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  • Werle, Jochen  (72)
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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: 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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  • 3
    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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  • 4
    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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  • 5
    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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  • 6
    In: Journal of the American Geriatrics Society, November 2015, Vol.63(11), pp.2408-2410
    Description: To purchase or authenticate to the full-text of this article, please visit this link: http://onlinelibrary.wiley.com/doi/10.1111/jgs.13802/abstract Byline: Claudia Luck-Sikorski, Melanie Luppa, Kathrin Heser, Markus Bleckwenn, Tina Posselt, Annette Ernst, Jochen Werle, Dagmar Weeg, Edelgard Mosch, Birgitt Wiese, Susanne Steinmann, Angela Fuchs, Michael Pentzek, Hans-Helmut Konig, Christian Brettschneider, Martin Scherer, Wolfgang Maier, Siegfried Weyerer, Steffi G. Riedel-Heller ***** No abstract is available for this article. ***** Article Note: Shared last authorship
    Keywords: Heart Failure – Prognosis ; Heart Failure – Psychological Aspects ; Heart Failure – Health Aspects ; Elderly – Psychological Aspects ; Elderly – Health Aspects ; Mortality – Psychological Aspects ; Depression (Mood Disorder) – Prognosis ; Depression (Mood Disorder) – Psychological Aspects ; Depression (Mood Disorder) – Health Aspects;
    ISSN: 0002-8614
    E-ISSN: 1532-5415
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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
    Language: English
    In: Journal of Affective Disorders, 15 July 2016, Vol.199, pp.139-147
    Description: The study aimed at determining excess costs of late-life depression from a societal perspective. Moreover, the impact of recognition of depression by GPs on costs was investigated. Cross-sectional data were obtained from a large multicenter observational cohort study (AgeMooDe). Participants (n=1197) aged 75 years or older and were recruited via their GPs in Leipzig, Bonn, Hamburg, and Mannheim in Germany from May 2012 until December 2013. In the base case analysis, depression was assessed using the Geriatric Depression Scale (GDS; cutoff GDS≥6). Data on health care utilization and costs were based on participants' self-reports for inpatient treatment, outpatient treatment, pharmaceuticals, and formal and informal nursing care. Unadjusted mean costs in a six-month period for depressed individuals (€5031) exceeded those of non-depressed (€2700) by the factor 1.86 and were higher in all health care sectors considered. Statistically significant positive excess costs persisted in all formal health care sectors after adjusting for comorbidity and socio-demographics. Recognition of depression by the GP did not moderate the relationship of depression and health care costs. Analyses were restricted to a cross-sectional design, not permitting any conclusions on causal interference of the variables considered. The findings stress the enormous burden of depression in old age for all sectors of the health care system. The fact that GPs' recognition of depression does not moderate the relationship between depression and costs adds further insights into the economics of this frequent psychiatric disorder.
    Keywords: Late-Life Depression ; Older Adults ; Health Care Use ; Costs ; Germany, Health Services Research
    ISSN: 0165-0327
    E-ISSN: 1573-2517
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  • 9
    Language: English
    In: Journal of Affective Disorders, 2013, Vol.150(1), pp.63-69
    Keywords: Cerebrovascular Accident ; Depression ; Epidemiology ; Prevention ; Risk Factors ; Mortality
    ISSN: 0165-0327
    ISSN: 1573-2517
    Source: NARCIS (National Academic Research and Collaborations Information System)
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  • 10
    Language: English
    In: Journal of Affective Disorders, 15 August 2013, Vol.150(1), pp.63-69
    Description: Depression is a risk factor for stroke and mortality but whether this also holds into old age is uncertain. We therefore studied the association of depression with the risk for non-fatal stroke and all-cause mortality in very old age. A representative sample of 3085 primary care patients aged ≥75 years were serially assessed during a 6-year follow-up. The relation between depression (Geriatric Depression Scale 〉6, =261) and relevant covariates including vascular risk factors and disease, functional and mild cognitive impairment and ApoE genotype on primary care givers information of incident stroke ( =209) and mortality ( =647) were assessed by Cox regression and by competing risk regressions. Depression was not independently associated with incident stroke in fully adjusted models that treated death as the competing event (subdistribution hazard ratio=0.80, 95% confidence interval=0.47 to 1.36). The risk associated with depression was similar for men and women, and for age groups 75–79, 80–84 and ≥85 years. In contrast, depression increased all-cause mortality rates, even after adjusting for a range of confounders (hazard ratio=1.31, 95% confidence interval=1.03 to 1.67). We have no information on past depressive episodes and cause of death. In contrast to reports in younger populations, depression does not appear to increase stroke risk among the old and very old, but continuous to be a risk factor for all-cause mortality.
    Keywords: Cerebrovascular Accident ; Depression ; Epidemiology ; Prevention ; Risk Factors ; Mortality
    ISSN: 0165-0327
    E-ISSN: 1573-2517
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