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Sebastian Köhler,
Frans Verhey,
Siegfried Weyerer,
Birgitt Wiese,
Kathrin Heser,
Michael Wagner,
Michael Pentzek,
Angela Fuchs,
Mirjam Köhler,
Cadja Bachmann,
Steffi G Riedel Heller,
Melanie Luppa, Sandra Eifflaender-Gorfer,
Jochen Werle,
Horst Bickel,
Edelgard Mösch,
Hans-Helmut König,
Christian Brettschneider,
Martin Scherer,
Wolfgang Maier
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ABSTRACT: BACKGROUND: Depression is a risk factor for stroke and mortality but whether this also holds into old age is uncertain. We therefore studied the association of depression with the risk for non-fatal stroke and all-cause mortality in very old age. METHODS: A representative sample of 3085 primary care patients aged ≥75 years were serially assessed during a 6-year follow-up. The relation between depression (Geriatric Depression Scale >6, n=261) and relevant covariates including vascular risk factors and disease, functional and mild cognitive impairment and ApoE genotype on primary care givers information of incident stroke (n=209) and mortality (n=647) were assessed by Cox regression and by competing risk regressions. RESULTS: Depression was not independently associated with incident stroke in fully adjusted models that treated death as the competing event (subdistribution hazard ratio=0.80, 95% confidence interval=0.47 to 1.36). The risk associated with depression was similar for men and women, and for age groups 75-79, 80-84 and ≥85 years. In contrast, depression increased all-cause mortality rates, even after adjusting for a range of confounders (hazard ratio=1.31, 95% confidence interval=1.03 to 1.67). LIMITATIONS: We have no information on past depressive episodes and cause of death. CONCLUSIONS: In contrast to reports in younger populations, depression does not appear to increase stroke risk among the old and very old, but continuous to be a risk factor for all-cause mortality.
Journal of affective disorders 03/2013; · 3.76 Impact Factor
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ABSTRACT: OBJECTIVE: to determine incidence and predictors of late-life depression. METHODS: this is a 3-year observational cohort study of 3,214 non-demented patients aged 75 and over completing three waves of assessment. The patients were recruited in 138 primary care practices in six urban areas in Germany. Depressive symptoms were measured at baseline, and 18 months and 36 months later using the GDS-15 Geriatric Depression Scale with a cut-off 0-5/6-15. Cox proportional hazard regression models were applied to examine predictors of incident depression, adjusting for sex, age, education, living situation, activities of daily living - and instrumental activities of daily living impairment, somatic comorbidity, alcohol consumption, smoking, mild cognitive impairment and apoE4 status. RESULTS: the incidence of depression was 36.8 (95% CI: 29.6-45.3) per 1,000 person-years in men and 46.0 (95% CI: 39.9-52.8) in women (sex difference P = 0.069). The incidence increased from 35.4 (95% CI: 29.7-41.9) per 1000 person-years between the ages of 75 and 79 to 75.2 (95% CI: 53.2-103.2) for subjects 85 years and older. After full adjustment for confounding variables, hazard ratios (HR) for incident depression were significantly higher for subjects 85 years and older (HR: 1.83, 95% CI: 1.24-2.70) and those with mobility impairment (HR: 2.53, 95% CI: 1.97-3.25), vision impairment (HR: 1.41, 95% CI: 1.04-1.91), mild cognitive impairment (HR: 1.52, 95% CI: 1.10-2.10), subjective memory impairment (HR: 1.33, 95% CI: 1.01-1.74) and current smoking (HR: 1.69, 95% CI: 1.13-2.53). CONCLUSIONS: the incidence of depression increased significantly with age. In designing prevention programmes, it is important to call more attention on functional impairment, cognitive impairment and smoking.
Age and Ageing 01/2013; · 3.09 Impact Factor
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Tobias Luck,
Melanie Luppa,
Birgit Wiese,
Wolfgang Maier,
Hendrik van den Bussche,
Marion Eisele,
Frank Jessen,
Dagmar Weeg,
Siegfried Weyerer,
Michael Pentzek,
Hanna Leicht,
Mirjam Koehler,
Franziska Tebarth,
Julia Olbrich, Sandra Eifflaender-Gorfer,
Angela Fuchs,
Hans-Helmut Koenig,
Steffi G Riedel-Heller
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ABSTRACT: OBJECTIVES:: There is an increasing call for a stronger consideration of impairment in instrumental activities of daily living (IADL) in the diagnostic criteria of Mild Cognitive Impairment (MCI) to improve the prediction of dementia. Thus, the aim of the study was to determine the predictive capability of MCI and IADL impairment for incident dementia. DESIGN:: Longitudinal cohort study with four assessments at 1.5-year intervals over a period of 4.5 years. SETTING:: Primary care medical record registry sample. PARTICIPANTS:: As part of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients, a sample of 3,327 patients from general practitioners, aged 75 years and older, was assessed. MEASUREMENTS:: The predictive capability of MCI and IADL impairment for incident dementia was analysed using receiver operating characteristics, Kaplan-Meier survival analyses, and Cox proportional hazards models. RESULTS:: MCI and IADL impairment were found to be significantly associated with higher conversion to, shorter time to, and better predictive power for future dementia. Regarding IADL, a significant impact was particularly found for impairment in responsibility for one's own medication, shopping, and housekeeping, and in the ability to use public transport. CONCLUSIONS:: Combining MCI with IADL impairment significantly improves the prediction of future dementia. Even though information on a set of risk factors is required to achieve a predictive accuracy for dementia in subjects with MCI being clinically useful, IADL impairment should be a very important element of such a risk factor set.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 06/2012; 20(11):943-954. · 3.35 Impact Factor
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Mirjam Koehler,
Matthias Kliegel,
Birgitt Wiese,
Horst Bickel,
Hanna Kaduszkiewicz,
Hendrik van den Bussche, Sandra Eifflaender-Gorfer,
Marion Eisele,
Angela Fuchs,
Hans-Helmut Koenig,
Hanna Leicht,
Tobias Luck,
Wolfgang Maier,
Edelgard Moesch,
Steffi Riedel-Heller,
Franziska Tebarth,
Michael Wagner,
Siegfried Weyerer,
Thomas Zimmermann,
Michael Pentzek
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ABSTRACT: Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed.
Here, 3,215 patients aged 75-98 years were included. Data were collected during home visits.
Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication.
Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment.
Dementia and Geriatric Cognitive Disorders 01/2011; 31(1):81-8. · 2.14 Impact Factor
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Frank Jessen,
Birgitt Wiese,
Cadja Bachmann, Sandra Eifflaender-Gorfer,
Franziska Haller,
Heike Kölsch,
Tobias Luck,
Edelgard Mösch,
Hendrik van den Bussche,
Michael Wagner,
Anja Wollny,
Thomas Zimmermann,
Michael Pentzek,
Steffi G Riedel-Heller,
Heinz-Peter Romberg,
Siegfried Weyerer,
Hanna Kaduszkiewicz,
Wolfgang Maier,
Horst Bickel
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ABSTRACT: Subjective memory impairment (SMI) is receiving increasing attention as a pre-mild cognitive impairment (MCI) condition in the course of the clinical manifestation of Alzheimer disease (AD).
To determine the risk for conversion to any dementia, dementia in AD, or vascular dementia by SMI, graded by the level of SMI-related worry and by the temporal association of SMI and subsequent MCI.
Longitudinal cohort study with follow-up examinations at 1(1/2) and 3 years after baseline.
Primary care medical record registry sample.
A total of 2415 subjects without cognitive impairment 75 years or older in the German Study on Aging, Cognition and Dementia in Primary Care Patients.
Conversion to any dementia, dementia in AD, or vascular dementia at follow-up 1 or follow-up 2 predicted by SMI with or without worry at baseline and at follow-up 2 predicted by different courses of SMI at baseline and MCI at follow-up 1.
In the first analysis, SMI with worry at baseline was associated with greatest risk for conversion to any dementia (hazard ratio [HR], 3.53; 95% confidence interval [CI], 2.07-6.03) or dementia in AD (6.54; 2.82-15.20) at follow-up 1 or follow-up 2. The sensitivity was 69.0% and the specificity was 74.3% conversion to dementia in AD. In the second analysis, SMI at baseline and MCI at follow-up 1 were associated with greatest risk for conversion to any dementia (odds ratio [OR], 8.92; 95% CI, 3.69-21.60) or dementia in AD (19.33; 5.29-70.81) at follow-up 2. Furthermore, SMI at baseline and amnestic MCI at follow-up 1 increased the risk for conversion to any dementia (OR, 29.24; 95% CI, 8.75-97.78) or dementia in AD (60.28; 12.23-297.10), with a sensitivity of 66.7% and a specificity of 98.3% for conversion to dementia in AD.
The prediction of dementia in AD by SMI with subsequent amnestic MCI supports the model of a consecutive 3-stage clinical manifestation of AD from SMI via MCI to dementia.
Archives of general psychiatry 04/2010; 67(4):414-22. · 12.26 Impact Factor
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Lena Ehreke,
Melanie Luppa,
Tobias Luck,
Birgitt Wiese,
Siegfried Weyerer, Sandra Eifflaender-Gorfer,
Dagmar Weeg,
Julia Olbrich,
Hendrik van den Bussche,
Cadja Bachmann,
Marion Eisele,
Wolfgang Maier,
Frank Jessen,
Michael Wagner,
Angela Fuchs,
Michael Pentzek,
Matthias C Angermeyer,
Hans-Helmut König,
Steffi G Riedel-Heller
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ABSTRACT: Individuals with mild cognitive impairment (MCI) are at high risk of developing dementia and are a target group for preventive interventions. Therefore, research aims at diagnosing MCI at an early stage with short, simple and easily administrable screening tests. Due to the fact that the Clock Drawing Test (CDT) is widely used to screen for dementia, it is questionable whether it is suited to screen for MCI.
3,198 primary care patients aged 75+ were divided into two groups according to their cognitive status, assessed by comprehensive neuropsychological testing: individuals without MCI and individuals with MCI. The CDT scores, evaluated by the scoring system of Sunderland et al. [J Am Geriatr Soc 1989;37:725-729], of both groups were compared. Multivariate analyses were calculated and the sensitivity and specificity of the CDT to screen for MCI were reported.
Significant differences were found for CDT results: MCI patients obtained worse results than cognitively unimpaired subjects. CDT has a significant impact on the diagnosis of MCI. However, sensitivity and specificity as well as receiver operating characteristic analyses are not adequate, meaning that the CDT could not be named as an exact screening tool. Limitations: Applying different CDT versions of administration and scoring could yield different results.
CDT does not achieve the quality to screen individuals for MCI.
Dementia and Geriatric Cognitive Disorders 10/2009; 28(4):365-72. · 2.14 Impact Factor
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Siegfried Weyerer,
Martina Schäufele, Sandra Eifflaender-Gorfer,
Leonore Köhler,
Wolfgang Maier,
Franziska Haller,
Gabriela Cvetanovska-Pllashiniku,
Michael Pentzek,
Angela Fuchs,
Hendrik van den Bussche,
Thomas Zimmermann,
Marion Eisele,
Horst Bickel,
Edelgard Mösch,
Birgitt Wiese,
Matthias C Angermeyer,
Steffi G Riedel-Heller
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ABSTRACT: Little is known about the prevalence and risk factors of alcohol problems among older people (especially those aged 75 years and more). The aims of this study were to report alcohol consumption patterns and to determine their association with socio-demographic variables and health characteristics.
3224 non-demented subjects aged 75 and over and attending general practitioners (GPs) (n = 138) in an urban area of Germany were studied by structured clinical interviews including detailed assessment of alcohol consumption patterns distinguishing between abstainers, moderate drinkers and at-risk drinkers (>20 g of alcohol for women and >30 g of alcohol for men).
A high proportion (50.1%) of the sample were abstainers, 43.4% were moderate drinkers. The prevalence of at-risk alcohol consumption was 6.5% (95% CI 5.6-7.4). Rates were significantly higher for men (12.1%; 95% CI 10.2-14.0) compared to women (3.6%; 95% CI 2.8-4.4). After full adjustment for confounding variables we found that compared to moderate drinking abstaining from alcohol was significantly associated with female gender, lower education, and mobility impairment. Compared to moderate drinking at-risk drinking was significantly higher among men, individuals with a liver disease, and current smokers.
Multivariate analysis revealed that, apart from liver disease, at-risk drinking in a non-demented population aged 75 and over was associated with relatively good physical and mental health. Nevertheless, public prevention measures should focus on at-risk drinkers to make them aware of potential risks of high alcohol consumption in old age.
International Journal of Geriatric Psychiatry 05/2009; 24(12):1376-85. · 2.42 Impact Factor
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Siegfried Weyerer, Sandra Eifflaender-Gorfer,
Leonore Köhler,
Frank Jessen,
Wolfgang Maier,
Angela Fuchs,
Michael Pentzek,
Hanna Kaduszkiewicz,
Cadja Bachmann,
Matthias C Angermeyer,
Melanie Luppa,
Birgitt Wiese,
Edelgard Mösch,
Horst Bickel
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ABSTRACT: Depression among the elderly is an important public health issue. The aims of this study were to report the prevalence of depression and to determine the impact of socio-demographic variables, functional impairment and medical diagnoses, lifestyle factors, and mild cognitive impairment on depression as part of the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe Study).
Included in the cross-sectional survey were 3327 non-demented subjects aged 75 and over attending general practitioners (GPs) (n=138) in an urban area of Germany. The GDS-15 Geriatric Depression Scale was used to measure depression with a threshold of <6/6+. Associations with social and clinical risk factors were assessed by means of multiple logistic regression models.
The prevalence of depression was 9.7% (95% confidence interval 8.7-10.7). In a univariate analysis, the following variables were significantly associated with depression: female gender, increasing age, living alone, divorce, lower educational status, functional impairment, comorbid somatic disorder, mild cognitive impairment, smoking, and abstinence from alcohol. After full adjustment for confounding variables, odds ratios for depression were significantly higher only for functional impairment, smoking, and multi-domain mild cognitive impairment.
Recruitment procedures might have led to an underestimation of current prevalence. The cross-sectional data did not allow us to analyze the temporal relationship between risk factors and depression.
The prevalence of depression in the elderly is high and remains high into old age. In designing prevention programs, it is important to call more attention to the impact of functional and cognitive impairment on depression.
Journal of Affective Disorders 03/2008; 111(2-3):153-63. · 3.52 Impact Factor
