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The high incidence of cognitive impairment in the ageing population, together with the challenges it imposes to health systems, raises the question of what affect working life has on cognitive abilities. The study, therefore, reviews recent work on the longitudinal impact of psychosocial work conditions on cognitive functioning and on dementia. Relevant articles were identified by a systematic literature search in PubMed and PsycINFO using a standardised search string and specific inclusion and exclusion criteria. We included articles reporting longitudinal effects that were investigated in cohort studies, case-control studies or randomised controlled trials in the working population. Two independent reviewers evaluated the studies in three subsequent phases: (i) title-abstract screening, (ii) full-text screening and (iii) checklist-based quality assessment.Methodical evaluation of the identified articles resulted in 17 studies of adequate quality. We found evidence for a protective effect of high job control and high work complexity with people and data on the risk of cognitive decline and dementia. Moreover, cognitively demanding work conditions seem to be associated with a decreased risk of cognitive deterioration in old age.Psychosocial work conditions can have an impact on cognitive functioning and even on the risk of dementia. As the world of work is undergoing fundamental changes, such as accelerated technological advances and an ageing working population, optimising work conditions is essential in order to promote and maintain cognitive abilities into old age.

Tobias Luck,1,2,* Tom Motzek,3,* Melanie Luppa,1 Herbert Matschinger,1 Steffen Fleischer,4 Yves Sesselmann,4 Gudrun Roling,5 Katrin Beutner,4 Hans-Helmut König,6 Johann Behrens,4 Steffi G Riedel-Heller11Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; 2Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany; 3Technical University Dresden, Dresden, Germany; 4Institute of Nursing and Health Science, Martin-Luther-University Halle-Wittenberg, Halle, Germany; 5Faculty of Health, Witten/Herdecke University, Witten, Germany; 6Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany*These authors contributed equally to this work Background: Falls in older people are a major public health issue, but the underlying causes are complex. We sought to evaluate the effectiveness of preventive home visits as a multifactorial, individualized strategy to reduce falls in community-dwelling older people.Methods: Data were derived from a prospective randomized controlled trial with follow-up examination after 18 months. Two hundred and thirty participants (≥80 years of age) with functional impairment were randomized to intervention and control groups. The intervention group received up to three preventive home visits including risk assessment, home counseling intervention, and a booster session. The control group received no preventive home visits. Structured interviews at baseline and follow-up provided information concerning falls in both study groups. Random-effects Poisson regression evaluated the effect of preventive home visits on the number of falls controlling for covariates.Results: Random-effects Poisson regression showed a significant increase in the number of falls between baseline and follow-up in the control group (incidence rate ratio 1.96) and a significant decrease in the intervention group (incidence rate ratio 0.63) controlling for age, sex, family status, level of care, and impairment in activities of daily living.Conclusion: Our results indicate that a preventive home visiting program can be effective in reducing falls in community-dwelling older people.Keywords: falls, randomized controlled trial, home visits, prevention, evaluation

Objective We sought to provide an overview on the assessment of mild cognitive impairment and dementia in epidemiological studies from Germany. Methods We conducted a literature search in the databases Pubmed and PsycInfo. Results Literature search identified 31 relevant studies using a broad spectrum of methods and neuropsychological instruments. Conclusion Further efforts are necessary to establish a generally accepted core set of instruments enabling a harmonized assessment of mild cognitive impairment and dementia in epidemiological studies. Such a core set should comprise neuropsychological tests but also standardized questionnaires on subjective cognitive impairment and impairment in activities of daily living. If possible, third-party information (proxy interviews) should be included.

Background It is unknown whether longitudinal stability versus instability in subjective cognitive decline (SCD) is a modifying factor of the association between SCD and risk of incident Alzheimer's disease (AD) dementia. Objective We tested the modifying role of temporal stability of the SCD report on AD dementia risk in cognitively normal elderly individuals. Methods We analyzed data of 1,990 cognitively normal participants from the longitudinal AgeCoDe Study. We assessed SCD with/without associated worries both at baseline and first follow-up 18 months later. Participants were then classified either as (a) Controls (CO, with no SCD at both baseline and follow-up 1, n = 613), (b) inconsistent SCD (with SCD reported only at baseline or at follow-up 1, n = 637), (c) consistent SCD but without/or with inconsistent worries (n = 610) or (d) consistent SCD with worries (n = 130). We estimated incident AD dementia risk over up to 6 years for each group with Cox-Proportional Hazard Regression analyses adjusted for age, gender, education, ApoE4 status, and depression. Results Compared to CO, inconsistent SCD was not associated with increased risk of incident AD dementia. In contrast, risk was doubled in the group of consistent SCD without/ with inconsistent worries, and almost 4-fold in the group of consistent SCD with worries. These results could be replicated when using follow-up 1 to follow-up 2 response patterns for group definition. Conclusion These findings suggest that longitudinal stability versus instability is an important modifying factor of the association between SCD and AD dementia risk. Worrisome SCD that is also consistently reported over time is associated with greatly increased risk of AD dementia.

Background The Generalized Anxiety Disorder Scales GAD-7 and GAD-2 are instruments for the assessment of anxiety. The aims of this study are to test psychometric properties of these questionnaires, to provide normative values, and to investigate associations with sociodemographic factors, quality of life, psychological variables, and behavioral factors. Methods A German community sample (n=9721) with an age range of 18–80 years was surveyed using the GAD-7 and several other questionnaires. Results Confirmatory factor analyses confirmed the unidimensionality and measurement invariance of the GAD-7 across age and gender. Females were more anxious than males (mean scores: M=4.07 vs. M=3.01; effect size: d=0.33). There was no linear age trend. A total of 5.9% fulfilled the cut-off criterion of 10 and above. Anxiety was correlated with low quality of life, fatigue, low habitual optimism, physical complaints, sleep problems, low life satisfaction, low social support, low education, unemployment, and low income. Cigarette smoking and alcohol consumption were also associated with heightened anxiety, especially in women. When comparing the GAD-7 (7 items) with the ultra-short GAD-2 (2 items), the GAD-7 instrument was superior to the GAD-2 regarding several psychometric criteria. Limitations The response rate (33%) was low. Because of the cross-sectional character of the study, causal conclusions cannot be drawn. A further limitation is the lack of a gold standard for diagnosing anxiety. Conclusions The GAD-7 can be recommended for use in clinical research and routine.

Midlife obesity has been associated with increased dementia risk, yet reports on brain structure and function are mixed. We therefore assessed the effects of body mass index (BMI) on gray matter volume (GMV) and cognition in a well-characterized sample of community-dwelled older adults. GMV was measured using 3T-neuroimaging in 617 participants (258 women, 60-80 years, BMI 17-41 kg/m(2)). In addition, cognitive performance and various confounders including hypertension, diabetes, and apolipoprotein E genotype were assessed. A higher BMI correlated significantly with lower GMV in multiple brain regions, including (pre)frontal, temporal, insular and occipital cortex, thalamus, putamen, amygdala, and cerebellum, even after adjusting for confounders. In addition, lower GMV in prefrontal and thalamic areas partially mediated negative effects of (1) higher BMI and (2) higher age on memory performance. We here showed that a higher BMI in older adults is associated with widespread gray matter alterations, irrespective of obesity-related comorbidities and other confounders. Our results further indicate that a higher BMI induces structural alterations that translate into subtle impairments in memory performance in aging.

Background As is common in developing countries, in Ethiopia young people with disabilities (YPWD) are more likely than the general population to be illiterate, unemployed and impoverished. They often lack equal access to information and education for reasons ranging from barriers regarding physical access to services to varied special learning needs. Very little is known about knowledge, attitude and practice (KAP) of YPWD regarding sexual and reproductive health (SRH) related issues. We, therefore, aimed to assess the KAP of 426 YPWD in Addis Ababa, Ethiopia. Methods A cross-sectional survey was conducted in 2012. Data were collected by trained interviewers using a structured questionnaire covering socio-demographic information, as well as information on KAP regarding SRH. Results Only 64.6 % of YPWD were aware of SRH services. Radio and TV were mentioned as the main sources of information by 62.2 % of the participants. 77.9 % had never had a discussion about SRH topics with their parents. Even though 96.7 % of the respondents had heard about HIV, 88 % had poor knowledge about ways of preventing HIV. Perception of the risk of getting infected with HIV was found to be generally low in YPWD; only 21.6 % believed that they were at risk of acquiring HIV. Conclusions Our study, in general, demonstrated that there is a lack of comprehensive knowledge, appropriate practice and favorable attitude of YPWD regarding different SRH-related issues. Our findings thus clearly indicate the need for strategies and programs to raise SRH-related awareness and to help YPWD to develop the appropriate skills and attitudes needed for a healthy reproductive life.

Objective The DSM-5 introduces mild neurocognitive disorder (miNCD) as a syndrome that recognizes the potential clinical importance of acquired cognitive deficits being too mild to qualify for diagnosis of dementia. We provide new empirical data on miNCD including total, age-, and sex-specific prevalence rates; number and types of neurocognitive domains being impaired; and diagnostic overlap with the well-established mild cognitive impairment (MCI) concept. Design Cross-sectional results of an observational cohort study (LIFE-Adult-Study). Setting General population. Participants A total of 1,080 dementia-free individuals, aged 60–79 years. Measurements We calculated weighted point prevalence rates with confidence intervals (95% CI) for miNCD and analyzed diagnostic overlap between miNCD and MCI by calculating overall percentage agreement and Cohen's kappa coefficient. Results Weighted total prevalence of miNCD was 20.3% (95% CI: 17.8–23.0). Prevalence was similar in both sexes, but significantly higher in older age. Two-thirds (66.2%) of the individuals with miNCD showed impairment restricted to only one out of six possible neurocognitive domains. Learning and memory was the most frequently (38.3%) impaired domain in all miNCD-cases, followed by social cognition (26.1%). Analysis of diagnostic overlap with MCI yielded an overall agreement of 98.6% and a kappa of 0.959. Conclusions By considering all six predefined neurocognitive domains, our study observed a substantial proportion of dementia-free older adults having miNCD. Provision of information on the underlying etiology/ies may be of prime importance in future studies aiming at evaluating the clinical relevance of the miNCD syndrome.

Objectives There is an increasing call for a stronger consideration of impairment in instrumental activities of daily living (IADL) in the diagnostic criteria of Mild Cognitive Impairment (MCI) to improve the prediction of dementia. Thus, the aim of the study was to determine the predictive capability of MCI and IADL impairment for incident dementia. Design Longitudinal cohort study with four assessments at 1.5-year intervals over a period of 4.5 years. Setting Primary care medical record registry sample. Participants As part of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients, a sample of 3,327 patients from general practitioners, aged 75 years and older, was assessed. Measurements The predictive capability of MCI and IADL impairment for incident dementia was analysed using receiver operating characteristics, Kaplan-Meier survival analyses, and Cox proportional hazards models. Results MCI and IADL impairment were found to be significantly associated with higher conversion to, shorter time to, and better predictive power for future dementia. Regarding IADL, a significant impact was particularly found for impairment in responsibility for one's own medication, shopping, and housekeeping, and in the ability to use public transport. Conclusions Combining MCI with IADL impairment significantly improves the prediction of future dementia. Even though information on a set of risk factors is required to achieve a predictive accuracy for dementia in subjects with MCI being clinically useful, IADL impairment should be a very important element of such a risk factor set.

Background Theory of Mind (ToM) is essential for successful social interactions, as it enables the understanding of another person’s mental state and the prediction of future behavior. As affective information is conveyed through gaze, the “Reading the Mind in the Eyes” Test (RMET) is a frequently used tool for the assessment of ToM. This is the first study to investigate the effects of sex on a wide age range (19–79 years) in a large, population-based German sample. As RMET scores have been shown to be sensitive to hormonal changes, the sex effect before and after menopause (cut-off age: 45) was of particular interest. Methods The sample comprised 1603 participants of the LIFE study. We investigated the effects of age and sex on RMET performance by applying linear regression, correcting for verbal ability. The size of the effects of sex and age were estimated using Hedges g. Effect sizes for the age groups below and above 45 years were analyzed with respect to male-female differences. Results We found significant effects of sex and age on RMET performance. Older adults presented lower accuracy rates compared to younger adults. Effects remained stable when considering other cognitive abilities. Women outperformed men before the age of 45, while the male-female performance difference was reduced in individuals above 45 years of age. Discussion Both men and women show a decline in affective ToM with increasing age in this comprehensive community-dwelling study. Thus, older adults may have particular problems inferring complex emotional content from gaze. Data suggest that female superiority in mindreading abilities is diminished after menopause, presumably due to changes in the concentration of circulating hormones.

Background:There is a strong demand for screening instruments for mild cognitive impairment (MCI), as a pre-stage of dementia. The clock drawing test (CDT) is widely used to screen for dementia, but the utility in screening for MCI remains uncertain. In particular, it is still questionable which scoring system is the best in order to screen for MCI. We therefore aimed to compare the utility of different CDT scoring systems for screening for MCI.Methods:In a sample of 428 subjects of the Leipzig Longitudinal Study of the Aged (LEILA 75+) study, CDT scores of different scoring systems were compared between subjects with and without MCI. Comparison of receiver operating characteristic (ROC; area under the curve, sensitivity, specificity) was performed and inter-rater reliability was calculated.Results:The CDT scores differed significantly between MCI and non-MCI subjects according to all scoring systems applied. However, ROC of the CDT scores was not adequate.Conclusions:None of the present CDT scoring systems has sufficient utility to screen reliably for MCI. The clinical value of the CDT could be improved by using semi-quantitative scoring, having a wider score range and focusing on specific details of the clock (e.g. the hands and numbers).

Introduction Because the oldest old will be the fastest-growing age group in the future and information about epidemiology of depressive symptoms in latest life is scarce, the present study aims at determining the age-specific and gender-specific prevalence rates and risk factors of depressive symptoms in latest life. Methods As part of the Leipzig Longitudinal Study of the Aged (LEILA 75+), a population-based sample of 1 006 individuals aged 75 years and older were interviewed on socio-demographic, clinical and psychometric variables. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (cut-off score ≥16); mild cognitive impairment (MCI) was diagnosed according to criteria of the International Working Group on MCI. Factors associated with depressive symptoms were determined with multiple logistic regression models. Results Of the overall sample, 38.2% (95% confidence interval, CI 35.2–41.2) were classified as depressed. In the full multivariate model, the following variables were significantly associated with depressive symptoms: divorced or widowed marital status, low educational level, poor self-rated health status, functional impairment, multi-domain MCI, stressful life events and poor social network. All variables but MCI remained significant correlates of depressive symptoms in the parsimonious model. Discussion Because depressive symptoms are common in oldest age and associated with broad categories of risk factors, latest-life depression represents an important public health issue. Employment of comprehensive geriatric assessment to ascertain depressive symptoms and its concomitants could help to improve treatment success. Copyright © 2011 John Wiley & Sons, Ltd.

In the last decades, many community-based studies have addressed predictors of nursing home placement (NHP) among the elderly. So far, predictors have not been analyzed separately for different age groups. For a German GP-sample of 3,208 subjects aged 75 years and older, socio-demographic, clinical, and psychometric parameters were requested every 1.5 years over three waves. Logistic regression models determined predictors of NHP for total sample and for two different age groups. A CART analysis identified factors discriminating best between institutionalized and non-institutionalized individuals. Of the overall sample, 4.7% of the sample (n = 150) was institutionalized during the study period. Baseline characteristics associated with a higher risk of NHP for the total sample were age, living without spouse, cognitive and functional impairment and depression. In the CART analysis, age was the major discriminator at the first level (at age 81). In subgroup regression analyses, for the younger elderly (age 75–81) being single as well as cognitive and functional impairment increased the risk of NHP; in the advanced elderly (age 82+) being widowed and subjective memory impairment were significant predictors for NHP, and cognitive and functional impairment became non-significant as predictors of NHP. Predictors of NHP may differ in old age groups. The fact that many predictors show inconsistent results as predictors of NHP in the international literature may be attributed to the lack of differentiation in age groups.

OBECTIVES: To provide information on age- and sex-specific incidence rates of mild cognitive impairment (MCI)and risk factors for incident MCI.DESIGN: Prospective longitudinal cohort.SETTING: Leipzig Longitudinal Study of the Aged, a pop-ulation-based German study of the epidemiology of de-mentia and mild cognitive impairment.PARTICIPANTS: At baseline, 1,692 subjects aged 75 andolder were included in the sample.MEASUREMENTS: Trained psychologists and physiciansconducted structured clinical interviews including neuropsy-chologicalassessmentandquestionsaboutsociodemograph-ics, familial history of dementia, activities of daily living,subjective memory impairment, and lifestyle (alcohol con-sumption,smoking)atparticipants’homes.Structuredthird-partyinterviewswereconductedwithproxies.Incidencewascalculated according to the person-years-at-risk method.Cox proportional hazards models were used to examine theassociation between risk factors and incident MCI.RESULTS: During an 8-year follow-up period, 26.4%(n5137) of the 519 study participants (population at risk)were identified as incident MCI cases (person-years51,791.1). The overallincidence rate ofMCI was 76.5(95%confidence interval564.7–90.4) per 1,000 person-years.Older age, subjective memory impairment, impairment ininstrumental activities of daily living, and antecedent lowercognitive performance were found to be significantly asso-ciated with the development of future MCI.CONCLUSION: MCI is highly incident in the elderlypopulation. For the purpose of early detection of dementia,subjective memory impairment should be taken seriouslyas a possible prestage of MCI. J Am Geriatr Soc 58:1903–1910, 2010.Key words: mild cognitive impairment; risk factors;incidence; epidemiology; dementia

Background: In recent decades a substantial number of studies have examined predictors of nursing home placement (NHP) in the elderly. This study provides a systematic review of gender-differences in predictors of NHP from population-based, longitudinal studies worldwide.Methods: Relevant articles were identified by a systematic search of literature. The articles based on prospective studies with representative samples of community-living elders identified predictors by gender-specific multivariate analyses.Results: Eleven studies were identified. We found gender differences in the prediction of NHP for marital status, living situation, housing and car availability and urinary incontinence. For both genders the risk of NHP did not differ substantially for age, functional impairment, cognitive impairment, dementia, and depression. The male to female ratio of admission rates ranged between 1 to 1.4 and 1 to 1.6.Conclusions: Only a few studies analyzed gender-specific predictors of NHP, probably owing to the associated statistical difficulties. However, gender differences in prediction of NHP do actually exist, and this should encourage further research activities in this area using appropriate statistical methods.

Background/Aim: Norms for change in Mini Mental State Examination (MMSE) total score suggest that only a decline of at least 2–4 points indicates a reliable change. However, it is unknown whether change norms (Reliable Change Indices, RCIs) of the MMSE total score are suitable to predict future dementia. Methods: 554 elderly individuals aged 75 and over without dementia at the first 2 visits were tested with the MMSE at a maximum of 6 visits with 1.5-year intervals. Two different RCIs for change in MMSE score (first to second visit) were computed – one RCI which corrects for practice and one RCI which corrects for regression to the mean. The main outcome measure was the diagnosis of dementia. Results: During the study, 88 persons developed dementia. RCIs were significantly associated with future dementia diagnosis. The best cutoff for raw change in MMSE total score to predict dementia was –1 point (sensitivity = 48%, specificity = 67%, relative risk = 1.6). With the RCI + regression to the mean, the diagnostic accuracy was moderate (sensitivity = 61%, specificity = 72%, relative risk = 3.2). Conclusion: A change in MMSE total score is significantly associated with future dementia, but the diagnostic accuracy for dementia prediction is rather low.

Über Häufigkeit und Inhalt neuerer deutschsprachiger Arbeiten zur psychiatrischen und psychotherapeutischen Versorgungsforschung sowie den Einbezug ökonomischer Evaluationen ist wenig bekannt. Zur Beurteilung des Forschungsstandes in diesem Bereich wurden alle Originalarbeiten der Zeitschrift für Psychosomatische Medizin und Psychotherapie sowie der Psychiatrischen Praxis der Jahre 2006 und 2007 hinsichtlich ihres Beitrages zur psychiatrischen und psychotherapeutischen Versorgungsforschung sowie zur Versorgungsökonomie ausgewertet. Die Hälfte der erschienenen Originalarbeiten konnte der Versorgungsforschung zugeordnet werden. 85 % dieser Arbeiten beschäftigten sich mit der Beschreibung und Analyse der Versorgungssituation sowie mit der Evaluation von Versorgungskonzepten im Alltag. Drei Viertel der Arbeiten konnten den Teildisziplinen Bedarfs-, Inanspruchnahmeforschung und Versorgungsepidemiologie zugeordnet werden. Unter den Studien zur Versorgungsforschung fanden sich fünf gesundheitsökonomische Analysen (10 %), die in der Mehrheit Kostenstudien waren. Im Vergleich mit früheren Analysen zeigt sich ein anhaltend starkes Interesse an versorgungsbezogenen Fragestellungen im Bereich der psychiatrischen und psychotherapeutischen Versorgungsforschung. Jedoch wurde ein Mangel an Publikationen zur Entwicklung und Implementierung neuer Konzepte in der Versorgung deutlich.

OBJECTIVE In order to identify mildly cognitively impaired subjects, MILD COGNITIVE IMPAIRMENT: (MCI) represents a current and well-discussed concept. Prevalence and conversion rates, relative risks and data on the sensitivity and specifity of MCI for the development of dementia will be calculated. METHODS 980 subjects aged 75 years and over who participated in the Leipzig Longitudinal Study of the Aged (LEILA 75+) were clinically interviewed and cognitively tested at regularly intervals over a mean period of six years. RESULTS At baseline, the prevalence of MCI was 19.3 %, including (original) and 41.5 % excluding (modified) the criterion of subjective cognitive complaints. Diagnoses of original and modified amnestic MCI-subtypes were associated with relative risks of more than three for the development of dementia. CONCLUSIONS MCI represents a risk factor for dementia, mainly if the cognitive impairments are related to the area of memory. However, in order to predict dementia reliably, further findings (e. g. biomarkers) are required.

Background/Aims: In the past decades, a substantial number of studies considered factors influencing institutionalisation of persons with dementia. This study reviews recent work on predictors of actual institutionalisation in dementia. Method: Relevant articles were identified by a systematic search of the literature. Studies were considered which included persons aged 65 and over, and whose results were based on prospective design and on multivariate statistical analyses. Results: Forty-two studies were identified. The rate of institutionalisation increased from 20% in the first year after diagnosis to 50% after 5 years. Median time to institutionalisation was estimated between 30 and 40 months. Predictors of institutionalisation were classified according to a provided conceptual framework in the categories sociodemographic and relationship characteristics of persons with dementia and caregivers, primary stressors, secondary stressors and resources. Conclusion: The overview of research activities in this area showed a lack of methodological strength in a large part of identified studies. Nevertheless, a lot of well-examined and less highlighted predictors could be identified.

Background: Information on the time until institutionalization and its predictors in demented subjects has so far been based on studies with selected samples or prevalent dementia cases. Thus, the aim of the study is to analyze the time until institutionalization and associated patient-related factors in incident dementia cases. Methods: Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA 75+), a population-based study of individuals aged 75 years and older. Kaplan-Meier survival analysis was used to determine the time until institutionalization. Factors associated with time until institutionalization were analyzed using Cox proportional hazards models. Results: One hundred and nine subjects with incident dementia who resided in a private home setting at the time of the dementia diagnosis were identified. Fifty-two (47.7%) of these subjects had become residents of a nursing home by the end of the study. The median time until institutionalization was 1,005 days (95% CI = 808–1,202). Being widowed/divorced (compared to being married) was associated with a significantly shorter time until institutionalization (univariate model: HR = 4.50, 95% CI = 1.09–18.57). Conclusion: Being without a spouse seems to be an important factor for a shorter time until institutionalization in incident dementia cases. Tailored interventions for these subjects at risk are required.

Objective: This study aimed to investigate whether mortality is higher for individuals suffering from Mild Cognitive Impairment (MCI). Methods: A community sample of 1,045 dementia-free individuals aged 75 years and over was examined using neuropsychological tests over a 4.5-year period. Data were analyzed with the Cox proportional hazards model after having been adjusted for age, gender, and incident dementia. Results: Association between MCI and mortality was examined subject to varied diagnostic criteria of MCI. We found an increased risk of death that was about 1.5 times higher for individuals with MCI when a cognitive performance of more than 1.5 standard deviation below the mean of age- and education-matched controls was required and the criterion of a cognitive complaint was excluded. Males were at about a 40% increased risk of death. Risk also increased with age by about 8% per year. Incident dementia showed a significant influence on mortality only if it became manifest by 1.5 years after the baseline measurement (follow-up 1). Conclusion: MCI is associated with increased mortality when certain diagnostic criteria are applied.

The causality between social predictors and HRQoL in old age remains almost unclear as only a few studies have examined the influence of social support on HRQoL in a longitudinal setting. Moreover, available studies investigating gender differences in the effect of social support on HRQoL in old age have been solely cross-sectional. Consequently, the aim of this study was to examine whether social support affects health-related quality of life (HRQoL) in old age and whether this effect is moderated by gender. In a population-based cohort (N = 2443) of people aged 75 years and older in Germany, the development of HRQoL was prospectively observed over a 3-year period. Quality of life was quantified by using the visual analogue scale of the EQ-5D instrument. Social support was assessed by using the 14-item form of the questionnaire for social support (F-SozU K-14). In order to control for unobserved heterogeneity, fixed-effects regression analysis was used. In the total sample (β = 0.55, p

Research increasingly suggests that subjective cognitive decline (SCD) in older adults, in the absence of objective cognitive dysfunction or depression, may be a harbinger of non-normative cognitive decline and eventual progression to dementia. Little is known, however, about the key features of self-report measures currently used to assess SCD. The Subjective Cognitive Decline Initiative (SCD-I) Working Group is an international consortium established to develop a conceptual framework and research criteria for SCD (Jessen et al., 2014, Alzheimers Dement 10, 844-852). In the current study we systematically compared cognitive self-report items used by 19 SCD-I Working Group studies, representing 8 countries and 5 languages. We identified 34 self-report measures comprising 640 cognitive self-report items. There was little overlap among measures- approximately 75% of measures were used by only one study. Wide variation existed in response options and item content. Items pertaining to the memory domain predominated, accounting for about 60% of items surveyed, followed by executive function and attention, with 16% and 11% of the items, respectively. Items relating to memory for the names of people and the placement of common objects were represented on the greatest percentage of measures (56% each). Working group members reported that instrument selection decisions were often based on practical considerations beyond the study of SCD specifically, such as availability and brevity of measures. Results document the heterogeneity of approaches across studies to the emerging construct of SCD. We offer preliminary recommendations for instrument selection and future research directions including identifying items and measure formats associated with important clinical outcomes.

Brain-derived neurotrophic factor (BDNF) has been discussed to be involved in plasticity processes in the human brain, in particular during aging. Recently, aging and its (neurodegenerative) diseases have increasingly been conceptualized as disconnection syndromes. Here, connectivity changes in neural networks (the connectome) are suggested to be the most relevant and characteristic features for such processes or diseases. To further elucidate the impact of aging on neural networks, we investigated the interaction between plasticity processes, brain connectivity, and healthy aging by measuring levels of serum BDNF and resting-state fMRI data in 25 young (mean age 24.8 ± 2.7 (SD) years) and 23 old healthy participants (mean age, 68.6 ± 4.1 years). To identify neural hubs most essentially related to serum BDNF, we applied graph theory approaches, namely the new data-driven and parameter-free approach eigenvector centrality (EC) mapping. The analysis revealed a positive correlation between serum BDNF and EC in the premotor and motor cortex in older participants in contrast to young volunteers, where we did not detect any association. This positive relationship between serum BDNF and EC appears to be specific for older adults. Our results might indicate that the amount of physical activity and learning capacities, leading to higher BDNF levels, increases brain connectivity in (pre)motor areas in healthy aging in agreement with rodent animal studies. Pilot results have to be replicated in a larger sample including behavioral data to disentangle the cause for the relationship between BDNF levels and connectivity.

Objectives: This study investigates the impact of occupation-based motivational processes and social network variables on the incidence of dementia over 8 years. Method: Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based longitudinal study of individuals aged 75 years and older (n = 1692 at baseline). Motivational processes were estimated based on the main occupation using the Occupational Information Network database. Results: In a Cox proportional hazard model, motivational processes were not associated with the risk of dementia (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74-1.16). Individuals with a higher frequency of social contact at baseline had a significantly lower risk of dementia (HR: 0.96, 95% CI: 0.91-0.99), while proximity of social contacts was not linked to the risk of dementia (HR: 1.03, 95% CI: 0.98-1.08). In individuals with low indices of motivational processes, the frequency of social contacts was associated with a lower risk of dementia (HR: 0.94, 95% CI: 0.88-1.00). On the other hand, proximity of social contacts was linked to a higher risk of dementia in individuals with high indices of motivational processes (HR: 1.09, 95% CI: 1.01-1.19). Discussion: Results indicate that the frequency and proximity of social contacts have a differential impact on the risk of dementia according to lower or higher indices of motivational processes, while the impact of motivational processes on risk of dementia could not be confirmed. Future studies should carefully disentangle different aspects of social interactions and their association with motivational processes.

BACKGROUND Studies have shown that dementia and cognitive impairment can increase mortality, but less is known about the association between subjectively perceived cognitive deficits (subjective cognitive decline, SCD) and mortality risk. OBJECTIVE In this study, we analyzed mortality in non-demented individuals with SCD in a general population sample aged 75+ years. METHOD Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+). We used the Kaplan-Meier survival method to estimate survival times of individuals with and without SCD and multivariable Cox proportional hazards regression to assess the association between SCD and mortality risk, controlled for covariates. RESULTS Out of 953 non-demented individuals at baseline, 117 (12.3% ) expressed SCD. Participants with SCD showed a significantly higher case-fatality rate per 1,000 person-years (114.8, 95% CI = 90.5-145.7 versus 71.7, 95% CI = 64.6-79.5) and a significantly shorter mean survival time than those without (5.4 versus 6.9 years, p < 0.001). The association between SCD and mortality remained significant in the Cox analysis; SCD increased mortality risk by about 50% (adjusted Hazard Ratio = 1.51) during the study period. Besides SCD, older age, male gender, diabetes mellitus, stroke, and lower global cognitive functioning were also significantly associated with increased mortality. CONCLUSION Our findings suggest an increased mortality risk in non-demented older individuals with SCD. Even though further studies are required to analyze potential underlying mechanisms, subjective reports on cognitive deficits may be taken seriously in clinical practice not only for an increased risk of developing dementia and AD but also for a broader range of possible adverse health outcomes.

Background Minor depression is as ubthreshold depressive disorder. It is diagnosed when a patient suffers from 2 to 4 depressive symptoms for at least 2 weeks. Though minor depression affects nearly ten percent of the elderly population, its pathophysiology has hardly been investigated. In our study we assessed serum levels of biomarkers for plasticity, glial and neuronal function: brain-derived neurotrophic factor (BDNF), S100B and neuron specific enolase (NSE). Methods 27 subjects with minor depressive episode and 82 healthy subjects, 60–79 years old, were selected from the database of the Leipzig population-based study of adults (LIFE-adult). Serum levels of BDNF, S100B and NSE were compared between groups, and correlated with age, body-mass index (BMI), and degree of white matter hyperintensities (calculated as a score on Fazekas scale). Results S100B was significantly increased in males with minor depression in comparison to healthy males, whereas other biomarkers did not differ between groups (p = 0.10–0.66). S100B correlated with BMI (rs = 0.246, p = 0.031) and with age in healthy subjects (rs = 0.345, p = 0.002). NSE correlated with Fazekas score in patients with minor depression (rs = 0.436, p = 0.048) and in the whole sample (rs = 0.252, p = 0.019). Discussion For the first time we assessed serum levels of BDNF, S100B and NSE in late life minor depression. We found evidence for increased biomarker for glial activation S100B. Increased S100B in males with minor depression, without alterations in BDNF and NSE, support the glial hypothesis of depression. According to this hypothesis glial alterations precede neuronal changes in depression. Correlation between white matter hyperintensities and NSE underscores the vascular hypothesis of late life depression.

Previous studies have shown that higher education, in sense of a cognitive reserve, promotes a good cognitive health. Poverty, on the other hand, represents a threat to health. We therefore investigated whether a cognitive reserve (higher education) would still enhance cognitive functioning under the constraints of poverty (low income). Our analyses were based on a sample of 45,000 individuals from low- and middle-income countries who participated in the World Health Organization’s multi-country Study on global AGEing and adult health (WHO SAGE). Multivariate regression analyses and structural equation modelling (adjusted for childhood socioeconomic conditions, health state, age, gender, and country) revealed that higher education as well as higher income was significantly associated with a better cognitive functioning – with similar effects in middle-aged and old-aged individuals. Our results suggest that a cognitive reserve of only six years of education could substantially enhance the cognitive health of individuals living in poverty. Therefore, expanding efforts to achieve universal education are essential for offsetting adverse effects of poverty and early life disadvantages and for promoting a good cognitive functioning over the entire life-span.

Objective To test for a possible effect of the apolipoprotein E epsilon 4 (APOE e4) allele on memory performance and executive functioning (EF) in cognitively intact elderly. Method The authors studied 202 randomly selected and cognitively intact older adults (65+ years) of the Leipzig Research Center for Civilization Diseases Health Care Study. Intact global cognitive functioning was defined using a Mini-Mental Status Examination (MMSE) score ≥ 28. Performance in memory was assessed with the CERAD Word List and Constructional Praxis Recall, performance in EF with the Trail Making Test Part B (TMT-B). Multivariable linear regressions were used to evaluate the association between cognitive performance and APOE status, controlled for covariates. Results Among the cognitively intact older adults, 21.3% (n = 43) were carriers of the APOE e4 allele. Carriers did not differ significantly from noncarriers in terms of age, gender, intelligence level, or performance in memory but showed a significantly lower TMT-B performance as a measure of EF (TMT-B M time/SD = 105.6/36.2 vs. 91.9/32.7 s; Mann-Whitney U = 4,313.000; p = .009). The association between lower TMT-B performance and APOE e4 genotype remained significant in multivariable linear regression analysis. Similar findings were found for the subsample of those 78 elderly, who reached a perfect MMSE-score of 30. Conclusions A lower EF performance in cognitively intact older APOE e4 allele carriers might be related to an early Alzheimer's dementia (AD) prodrome. In this case, a stronger focus on first subtle changes in EF may help to improve early AD detection in those being at genetic risk.

In Ethiopia, young people with disabilities (YPWD) are often marginalized and not recognized as being sexual, and only little is known about their sexual reproductive health (SRH) status. We therefore aimed to assess the SRH status and associated factors among 426 YPWD in Addis Ababa, Ethiopia.A cross-sectional survey was conducted in 2012. Data were collected by trained interviewers using a structured questionnaire.Fifty-two percent of YPWD ever had sexual intercourse. Seventy-five percent started sex between 15 and 19 years. Only 35% had used contraceptive during their first sexual encounter. Fifty-nine percent of the sexually experienced YPWD had multiple lifetime sexual partners; 19%, a casual sexual partner; and 21%, a commercial sexual partner. Only 48% consistently used condoms with their casual or commercial sexual partners. Twenty-four percent of the sexually experienced YPWD had a history of sexually transmitted infections.Our findings indicate that YPWD in Ethiopia are sexually active, but also highly involved in risky sexual practices. There is a need for in-depth research to better understand the determinants of risky sexual behavior and to propose preventive approaches.

Objectives: The aim of the present study was to investigate how different mentally demanding work conditions during the professional life—i.e., enriched environments at work—might influence the rate of cognitive decline in old age. Methods: Individuals (n = 1,054) of the Leipzig Longitudinal Study of the Aged, a representative population-based cohort study of individuals aged 75 years and older, underwent cognitive testing via the Mini-Mental State Examination (MMSE) in up to 6 measurement waves. Type and level of mentally demanding work conditions in the participants9 former professional life were classified based on the O*NET job descriptor database. Results: In multivariate mixed-model analyses (controlling for sociodemographic and health-related factors), a high level of mentally demanding work tasks stimulating verbal intelligence was significantly associated with a better cognitive functioning at baseline (on average 5 MMSE points higher) as well as a lower rate of cognitive decline (on average 2 MMSE points less) over the 8-year follow-up period compared with a low level. The rate of cognitive decline in old age was also significantly lower (on average 3 MMSE points less) in individuals who had a high level of mentally demanding work tasks stimulating executive functions than those who had a low level. Conclusions: The results suggest that a professional life enriched with work tasks stimulating verbal intelligence and executive functions may help to sustain a good cognitive functioning in old age (75+ years). The findings thus emphasize that today9s challenging work conditions may also promote positive health effects.

Background The level of mental demands in the workplace is rising. The present study investigated whether and how mental demands at work are associated with cognitive functioning in the general population. Methods The analysis is based on data of the Health Study of the Leipzig Research Centre for Civilization Disease (LIFE). 2,725 participants aged 40–80 years underwent cognitive testing (Trail-Making Test, Verbal Fluency Test) and provided information on their occupational situation. Participants over the age of 65 years additionally completed the Mini-Mental State Examination. Mental demands at work were rated by a standardized classification system (O*NET). The association between mental demands and cognitive functioning was analyzed using Generalized Linear Modeling (GENLIN) adjusted for age, gender, self-regulation, working hour status, education, and health-related factors. Results Univariate as well as multivariate analyses demonstrated significant and highly consistent effects of higher mental demands on better performance in cognitive testing. The results also indicated that the effects are independent of education and intelligence. Moreover, analyses of retired individuals implied a significant association between high mental demands at work of the job they once held and a better cognitive functioning in old age. Conclusions In sum, our findings suggest a significant association between high mental demands at work and better cognitive functioning. In this sense, higher levels of mental demands – as brought about by technological changes in the working environment – may also have beneficial effects for the society as they could increase cognitive capacity levels and might even delay cognitive decline in old age.

PURPOSE The concept of mild cognitive impairment (MCI) has recently been introduced into the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edi- tion (DSM-5) as mild neurocognitive disorder, making it a formal diagnosis. We investigated the prognostic value of such a diagnosis and analyzed the determi- nants of the future course of MCI in the AgeCoDe study (German Study on Age- ing, Cognition, and Dementia in Primary Care Patients). METHODS We recruited 357 patients with MCI aged 75 years or older from primary care practices and conducted follow-up with interviews for 3 years. Depending on the course of impairment over time, the patients were retrospec- tively split into 4 groups representing remittent, fluctuating, stable, and progres - sive courses of MCI. We performed ordinal logistic regression analysis and clas- sification and regression tree (CART) analysis. RESULTS Overall, 41.5% of the patients had remission of symptoms with normal cognitive function 1.5 and 3 years later, 21.3% showed a fluctuating course, 14.8% had stable symptoms, and 22.4% had progression to dementia. Patients were at higher risk for advancing from one course to the next along this spec- trum if they had symptoms of depression, impairment in more than 1 cognitive domain, or more severe cognitive impairment, or were older. The result on a test of the ability to learn and reproduce new material 10 minutes later was the best indicator at baseline for differentiating between remittent and progressive MCI. Symptoms of depression modified the prognosis. CONCLUSIONS In primary care, about one-quarter of patients with MCI have pro- gression to dementia within the next 3 years. Assessments of memory function and depressive symptoms are helpful in predicting a progressive vs a remittent course. When transferring the concept of MCI into clinical diagnostic algorithms (eg, DSM-5), however, we should not forget that three-quarters of patients with MCI stayed cognitively stable or even improved within 3 years. They should not be alarmed unnecessarily by receiving such a diagnosis.

Objective Progression from cognitive impairment (CI) to dementia is predicted by several factors, but their relative importance and interaction are unclear. Method We investigated numerous such factors in the AgeCoDe study, a longitudinal study of general practice patients aged 75+. We used recursive partitioning analysis (RPA) to identify hierarchical patterns of baseline covariates that predicted dementia-free survival. Results Among 784 non-demented patients with CI, 157 (20.0%) developed dementia over a follow-up interval of 4.5 years. RPA showed that more severe cognitive compromise, revealed by a Mini-Mental State Examination (MMSE) score