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Luck T, Luck-Sikorski C. Feelings of Guilt in the General Adult Population: Prevalence, Intensity and Association with Depression. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- T Luck
- Fachhochschule Erfurt, Fakultät Angewandte Sozialwissenschaften
- Hochschule Nordhausen, Fachbereich Wirtschafts- und Sozialwissenschaften
| | - C Luck-Sikorski
- SRH Hochschule für Gesundheit, Forschungsgruppe COPE Chronische Erkrankungen und Psychische Gesundheit
- Universitätsmedizin Leipzig, Integriertes Forschungs- und Behandlungszentrum (IFB) AdipositasErkrankungen
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Zülke A, Luck T, Löffler M, Thiery J, Villringer A, Riedel-Heller SG. The association between unemployment and depression – Results from the population-based LIFE-Adult-Study. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Zülke
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - T Luck
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
- Hochschule Nordhausen, Fachbereich Wirtschafts- und Sozialwissenschaften, Nordhausen, Deutschland
- Leipziger Forschungszentrum für Zivilisationserkrankungen (LIFE), Universität Leipzig, Leipzig, Deutschland
| | - M Löffler
- Institut für Medizinische Informatik, Statistik und Epidemiologie (IMISE), Universität Leipzig, Deutschland, Deutschland
| | - J Thiery
- Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik (ILM), Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - A Villringer
- Max-Planck-Institut für Kognitions- und Neurowissenschaften, Leipzig, Deutschland
- Tagesklinik für kognitive Neurologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - SG Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
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Roehr S, Luck T, Rodriguez F, Thiery J, Loeffler M, Villringer A, Riedel-Heller S. The mediating effect of cognitive reserve between social isolation and cognitive function – Results of the population-based LIFE-Adult-Study. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Roehr
- Universitaet Leipzig, Institut fuer Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig, Deutschland
| | - T Luck
- HS Nordhausen, Nordhausen, Deutschland
| | - F Rodriguez
- Universitaet Kaiserlautern, Kaiserslautern, Deutschland
- University of Southern California, Edward R. Royal Institute on Aging, Los Angeles, Deutschland
| | - J Thiery
- Universität Leipzig, Institut für Laboratoriumsmedizin, Klinische Chemie und Molekulare Diagnostik, Leipzig, Deutschland
| | - M Loeffler
- LIFE – Leipziger Forschungszentrum fuer Zivilisationskrankheiten, Leipzig, Deutschland
- Universitaet Leipzig, Institut für Medizinische Informatik, Statistik und Epidemiologie, Leipzig, Deutschland
| | - A Villringer
- Max-Planck-Instituts für Kognitions- und Neurowissenschaften, Leipzig, Deutschland
| | - S Riedel-Heller
- Universitaet Leipzig, Institut fuer Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig, Deutschland
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Zülke A, Kersting A, Dietrich S, Luck T, Riedel-Heller SG, Stengler K. Screening Instruments for the Detection of Male-Specific Symptoms of Unipolar Depression – A Critical Overview. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- A Zülke
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - S Dietrich
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - T Luck
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
- Hochschule Nordhausen, Fachbereich Wirtschafts- und Sozialwissenschaften, Nordhausen, Deutschland
| | - SG Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - K Stengler
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Helios Park-Klinikum Leipzig, Leipzig, Deutschland
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Brettschneider C, Hajek A, Stein J, Luck T, Mamone S, Wiese B, Mösch E, Weeg D, Fuchs A, Pentzek M, Werle J, Weyerer S, Mallon T, van den Bussche H, Heser K, Wagner M, Scherer M, Maier W, Riedel-Heller SG, König HH. [Informal care for dementia according to type of service]. Nervenarzt 2018; 89:509-515. [PMID: 29637234 DOI: 10.1007/s00115-018-0511-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Dementia is a major challenge for society and its impact will grow in the future. Informal care is an essential part of dementia care. Previous studies considered informal care as a whole and not by its components. OBJECTIVE We aimed to assess the degree of association between specific informal care services and dementia. MATERIAL AND METHODS This analysis is based on data from the seventh wave of the AgeCoDe/AgeQualiDe study. Dementia was diagnosed based on the DSM-IV criteria. Severity of dementia was assessed and categorized by means of the Clinical Dementia Rating and eight individual informal care services were considered. Logistic regression models were used to assess associations. RESULTS Of the 864 participants 18% suffered from dementia (very mild: 4%; mild: 6%; moderate: 5%; severe: 3%). All informal care services were significantly associated with dementia, with an emphasis on "supervision", "regulation of financial matters" and "assistance in the intake of medication". Considering different degrees of dementia severity, similar results arose from the analyses. All three aforementioned services showed a pronounced association with all degrees of dementia severity, except for supervision and very mild dementia. CONCLUSION The provision of all types of informal care services is associated with dementia. The association is pronounced for services that can be more easily integrated into the daily routines of the informal caregiver. Policy makers who plan to integrate informal care into the general care arrangements for dementia should consider this.
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Affiliation(s)
- C Brettschneider
- Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg Center for Health Economics, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - A Hajek
- Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg Center for Health Economics, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
| | - J Stein
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - T Luck
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - S Mamone
- Institut für Allgemeinmedizin, AG Medizinische Statistik und IT-Infrastruktur, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - B Wiese
- Institut für Allgemeinmedizin, AG Medizinische Statistik und IT-Infrastruktur, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - E Mösch
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - D Weeg
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - A Fuchs
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - M Pentzek
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - J Werle
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - S Weyerer
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - T Mallon
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - H van den Bussche
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - K Heser
- Klinik und Poliklinik für Psychiatrie/Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
| | - M Wagner
- Klinik und Poliklinik für Psychiatrie/Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Deutschland
| | - M Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - W Maier
- Klinik und Poliklinik für Psychiatrie/Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Deutschland
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn, Deutschland
| | - S G Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Leipzig, Deutschland
| | - H-H König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Hamburg Center for Health Economics, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland
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6
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Hajek A, Brettschneider C, van den Bussche H, Kaduszkiewicz H, Oey A, Wiese B, Weyerer S, Werle J, Fuchs A, Pentzek M, Stein J, Luck T, Bickel H, Mösch E, Heser K, Bleckwenn M, Scherer M, Riedel-Heller SG, Maier W, König HH. Longitudinal Analysis of Outpatient Physician Visits in the Oldest Old: Results of the AgeQualiDe Prospective Cohort Study. J Nutr Health Aging 2018; 22:689-694. [PMID: 29806857 DOI: 10.1007/s12603-018-0997-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The aim of this study was to identify determinants of outpatient health care utilization among the oldest old in Germany longitudinally. DESIGN Multicenter prospective cohort "Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest-old primary care patients (85+)" (AgeQualiDe). SETTING Individuals in very old age were recruited via GP offices at six study centers in Germany. The course of outpatient health care was observed over 10 months (two waves). PARTICIPANTS Primary care patients aged 85 years and over (at baseline: n=861, with mean age of 89.0 years±2.9 years; 85-100 years). MEASUREMENTS Self-reported numbers of outpatient visits to general practitioners (GP) and specialists in the past three months were used as dependent variables. Widely used scales were used to quantify explanatory variables (e.g., Geriatric Depression Scale, Instrumental Activities of Daily Living Scale, or Global Deterioration Scale). RESULTS Fixed effects regressions showed that increases in GP visits were associated with increases in cognitive impairment, whereas they were not associated with changes in marital status, functional decline, increasing number of chronic conditions, increasing age, and changes in social network. Increases in specialist visits were not associated with changes in the explanatory variables. CONCLUSION Our findings underline the importance of cognitive impairment for GP visits. Creating strategies to postpone cognitive decline might be beneficial for the health care system.
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Affiliation(s)
- A Hajek
- Dr. André Hajek, University Medical Center, Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, Telephone +49 40 7410 52877; Fax +49 40 7410 40261, E-Mail:
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Röhr S, Villringer A, Angermeyer MC, Luck T, Riedel-Heller SG. Outcomes of stable and unstable reports of subjective cognitive decline – results from the Leipzig Longitudinal Study of the Aged (LEILA75+). Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Röhr
- Universität Leipzig, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig
- Universität Leipzig, LIFE – Leipziger Forschungszentrum für Zivilisationserkrankungen, Leipzig
| | - A Villringer
- Max-Planck-Institut für Kognitions- und Neurowissenschaften, Leipzig
- Universitätsklinikum Leipzig, Klinik für Kognitive Neurologie, Leipzig
| | - MC Angermeyer
- Center for Public Mental Health, Gösing a. W
- University of Cagliari, Department of Public Health, Cagliari
| | - T Luck
- Universität Leipzig, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig
| | - SG Riedel-Heller
- Universität Leipzig, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig
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Yahiaoui-Doktor M, Luck T, Riedel-Heller SG, Löffler M, Wirkner K, Engel C. Association between cognitive and olfactory performance: results from the population-based LIFE-Adult-Study. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M Yahiaoui-Doktor
- University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology, Leipzig
- University of Leipzig, LIFE – Leipzig Research Centre for Civilization Diseases, Leipzig
| | - T Luck
- University of Leipzig, LIFE – Leipzig Research Centre for Civilization Diseases, Leipzig
- University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Leipzig
| | - SG Riedel-Heller
- University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Leipzig
| | - M Löffler
- University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology, Leipzig
- University of Leipzig, LIFE – Leipzig Research Centre for Civilization Diseases, Leipzig
| | - K Wirkner
- University of Leipzig, LIFE – Leipzig Research Centre for Civilization Diseases, Leipzig
| | - C Engel
- University of Leipzig, Institute for Medical Informatics, Statistics and Epidemiology, Leipzig
- University of Leipzig, LIFE – Leipzig Research Centre for Civilization Diseases, Leipzig
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Kornej J, Luck T, Zeynalova S, Loeffler M, Riedel-Heller S, Husser D. Assocation between PR interval prolongation, atrial fibrillation and cognitive function: insights from the LIFE-Adult-Study. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Kornej
- Herzzentrum Leipzig, Rhythmologie, Leipzig
- Universität Leipzig, LIFE – Leipzig Research Center of Civilization Diseases, Leipzig
| | - T Luck
- Universität Leipzig, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig
- Universität Leipzig, LIFE – Leipzig Research Center of Civilization Diseases, Leipzig
| | - S Zeynalova
- Universität Leipzig, Institut für Medizinische Informatik, Statistik und Epidemiologie, Leipzig
- Universität Leipzig, LIFE – Leipzig Research Center of Civilization Diseases, Leipzig
| | - M Loeffler
- Universität Leipzig, Institut für Medizinische Informatik, Statistik und Epidemiologie, Leipzig
- Universität Leipzig, LIFE – Leipzig Research Center of Civilization Diseases, Leipzig
| | - S Riedel-Heller
- Universität Leipzig, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig
- Universität Leipzig, LIFE – Leipzig Research Center of Civilization Diseases, Leipzig
| | - D Husser
- Herzzentrum Leipzig, Rhythmologie, Leipzig
- Universität Leipzig, LIFE – Leipzig Research Center of Civilization Diseases, Leipzig
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Luck T, Riedel-Heller SG, Roehr S, Wiese B, Bickel H, Pentzek M, König HH, Scherer M, Maier W, Weyerer S. Mortality in incident cognitive impairment – Results of the prospective AgeCoDe study. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T Luck
- University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Leipzig
| | - SG Riedel-Heller
- University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Leipzig
| | - S Roehr
- University of Leipzig, Institute of Social Medicine, Occupational Health and Public Health (ISAP), Leipzig
| | - B Wiese
- Hannover Medical School, Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover
| | - H Bickel
- Technical University of Munich, Department of Psychiatry, Klinikum rechts der Isar, Munich
| | - M Pentzek
- Heinrich-Heine-University Düsseldorf, Institute of General Practice, Medical Faculty, Düsseldorf
| | - HH König
- University Medical Center Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, Hamburg
| | - M Scherer
- University Medical Center Hamburg-Eppendorf, Department of Primary Medical Care, Center for Psychosocial Medicine, Hamburg
| | - W Maier
- Department of Psychiatry, University of Bonn, Bonn
- DZNE, German Center for Neurodegenerative Diseases, Bonn
| | - S Weyerer
- Medical Faculty Mannheim/Heidelberg University, Central Institute of Mental Health, Mannheim
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Luck T, Rodriguez FS, Engel C, Löffler M, Thiery J, Villringer A, Riedel-Heller SG. Die Prävalenz aktueller depressiver Symptomatik bei urban lebenden Erwachsenen – Ergebnisse der LIFE-ADULT-Studie. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1606016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T Luck
- Universität Leipzig, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig
- Universität Leipzig, LIFE – Leipziger Forschungszentrum für Zivilisationserkrankungen, Leipzig
| | - FS Rodriguez
- Universität Leipzig, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig
- University of Southern California, Edward R. Roybal Institute on Aging, Los Angeles
| | - C Engel
- Universität Leipzig, Institut für Medizinische Informatik, Statistik und Epidemiologie (MISE), Leipzig
| | - M Löffler
- Universität Leipzig, Institut für Medizinische Informatik, Statistik und Epidemiologie (MISE), Leipzig
| | - J Thiery
- Universität Leipzig, Universitätsklinikum Leipzig, Institut für Laboratoriumsmedizin, Klinische Medizin und Molekulare Diagnostik (ILM), Leipzig
| | - A Villringer
- MPI für Kognitions- und Neurowissenschaften, Leipzig
- Universitätsklinikum Leipzig, Tagesklinik für kognitive Neurologie, Leipzig
| | - SG Riedel-Heller
- Universität Leipzig, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Leipzig
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Then F, Riedel-Heller S, Luck T, Chatterji S. IMPACT OF EDUCATION AND INCOME ON COGNITIVE FUNCTIONING IN LOW- AND MIDDLE-INCOME COUNTRIES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- F.S. Then
- USC Edward R Roybal Institute on Aging, Los Angeles, California,
- University of Leipzig, Leipzig, Germany,
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- University of Leipzig, Leipzig, Germany,
| | - S. Chatterji
- World Health Organization (WHO), Geneva, Switzerland
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Luck T, Riedel-Heller SG. [Prevention of Alzheimer's dementia in Germany : A projection of the possible potential of reducing selected risk factors]. Nervenarzt 2017; 87:1194-1200. [PMID: 26781245 DOI: 10.1007/s00115-015-0045-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Current international projections suggest that reducing the prevalence of seven well-established risk factors, midlife hypertension and obesity, diabetes mellitus, depression, physical inactivity, smoking and low educational attainment, may also substantially reduce the prevalence of Alzheimer's dementia (AD). OBJECTIVE Following the procedures of the international projections, in this study we aimed to provide projections of a corresponding potential for prevention specific for Germany. METHODS For each risk factor separately and combined (with adjustment for the association between the risk factors) we calculated (1) the population attributable risk (PAR) for AD, (2) the corresponding total number of attributable AD cases and (3) the potential number of current AD cases that may have been prevented by a 10 %, 25 % and 50 % lower prevalence of the risk factors. RESULTS According to the population projections 30.5 % of the current AD cases in Germany could be attributable to the risk factors considered (305,000 AD cases in total). The highest estimated impact on AD prevalence was found for physical inactivity (PAR = 21.7 %, 217,000 attributable cases) and smoking (PAR = 14.9 %, 149,000 cases). A 10-50 % reduction in the prevalence of all seven risk factors could have potentially prevented 23,000-130,000 of the current AD cases in Germany. CONCLUSION The identified possible substantial potential for reducing AD prevalence should act as a strong additional incentive to reduce the seven risk factors in Germany.
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Affiliation(s)
- T Luck
- Medizinische Fakultät, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland.
| | - S G Riedel-Heller
- Medizinische Fakultät, Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Deutschland
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Hajek A, Luck T, Brettschneider C, Posselt T, Lange C, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Bickel H, Mösch E, Wagner M, Heser K, Maier W, Scherer JM, Riedel-Heller SG, König HH. Factors Affecting Functional Impairment among Elderly Germans - Results of a Longitudinal Study. J Nutr Health Aging 2017; 21:299-306. [PMID: 28244570 DOI: 10.1007/s12603-016-0771-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate causal factors of functional impairment in old age in a longitudinal approach. DESIGN A population-based prospective cohort study. SETTING Elderly individuals were recruited via GP offices at six study centers in Germany. They were observed every 1.5 years over six waves. PARTICIPANTS Three thousand two hundred fifty-six people aged 75 years and older at baseline. MEASUREMENTS Functional impairment was quantified by the Lawton and Brody Instrumental Activities of Daily Living scale (IADL) and the Barthel-Index (BI). RESULTS Fixed effects regressions revealed that functional impairment (IADL; BI) increased significantly with ageing (β=-.2; β=-1.1), loss of a spouse (β= .5; β=-3.1), not living alone in private household (β=-1.2; β=-5.5), depression (solely significant for IADL: β= .6) and dementia (β=-2.3; β=-18.2). The comorbidity score did not affect functional impairment. CONCLUSION Our findings underline the relevance of changes in sociodemographic variables as well as the occurrence of depression or dementia for functional impairment. While several of these causal factors for functional decline in the oldest old are inevitable, some may not be, such as depression. Therefore, developing interventional strategies to prevent depression might be a fruitful approach in order to delay functional impairment in old age.
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Affiliation(s)
- A Hajek
- Dr. André Hajek, University Medical Center, Hamburg-Eppendorf, Hamburg Center for Health Economics, Department of Health Economics and Health Services Research, Telephone +49 40 7410 52877; Fax +49 40 7410 40261, E-mail:
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Hajek A, Brettschneider C, Lühmann D, Eisele M, Mamone S, Wiese B, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Luck T, Bickel H, Weeg D, Heser K, Jessen F, Maier W, Scherer M, Riedel-Heller SG, König HH. Does Visual Impairment Affect Social Ties in Late Life? Findings of a Multicenter Prospective Cohort Study in Germany. J Nutr Health Aging 2017; 21:692-698. [PMID: 28537334 DOI: 10.1007/s12603-016-0768-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate how visual impairment affects social ties in late life longitudinally. DESIGN Population-based prospective cohort study. SETTING Individuals in old age were recruited via general practitioners' offices (at six study centers) in Germany. They were interviewed every 18 months. PARTICIPANTS Individuals aged 75 years and above at baseline. Follow-up wave 2 (36 months after baseline, n=2,443) and wave 4 (72 months after baseline, n=1,618) were used for the analyses presented here. MEASUREMENTS Social ties were assessed using the 14-item form of the questionnaire for social support (F-SozU K-14). Visual impairment was self-rated on a three level Likert scale (no impairment, mild visual impairment, or severe/profound visual impairment). RESULTS Adjusting for sociodemographic factors, hearing impairment and comorbidity, fixed effects regressions revealed that the onset of mild visual impairment decreased the social support score, in particular the emotional support score. Additionally, the onset of mild hearing impairment decreased the social support score in men. Moreover, increasing age decreased the social support score in the total sample and in both sexes. Loss of spouse and increasing comorbidity did not affect the social support score. CONCLUSION Our results highlight the importance of visual impairment for social ties in late life. Consequently, appropriate strategies in order to delay visual impairment might help to maintain social ties in old age.
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Affiliation(s)
- A Hajek
- Dr. André Hajek, University Medical Center, Hamburg-Eppendorf, Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, Telephone +49 40 7410 52877; Fax +49 40 7410 40261, E-mail:
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Then F, Schroeter ML, Arélin K, Witte V, Barber R, Burkhardt R, Engel C, Löffler M, Thiery J, Villringer A, Luck T, Riedel-Heller SG. Interactions between APOE genotype and lifestyle factors on cognitive functioning: Results of the health study of the Leipzig research center for civilization diseases (LIFE). Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Then F, Schroeter ML, Witte V, Engel C, Löffler M, Thiery J, Villringer A, Luck T, Riedel-Heller SG. The Cognitive Functioning of Socially Isolated Individuals may Profit from High Mental Work Demands. Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hajek A, Brettschneider C, Ernst A, Posselt T, Mamone S, Wiese B, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Luck T, Bickel H, Mösch E, Kleineidam L, Heser K, Maier W, Scherer M, Riedel-Heller S, König HH. Einflussfaktoren auf die Pflegebedürftigkeit im Längsschnitt. Gesundheitswesen 2016; 79:73-79. [DOI: 10.1055/s-0041-111841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- A. Hajek
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - C. Brettschneider
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - A. Ernst
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - T. Posselt
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - S. Mamone
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover
| | - B. Wiese
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Hannover
| | - S. Weyerer
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Mannheim
| | - J. Werle
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Mannheim
| | - M. Pentzek
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - A. Fuchs
- Institut für Allgemeinmedizin, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - J. Stein
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Leipzig
| | - T. Luck
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Leipzig
| | - H. Bickel
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München – Klinikum rechts der Isar, München
| | - E. Mösch
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, TU München – Klinikum rechts der Isar, München
| | - L. Kleineidam
- Klinik und Poliklinik für Psychiatrie/Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn
| | - K. Heser
- Klinik und Poliklinik für Psychiatrie/Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn
| | - W. Maier
- Klinik und Poliklinik für Psychiatrie/Psychotherapie, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn
| | - M. Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - S. Riedel-Heller
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health, Universität Leipzig, Leipzig
| | - H.-H. König
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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Polyakova M, Sander C, Arelin K, Lampe L, Luck T, Kratzsch J, Hoffman K, Riedel-Heller S, Villringer A, Schoenknecht P, Schroeter M. First Evidence For Glial Pathology In Late Life Minor Depression: s100b Is Increased In Males With Minor Depression. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Minor depression is diagnosed when a patient suffers from two to four depressive symptoms for at least two weeks. Though minor depression is a widespread phenomenon, its pathophysiology has hardly been studied. To get a first insight into the pathophysiological mechanisms underlying this disorder we assessed serum levels of biomarkers for plasticity, glial and neuronal function: brain-derived neurotrophic factor (BDNF), S100B and neuron specific enolase (NSE). Twenty-seven subjects with minor depressive episode and 82 healthy subjects over 60 years of age were selected from the database of the Leipzig population-based study of civilization diseases (LIFE). Serum levels of BDNF, S100B and NSE were compared between groups, and correlated with age, body-mass index, and degree of white matter hyperintensities (score on Fazekas scale). 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). 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). S100B correlated with body mass index (rs = 0.246, P = 0.031) and with age in healthy subjects (rs = 0.345, P = 0.002). Increased S100B in males with minor depression, without alterations in BDNF and NSE, supports the glial hypothesis of depression. Correlation between white matter hyperintensities and NSE underscores the vascular hypothesis of late life depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hajek A, Brettschneider C, Posselt T, Lange C, Mamone S, Wiese B, Weyerer S, Werle J, Fuchs A, Pentzek M, Stein J, Luck T, Bickel H, Mösch E, Heser K, Jessen F, Maier W, Scherer M, Riedel-Heller SG, König HH. Predictors of Frailty in Old Age - Results of a Longitudinal Study. J Nutr Health Aging 2016; 20:952-957. [PMID: 27791226 DOI: 10.1007/s12603-015-0634-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To investigate time-dependent predictors of frailty in old age longitudinally. DESIGN Population-based prospective cohort study. SETTING Elderly individuals were recruited via GP offices at six study centers in Germany. The course of frailty was observed over 1.5 years (follow up wave 4 and follow up wave 5). PARTICIPANTS 1,602 individuals aged 80 years and older (mean age 85.4 years SD 3.2, with mean CSHA CFS 3.5 SD 1.6) at follow up wave 4. MEASUREMENTS Frailty was assessed by using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA CFS), ranging from 1 (very fit) to 7 (severely frail). RESULTS Fixed effects regressions revealed that frailty increased significantly with increasing age (β=.2) as well as the occurrence of depression (β=.5) and dementia (β=.8) in the total sample. Changes in marital status and comorbidity did not affect frailty. While the effects of depression and dementia were significant in women, these effects did not achieve statistical significance in men. CONCLUSION Our findings highlight the role of aging as well as the occurrence of dementia and depression for frailty. Specifically, in order to delay frailty in old age, developing interventional strategies to prevent depression might be a fruitful approach.
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Affiliation(s)
- A Hajek
- JDr. André Hajek, University Medical Center, Hamburg-Eppendorf, Hamburg Center for Health Economics, Department of Health Economics and Health Services Research, Telephone +49 40 7410 52877; Fax +49 40 7410 40261, E-mail:
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Roehr S, Luck T, Bickel H, Brettschneider C, Ernst A, Fuchs A, Heser K, König HH, Jessen F, Lange C, Mösch E, Pentzek M, Steinmann S, Weyerer S, Werle J, Wiese B, Scherer M, Maier W, Riedel-Heller SG. Mortality in incident dementia - results from the German Study on Aging, Cognition, and Dementia in Primary Care Patients. Acta Psychiatr Scand 2015; 132:257-69. [PMID: 26052745 DOI: 10.1111/acps.12454] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Dementia is known to increase mortality, but the relative loss of life years and contributing factors are not well established. Thus, we aimed to investigate mortality in incident dementia from disease onset. METHOD Data were derived from the prospective longitudinal German AgeCoDe study. We used proportional hazards models to assess the impact of sociodemographic and health characteristics on mortality after dementia onset, Kaplan-Meier method for median survival times. RESULTS Of 3214 subjects at risk, 523 (16.3%) developed incident dementia during a 9-year follow-up period. Median survival time after onset was 3.2 years (95% CI = 2.8-3.7) at a mean age of 85.0 (SD = 4.0) years (≥2.6 life years lost compared with the general German population). Survival was shorter in older age, males other dementias than Alzheimer's, and in the absence of subjective memory complaints (SMC). CONCLUSION Our findings emphasize that dementia substantially shortens life expectancy. Future studies should further investigate the potential impact of SMC on mortality in dementia.
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Affiliation(s)
- S Roehr
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
| | - T Luck
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany.,LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
| | - H Bickel
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - C Brettschneider
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Ernst
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - A Fuchs
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - K Heser
- Department of Psychiatry, University of Bonn, Bonn, Germany
| | - H-H König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Jessen
- Department of Psychiatry, University of Cologne, Medical Faculty, Cologne, Germany.,German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany
| | - C Lange
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - E Mösch
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - M Pentzek
- Institute of General Practice, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - S Steinmann
- Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - S Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - J Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - B Wiese
- Work Group Medical Statistics and IT-Infrastructure, Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - M Scherer
- Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center, Hamburg-Eppendorf, Germany
| | - W Maier
- Department of Psychiatry, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Leipzig, Germany
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Luck T, Luppa M, Matschinger H, Jessen F, Angermeyer MC, Riedel-Heller SG. Incident subjective memory complaints and the risk of subsequent dementia. Acta Psychiatr Scand 2015; 131:290-6. [PMID: 25201166 DOI: 10.1111/acps.12328] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE In this study, we aimed to analyze the association between new-incident-subjective memory complaints (SMC) and risk of subsequent dementia in a general population sample aged 75+ years. METHOD Data were derived from follow-up (FUP) waves I-V of the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). We used the Kaplan-Meier survival method to estimate dementia-free survival times of individuals with and without incident SMC and multivariable Cox proportional hazards regression to assess the association between incident SMC and risk of subsequent dementia, controlled for covariates. RESULTS Of 443 non-demented individuals, 58 (13.1%) developed dementia during a subsequent 5.4-year follow-up period. Participants with incident SMC showed a significantly higher progression to dementia (18.5% vs. 10.0%; P=0.010) and a significantly shorter mean dementia-free survival time than those without (6.2 vs. 6.8 years; P=0.008). The association between incident SMC and risk of subsequent dementia remained significant in the multivariable Cox analysis (adjusted hazard ratio=1.8; P=0.028). CONCLUSION Our findings suggest higher progression to dementia and shorter dementia-free survival in older individuals with incident SMC. These findings support the notion that such subjective complaints should be taken seriously in clinical practice as possible early indicators of incipient dementia.
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Affiliation(s)
- T Luck
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany
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Brettschneider C, Luck T, Fleischer S, Roling G, Beutner K, Sesselmann Y, Luppa M, Behrens J, Riedel-Heller S, König HH. Cost-Utility Analysis of Preventive Home Visits in Older Adults. Value Health 2014; 17:A511. [PMID: 27201571 DOI: 10.1016/j.jval.2014.08.1569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - T Luck
- University Leipzig, Leipzig, Germany
| | - S Fleischer
- University Medical Center Halle (Saale), Halle (Saale), Germany
| | - G Roling
- University Medical Center Halle (Saale), Halle (Saale), Germany
| | - K Beutner
- University Medical Center Halle (Saale), Halle (Saale), Germany
| | - Y Sesselmann
- University Medical Center Halle (Saale), Halle (Saale), Germany
| | - M Luppa
- University of Leipzig, Leipzig, Germany
| | - J Behrens
- University Medical Center Halle (Saale), Halle (Saale), Germany
| | | | - H H König
- University Medical Center Hamburg, Hamburg, Germany
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Luck T, Riedel-Heller SG, Luppa M, Wiese B, Köhler M, Jessen F, Bickel H, Weyerer S, Pentzek M, König HH, Prokein J, Ernst A, Wagner M, Mösch E, Werle J, Fuchs A, Brettschneider C, Scherer M, Maier W. Apolipoprotein E epsilon 4 genotype and a physically active lifestyle in late life: analysis of gene-environment interaction for the risk of dementia and Alzheimer's disease dementia. Psychol Med 2014; 44:1319-1329. [PMID: 23883793 DOI: 10.1017/s0033291713001918] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND As physical activity may modify the effect of the apolipoprotein E (APOE) ε4 allele on the risk of dementia and Alzheimer's disease (AD) dementia, we tested for such a gene-environment interaction in a sample of general practice patients aged ⩾75 years. METHOD Data were derived from follow-up waves I-IV of the longitudinal German study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). The Kaplan-Meier survival method was used to estimate dementia- and AD-free survival times. Multivariable Cox regression was used to assess individual associations of APOE ε4 and physical activity with risk for dementia and AD, controlling for covariates. We tested for gene-environment interaction by calculating three indices of additive interaction. RESULTS Among the randomly selected sample of 6619 patients, 3327 (50.3%) individuals participated in the study at baseline and 2810 (42.5%) at follow-up I. Of the 2492 patients without dementia included at follow-up I, 278 developed dementia (184 AD) over the subsequent follow-up interval of 4.5 years. The presence of the APOE ε4 allele significantly increased and higher physical activity significantly decreased risk for dementia and AD. The co-presence of APOE ε4 with low physical activity was associated with higher risk for dementia and AD and shorter dementia- and AD-free survival time than the presence of APOE ε4 or low physical activity alone. Indices of interaction indicated no significant interaction between low physical activity and the APOE ε4 allele for general dementia risk, but a possible additive interaction for AD risk. CONCLUSIONS Physical activity even in late life may be effective in reducing conversion to dementia and AD or in delaying the onset of clinical manifestations. APOE ε4 carriers may particularly benefit from increasing physical activity with regard to their risk for AD.
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Affiliation(s)
- T Luck
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - S G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - M Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Germany
| | - B Wiese
- Institute for Biometrics, Hannover Medical School, Germany
| | - M Köhler
- Centre for Psychosocial Medicine, Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Germany
| | - F Jessen
- Department of Psychiatry, University of Bonn, Germany
| | - H Bickel
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - S Weyerer
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - M Pentzek
- Medical Faculty, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Germany
| | - H-H König
- Department of Medical Sociology and Health Economics, University Medical Centre Hamburg-Eppendorf, Germany
| | - J Prokein
- Institute for Biometrics, Hannover Medical School, Germany
| | - A Ernst
- Centre for Psychosocial Medicine, Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Germany
| | - M Wagner
- Department of Psychiatry, University of Bonn, Germany
| | - E Mösch
- Department of Psychiatry, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - J Werle
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - A Fuchs
- Medical Faculty, Institute of General Practice, Heinrich-Heine-University Düsseldorf, Germany
| | - C Brettschneider
- Department of Medical Sociology and Health Economics, University Medical Centre Hamburg-Eppendorf, Germany
| | - M Scherer
- Centre for Psychosocial Medicine, Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Germany
| | - W Maier
- Department of Psychiatry, University of Bonn, Germany
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Luck T, Riedel-Heller SG, Luppa M, Wiese B, Bachmann C, Jessen F, Bickel H, Weyerer S, Pentzek M, König HH, Prokein J, Eisele M, Wagner M, Mösch E, Werle J, Fuchs A, Brettschneider C, Scherer M, Breitner JCS, Maier W. A hierarchy of predictors for dementia-free survival in old-age: results of the AgeCoDe study. Acta Psychiatr Scand 2014; 129:63-72. [PMID: 23521526 DOI: 10.1111/acps.12129] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/19/2013] [Indexed: 11/30/2022]
Abstract
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 < 27.47, was the strongest predictor of imminent dementia. Dementia-free survival time was shortest (mean 2.4 years) in such low-scoring patients who also had impaired instrumental activities of daily living (iADL) and subjective memory impairment with related worry (SMI-w). Patients with identical characteristics but without SMI-w had an estimated mean dementia-free survival time of 3.8 years, which was still shorter than in patients who had subthreshold MMSE scores but intact iADL (4.2-5.2 years). CONCLUSION Hierarchical patterns of readily available covariates can predict dementia-free survival in older general practice patients with CI. Although less widely appreciated than other variables, iADL impairment appears to be an especially noteworthy predictor of progression to dementia.
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Affiliation(s)
- T Luck
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; Douglas Mental Health University Institute, McGill University, Montreal, Canada
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Then FS, Luck T, Luppa M, Thinschmidt M, Deckert S, Nieuwenhuijsen K, Seidler A, Riedel-Heller SG. Effect of the psychosocial working environment on cognition and dementia - A systematic review. Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Then FS, Luck T, Arélin K, Schroeter ML, Villringer A, Löffler M, Engel C, Thiery J, Riedel-Heller SG. Berufliche Einflussfaktoren auf die kognitive Leistungsfähigkeit - Ergebnisse der Gesundheitsstudie des Leipziger Forschungszentrums für Zivilisationserkrankungen (LIFE). Gesundheitswesen 2013. [DOI: 10.1055/s-0033-1354085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Luck T, Luppa M, Sieber J, Riedel-Heller SG. Attitudes of the German general population toward early diagnosis of dementia. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Luppa M, Sikorski C, Luck T, Ehreke L, Konnopka A, Wiese B, Weyerer S, König HH, Riedel-Heller SG. Age- and gender-specific prevalence of depression in latest-life--systematic review and meta-analysis. J Affect Disord 2012; 136:212-21. [PMID: 21194754 DOI: 10.1016/j.jad.2010.11.033] [Citation(s) in RCA: 484] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 11/09/2010] [Accepted: 11/30/2010] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of the study is to systematically analyze the prevalence of depression in latest life (75+), particularly focusing on age- and gender-specific rates across the latest-life age groups. DESIGN Relevant articles were identified by systematically searching the databases MEDLINE, Web of Science, Cochrane Library and Psycinfo and relevant literature from 1999 onwards was reviewed. Studies based on the community-based elderly population aged 75 years and older were included. Quality of studies was assessed. Meta-analysis was performed using random effects model. RESULTS 24 studies reporting age- and gender-specific prevalence of depression were found. 13 studies had a high to moderate methodical quality. The prevalence of major depression ranged from 4.6% to 9.3%, and that of depressive disorders from 4.5% to 37.4%. Pooled prevalence was 7.2% (95% CI 4.4-10.6%) for major depression and 17.1% (95% CI 9.7-26.1%) for depressive disorders. Potential sources of high heterogeneity of prevalence were study design, sampling strategy, study quality and applied diagnostics of latest life depression. CONCLUSIONS Despite the wide variation in estimates, it is evident that latest life depression is common. To reduce variability of study results, particularly sampling strategies (inclusion of nursing home residents and severe cognitively impaired individuals) for the old age study populations should be addressed more thoroughly in future research.
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Affiliation(s)
- M Luppa
- Institute of Social Medicine, Occupational Health and Public Health, Public Health Research Unit, University of Leipzig, Leipzig, Germany.
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Luppa M, Sikorski C, Luck T, Weyerer S, Villringer A, Konig HH, Riedel-Heller SG. P1-221 Epidemiology of depression in old age: results of the Leipzig longitudinal study of the aged (LEILA 75+). J Epidemiol Community Health 2011. [DOI: 10.1136/jech.2011.142976e.14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Luck T, Gentzsch K, Motzek T, Sesselmann Y, Fleischer S, Roling G, Beutner K, Heinrich S, Koenig HH, Behrens J, Riedel-Heller SG. Growing old at home – Evaluation of preventive home visits to reduce the number of falls and to preserve the quality of life. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Luck T, Luppa M, Briel S, Riedel-Heller SG. P1-225 Incidence of mild cognitive impairment: a systematic review. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976e.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Luppa M, Luck T, Matschinger H, Konig HH, Riedel-Heller SG. P1-222 Predictors of institutionalisation in individuals with and without dementia: results from the Leipzig longitudinal study of the aged (LEILA75+). Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976e.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Luck T, Luppa M, Briel S, Matschinger H, Konig HH, Villringer A, Riedel-Heller SG. P1-223 Mild cognitive impairment: incidence and risk factors: results of the Leipzig longitudinal study of the aged (LEILA75+). Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976e.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Luck T, Luppa M, Angermeyer MC, Villringer A, Konig HH, Riedel-Heller SG. P1-224 Impact of impairment in instrumental activities of daily living and mild cognitive impairment on time to incident dementia: results of the Leipzig longitudinal study of the aged (LEILA75+). Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976e.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Luck T, Luppa M, Angermeyer MC, Villringer A, König HH, Riedel-Heller SG. Impact of impairment in instrumental activities of daily living and mild cognitive impairment on time to incident dementia: results of the Leipzig Longitudinal Study of the Aged. Psychol Med 2011; 41:1087-1097. [PMID: 20667169 DOI: 10.1017/s003329171000142x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Early diagnosis of dementia requires knowledge about associated predictors. The aim of this study was to determine the impact of mild cognitive impairment (MCI) and impairment in instrumental activities of daily living (IADL) on the time to an incident dementia diagnosis. METHOD Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based study of individuals aged ≥75 years. Kaplan-Meier survival analysis was used to determine time to incident dementia. Cox proportional hazards models were applied to determine the impact of MCI and IADL impairment on the time to incident dementia. RESULTS In total, 180 (22.0%) of 819 initially dementia-free subjects developed dementia by the end of the study. Mean time to incident dementia was 6.7 years [95% confidence interval (CI) 6.5-6.9]. MCI combined with IADL impairment was associated with a higher conversion rate to dementia, a shorter time to clinically manifest diagnosis and a lower chance of reversibility to cognitive normal. The highest risk for a shorter time to incident dementia was found for amnestic MCI combined with IADL impairment. The mean time to incident dementia was 3.7 years (95% CI 2.9-4.4) and thus half as long as in subjects without MCI and IADL impairment. CONCLUSIONS Subjects with MCI and IADL impairment constitute a high-risk population for future dementia. The consideration of both--MCI and IADL impairment-- might help to improve the prediction of dementia.
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Affiliation(s)
- T Luck
- Department of Social Medicine, University of Leipzig, Leipzig, Germany
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Riedel-Heller S, Luck T, Matschinger H, Luppa M. Mild Cognitive Impairment: Incidence and Risk factors – Results of the Leipzig Longitudinal Study of the Aged (LEILA75+). Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Fleischer S, Sesselmann Y, Roling G, Behrens J, Luck T, Riedel-Heller S. Partizipation im individuellen Lebensumfeld: Analyse des Modells der präventiven Hausbesuche (eingeladener Vortrag). Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ehreke L, Luppa M, Luck T, Wiese B, Weyerer S, Weeg D, Olbrich J, van den Bussche H, Maier W, Pentzek M, König H, Riedel-Heller S. Is the Clock Drawing Test appropriate for screening for Mild Cognitive Impairment? Results of the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Luck T, Luppa M, Briel S, Riedel-Heller S. Incidence of Mild Cognitive Impairment – A systematic review. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Luppa M, Luck T, Weyerer S, König H, Riedel-Heller S. Gender differences in predictors of nursing home placement in the elderly. A Systematic Review. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Luck T, Luppa M, Angermeyer M, Villringer A, König H, Riedel-Heller S. Impact of impairment in instrumental activities of daily living and mild cognitive impairment on time to incident dementia – results of the Leipzig Longitudinal Study of the Aged (LEILA75+). Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Luck T, Riedel-Heller SG, Luppa M, Wiese B, Wollny A, Wagner M, Bickel H, Weyerer S, Pentzek M, Haller F, Moesch E, Werle J, Eisele M, Maier W, van den Bussche H, Kaduszkiewicz H. Risk factors for incident mild cognitive impairment--results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Acta Psychiatr Scand 2010; 121:260-72. [PMID: 19824992 DOI: 10.1111/j.1600-0447.2009.01481.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To provide age- and gender-specific incidence rates of MCI among elderly general practitioner (GP) patients (75+ years) and to identify risk factors for incident MCI. METHOD Data were derived from the longitudinal German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe). Incidence was calculated according to the 'person-years-at-risk' method. Risk factors were analysed using multivariate logistic regression models. RESULTS During the 3-year follow-up period, 350 (15.0%) of the 2331 patients whose data were included in the calculation of incidence developed MCI [person-years (PY) = 6198.20]. The overall incidence of MCI was 56.5 (95% confidence interval = 50.7-62.7) per 1000 PY. Older age, vascular diseases, the apoE epsilon4 allele and subjective memory complaints were identified as significant risk factors for future MCI. CONCLUSION Mild cognitive impairment is frequent in older GP patients. Subjective memory complaints predict incident MCI. Especially vascular risk factors provide the opportunity of preventive approaches.
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Affiliation(s)
- T Luck
- Public Health Research Unit, Department of Psychiatry, University of Leipzig, Leipzig, Germany.
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Luck T, Kuske B, Fleischer S, Roling G, Beutner K, Hanns S, Behrens J, Angermeyer M, Heinrich S, König H, Lautenschläger C, Riedel-Heller S. Growing old at home – A randomized controlled trial. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Riedel-Heller S, Luck T, Matschinger H, Luppa M. Was Kohortenstudien für die Versorgungsforschung leisten können: Empirische Ergebnisse zur Institutionalisierung aus der Leipziger Langzeitstudie in der Altenbevölkerung (LEILA 75+). Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kuske B, Hanns S, Luck T, Angermeyer M, Behrens J, Riedel-Heller S. Nursing home staff training in dementia care. A systematic review of evaluated programs. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kuske B, Luck T, Hanns S, Matschinger H, Behrens J, Riedel-Heller S. Training in dementia care: a cluster-randomised controlled trial of a training program for nursing home staff in Germany. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stein J, Hensel A, Luppa M, Luck T, Angermeyer M, Riedel-Heller S. Die Messung kognitiver Veränderung bei älteren Menschen: Veränderungsnormen für SISCO und MMST. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Luppa M, Heinrich S, Matschinger H, Hensel A, Luck T, Riedel-Heller S, König H. Direct costs associated with mild cognitive impairment in primary care. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Heun R, Gühne U, Luck T, Angermeyer MC, Ueberham U, Potluri R, Natalwala A, Arendt T, Riedel-Heller SG. Apolipoprotein E allele 4 is not a sufficient or a necessary predictor of the development of Mild Cognitive Impairment. Eur Psychiatry 2009; 25:15-8. [PMID: 19560323 DOI: 10.1016/j.eurpsy.2009.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 02/16/2009] [Accepted: 02/20/2009] [Indexed: 11/26/2022] Open
Abstract
The presence of Mild Cognitive Impairment (MCI) and of an apolipoprotein E (apoE) varepsilon4 allele both predict the development of Alzheimer's disease. However, the extent to which this allele also predicts the development of MCI is unclear even though MCI is an early transitional stage in the development of Alzheimer's disease. The present study investigates the prevalence of the apoE varepsilon4 allele in incipient MCI. Participants were recruited from the population-based Leipzig Longitudinal Study of the Aged (LEILA75+). All subjects who were initially cognitively healthy, i.e. did not meet MCI criteria described by Petersen [Petersen RC. Mild cognitive impairment. J Intern Med 2004; 256(3): 183-94], and whose apoE status could be determined were followed-up. After 4.5 years, 15.5% of the cognitively healthy target population had developed MCI. The frequencies of the apoE varepsilon4 genotype did not differ between individuals with incipient MCI (12.9%) and individuals who remained cognitively healthy during the study (18.4%, p>0.5). Consequently, the apoE varepsilon4 genotype is not a necessary or sufficient risk factor for MCI. Further studies need to investigate the influence of the whole range of genetic and environmental risk factors on the course of Alzheimer's disease including the initial development of MCI and the later conversion to Alzheimer's disease.
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Affiliation(s)
- R Heun
- Department of Psychiatry, Derby City General Hospital, Uttoxeter Road, Derby 22, UK.
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