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  • Jessen, Frank  (57)
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  • 1
    Language: English
    In: Psychology and Aging, 2012, Vol.27(2), pp.353-363
    Description: Midlife motivational abilities, that is, skills to initiate and persevere in the implementation of goals, have been related to mental and physical health, but their association with risk of mild cognitive impairment (MCI) and Alzheimer's disease (AD) has not yet been directly investigated. This relation was examined with data from the German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe). A total of 3,327 nondemented participants (50.3% of a randomly selected sample) aged 75–89 years were recruited in primary care and followed up twice (after 1.5 and 3 years). Motivation-related occupational abilities were estimated on the basis of the main occupation (assessed at follow-up II) using the Occupational Information Network (O* NET) database, which provides detailed information on worker characteristics and abilities. Cox proportional hazards models were used to evaluate the relative risk of developing MCI and AD in relation to motivation-related occupational abilities, adjusting for various covariates. Over the 3 years of follow-up, 15.2% participants developed MCI and 3.0% developed AD. In a fully adjusted model, motivation-related occupational abilities were found to be associated with a reduced risk of MCI (HR: 0.77; 95% CI: 0.64–0.92). Motivation-related occupational abilities were associated with reduced risk of AD in ApoE ε4 carriers (HR: 0.48; CI: 0.25–0.91), but not in noncarriers (HR: 0.99; CI: 0.65–1.53). These results suggest that midlife motivational abilities are associated with reduced risk of MCI in general and with reduced risk of AD in ApoE ε4 carriers. Revealing the mechanisms underlying this association may inform novel prevention strategies for decelerating cognitive decline in old age.
    Keywords: Motivation ; Self-Regulation ; Alzheimer'S Disease ; Dementia ; Mild Cognitive Impairment
    ISSN: 0882-7974
    E-ISSN: 1939-1498
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  • 2
    Language: English
    In: European archives of psychiatry and clinical neuroscience, November 2010, Vol.260 Suppl 2, pp.S111-5
    Description: An increasing number of longitudinal cohort studies have identified a risk increase for dementia by the chronic use of drugs with anticholinergic properties. The respective data from the German Study on Aging, Cognition and Dementia in Primary Care Patients (AgeCoDe) also showing risk increase (hazard ratio = 2.081) are reported here. The mechanisms by which the risk increase is transported are still unknown. Irritation of compensated alterations of cholinergic transmission at the pre-dementia stage of Alzheimer's disease (AD) or acceleration of neuroinflammation by disturbance of the anti-inflammatory effect of cholinergic innervation are discussed. In terms of dementia prevention, centrally acting anticholinergic drugs should be strictly avoided, because of long-term dementia risk increase in addition to acute negative effects on cognition.
    Keywords: Dementia ; Cholinergic Antagonists -- Adverse Effects
    ISSN: 09401334
    E-ISSN: 1433-8491
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  • 3
    Language: English
    In: Journal of General Internal Medicine, 2009, Vol.24(12), pp.1314-1317
    Description: Byline: Michael Pentzek (1), Angela Fuchs (1), Birgitt Wiese (2), Gabriela Cvetanovska-Pllashniku (3), Franziska Haller (3), Wolfgang Maier (3), Steffi G. Riedel-Heller (4), Matthias C. Angermeyer (5), Horst Bickel (6), Edelgard Mosch (6), Siegfried Weyerer (7), Jochen Werle (7), Hendrik Bussche (8), Marion Eisele (8), Hanna Kaduszkiewicz (8) Keywords: general practice; cognition; dementia; clinical judgment Abstract: Background General practitioners (GP) play an important role in detecting cognitive impairment among their patients. Objectives To explore factors associated with GPs' judgment of their elderly patients' cognitive status. Design Cross-sectional data from an observational cohort study (AgeCoDe study) General practice surgeries in six German metropolitan study centers home visits by interviewers. Participants 138 GPs, 3,181 patients (80.13+-3.61 years, 65.23% female). Measurements General practitioner questionnaire for each patient: familiarity with the patient, patient morbidity, judgment of cognitive status. Home visits by trained interviewers: sociodemographic and clinical data, psychometric test performance. Multivariate regression analysis was used to identify independent associations with the GPs' judgment of "cognitively impaired" vs. "cognitively unimpaired." Results Less familiar patients (adjusted odds ratio [aOR] 2.42, 95% CI 1.35--4.32, for poor vs. very high familiarity), less mobile patients (aOR 1.29, 95% CI 1.13--1.46), patients with impaired hearing (aOR 5.46, 95% CI 2.35--12.67 for serious vs. no problems), and patients with greater comorbidity (aOR 1.15, 95% CI 1.08--1.22) were more likely to be rated as "cognitively impaired" by their GPs. Conclusions The associations between GPs' assessments of cognitive impairment and their familiarity with their patients and patients' mobility, hearing, and morbidity provide important insights into how GPs make their judgments. Author Affiliation: (1) Department of General Practice, University Medical Center Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany (2) Center of Biometrics and Medical Informatics, Hannover Medical School, 30625, Hannover, Germany (3) Department of Psychiatry, University of Bonn, 53105, Bonn, Germany (4) Public Health Research Unit, Department of Psychiatry, University of Leipzig, 04317, Leipzig, Germany (5) Center for Public Mental Health, 3482, Gosing am Wagram, Austria (6) Clinic and Polyclinic for Psychiatry and Psychotherapy, Munich Technical University, 81675, Munich, Germany (7) Central Institute of Mental Health, 68159, Mannheim, Germany (8) Department for Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany Article History: Registration Date: 02/09/2009 Received Date: 12/01/2009 Accepted Date: 02/09/2009 Online Date: 21/10/2009 Article note: Further members of the AgeCoDe Study Group: Heinz-Harald Abholz, Cadja Bachmann, Michaela Buchwald, Mirjam Colditz, Moritz Daerr, Sandra Eifflander-Gorfer, Sven Heinrich, Frank Jessen, Teresa Kaufeler, Hans-Helmut Konig, Tobias Luck, Melanie Luppa, Manfred Mayer, Julia Olbrich, Heinz-Peter Romberg, Anja Rudolph, Melanie Sauder, Britta Schuermann, Michael Wagner, Anja Wollny, and Thomas Zimmermann.
    Keywords: general practice ; cognition ; dementia ; clinical judgment
    ISSN: 0884-8734
    E-ISSN: 1525-1497
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  • 4
    Language: English
    In: Health and Quality of Life Outcomes, 01 July 2017, Vol.15(1), pp.1-8
    Description: Abstract Background Thus far, only a few longitudinal studies investigated the impact of social engagement on health-related quality of life (HRQoL) and depressive symptoms in old age. Therefore, we aimed to examine the impact of social engagement on HRQoL and depressive symptoms in late life. Methods Individuals aged 75 years and over at baseline were interviewed every 1.5 years in a multicenter prospective cohort study in Germany. While HRQoL was quantified by using the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, depressive symptoms was assessed by using the Geriatric Depression Scale (GDS). Individuals reported the frequency (“never” to “every day”) of social engagement (e.g., engagement in the church, as a volunteer, in a party, or in a club) in the last four weeks. Fixed effects regressions were used to estimate the effect of social engagement on the outcome variables. Results After adjusting for age, marital status, functional status and chronic diseases, fixed effects regressions revealed that the onset of social engagement markedly increased HRQoL and considerably decreased depressive symptoms in the total sample and in women, but not men. Conclusions Our findings corroborate the relevance of social engagement for HRQoL and depressive symptoms in old age. Encouraging the individuals to start, maintain and expand social engagement in late life might help to maintain and improve HRQoL and decrease depressive symptoms.
    Keywords: Depressive Symptoms ; Eq-Vas ; Geriatric Depression Scale ; Health-Related Quality of Life ; Old Age ; Public Health
    E-ISSN: 1477-7525
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  • 5
    In: Age and Ageing, 2011, Vol. 40(4), pp.456-463
    Description: Objective: to investigate prospectively the relationship between current alcohol consumption (quantity and type of alcohol) and incident overall dementia and Alzheimer dementia. the study is based on individuals (75+) attending general practitioners in Germany: 3,202 subjects free of dementia were studied at baseline, 1.5 years and 3 years later by means of structured clinical interviews including detailed assessment of current alcohol consumption and DSM-IV dementia diagnoses. Associations between alcohol consumption (in grams of ethanol), type of alcohol (wine, beer, mixed alcohol beverages) and incident dementia were examined using Cox proportional hazard models, controlling for several confounders. incident overall dementia occurred in 217 of 3,202 participants over a mean follow-up period of 3 years. Significant relationships were found between alcohol consumption (prevalence at baseline: 50.0%) and incident overall dementia (adjusted hazard ratio (HR) 0.71, 95% CI 0.53–0.96), respectively, incident Alzheimer dementia (adjusted HR 0.58, 95% CI 0.38–0.89). With regard to quantity of alcohol and type of alcohol, all hazard ratios were found to be lower than 1. in agreement with meta-analyses that include younger age groups, our study suggests that light-to-moderate alcohol consumption is inversely related to incident dementia, also among individuals aged 75 years and older.
    Keywords: Incident Dementia ; Alcohol Consumption ; Prospective Longitudinal Study ; Elderly
    ISSN: 0002-0729
    E-ISSN: 1468-2834
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  • 6
    Language: English
    In: Social psychiatry and psychiatric epidemiology, February 2012, Vol.47(2), pp.263-70
    Description: 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.
    Keywords: Aging -- Psychology ; Cognition Disorders -- Epidemiology ; Dementia -- Epidemiology ; Institutionalization -- Trends
    ISSN: 09337954
    E-ISSN: 1433-9285
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  • 7
    Language: English
    In: Archives of general psychiatry, April 2010, Vol.67(4), pp.414-22
    Description: Subjective memory impairment (SMI) is receiving increasing attention as a pre-mild cognitive impairment (MCI) condition in the course of the clinical manifestation of Alzheimer disease (AD). To determine the risk for conversion to any dementia, dementia in AD, or vascular dementia by SMI, graded by the level of SMI-related worry and by the temporal association of SMI and subsequent MCI. Longitudinal cohort study with follow-up examinations at 1(1/2) and 3 years after baseline. Primary care medical record registry sample. A total of 2415 subjects without cognitive impairment 75 years or older in the German Study on Aging, Cognition and Dementia in Primary Care Patients. Conversion to any dementia, dementia in AD, or vascular dementia at follow-up 1 or follow-up 2 predicted by SMI with or without worry at baseline and at follow-up 2 predicted by different courses of SMI at baseline and MCI at follow-up 1. In the first analysis, SMI with worry at baseline was associated with greatest risk for conversion to any dementia (hazard ratio [HR], 3.53; 95% confidence interval [CI], 2.07-6.03) or dementia in AD (6.54; 2.82-15.20) at follow-up 1 or follow-up 2. The sensitivity was 69.0% and the specificity was 74.3% conversion to dementia in AD. In the second analysis, SMI at baseline and MCI at follow-up 1 were associated with greatest risk for conversion to any dementia (odds ratio [OR], 8.92; 95% CI, 3.69-21.60) or dementia in AD (19.33; 5.29-70.81) at follow-up 2. Furthermore, SMI at baseline and amnestic MCI at follow-up 1 increased the risk for conversion to any dementia (OR, 29.24; 95% CI, 8.75-97.78) or dementia in AD (60.28; 12.23-297.10), with a sensitivity of 66.7% and a specificity of 98.3% for conversion to dementia in AD. The prediction of dementia in AD by SMI with subsequent amnestic MCI supports the model of a consecutive 3-stage clinical manifestation of AD from SMI via MCI to dementia.
    Keywords: Cognition Disorders -- Psychology ; Dementia -- Psychology ; Memory Disorders -- Psychology
    ISSN: 0003990X
    E-ISSN: 1538-3636
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  • 8
    In: PLoS ONE, 2011, Vol.6(2)
    Description: Background Current approaches for AD prediction are based on biomarkers, which are however of restricted availability in primary care. AD prediction tools for primary care are therefore needed. We present a prediction score based on information that can be obtained in the primary care setting. Methodology/Principal Findings We performed a longitudinal cohort study in 3.055 non-demented individuals above 75 years recruited via primary care chart registries (Study on Aging, Cognition and Dementia, AgeCoDe). After the baseline investigation we performed three follow-up investigations at 18 months intervals with incident dementia as the primary outcome. The best set of predictors was extracted from the baseline variables in one randomly selected half of the sample. This set included age, subjective memory impairment, performance on delayed verbal recall and verbal fluency, on the Mini-Mental-State-Examination, and on an instrumental activities of daily living scale. These variables were aggregated to a prediction score, which achieved a prediction accuracy of 0.84 for AD. The score was applied to the second half of the sample (test cohort). Here, the prediction accuracy was 0.79. With a cut-off of at least 80% sensitivity in the first cohort, 79.6% sensitivity, 66.4% specificity, 14.7% positive predictive value (PPV) and 97.8% negative predictive value of (NPV) for AD were achieved in the test cohort. At a cut-off for a high risk population (5% of individuals with the highest risk score in the first cohort) the PPV for AD was 39.1% (52% for any dementia) in the test cohort. Conclusions The prediction score has useful prediction accuracy. It can define individuals (1) sensitively for low cost-low risk interventions, or (2) more specific and with increased PPV for measures of prevention with greater costs or risks. As it is independent of technical aids, it may be used within large scale prevention programs.
    Keywords: Research Article ; Medicine
    E-ISSN: 1932-6203
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  • 9
    In: Journal of the American Geriatrics Society, November 2016, Vol.64(11), pp.2311-2316
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/jgs.14458/abstract Byline: Andre Hajek, Christian Brettschneider, Dagmar Luhmann, Marion Eisele, Silke Mamone, Birgitt Wiese, Siegfried Weyerer, Jochen Werle, Michael Pentzek, Angela Fuchs, Steffi G. Riedel-Heller, Tobias Luck, Horst Bickel, Dagmar Weeg, Alexander Koppara, Michael Wagner, Martin Scherer, Wolfgang Maier, Hans-Helmut Konig,, Heinz-Harald Abholz, Cadja Bachmann, Wolfgang Blank, Hendrik den Bussche, Sandra Eifflaender-Gorfer, Annette Ernst, Kathrin Heser, Frank Jessen, Hanna Kaduszkiewicz, Teresa Kaufeler, Mirjam Kohler, Carolin Lange, Diana Lubisch, Melanie Luppa, Manfred Mayer, Edelgard Mosch, Julia Olbrich, Tina Posselt, Jana Prokein, Susanne Rohr, Anna Schumacher, Janine Stein, Susanne Steinmann, Franziska Tebarth, Klaus Weckbecker, Steffen Wolfsgruber, Thomas Zimmermann Keywords: visual impairment; physical function; cognitive function; older people; longitudinal study Objectives To examine how visual impairment affects physical and cognitive function in old age. Design A longitudinal population-based prospective cohort study. Setting General practitioner offices at six study centers in Germany. They were observed every 1.5 years over four waves. Participants Individuals aged 77-101 at follow-up Wave 2 (N = 2,394). Measurements Physical and cognitive function were assessed using an adapted scale that had been previously developed, and visual impairment was rated on a Likert scale (none, mild, severe or profound). Results Adjusting for sociodemographic factors and comorbidity, linear fixed-effects regression showed that the onset of severe visual impairment was associated with a decline in physical function score in the total sample ([beta] = -0.15, P = .01) and in women ([beta] = -.15, P = .03). Moreover, the onset of severe visual impairment was associated with decline in cognitive function score in the total sample ([beta] = -0.38, P 〈 .001) and in women ([beta] = -0.38, P 〈 .001) and men ([beta] = -0.37, P = .001). Conclusion Visual impairment affects physical and cognitive function in old age. Interventional strategies to postpone visual impairment may contribute to maintaining physical and cognitive function. Article Note: These authors contributed equally to this work. See Appendix 1. CAPTION(S): Table S1. Mean level of changes in visual impairment, physical and cognitive function (all treated as continuous variables) from FU Wave 2 to FU Wave 5. Table S2. Pairwise correlations in differences (from FU Wave 2 to FU Wave 5). Table S3. Predictors of physical function. Results of fixed effects regressions for individuals with complete data (FU Waves 2-5). Table S4. Predictors of cognitive function. Results of fixed effects regressions for individuals with complete data (FU Waves 2-5).
    Keywords: Visual Impairment ; Physical Function ; Cognitive Function ; Older People ; Longitudinal Study
    ISSN: 0002-8614
    E-ISSN: 1532-5415
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  • 10
    In: Journal of the American Geriatrics Society, July 2012, Vol.60(7), pp.1286-1291
    Description: Keywords: cardiovascular disease; diabetes mellitus; cognition; cognitive change Objectives To examine the effect of cardiovascular and metabolic diseases on initial cognitive test performance and rate of change in three cognitive measures. Design Prospective cohort study. Setting General practices in six towns throughout Germany. Participants Three thousand three hundred twenty-seven participants aged 75 and older (average 79.7 [+ or -] 3.6). Measurements Data were collected during home visits every 18 months and included sociodemographic variables, depression, disease status, drug intake, and cognition. Results Although the presence of transient ischemic attack (TIA) or stroke and diabetes mellitus was related to poor initial cognitive test performance, the presence of those and other far-reaching chronic diseases or a higher disease burden were not related to the rate of change in cognition over time. Conclusion Diabetes mellitus, stroke and TIA affect cognitive test performance beyond well-known sociodemographic variables and depressive symptoms, although none of these diseases contributed to cognitive decline over time. In practical terms, prevention and diagnosis of cardiovascular and metabolic diseases may be essential to cognitively healthy aging. Author Affiliation: Article Note:
    Keywords: Cardiovascular Disease ; Diabetes Mellitus ; Cognition ; Cognitive Change
    ISSN: 0002-8614
    E-ISSN: 1532-5415
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