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The evidence on the association between lifetime traumatic events (LTE) and the occurrence of cognitive changes and dementia is heterogeneous and often based on studies in high-risk populations. Using data from a German population-based study, this study examines whether there is a connection between LTE and experiences of abuse (CA) and neglect (CN) in childhood with mild Neurocognitive Disorder (miNCD) in old age.889 participants were included in the analysis. The trauma list of the PTSD module of the Structured Clinical Interview for DSM-IV (SKID-I) and the Childhood Trauma Screener (CTS) were used to record LTE. miNCD was diagnosed using a neurocognitive test battery according to DSM-5 criteria. Binary logistic regression analyses were used to examine the extent to which the presence LTE is related to the presence of miNCD.In the sample 31.0% reported at least one LTE, 30.3% reported CN and 13.2% reported CA. 19.1% met the criteria for miNCD. Four models were tested, including age, gender and educational level as possible confounding variables. Model 1 examined whether LTE (yes/no) was associated with miNCD in old age. Model 2 tested whether the number of LTE was related to miNCD. Model 3 tested whether CN was related to miNCD, and model 4 tested whether CA was related to miNCD. None of the models showed a significant effect of the investigated variables on the occurrence of miNCD.International studies show indications of a correlation between TLE, CN, CA and miNCD, but there is a lack of corresponding studies in Germany. Despite methodological strengths (standardized recording of all variables, population-based study), our analysis found no correlations. Maybe study requirements led to a positive selection of healthy older people. Nevertheless, LTE, CA and CN were not underrepresented. The results contradict those in high-risk populations, but are consistent with more recent population-based studies that find no associations.In the wider population, the investigated link does not appear to be as clearly demonstrable as in populations with high traumatic burden, such as veterans, which seems reassuring news given that LTE are risk factors for numerous comorbidities that could then play a role in the development of the cognitive changes., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objective: The aim is to analyze pandemic-related effects on everyday life and psychosocial health in the understudied vulnerable group of cognitively impaired elderly people living at home., Methods: Structured telephone interviews in 2020 (n+=+141) and 2021 (n+=+107) were used to survey over-65s with cognitive impairment (MMSE Ø 23.4). The results from the 2021 survey presented here reflect experiences and attitudes, effects on daily life and health care, and psychosocial burdens and resources. Longitudinal analysis of selected indicators of burden is provided for n+=+66., Results: Even in the face of increasing concerns and moderate impacts on everyday life and health care, overall psychosocial health is proving to be good and largely stable over time., Conclusion: Respondents have high levels of personal and social resources, and their coping with limitations is characterized by acceptance and willingness to adapt., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim: Risky alcohol consumption increases the risk of dementia for people with mild cognitive impairment (MCI). The aim of this study is to assess alcohol consumption in people with MCI., Methods: Socio-demographics, 12-month prevalence, 30-d prevalence, prevalence of risky consumption (>10 g/20 g/d pure alcohol for women/men) and binge drinking (≥50 g pure alcohol on one occasion) were recorded in 270 people (≥60 years) with MCI from the German RCT "Brainfit-Nutrition" in 2022., Results: Approximately half of the people with MCI (50.8%) drink at least once a week. About one fifth (17.0%) of participants met the criterion for binge drinking; every third woman (34.8%) and every fifth man (18.6%) crossed the line to risky consumption in the last 30 d., Discussion: Generally, people with MCI show similar consumption prevalence as the 65+German general population. However, the prevalence of risky consumption in women with MCI is significantly higher., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonfliktbesteht., (Thieme. All rights reserved.)

Aim of the Study: Study of the long-term effects of a psychosocial intervention in dementia including its implementation under real world conditions in day care centers. In the present study this was investigated for the MAKS intervention - Motor, Activities of daily living, (K)Cognitive and Social-communicative component., Methods: At the end of a 6-month, cluster-randomised, controlled study, professional caregivers in all 32 day care centers (DCC) were trained in MAKS. From then on, all centers were free to carry out the intervention or not (open phase). In the 18-month follow-up phase, after 6 and 18 months the heads of the DCC were asked whether MAKS was carried out regularly in the trained form. After 6 months in the open phase, the cognitive abilities of the study participants with mild cognitive impairment, mild to moderate dementia were again assessed using Mini-Mental Status Examination (MMSE). Multiple linear regression analysis was used to investigate whether the MMSE score was predicted by carrying out MAKS or not. Other adjustment variables were MMST score at t6, age, sex, frequency of visits to TP, antidementia medication use, and depressiveness., Results: In the first 6 months of the open phase, 22 DCC (69%) stated that they performed MAKS. In months 7 to 18, this proportion increased up to 81%. For the 287 study participants in the 32 DCC, the fact whether they were guests in a DCC with or without MAKS was a significant predictor of the course of cognitive abilities (p=0.019). The average MMSE score in DCC without MAKS decreased; in DCC with MAKS it stayed approximately the same. Other significant predictors were baseline score and use of antidementia medications (individuals on antidementia medications scored worse)., Conclusion: The multimodal, psychosocial MAKS intervention for people with cognitive impairment that has been trained in a structured way can be implemented in day care centers on a long-term basis. MAKS has a positive effect on cognitive abilities also in a real world scenario., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Adult day care is an established concept in Germany for people with cognitive impairment; however, only a small fraction of people in need for care actually use adult day care. Studies so far highlighted some predictors for the use of adult day care; however, it remains unclear which factors are associated with the intensity of use., Objective: To identify relevant predictors for the intensity of use of adult day care using the Andersen healthcare utilization model., Material and Methods: Data used were obtained within the project dementia in day care with psychosocial MAKS interventions (DeTaMAKS), which studied adult day care users with cognitive impairments and their family caregivers. A logistic regression was performed to predict frequent or low use of adult day care., Results: The following factors were significantly associated with higher intensity of use: civil status of adult care user being widowed or single, higher educational level of caregiver, higher care level, longer duration of adult day care use and more mental and behavioral symptoms of the adult day care user. The sensitivity analysis for cohabiting dyads additionally showed a higher intensity of use with a lower age of the caregiver and shorter distance between place of residence and adult day care but not with respect to educational level of the caregiver and mental and behavioral symptoms of the user., Conclusion: The results show a need for adult day care, which increases with caregivers being employed and users living outside of permanent relationships. A short distance to the adult care center as well as flexible care options may increase the frequency of use., (© 2021. The Author(s).)

Background: Due to demographic changes an increasing prevalence of hospitalized patients suffering from cognitive impairments must be assumed. To enable the best possible treatment a routine procedure is necessary to detect this group of patients early on admission., Method: The current study assessed the prevalence rate of cognitive impairment in inpatients >65 years who were tested by the mini mental state examination (MMSE) during admission. Based on the screening quota the willingness of nurses to use the MMSE as a routine instrument was tested. The quota was also compared to the number of diagnoses coded as F in the ICD-10-GM. This retrospective study was conducted from October 2018 to March 2019 at a university hospital., Results: Of the 7311 inpatients >65 years, 11.7% were screened. The prevalence of cognitive impairments was 20.7% and was higher than the prevalence rate of dementia and delirium on the basis of medical diagnoses (p <0.001). With only 11.7% the willingness of the nursing staff to use the MMSE to assess cognitive impairments during patient admission was low., Conclusion: The higher prevalence confirms the necessity to detect patients with cognitive disorders; however, the low willingness to use the MMSE suggests that a shorter instrument should be used and more information should be provided to nurses about patients with cognitive impairments.

The COVID-19 pandemic poses new challenges for the healthcare systems world-wide which will go beyond prevention, acute and intensive care treatment of patients with severe illness. A large proportion of "COVID-survivors" - and not only elderly patients - suffers from "post-COVID-syndrome". Risk factors are preexisting somatic multimorbidity, cognitive and cerebral changes together with pneumonia and hypoxemia, intensive care treatment and confusional states during the acute phase of illness. Post-COVID cognitive deficits usually manifest as a frontal dysexecutive syndrome combined with fatigue and dysphoria and/or with attentional and memory deficits. Several pathogenetic mechanisms of COVID encephalopathy are understood, but no specific treatment strategies have been established so far. We assume that general practitioners, psychiatrists, neurologists and social workers will need to take care of the activation, reintegration and expert appraisals of patients with post-COVID fatigue and cognitive deficits during the years to come., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Diabetes mellitus is a chronic metabolic disease associated with multiple long-term complications. Besides macro- and microvascular complications, patient's well-being can be severely impaired by complications affecting the nervous system. About 50 % of patients with diabetes suffer from polyneuropathy. Moreover, the risk of developing cognitive impairment and dementia is also increased in older people with diabetes. Insufficient glycemic control, young age at diagnosis of diabetes are discussed as risk factors for developing diabetes complications. The early identification and prevention of factors predicting diabetes complications that affect the nervous system are still challenging and in need for further research., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Approximately 40% of patients with heart failure show cognitive deficits, such as concentration difficulties, attention deficits, and memory impairment. Affected patients have a higher rate of rehospitalization and an increased mortality. This could be due to low adherence mediated by a lack of disease-specific knowledge and strategies to deal with symptom exacerbation. The pathogenesis of cognitive deficits in heart failure is multifactorial. In this respect the heart failure itself as well as cardiovascular risk factors and comorbidities play a role. Orientating neuropsychological screening tests can show a first indication of the presence of cognitive impairment. When identified, the causes can be specifically treated and care can be optimized through certain measures, such as the involvement of caregivers and healthcare providers.

The increasing aging demographics never seen before is associated with the enormous challenge of dementia epidemics which urgently needs a paradigm shift in the approach to cognitive functions in health and disease. If on one hand the achievement or maintenance of a healthy lifestyle should be a medical priority, the early recognition of cognitive disturbances is mandatory. Cognitive impairment is not only associated with disability and lack of compliance and adherence, but also with dangerous geriatric syndromes such as instability, falls, and delirium. The evaluation of cognitive performance, particularly in older patients and especially in those hospitalized for other reasons, should be performed in all cases. While the National Institute of Aging and Alzheimer Association established new criteria for the diagnosis of Alzheimer's disease, the large majority of dementia cases are assigned to a multifactorial syndrome presenting as a long-lasting continuum from organ/function integrity to dementia. While the monoclonal antibody aducanumab is under careful evaluation for release on the market as the first curative drug, current anti-Alzheimer medication strategies remain symptomatic. In spite of the previous distinction between neurodegenerative and vascular forms of dementia, it is now accepted that control of vascular risk factors and comorbidities strongly affects the prevention of all types of cognitive impairment. The WHO has published in May 2019 an official guideline document for reducing dementia risk. The guidelines provide recommendations on the major modifiable lifestyle factors and chronic diseases. The best way to prevent cognitive impairment and its worsening include vascular risk control and a healthy diet including a balanced natural nutrition (without nutritional supplements for which scientific evidence is lacking), physical exercise (preferably aerobic), enough social participation, interaction and conviviality as well as cognitive exercise (focusing on general cognitive function, executive function and working memory) While the activation of all domains of lifestyle are critical for the achievement of the best preventive effects, these should be implemented 1) in a personalized, goal-oriented fashion (the so called tailored interventions) and 2) with the ultimate goal of maintaining the care of personal interests and functions along with quality of life and wellbeing.For an effective prevention of cognitive decline, resources from all domains of lifestyle (nutrition, exercise, rest, social participation, cognitive activity) should be used, however in a personalized way. The Comprehensive Geriatric Assessment (CGA), evaluating the physical, psychosocial and functional aspects of young-old, old-old and oldest-old persons, can be used to detect early cognitive impairment and factors associated with its course in order to modulate them., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: In Germany, the number of patients with dementia is expected to increase from 1.7 (2017) to more than 3 million people (2050). Preventive and therapeutic measures target at early stages of dementia such as mild cognitive impairment (MCI). Aim of the study is to compare prevalence rates of MCI and dementia over time., Methods: The study was based on the complete nation-wide outpatient claims data of the panel doctors services according to § 295 SGB V. We identified prevalent patients with MCI (PwMCI) and with dementia (PwD) in the years 2009 to 2016 treated by general practitioners or neuropsychiatric specialists., Results: The number of prevalent PwMCI/PwD increased from 50,760/1,014,381 (2009) to 166,919/1,416,319 (2016) and the corresponding prevalence rates from 0.13 % to 0.42 % (MCI) and from 2.52 % to 3.55 % (dementia), resp., Conclusion: Despite the significant prevalence gain, the number of PwMCI identified in outpatient health claims data is much lower than the expected number of 2,8 to 3,7 million people at the population level. Therefore, we anticipate a further increase in the number of PwMCI being treated in the outpatient sector over the coming years., Competing Interests: J. Bohlken erhielt innerhalb der letzten drei Jahre finanzielle Unterstützung von der Firma Dr. Willmar Schwabe und dem Berufsverband Deutscher Nervenärzte (BVDN) für Forschungsprojekte und Vortragstätigkeit. D. v. Stillfried und M. Schulz sind Mitarbeiter des Zentralinstituts für die kassenärztliche Versorgung in Deutschland (Zi). Träger des Zi sind die Kassenärztlichen Vereinigungen und die Kassenärztliche Bundesvereinigung., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Especially during admission the detection of cognitive deficits relevant to everyday life should burden patient and examiner as little as possible. The 6‑item screener (SIS) takes approximately 1 min, is easy to learn, does not require any material and is independent of the patient's visual and fine motor skills. The test was first published in 2002 by Callahan who approved the present German translation., Objective: We checked the convergent and discriminant validity, reliability and sensitivity to change of the German translation among geriatric patients., Material and Methods: A total of 165 patients in an acute geriatric department performed the SIS (4 times), the mini mental state examination (MMSE, 2 times), clock-drawing test according to Shulman (2 times), the Regensburg verbal fluency test (2 times) and the Montgomery-Åsberg depression rating scale within a period of 16 days. The overall judgment of a physician blinded to the test results served as the reference standard., Results: The SIS closely correlated with the medical judgment (-0.729). The retest reliability was 0.705 and the internal consistency 0.821 (Cronbach's alpha). The sensitivity to detect cognitive deficits relevant to activities of daily living was 100% if a threshold of 5 points was chosen. The achievement of maximum points largely rules out even mild cognitive impairment., Conclusion: The SIS is a valid, reliable short cognitive test. Using a threshold of 5 points the SIS detects cognitive deficits relevant to daily living with a higher sensitivity than the MMSE with a threshold of 25. When the maximum score is achieved there are no medical indications for further cognitive assessment of clinically unremarkable geriatric patients. The brevity and simple application of the SIS also enable its application outside geriatric wards.

Background: The rising prevalence of the burnout syndrome has increasingly moved it into the focus of scientific interest. In addition to emotional exhaustion and depersonalization, particularly reduced personal accomplishment has strong societal and economic effects. In recent years reduced personal accomplishment has increasingly been linked to cognitive impairment. However, up to now only a few studies have objectively assessed cognitive deficits in burnout patients. This article gives an overview of 16 studies which examined cognitive abilities in burnout patients. The findings are partly contradictory, probably due to methodical differences. Consensus has emerged concerning impairments of executive functions, i.a. vigilance, and memory updating and monitoring. Multifactorial causation may underlie the cognitive impairments., Outlook: Targeted longitudinal studies are necessary in order to identify the affected cognitive functions and be able to make causal inferences on links between the burnout syndrome and specific cognitive impairments.

Aim  To estimate the rate of progression of mild cognitive impairment (MCI) to dementia and to identify potential risk factors in patients in German primary-care practices. Methodology  From those seen at 723 general physicians' practices, this study included 4057 patients aged 40 years and above who were initially diagnosed with MCI between 2000 and 2014. The primary outcome was diagnosis of all-cause dementia recorded between the index date and the end of the five-year follow-up. Cox regression models were performed to examine MCI progression to dementia when adjusted for confounders (age, sex and health insurance type). Results  The mean age was 73.9 years. There were 43.9 % of men and 5.2 % of individuals with private health insurance coverage. There were 27.4 % of women and 25.7 % of men with dementia after the five-year follow-up (P = 0.192). The proportion of dementia increased with age from 6.6 % in the age group of ≤ 60 years to 39.0 % in the age group of > 80 years, with the hazard ratio increasing every additional year (HR = 1.06). Conclusion  About one out of four patients developed dementia in the five years following MCI diagnosis. Age but not sex or type of health insurance was associated with this higher risk., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: In recent years German long-term care insurance coverage has gradually been extended to include services for people with limitations in daily living skills. Until now, however, it was unclear who exactly people with limited daily living skills are., Aim: The study aimed to characterize people with limited daily living skills who use additional support services as defined by § 45b of the Social Services Code XI (SGB XI)., Material and Methods: This study was based on a survey of 1284 people with limited daily living skills who used additional support services (§ 45b SGB XI). The data were analyzed descriptively., Results: The average recipient was 81 years old, mainly in care level I and the majority of them were exclusively cared for by relatives. Of these recipients 61 % were diagnosed with dementia, 73.4 % had medium cognitive impairments while more than half could no longer carry out the instrumental activities of daily living (IADL)., Conclusion: Statistics on people with limited daily living skills should be included in publications and reports so that the need for care and assistance can be estimated more precisely.

Background: Studies on quality of life in people with mild cognitive disorders are rare and show inconsistent results., Methods: A representative population survey of 997 older individuals (60 - 69 y., 70 - 79 y., 80+ y.) was conducted. Study participants were interviewed face-to-face. Core instrument for the assessment of cognitive performance was the DemTect. Quality of life (QOL) was measured with the WHOQOL-BREF in four domains (physical, psychological, social, and environment domains) and the add-on module WHOQOL-OLD, which contains 24 items in six facets., Results: Older people with mild cognitive impairment showed a significantly reduced QOL compared to their cognitively healthy counterparts. This holds true for the physical, psychological, social, and environment domains of the WHOQOL-BREF and in five of the six facets covered by the instrument WHOQOL-OLD (with exception of the facet which assesses worries about death and dying). Influences of socio-demographic indicators and health related aspects on QOL are assessed., Conclusions: The fact, that mild cognitive disorders are associated with such a significant reduction in QOL for those affected, received little attention so far and may warrant interventions., (© Georg Thieme Verlag KG Stuttgart · New York.)

The prediction of Alzheimer's dementia is relevant for the development and design of prevention trials but also for individual counselling of patients. There are two key characteristics which determine the level of prediction that can be achieved. Firstly, the prevalence of Alzheimer's dementia in the respective setting is important. In low prevalence settings, such as primary care populations, it is probably impossible to achieve positive predictive values above 50%. In high prevalence settings, such as memory clinics, the positive predictive value of Alzheimer's dementia can be much higher. The second major characteristic is the level of cognitive impairment of an individual. The predictive power for Alzheimer's dementia increases from the cognitively healthy status to the status of progressive mild cognitive impairment. Prediction can further be increased by the use of cerebral spinal fluid and brain imaging biomarkers of Alzheimer's disease. The combination of different biomarkers may increase prediction even further. The present article reviews studies and outlines the principles of prediction of Alzheimer's dementia.

Objective: We sought to provide an overview on the assessment of mild cognitive impairment and dementia in epidemiological studies from Germany., Methods: We conducted a literature search in the databases Pubmed and PsycInfo., Results: Literature search identified 31 relevant studies using a broad spectrum of methods and neuropsychological instruments., Conclusion: Further efforts are necessary to establish a generally accepted core set of instruments enabling a harmonized assessment of mild cognitive impairment and dementia in epidemiological studies. Such a core set should comprise neuropsychological tests but also standardized questionnaires on subjective cognitive impairment and impairment in activities of daily living. If possible, third-party information (proxy interviews) should be included., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Demographic change calls for increased efforts in dementia research., Methods: A systematic analysis of a German-speaking psychiatric journal was performed., Results: 18.2 % of all papers published in were related to dementia and cognition., Conclusions: Dementia is a main issue; only papers regarding schizophrenia were more common. Health service research is largely lacking., (© Georg Thieme Verlag KG Stuttgart · New York.)