McKeith IG (2000) A comparison of sleep profiles in patients with dementia with Lewy bodies and Alzheimer disease. Int J Geriatr Psychiatry 15:1028–1033PubMedCrossRef
21.
Zurück zum Zitat Bracco L, Piccini C, Moretti M, Mascalchi M, Sforza A, Nacmias B, Cellini E, Bagnoli S, Sorbi S (2005) Alzheimer’s disease: role of size and location of white matter changes in determining cognitive deficits. Dement Geriatr Cogn Disord 20:358–366PubMedCrossRef Bracco L, Piccini C, Moretti M, Mascalchi M, Sforza A, Nacmias B, Cellini E, Bagnoli S, Sorbi S (2005) Alzheimer’s disease: role of size and location of white matter changes in determining cognitive deficits. Dement Geriatr Cogn Disord 20:358–366PubMedCrossRef
22.
Zurück zum Zitat Peters F, Perani D, Herholz K, Holthoff V, Beuthien-Baumann B, Sorbi S, Pupi A, Degueldre C, Lemaire C, Collette F, Salmon E (2006) Orbitofrontal dysfunction related to both apathy and disinhibition in frontotemporal dementia. Dement Geriatr Cogn Disord 21(5–6):373–379PubMedCrossRef Peters F, Perani D, Herholz K, Holthoff V, Beuthien-Baumann B, Sorbi S, Pupi A, Degueldre C, Lemaire C, Collette F, Salmon E (2006) Orbitofrontal dysfunction related to both apathy and disinhibition in frontotemporal dementia. Dement Geriatr Cogn Disord 21(5–6):373–379PubMedCrossRef
23.
Zurück zum Zitat International Classification of Sleep Disorders (2005) Diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester International Classification of Sleep Disorders (2005) Diagnostic and coding manual, 2nd edn. American Academy of Sleep Medicine, Westchester
24.
Zurück zum Zitat Pollak P, Perlick D (1991) Sleep problems and institutionalization of the elderly. J Geriatr Psychiatry Neurol 4:204–210PubMedCrossRef Pollak P, Perlick D (1991) Sleep problems and institutionalization of the elderly. J Geriatr Psychiatry Neurol 4:204–210PubMedCrossRef
26.
Zurück zum Zitat American Psychiatric Association: DSM IVTR (2000) Diagnostic and Statistical Manual of Mental Disorders, ed 4, text revision American Psychiatric Association: DSM IVTR (2000) Diagnostic and Statistical Manual of Mental Disorders, ed 4, text revision
27.
Zurück zum Zitat McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34:939944CrossRef McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 34:939944CrossRef
28.
Zurück zum Zitat Romàn GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH et al (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43:250–260PubMedCrossRef Romàn GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH et al (1993) Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 43:250–260PubMedCrossRef
29.
Zurück zum Zitat McKeith IG (2006) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the Consortium on DLB International Workshop. J Alzheimers Dis 9(3 suppl):417–423PubMed McKeith IG (2006) Consensus guidelines for the clinical and pathologic diagnosis of dementia with Lewy bodies (DLB): report of the Consortium on DLB International Workshop. J Alzheimers Dis 9(3 suppl):417–423PubMed
30.
Zurück zum Zitat Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund L-O et al (2004) Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 256:240–246PubMedCrossRef Winblad B, Palmer K, Kivipelto M, Jelic V, Fratiglioni L, Wahlund L-O et al (2004) Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 256:240–246PubMedCrossRef
31.
Zurück zum Zitat Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919PubMedCrossRef Katz S, Ford AB, Moskowitz RW et al (1963) Studies of illness in the aged: the index of ADL: a standardized measure of biological and psychosocial function. JAMA 185:914–919PubMedCrossRef
32.
Zurück zum Zitat Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186PubMedCrossRef Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186PubMedCrossRef
33.
Zurück zum Zitat Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRef Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198PubMedCrossRef
34.
Zurück zum Zitat Yesavage JA, Brink TL, Rose TL et al (1982–1983) Development and validation of a geriatric screening scale: a preliminary report. J Psychiatr Res 17(1):37–49CrossRef Yesavage JA, Brink TL, Rose TL et al (1982–1983) Development and validation of a geriatric screening scale: a preliminary report. J Psychiatr Res 17(1):37–49CrossRef
35.
Zurück zum Zitat Rinaldi R, Vignatelli L, D’Alessandro R, Bassein L, Sforza E, Plazzi G et al (2001) Validation of symptoms related to excessive daytime sleepiness. Neuroepidemiology 20:248–256PubMedCrossRef Rinaldi R, Vignatelli L, D’Alessandro R, Bassein L, Sforza E, Plazzi G et al (2001) Validation of symptoms related to excessive daytime sleepiness. Neuroepidemiology 20:248–256PubMedCrossRef
36.
Zurück zum Zitat Vignatelli L, Plazzi G, Barbato A et al (2003) Italian version of the Epworth sleepiness scale: external validity. Neurological Sci 23:295–300CrossRef Vignatelli L, Plazzi G, Barbato A et al (2003) Italian version of the Epworth sleepiness scale: external validity. Neurological Sci 23:295–300CrossRef
37.
Zurück zum Zitat Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J (2003) Restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health, International Restless Legs Syndrome Study Group: restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 4:101–119PubMedCrossRef Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J (2003) Restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health, International Restless Legs Syndrome Study Group: restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 4:101–119PubMedCrossRef
38.
Zurück zum Zitat Rothdach AJ, Trenkwalder C, Haberstock J, Keil U, Berger K (2000) Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and morbidity in Augsburg elderly. Neurology 54:1064–1068PubMedCrossRef Rothdach AJ, Trenkwalder C, Haberstock J, Keil U, Berger K (2000) Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and morbidity in Augsburg elderly. Neurology 54:1064–1068PubMedCrossRef
39.
Zurück zum Zitat Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J (2003) Restless legs syndrome Diagnosis and Epidemiology Workshop at the National Institutes of Health, International Restless Legs Syndrome Study Group: restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 4:101–119PubMedCrossRef Allen RP, Picchietti D, Hening WA, Trenkwalder C, Walters AS, Montplaisi J (2003) Restless legs syndrome Diagnosis and Epidemiology Workshop at the National Institutes of Health, International Restless Legs Syndrome Study Group: restless legs syndrome: diagnostic criteria, special considerations, and epidemiology. A report from the restless legs syndrome diagnosis and epidemiology workshop at the National Institutes of Health. Sleep Med 4:101–119PubMedCrossRef
40.
Zurück zum Zitat Rothdach AJ, Trenkwalder C, Haberstock J, Keil U, Berger K (2000) Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and morbidity in Augsburg elderly. Neurology 54:1064–1068PubMedCrossRef Rothdach AJ, Trenkwalder C, Haberstock J, Keil U, Berger K (2000) Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and morbidity in Augsburg elderly. Neurology 54:1064–1068PubMedCrossRef
41.
Zurück zum Zitat Bradley MD, Boeve F (2010) REM sleep behavior disorder: updated review of the core features, the RBD-Neurodegenerative Disease Association, evolving concepts, controversies, and future directions. Ann N Y Acad Sci 1184:15–54CrossRef Bradley MD, Boeve F (2010) REM sleep behavior disorder: updated review of the core features, the RBD-Neurodegenerative Disease Association, evolving concepts, controversies, and future directions. Ann N Y Acad Sci 1184:15–54CrossRef
42.
Zurück zum Zitat Terzano MG, Parrino L, Cirignotta F et al (2004) Studio morfeo: insomnia in primary care, a survey conducted on the Italian population. Sleep Med 5:67–75PubMedCrossRef Terzano MG, Parrino L, Cirignotta F et al (2004) Studio morfeo: insomnia in primary care, a survey conducted on the Italian population. Sleep Med 5:67–75PubMedCrossRef
43.
Zurück zum Zitat Foley DJ, Monjan AA, Masaki KH, Enright PL, Quan SF, White LR (1999) Associations of symptoms of sleep apnea with cardiovascular disease, cognitive impairment, and mortality among older Japanese-American men. J Am Geriatr Soc 47:524–528PubMed Foley DJ, Monjan AA, Masaki KH, Enright PL, Quan SF, White LR (1999) Associations of symptoms of sleep apnea with cardiovascular disease, cognitive impairment, and mortality among older Japanese-American men. J Am Geriatr Soc 47:524–528PubMed
44.
Zurück zum Zitat Foley D, Monjan A, Masaki K, Ross W, Havlik R, White L et al (2001) Daytime sleepiness is associated with 3-year incident dementia and cognitive decline in older Japanese-American men. J Am Geriatr Soc 49:1628–1632PubMedCrossRef Foley D, Monjan A, Masaki K, Ross W, Havlik R, White L et al (2001) Daytime sleepiness is associated with 3-year incident dementia and cognitive decline in older Japanese-American men. J Am Geriatr Soc 49:1628–1632PubMedCrossRef
45.
46.
Zurück zum Zitat Boeve BF, Dickson DW, Olson EJ et al (2007) Insights into REM sleep behavior disorder pathophysiology in brainstem-predominant Lewy body disease. Sleep Med 8:60–64PubMedCentralPubMedCrossRef Boeve BF, Dickson DW, Olson EJ et al (2007) Insights into REM sleep behavior disorder pathophysiology in brainstem-predominant Lewy body disease. Sleep Med 8:60–64PubMedCentralPubMedCrossRef
47.
Zurück zum Zitat Britton TC, Chaudhuri KR (2009) REM sleep behavior disorder and the risk of developing Parkinson disease or dementia. Neurology 72:1294–1295PubMedCrossRef Britton TC, Chaudhuri KR (2009) REM sleep behavior disorder and the risk of developing Parkinson disease or dementia. Neurology 72:1294–1295PubMedCrossRef
48.
Zurück zum Zitat Calzetti S, Negrotti A, Bonavina G, Angelini M, Marchesi E (2009) Absence of co-morbidity of parkinson disease and restless legs syndrome: a case-control study in patients attending a movement disorders clinic. Neurol Sci 30:119–122PubMedCrossRef Calzetti S, Negrotti A, Bonavina G, Angelini M, Marchesi E (2009) Absence of co-morbidity of parkinson disease and restless legs syndrome: a case-control study in patients attending a movement disorders clinic. Neurol Sci 30:119–122PubMedCrossRef
49.
Zurück zum Zitat Lee JE, Shin H-W, Kim KS, Sohn YH (2009) Factors contributing to the development of restlesslegs syndrome in patients with Parkinson. Mov Disord 24(4):579–582 Lee JE, Shin H-W, Kim KS, Sohn YH (2009) Factors contributing to the development of restlesslegs syndrome in patients with Parkinson. Mov Disord 24(4):579–582
Metadaten
Titel
Sleep disturbance and cognitive disorder: epidemiological analysis in a cohort of 263 patients
verfasst von
Michele Pistacchi
Manuela Gioulis
Franco Contin
Flavio Sanson
Sandro Zambito Marsala
Publikationsdatum
01.12.2014
Verlag
Springer Milan
Erschienen in
Neurological Sciences / Ausgabe 12/2014
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI
https://doi.org/10.1007/s10072-014-1870-x

Weitere Artikel der Ausgabe 12/2014

Neurological Sciences 12/2014 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Frühe Alzheimertherapie lohnt sich

25.04.2024 AAN-Jahrestagung 2024 Nachrichten

Ist die Tau-Last noch gering, scheint der Vorteil von Lecanemab besonders groß zu sein. Und beginnen Erkrankte verzögert mit der Behandlung, erreichen sie nicht mehr die kognitive Leistung wie bei einem früheren Start. Darauf deuten neue Analysen der Phase-3-Studie Clarity AD.

Viel Bewegung in der Parkinsonforschung

25.04.2024 Parkinson-Krankheit Nachrichten

Neue arznei- und zellbasierte Ansätze, Frühdiagnose mit Bewegungssensoren, Rückenmarkstimulation gegen Gehblockaden – in der Parkinsonforschung tut sich einiges. Auf dem Deutschen Parkinsonkongress ging es auch viel um technische Innovationen.

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.