Background
Social isolation (SI) is considered a modifiable risk factor for cognitive decline and dementia, is associated with unhealthy lifestyle. We investigated independent and combined ...associations of SI and lifestyle with cognitive functioning (CF) in a midlife to early‐late life population without dementia. This informs developing more targeted preventive strategies against cognitive decline and dementia.
Method
The “LIfestyle for BRAin health” (LIBRA) score was computed for 6,203 baseline participants of the LIFE‐Adult‐Study, a population‐based German cohort. LIBRA is validated for dementia prediction in midlife to early‐late life populations, consisting of 12 modifiable factors (heart disease, kidney disease, diabetes, obesity, hypertension, hypercholesterolemia, alcohol consumption, smoking, physical inactivity, diet, depression, cognitive activity). Higher scores (‐5.9,+12.7) indicate “worse” lifestyle. SI was assessed with the short Lubben Social Network Scale (score < 12). For CF, we calculated a z‐standardized composite score of the Verbal Fluency Test, the Trail Making Test A and B. Associations of SI and LIBRA with CF were investigated using generalized linear modelling. Bootstrapped structural equation modelling (SEM) tested whether LIBRA mediated the association between SI and CF. Sampling weights were applied, variables z‐standardized for SEM.
Results
Participants were M = 57.7 (SD = 12.0, range: 40‐79) years old; 50.7% were female; 15.8% were socially isolated. SI (β: ‐.17, 95%CI‐.24,‐.10; Wald = 21.45, p < .001) and a higher LIBRA score (β: ‐.03, 95%CI‐.04,‐.02; Wald = 31.49, p < .001) were independently associated with lower CF; there was no interaction (β: ‐.003, 95%CI‐.03,.02; Wald = 0.06, p = .814; Fig.1). Bootstrapped SEM (reps = 10,000; R² = .34) indicated that LIBRA partially mediated the association between SI and CF (IE = ‐.006, 95%CI‐.008,‐.003, p < .001; proportion mediated = 8.5%; Fig.2).
Conclusion
CF is lower in socially isolated than socially integrated individuals without dementia. The CF difference can be partially attributed to modifiable health and lifestyle factors; however, only to a small extent. Therefore, public health initiatives aiming at preventing SI might be more effective in promoting good CF than lifestyle interventions in socially isolated individuals in midlife to early‐late life. This would likely benefit risk reduction of cognitive decline and dementia in later life.
Background and aims
Previous research indicates that compared with individuals with lower socio‐economic status (SES), individuals in higher SES groups are more often drinkers but those who drink ...report drinking smaller amounts more frequently. We aimed to decompose trends in self‐reported alcohol consumption in Germany into age, period and birth cohort effects and examine whether these effects varied by SES.
Design
Age–period–cohort (APC) analysis using data from eight waves of the cross‐sectional German Epidemiological Survey of Substance Abuse (ESA) collected between 1995 and 2015.
Setting
Germany.
Participants
The analytical sample included n = 65 821 individuals aged 18–64 years reporting alcohol use within the last 30 days.
Measurements
Alcohol measures included drinking prevalence, alcohol volume and prevalence of episodic heavy drinking (EHD). Educational attainment was used as an indicator of SES. A series of generalized linear and logistic regression models, including both main and interaction effects of age, period and cohort with SES, were estimated.
Findings
Regression models revealed significant interactions between APC effects and SES on two alcohol consumption measures. Higher SES was consistently associated with drinking prevalence across age (P < 0.001), period (P = 0.016) and cohort (P = 0.016), and with volume of drinking in younger cohorts (P = 0.002) and 50+‐year‐olds (P = 0.001). Model results were inconclusive as to whether or not APC effects on EHD prevalence differed by SES.
Conclusions
In Germany, there are positive associations between socio‐economic status and alcohol consumption during the life‐course, over time and among birth cohorts. Three groups appear vulnerable to risky drinking: high socio‐economic status young birth cohorts who drink high average quantities, low socio‐economic status young birth cohorts who show a risky drinking pattern and high socio‐economic status adults in their 50s and older who increase their drinking volume beyond that age.
•Patients with mild to moderately severe depression benefit from self-management cCBT as an adjunct element of GP care.•Seven patients need to be treated for one additional remission after 6 months ...compared with the control group.•The @ktiv trial adds to the external validity of cCBT, since it was conducted under real-life routine practice conditions.•Implementing cCBT under careful observation by GPs may be a useful first step within stepped care approaches.
Self-guided computerized cognitive behavior therapy (cCBT) has the potential to be a feasible alternative to current first-step treatment approaches for depression. Yet, research regarding the effectiveness and acceptability of self-guided cCBT as an adjunct element of GP care is controversial.
Primary care patients with symptoms of mild to moderately severe depression (N = 647) were recruited from 112 GP practices within a cluster randomized controlled trial. GPs were randomized to groups that provided either cCBT (internet intervention) plus treatment as usual (TAU) or TAU alone. Primary outcomes were self-reported depression severity according to the Beck Depression Inventory (BDI-II) and Patient Health Questionnaire (PHQ-9). Intention to treat (ITT) and per protocol (PP) analysis was performed.
ITT analyses showed significant between group differences in depressive symptoms for BDI-II in favor of the intervention group, corresponding to a small effect size (6 weeks: d = 0.36, 95% CI 0.19 to 0.53, P < .001; 6 months: d = 0.41, 95% 0.22 to 0.59, P < .001). The number needed to treat (NNT) at six months was 6.2. PHQ-9 analyses was solely significant at six months (d = 0.26, 95% CI 0.08 to 0.44, P < .05, NNT = 9.2). PP analyses highly agree with these findings.
The initial response rate with regard to the recruitment of GP practices for the trial was low.
The results suggest that cCBT is effective in reducing depressive symptoms in mildly to moderately severe depressed primary care patients. Efforts should be made to raise awareness about the potential of such freely accessible treatment options among GPs and patients.
The primary health care setting is considered a major starting point in successful obesity management. However, research indicates insufficient quality of weight counseling in primary care. Aim of ...the present study was to implement and evaluate a 5A online tutorial aimed at improving weight management and provider-patient-interaction in primary health care. The online tutorial is a stand-alone low-threshold minimal e-health intervention for general practitioners based on the 5As guidance for obesity management by the Canadian Obesity Network.
In a cluster-randomized controlled trial, 50 primary care practices included 160 patients aged 18 to 60 years with obesity (BMI ≥ 30). The intervention practices had continuous access to the 5A online tutorial for the general practitioner. Patients of control practices were treated as usual. Primary outcome was the patients' perspective of the doctor-patient-interaction regarding obesity management, assessed with the Patient Assessment of Chronic Illness Care before and after (6/12 months) the training. Treatment effects over time (intention-to-treat) were evaluated using mixed-effects linear regression models.
More than half of the physicians (57%) wished for more training offers on obesity counseling. The 5A online tutorial was completed by 76% of the physicians in the intervention practices. Results of the mixed-effects regression analysis showed no treatment effect at 6 months and 12 months' follow-up for the PACIC 5A sum score. Patients with obesity in the intervention group scored lower on self-stigma and readiness for weight management compared to participants in the control group at 6 months' follow-up. However, there were no significant group differences for weight, quality of life, readiness to engage in weight management, self-stigma and depression at 12 months' follow-up.
To our knowledge, the present study provides the first long-term results for a 5A-based intervention in the context of the German primary care setting. The results suggest that a stand-alone low-threshold minimal e-health intervention for general practitioners does not improve weight management in the long term. To improve weight management in primary care, more comprehensive strategies are needed. However, due to recruitment difficulties the final sample was smaller than intended. This may have contributed to the null results.
The study has been registered at the German Clinical Trials Register (Identifier: DRKS00009241 , Registered 3 February 2016).
Background
Activities of daily living functioning (ADL) are relevant in the diagnosis of neurocognitive disorders (NCD). Currently, however, there has been no standardized and validated instrument ...based on DSM‐5 diagnosis criteria. Our aim was to psychometrically evaluate the differentiated assessment of ADL impairments due to NCD (A‐NKS).
Method
We interviewed 92 dyads of individuals with either mild NCDs, major NCDs, or cognitively healthy individuals and a relative each and examined reliability, validity, and acceptability of the A‐NKS.
Result
Both versions had excellent internal consistency and are correlated with other (I)ADL instruments (patient informant: Barthel Index: rs = ‐0.26, p ≤ .05 rs = ‐0.30, p ≤ .01; Amsterdam IADL: rs = 0.59, p ≤ .01 rs = 0.48, p ≤ .01; SIDAM ADL: rs = 0.46, p ≤ .001 rs = 0.47, p ≤ .001). Aditionally, there are correlations with the scale autonomy of the WHOQOL‐OLD (rs = ‐0.50, p ≤ .001 rs = ‐0.37, p ≤ .001) and physical, as well as cognitive activities (rs = ‐0.39, p ≤ .001 rs = ‐0.50, p ≤ .001). All participants found the questionnaire acceptable.
Conclusion
The A‐NKS shows promise as a valid, reliable and acceptable measure to assess ADL due to neurodegenerative decline in healthy individuals, individuals with mild NCDs and those with major NCD.
The elderly population is one of the high-risk groups with regard to a severe course of disease and increased mortality when infected with the coronavirus SARS-CoV‑2 (Severe Acute Raspiratory Syndrom ...Coronavirus 2). This group may be at higher risk for psychological strains from the COVID-19 pandemic itself but also from the health protection measures. The aim is to examine how symptoms of depressiveness, anxiety, and somatization change over the course of the pandemic and which role social support plays in that.
Using two written surveys of n = 156 elderly participants in the periods May to June 2020 and March to May 2021, sociodemographic data, factors of psychological strain (depressiveness, anxiety, and somatization), as well as the perceived social support were recorded. The mean age of the respondents was 87.20 years (SD = 4.65; age range = 77.68-96.75 years) and 88.03 years (SD = 4.63; age range = 78.52-97.62 years) for 2020 and 2021, respectively. Data were analyzed using Wilcoxon t‑tests and generalized linear regression models.
A significant increase in the expression of psychological strain with regards to depressiveness, anxiety, and somatization can be identified. Higher scores of psychological strains in 2020 are associated with a higher psychological strain in 2021. Higher perceived social support in 2020 is associated with lower depressiveness one year later.
An increase in psychological strain has been observed in the elderly population over the course of the COVID-19 pandemic until May 2021. This population should be supported by preventive programs to avert a further increase in symptoms. The expansion of social support could be useful, especially in the prevention of depressive symptoms.
The aim of the study is to investigate psychosocial factors that are associated with positive and negative coping with stress, as well as with worries about and perceived threat by COVID-19 to enable ...us to provide adequate support for oldest-old individuals. A paper-pencil-based survey assessed COVID-19 worries and perceived threat, depression, anxiety, somatization, social support, loneliness, resilience, positive and negative coping in a sample of n = 197 oldest-old individuals (78-100 years). Linear multivariate and binary logistic regression analyses were conducted. Individuals with high levels of resilience were more likely to feel self-efficient when coping with stress. High levels of depression, anxiety and loneliness were associated with feeling more helpless when coping with stress. However, oldest-old individuals who felt lonely also experienced situations where they felt competent in stress coping. Being male and experiencing high levels of social support was more likely associated with high levels of worries due to COVID-19. Increased age and higher levels of depression were associated with lower levels of perceived personal threat, whereas higher somatization scores were more likely associated with higher perceived personal threat. Findings suggest that mental health factors may shape the way oldest-old individuals cope with pandemic-related stress. Resilience might be an important factor to take into account when targeting an improvement in positive coping with stress. Oldest-old individuals who have higher levels of depression, anxiety and feel lonely may be supported by adapting their coping skill repertoire to reduce the feeling of helplessness when coping with stress.
Little is known about resilience in old age and its manifestation during the COVID-19 pandemic. This study aims to estimate the prevalence of high resilience in the German old age population. We ...further examine the socio-demographic correlates and whether high resilience reflects on older adults’ perception of the threat posed by COVID-19. The data were derived from a representative telephone survey of n = 1005 older adults (≥65 years) during the first COVID-19 lockdown. Assessments included socio-demographic variables, the perceived threat of COVID-19, and high resilience (Brief Resilience Scale; cutoff: ≥4.31). The association between high resilience and threat from COVID-19 was analyzed using ordinal logistic regression. The study sample had a mean age (SD) of 75.5 (7.1) years, and n = 566 (56.3%) were female. The estimated prevalence of high resilience was 18.7% (95% CI = 16.3; 21.2). High resilience was more prevalent in the younger age group and participants with higher education levels. High resilience was significantly associated with a lower perception of threat from COVID-19. The results of the representative survey in the German old age population showed that one out of five adults aged 65 years and older had high resilience. Older adults with high resilience tended to feel less threatened by COVID-19. Further research on resilience in old age is needed to support vulnerable groups in the context of care.
With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk ...factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups.
We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife.
These results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.
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