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The heterogeneity in the operationalisation of successful ageing (SA) hinders a straightforward examination of SA associations and correlates, and in turn, the identification of potentially modifiable predictors of SA. It is unclear which SA associations and correlates influence all facets of the SA construct, and whether psychosocial reserve models developed in neuropathological ageing research can also be linked to SA. It was therefore the aim of this study to disentangle the effect of various previously identified SA associations and correlates on (1) a general SA factor, which represents the shared underpinnings of three SA facets, and (2) more confined, specific factors, using bifactor modelling. The associations and correlates of three recently validated SA operationalisations were compared in 2478 participants from the German AgeCoDe study, aged 75 years and above. Based on participants’ main occupation, cognitive reserve (CR) and motivational reserve (MR) models were built. Younger age, male gender, more education, higher socio-economic status, being married or widowed, as well as more physical exercise and cognitive activities in old age were found to correlate positively with the general SA factor, indicating a simultaneous effect on all aspects of SA. Smoking and ApoE-ε4 were related only to the physiological facet of SA. CR models were significantly related to the general SA factor. Among all SA associations and correlates, proxy indicators of lifelong cognitive activity and physical exercise showed the strongest effects on SA. Future intervention studies should assess the influence of the preservation of active lifestyle across the life span on SA. Electronic supplementary material The online version of this article (10.1007/s10433-020-00593-4) contains supplementary material, which is available to authorised users.

Brain reserve (i.e., the ability of the brain to tolerate age- and disease-related changes in a way that cognitive function is still maintained) is assumed to be based on the lifelong training of various abilities. Motivational reserve (MR) is a form of brain reserve and can be defined as a set of motivational abilities that provide the individual with resilience to neuropathological damage. The first part of the chapter explains the term motivational processes and the model of MR and describes the measurement concept. The second part summarizes the results of several studies on the model of MR. For example, motivational abilities have been shown to be associated with a reduced risk of mild cognitive impairment and Alzheimer disease (AD) in apolipoprotein E ɛ4 carriers, but not in noncarriers. Revealing the mechanisms underlying the association of motivational abilities and cognitive decline may lead to novel strategies for delaying the onset of AD symptoms.

BACKGROUND: The present study aims to investigate the quality of the dyadic relationship between mild Alzheimer patients and their caregivers. The main objective is to evaluate the consistency, agreement and validity of the German version of the Scale for Quality of the Current Relationship in Caregiving (SQCRC). The secondary objective was to examine the association of relationship quality with quality of life (QOL) in patients with mild Alzheimer's disease (AD) and their caregivers. METHODS: In this study, a sample of 50 patients diagnosed with mild AD and their primary caregivers were included. Participants underwent a full neuropsychological evaluation. The quality of the relationship between persons with AD and their caregivers was assessed using the SQCRC. Furthermore, other scales of relationship quality, well-being of the person with AD, and well-being of the caregiver were used. RESULTS: The results showed that the SQCRC has a good internal consistency and high validity. Also, relationship quality as rated by the AD patients (r = 0.37, P

Traumatic experiences may affect an individual’s ability to exercise self-control, which is an essential characteristic for successfully managing life. As a measure of self-control, we used the delay discounting paradigm, that is, the extent to which a person devalues delayed gratification. The aim of this study was to investigate the relationship between childhood trauma and delay discounting using a control group design with elderly participants with a mean age of 76.2 years. Swiss former indentured child laborers (n = 103) who had been exposed to trauma during their childhood were compared with nontraumatized controls (n = 50). The trauma exposure group showed a considerably higher preference for immediate smaller rewards than the controls, indicating their lower self-control. A hierarchical regression analysis revealed that a history of abuse, current self-efficacy, and education were significantly associated with delay discounting. Implications for future research are discussed.

Background:Only a few population-based studies on the epidemiology of post-traumatic stress disorders (PTSDs) are available to date. Most of the existing studies are from the U.S.A. Against the background of World War II, the extent and long-term effects of war-related traumatic experiences in the German elderly population are of special interest. Nevertheless, population-based data on this topic are lacking to date.Methods:This study examines the occurrence of traumatic experiences and the prevalence rates of PTSD according to DSM-IV and of partial PTSD in a randomly selected sample of the German general population aged 60 years and over (N = 814) using self-rating instruments.Results:PTSD is apparent in 3.4%; when partial post-traumatic stress syndromes are included, a total of 7.2% of the aged population are involved. The most common individual symptoms resulting from war-induced trauma are avoidance of thoughts and feelings, sleep disturbances, distressing dreams and intrusive thoughts. The most frequently mentioned traumatic experiences of the generation examined in this study were war-related trauma experienced as children or in early adulthood during World War II. As a person's age increases, so does the prevalence of war-related traumatic experiences. There are some gender differences in traumatic experiences, but not in post-traumatic symptoms.Conclusion:The results emphasize the importance of war-related traumatic experiences from World War II in the German elderly population and their impact on the prevalence of PTSD more than 60 years later.

In der vorliegenden Arbeit werden Befunde zu Kompetenzen im Bereich der emotionalen Verarbeitung bei Patienten mit Alzheimer-Demenz zusammengefasst und deren mögliche Nutzung für psychosoziale Interventionen diskutiert. Anschliessend werden Hypothesen zur Bedeutung emotionaler Kompetenzen für die Wirkung bereits bestehender erfolgreicher psychosozialer Interventionen dargestellt. Zudem werden Empfehlungen für die Forschung und Praxis aus den dargestellten Befunden und Überlegungen abgeleitet.

Delay of gratification (DoG) refers to the ability to postpone immediate rewards in favor of later and better rewards. A successful DoG in children/adolescents is subject to the maturation of the lateral and medial prefrontal cortex which is more prone to normal age related atrophy compared with other brain regions. Therefore we investigated morphological brain correlates of DoG using structural MRI surface based morphometry as well as determined whether dorsolateral prefrontal cortex (DLPFC) atrophy is related to DoG in the elderly. We used the behavioral Delay of Gratification Test for Adults to measure DoG in 40 healthy older adults aged between 63 and 93 years. When simultaneously controlling for age and intracranial volume high DoG significantly positively correlated with cortical surface area of the left DLPFC. At a more liberal statistical threshold we found positive correlations between DoG and cortical thickness of the left and right DLPFC left and right ventrolateral prefrontal cortex and left midanterior cingulate cortex. Additionally cortical surface area in the left DLPFC correlated positively with DoG as well as with the volume of the left caudate nucleus. The results suggest that the DLPFC medial prefrontal cortex and the caudate nucleus play a crucial role in DoG in the elderly supporting studies in related constructs such as delay discounting and impulsivity. Further the study shows that age related prefrontal atrophy is associated with DoG performance. The findings are in line with concepts of "willpower" that postulate a central role of frontostriatal connectivity in self regulation and self control. (PsycINFO Database Record (c) 2014 APA all rights reserved).

OBJECTIVE: Discrepancy between self and caregiver apathy ratings was examined longitudinally for persons with mild cognitive impairment or Alzheimer's disease. Particular focus was on the distinction between the positive and negative caregiver bias and its predictive value for a clinical diagnosis of apathy. METHOD: Apathy rating discrepancy was based on the apathy evaluation scale. Dyads were categorized depending on whether the caregiver reported fewer deficits (positive caregiver bias) or more deficits (negative caregiver bias) than the cognitively impaired person did. RESULTS: Caregiver ratings and rating discrepancy showed a significant increase from baseline to follow up. By contrast self and clinician ratings showed no change across the two time points. Ratings with a negative caregiver bias remained stable while those with a positive caregiver bias showed a significant increase in the caregiver ratings but also a significant decrease in the self ratings. A negative caregiver bias at baseline was significantly related to greater likelihood of having clinical apathy at follow up adjusted for an array of control variables. CONCLUSION: Positive and negative caregiver bias should be distinguished as they seem to reflect distinct dyadic processes and are relevant for clinical outcome. Furthermore negative rating discrepancies can be considered a risk factor for developing apathy.

Background: Caregivers of individuals with dementia are biased in their rating of mental health measures of the care receiver. This study examines caregiver burden and depression as predictors of this bias for mild cognitive impairment and mild Alzheimer's disease in different domains.Methods: The sample consisted of 202 persons: 60 with mild cognitive impairment, 41 with mild Alzheimer's disease, and 101 caregivers. Discrepancy scores were calculated by subtracting the mean caregiver score from the respective mean patient score on the following assessment instruments: the Geriatric Depression Scale, Apathy Evaluation Scale, Bayer-Activities of Daily Living Scale, and Quality of Life-AD scale. Caregiver burden and depression were assessed by the Zarit Burden Interview and the Center for Epidemiologic Studies Depression Scale.Results: Intraclass correlation coefficients were low for apathy (0.38), daily functioning (0.38), and quality of life (0.30) and moderate for depression (0.49). These domains showed negative rating discrepancies, which indicates caregiver rating bias for all four domains. Regression analyses revealed that caregiver burden significantly contributed to explaining these discrepancies in the domains apathy, daily functioning, and quality of life.Conclusion: Caregiver rating bias can be attributed to caregiver burden. When caregiver burden is present, data based on caregiver ratings should therefore be interpreted with caution.

Self-regulation refers to the successful use of executive functions and initiation of top-down processes to control one’s thoughts, behavior, and emotions, and it is crucial to perform self-control. Self-control is needed to overcome impulses and can be assessed by delay of gratification (DoG) and delay discounting (DD) paradigms. In children/adolescents, good DoG/DD ability depends on the maturity of frontostriatal connectivity, and its decline in strength with advancing age might adversely affect self-control because prefrontal brain regions are more prone to normal age-related atrophy than other regions. Here, we aimed at highlighting the relationship between frontostriatal connectivity strength and DoG performance in advanced age. We recruited 40 healthy elderly individuals (mean age 74.0±7.7 years) and assessed the DoG ability using the German version of the delay of gratification (DoG) test for adults in addition to the delay discounting (DD) paradigm. Based on diffusion-weighted and resting-state functional magnetic resonance imaging data, respectively, the structural and functional whole-brain connectome were reconstructed based on 90 different brain regions of interest in addition to a 12-node frontostriatal DoG-specific network and the resulting connectivity matrices were subjected to network-based statistics. The 90-nodes whole-brain connectome analyses revealed subnetworks significantly associated with DoG and DD with a preponderance of frontostriatal nodes involved suggesting a high specificity of the findings. Structural and functional connectivity strengths between the putamen, caudate nucleus, and nucleus accumbens on the one hand and orbitofrontal, dorsal and ventral lateral prefrontal cortices on the other hand showed strong positive correlations with DoG and negative correlations with DD corrected for age, sex, intracranial volume and head motion parameters. These associations cannot be explained by differences in impulsivity and executive functioning. This pattern of correlations between structural or functional frontostriatal connectivity strength and self-control suggests that, in addition to the importance of the frontostriatal nodes itself, the structural and functional properties of different connections within the frontostriatal network are crucial for self-controlled behaviors in the healthy elderly. Because high DoG/low DD is a significant predictor of willpower and wellbeing in the elderly population, interventions aiming at strengthening frontostriatal connectivity to strengthen self-controlled behavior are needed in the future.

Life-review therapy has been recognized as an effective therapeutic approach for depression in older adults. Additionally, the use of new media is becoming increasingly common in psychological interventions. The aim of this study was to investigate a life-review therapy in a face-to-face setting with additional computer use. This study explored whether a six-week life-review therapy with computer supplements from the e-mental health Butler system constitutes an effective approach to treat depression in older adults aged 65 and over. A total of 36 participants with elevated levels of depressive symptoms were randomized to a treatment group or a waiting-list control group and completed the post-assessment. Fourteen individuals in the intervention group completed the follow-up assessment. Analyses revealed significant changes from pre- to post-treatment or follow-up for depression, well-being, self-esteem, and obsessive reminiscence, but not for integrative reminiscence and life satisfaction. Depressive symptoms decreased significantly over time until the three-month follow-up in the intervention group compared to the control group (pre to post: d = 1.13; pre to follow-up: d = 1.27; and group × time effect pre to post: d = 0.72). Furthermore, the therapy led to an increase in well-being and a decrease in obsessive reminiscence among the participants in the intervention group from pre-treatment to follow-up (well-being: d = 0.70; obsessive reminiscence: d = 0.93). Analyses further revealed a significant but small group × time effect regarding self-esteem (d = 0.19). By and large, the results indicate that the life-review therapy in this combined setting could be recommended for depressive older adults.

Objectives: This is the first study to estimate the prevalence of adjustment disorder (AjD) in the general population. A new conceptualisation of AjD as a stress response syndrome was applied, which allowed AjD to be assessed directly from its symptom profile, including intrusive, avoidance and failure-to-adapt symptoms (Maercker et al., Psychopathology 40:135-146, 2007). Methods: Prevalence rates of distressing life events and AjD were estimated from a representative sample of the German general population (n=2,512) with a broad age range (14-93years). A questionnaire including a life events checklist and self-rating questions that assessed AjD symptoms and symptom duration were personally handed out by an interviewer. Results: The prevalence of AjD fulfilling the criterion of clinically significant impairment was 0.9%; a further 1.4% of the sample was diagnosed with AjD without fulfilling the impairment criterion. In ~72.5% of AjD cases, symptoms had developed 6-24months prior to assessment. AjD was most often associated with acute events such as moving or chronic stressors such as serious illness, conflicts at the respondent's job or with friends or neighbours (with ~5% conditional probability each). Conclusions: The results correspond with the few other studies that have examined the prevalence of AjD, even though a new conceptualisation of the disorder was used. Explorative results regarding the duration of AjD syndromes and symptoms call for further redefinition and empirical investigation of this under-researched mental condition

This study integrated results from controlled trials of reminiscence interventions.Meta-analysis was used to aggregate results from 128 studies on 9 outcome VARIABLES.Compared to non-specific changes in control-group members, moderate improvements were observed at posttest with regard to ego-integrity (g=0.64) and depression (g=0.57 standard deviation units). Small effects were found on purpose in life (g=0.48), death preparation (g=0.40), mastery (g=0.40), mental health symptoms (g=0.33), positive well-being (g=0.33), social integration (g=0.31), and cognitive performance (g=0.24). Most effects were maintained at follow-up. We observed larger improvements of depressive symptoms in depressed individuals (g=1.09) and persons with chronic physical disease (g=0.94) than in other individuals, and in those receiving life-review therapy (g=1.28) rather than life-review or simple reminiscence. Moderating effects of the control condition were also detected.Reminiscence interventions affect a broad range of outcomes, and therapeutic as well as preventive effects are similar to those observed in other frequently used interventions.

Storungsmodelle in der Verhaltenstherapie beziehen nicht nur lerntheoretische und kognitive Konzepte sondern auch gerontologische Konzepte mit ein. Daher werden zunachst das alters- und storungsspezifische Rahmenmodell sowie das Modell der selektiven Optimierung mit Kompensation dargestellt. Insbesondere sind erschwerende Faktoren wie Multimorbiditat, Verluste, Fahigkeitseinschrankungen sowie erleichternden Faktoren wie Bewaltigungs- und Lebenserfahrung, angepasste Wohlbefindensregulation relevant. Interventionen in der Altersverhaltenstherapie sind zum einen Modifikationen bestehender Verfahren, die in diesem Artikel fur die Behandlung von Depression, Angst und Traumafolgen dargestellt werden. Zum anderen gibt es speziell fur diese Altersgruppe neu entwickelte Verfahren. Hier wird die Lebensruckblicksintervention beschrieben, die gut in einen verhaltenstherapeutischen Gesamtbehandlungsplan eingebettet werden kann. Ein Fallbeispiel illustriert das Vorgehen dieser Intervention. Schliesslich gibt es einige Storungen und Problemen, die in jungeren Altersgruppen nicht vorhanden sind, von denen hier die Fallangst und ihre Behandlung dargestellt werden.

Background About 90 % of all persons with mild Alzheimer’s disease experience neuropsychiatric symptoms, most frequently apathy, depression, anxiety and irritability. These symptoms are associated with greater morbidity, a reduced quality of life for the patient, an increased burden and depression for the caregiver, and higher costs of care and nursing home placement. Psychosocial interventions based on behaviour therapy represent the most efficacious treatment of neuropsychiatric symptoms. However, there is no study, to our knowledge, that has evaluated a multicomponent treatment programme based on comprehensive, cognitive behavioural therapy (CBT). This randomized controlled trial aims to evaluate a CBT-based treatment programme consisting of 8 modules and 25 sessions. Methods/design Fifty patients with mild Alzheimer’s disease alone or with mild mixed dementia (Alzheimer’s disease and vascular dementia) who have any neuropsychiatric symptom will be included. A caregiver must be available. The patients and their caregivers will be randomized to either the CBT-based intervention group or to the control condition group, which receives treatment as usual. The primary outcome measure is depression in the patient with Alzheimer’s disease. The secondary outcome measures for a person with Alzheimer’s disease are other neuropsychiatric symptoms, quality of life and coping strategies. The secondary outcome measures for a caregiver are caregiver’s burden, depression, anxiety, anger, quality of life and coping strategies. Neuropsychological testing includes tests of cognitive function and activities of daily living and a global clinical assessment of severity. Participants in both groups will be assessed before and after the treatment phase (lasting approximately 9 months). Follow-up assessments will take place 6 and 12 months after treatment. All assessments will be conducted by blinded assessors. Discussion This trial has the potential to establish an empirically based psychological treatment for non-cognitive symptoms that reduce the quality of life of a person with dementia and a caregiver. This treatment approach focuses not only on the person with dementia, but also on the caregiver and on the dyad. The treatment manual will be published and training workshops will be offered, so that the information can be widely spread among healthcare professionals. Trial registration ClinicalTrials.gov NCT01273272.

Zusammenfassung: Als Ergänzung zur psychopathologisch orientierten Diagnostik zieht seit einiger Zeit die Beschäftigung mit Stärken, Kompetenzen und Ressourcen einer Person Aufmerksamkeit auf sich, zuletzt unter den Bemühungen der Positiven Psychologie. Gerade die Alterspsychotherapie kann von einer Ressourcenorientierung profitieren. Dieser Artikel verfolgt zum einen das Ziel, Instrumente zur Diagnostik verschiedener Ressourcen darzustellen, zum anderen Befunde zu positiven Konsequenzen dieser Ressourcen im Alter zusammenzufassen. Berücksichtigt werden emotionale Ressourcen (positiver Affekt, Lebenszufriedenheit, Selbstwerterleben), motivationale Ressourcen (Kontrollüberzeugung, Selbstwirksamkeitserwartung, dispositionaler Optimismus, optimistischer Attributionsstil, Hoffnung, intrinsische Lebensziele), volitionale Ressourcen (Handlungsorientierung, Selbstregulation und Selbstkontrolle, Aufmerksamkeitsregulation, Emotionsregulation), interpersonale Ressourcen (Bindung, Altruismus, soziale Verantwortung, Vergebung, Humor) und soziale Ressourcen (soziales Netzwerk, soziale Unterstützung, Partnerbeziehung). Diskutiert wird die Notwendigkeit einer Diagnostik der Ressourcen in der Psychotherapie, vorgeschlagene Änderungen am DSM-IV und Schlussfolgerungen für geplante Forschungsprojekte.

Hintergrund: Selbstkontrolle ist ein in der Verhaltenstherapie weit verbreitetes Konzept, die Effektivitat der Techniken der Selbstkontrolle ist gut belegt. In der Volitionsforschung wird der Selbstkontrolle als der selbstdisziplinierenden Volitionsform die Selbstregulation als die selbstintegrierende Volitionsform gegenubergestellt. In dieser Studie sollen diese Volitionsformen hinsichtlich Gefuhlswahrnehmung, Affektivitat, psychischen und korperlichen Beschwerden (Komorbiditat) sowie Therapieerfolg uberpruft werden. Patienten und Methode: Bei 1018 Patienten einer psychosomatischen Fachklinik wurden zu Beginn der Rehabilitation der volitionale Stil sowie psychische und korperliche Beschwerden erhoben, bei 242 Patienten zusatzlich Variablen der Gefuhlswahrnehmung und der Affektivitat. Die Beschwerden wurden auch nach der Rehabilitation erfasst. Alle Patienten wurden in eine von vier Subgruppen des volitionalen Stils eingeteilt: selbstregulierend, selbstkontrollierend, lageorientiert, handlungsorientiert. Der «volitionale Stil» wurde als 4-stufiger Faktor in 1-faktoriellen Varianzanalysen verwendet und Mittelwertsvergleiche zwischen selbstregulierenden und selbstkontrollierenden Patienten wurden angeschlossen. Ergebnisse: Selbstregulierende Patienten haben signifikant weniger Schwierigkeiten bei der Identifikation von Gefuhlen, weisen mehr positive und weniger negative Emotionen auf und sind weniger depressiv und symptombelastet. Sie erreichen zudem einen signifikant besseren Rehabilitationserfolg hinsichtlich Depressivitat, Erschopfung und korperlichem Beschwerdedruck. Keine Unterschiede zwischen Selbstregulation und Selbstkontrolle finden sich hinsichtlich des extern orientierten Denkstils und der korperlichen Beschwerden zu Beginn der Therapie. Schlussfolgerungen: Die Ergebnisse zeigen sehr deutlich die negativen Konsequenzen chronischer Selbstkontrolle und die Uberlegenheit von Selbstregulation. Selbstkontrolle ist nur so lange adaptiv, wie sie als Verhaltensoption verfugbar ist und nur vorubergehend eingesetzt wird. Langfristig ist Selbstregulation gesunder und daher prinzipiell der Selbstkontrolle vorzuziehen.

Objectives: This study investigates the impact of occupation-based motivational processes and social network variables on the incidence of dementia over 8 years. Method: Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based longitudinal study of individuals aged 75 years and older (n = 1692 at baseline). Motivational processes were estimated based on the main occupation using the Occupational Information Network database. Results: In a Cox proportional hazard model, motivational processes were not associated with the risk of dementia (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74-1.16). Individuals with a higher frequency of social contact at baseline had a significantly lower risk of dementia (HR: 0.96, 95% CI: 0.91-0.99), while proximity of social contacts was not linked to the risk of dementia (HR: 1.03, 95% CI: 0.98-1.08). In individuals with low indices of motivational processes, the frequency of social contacts was associated with a lower risk of dementia (HR: 0.94, 95% CI: 0.88-1.00). On the other hand, proximity of social contacts was linked to a higher risk of dementia in individuals with high indices of motivational processes (HR: 1.09, 95% CI: 1.01-1.19). Discussion: Results indicate that the frequency and proximity of social contacts have a differential impact on the risk of dementia according to lower or higher indices of motivational processes, while the impact of motivational processes on risk of dementia could not be confirmed. Future studies should carefully disentangle different aspects of social interactions and their association with motivational processes.

This study investigates the role of a motivational process based on a composite of four subcomponents (self-efficacy, decision regulation, activation regulation and motivation regulation), as a mediator of the relationship between social support and depression assessed with the Geriatric Depression Scale in cognitively impaired and unimpaired individuals. Participants were 229 adults with a mean age of 74 years (range: 52–94 years). The sample comprised 64 participants diagnosed with mild cognitive impairment (MCI), 47 participants diagnosed with early-stage Alzheimer’s disease (AD), and a group of 118 participants without any cognitive impairment. In this cross-sectional study, bivariate correlations and linear regression models were used to assess the association between the predictor variables and depression. Linear regression models were controlled for age, gender, education, cognitive status, cognitive impairment and activities. In the total sample, social support (β = −0.15, p

Das Erinnern und Erzahlen von Geschichten ist ein besonderes Merkmal menschlichen Erlebens und Handelns. Der Schriftsteller Max Frisch (1998) glaubte, dass sich jeder Mensch fruher oder spater eine Geschichte erfinde, die er, selbst unter gewaltigen Opfern, fur sein Leben halte, obwohl sie doch letztlich eine Fiktion sei.

SummaryVarious research approaches try to solve the puzzles related to dementia or healthy brain ageing. Neurogenetic, neuroimaging and neuropharmacological research are the most visible of these. Psychological research in dementia has been instrumental in improving familial or institutional care. However, it has not been regarded as basic research. Recent psychological research into the mechanisms of co-forming or shaping the clinical presentation of dementias can be counted as truly basic research. The ‘cognitive or brain reserve’ concept has been fruitful in implementing psychological knowledge on plasticity factors in dementia. The new concept of ‘motivational reserve capacity’ extends these psychological concepts. In particular, it provides a basis for integrating various findings on how lifestyle factors effectively shape clinical dementia presentations – or lead to healthy brain ageing.

Apathy and depression are the most common neuropsychiatric symptoms in mild cognitive impairment (MCI) and Alzheimer disease (AD). This study was the first to explore midlife motivational abilities as a predictor of the progression of apathy and depression in MCI and AD. It used a subsample of the Aging, Demographics, and Memory Study (N = 137). Participants, aged over 70, were categorized according to baseline clinical diagnosis (normal cognition, MCI, or AD). Assessments were conducted at an 18-month interval. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory. Midlife motivational abilities were estimated on the basis of the main occupation using the Occupational Information Network (O*NET) database, which provides detailed information on worker abilities. Repeated measures analysis of covariance was used. Apathy and depression were found to be particularly high in participants with AD and high motivational abilities. Apathy, but not depression, increased over time in those with AD and high motivational abilities. It would appear that holding on to unattainable goals with strong motivational efforts when faced with severe cognitive loss might lead to unproductive persistence, depressive reaction, and more apathetic behavior.

Stress response syndromes like adjustment disorders or complicated grief are assumed to be shaped by social-cultural factors in addition to biological and psychological factors. In previous research, value orientations and interpersonal factors were found to jointly predict those syndromes (Maercker, A., Mohiyeddini, C., Müller, M., Xie, W., Hui Yang, Z., Wang, J.,Müller, J. ( 2009 ). Traditional versus modern values, self-perceived interpersonal factors, and posttraumatic stress in Chinese and German crime victims. Psychology and Psychotherapy, 82(Pt 2), 219-232.). In addition to the previous finding, the current study using Swiss elderly (65-97 years) aimed to replicate patterns of predictors leading to stress responses in people with recent bereavement or severe life events. Traditional (conformity, tradition and benevolence) and modern values (stimulation, hedonism and achievement) and two self-perceived interpersonal mediator processes (disclosure intentions and social acknowledgement as a victim) were assessed. The current study confirms the previous model in parts, that is, the indirect path from social acknowledgment to stress response syndrome is mediated by disclosure intentions. Traditional values and not modern values explained substantial variance for disclosure intentions and are therefore indirectly linked to worse mental health outcomes whereas the direct association appears somewhat controversial in light of previous findings.

Most previous delay of gratification tests were developed for children and are inappropriate for application in adults. The authors therefore developed the Delay of Gratification Test for Adults (DoG-A), which includes four types of reward that are meaningful to adults, namely snacks, real money, hypothetical money, and magazines. Four subscores and two composite scores can be calculated. This study is the first to evaluate the DoG-A and to investigate its association with external variables. A community sample of 147 cognitively healthy participants aged between 60 and 94 years completed a questionnaire and cognitive tests measuring delay discounting, self-regulation, motivational self-concept, personality, wellbeing, and cognitive function. The intercorrelations of the subscales were low to medium and the internal consistency of the composite scores was moderate (α = .4), indicating relative domain independence of the four reward types. The nomological net established by investigating the relations of the DoG-A with other constructs proved to be fairly meaningful. The correlations of all subscales with the delay discounting rate were significant and moderate. The Snacks subscale showed the most consistent pattern of results in terms of moderate positive correlations with self-reported motivation regulation, optimism, dutifulness, and deliberation. The Snacks subscale also correlated with various measures of wellbeing. A regression analysis showed that DoG Snacks remained a significant predictor of wellbeing when self-reported self-regulation and other variables were controlled. These findings indicate that the DoG-A yields an interpretable behavioral measure of self-motivation and offers a developmentally adequate extension of the delay of gratification paradigm for use with adults.

Delay discounting procedures are used to assess self-control vs. impulsivity on a behavioural level. Such procedures include a presentation of a series of choices between smaller, immediate and larger, delayed rewards. The Delay Discounting Test (DDT) by Kirby is an elegant and relatively short procedure. A German DDT version was evaluated in a sample of 147 older and healthy individuals (60-94 years). The discounting rate is in the magnitude of the American version. Its consistency was very high. The largest correlation to external criteria was found for delay of gratification, but also for activation regulation, order, and impulsivity. Further, the discounting rate correlated with anxiety and negative affect, but not with depression and cognitive functioning. Criterion validity and reliability of the DDT could be confirmed. A comprehensive assessment of self-control or impulsivity should include behavioural measures like the DDT besides self-report measures.

The authors recently developed the concept of motivational reserve, which implies a set of motivational abilities that provide individuals with resilience to neuropathological damage. This study investigated how lifetime motivational abilities are associated with current cognitive status, mild cognitive impairment, and psychological well-being in old age. A community sample of 147 participants without dementia between 60 and 94 years of age, stratified for age group, sex, and education, completed motivation and well-being questionnaires and cognitive tests. A new procedure was used to estimate their midlife motivational and cognitive abilities on the basis of their main occupation using the Occupational Information Network (O*NET) system. O*NET-estimated motivational abilities predicted cognitive status, psychological well-being, and odds of mild cognitive impairment, even when age, sex, education, and cognitive ability were controlled. Although O*NET-estimated cognitive abilities were not significant predictors, scores on a measure of crystallized intelligence were associated with current cognitive status and odds of mild cognitive impairment. Findings suggest that motivational reserve acts as a protective factor against the manifestation of cognitive impairment and emotional problems in later life.

Objectives To examine posttraumatic growth (PTG) and its predictors social acknowledgment as survivors, sense of coherence (SOC), trauma severity, and further factors in former child soldiers more than 60 years after deployment. Design Cross-sectional. Setting University-based geropsychiatric center in Germany. Participants One hundred three former German child soldiers of World War II, mean age 78 years in which 96% experienced at least one war trauma. Measurement Subjects completed the Posttraumatic Growth Inventory, Social Acknowledgment Questionnaire (SAQ), and SOC Scale. Trauma exposure and posttraumatic stress disorder (PTSD) symptoms were assessed by the Posttraumatic Diagnostic Scale. Depression, anxiety, and somatization were assessed using the Brief Symptom Inventory. Results Number of traumas, recognition by significant others, and general disapproval as facets of social acknowledgment as a survivor, and meaningfulness as a dimension of SOC correlated significantly with PTG. In a multiple hierarchical regression analysis, recognition as a survivor by significant others (SAQ) and meaningfulness (SOC) remained the only significant predictors of PTG. Conclusion Social acknowledgment as a survivor by significant others and the belief that the world is meaningful are among the most important factors contributing to PTG. Further research should investigate whether treatments of PTSD in people who experienced war traumas recently or many years ago might benefit from a focus on the belief system and the role of family and social support.

This article summarises empirical findings on major potentially modifiable risk factors in the development of Alzheimer’s disease (AD), drawing on data from longitudinal epidemiological studies on the incidence of AD or any-cause dementia. Risk factors investigated to date include cognitive ability, motivational ability, emotional health, physical activity, social activity and social network, vascular risk factors and nutrition. The authors find most empirical support for two main clusters of risk factors that also represent potential targets for prevention. First, an active and stimulating lifestyle including cognitive, social, and physical activities reduces the risk of AD. Second, the absence of vascular risk factors such as diabetes, hypertension, hypercholesterol and obesity reduces the risk of AD. More prevention trials are warranted to investigate the preventative effects of an active and stimulating lifestyle on the one hand, and vascular health on the other, in delaying the onset of AD or slowing its progression.

Die Reservekapazität des Gehirns ist seine Fähigkeit, neuropathologische Veränderungen so zu tolerieren, dass ihre klinische Manifestation hinausgezögert wird. Diese Studie untersucht, inwiefern frühere motivationale („motivationale Reserve“), kognitive und körperliche Fähigkeiten bzw. Aktivitäten unabhängige Prädiktoren einer leichten kognitiven Beeinträchtigung im Alter sind. Eine Stichprobe von 147 nicht-dementen Personen zwischen 60 und 94 Jahren absolvierte kognitive Tests und Fragebogen zur Berufsbiographie sowie früheren körperlichen Aktivitäten. Frühere motivationale und kognitive Fähigkeiten wurden auf der Basis des Hauptberufs unter Anwendung der Datenbank des Occupational Information Networks (O*NET) geschätzt. Die früheren motivationalen Fähigkeiten und die kristallisierte Intelligenz sagten ein reduziertes Risiko einer leichten kognitiven Beeinträchtigung voraus, nicht aber frühere körperliche Aktivitäten. Die Ergebnisse legen nahe, dass insbesondere die motivationale Reservekapazität als protektiver Faktor gegen kognitive Beeinträchtigung im Alter wirkt.

Volitional competences (skills of will), including self-regulation skills such as self-motivation and emotion regulation and self-control skills such as impulse control, are particularly necessary for patients with psychiatric and psychosomatic disorders. The Volitional Components Questionnaire (VCQ) is an instrument designed to measure volitional competences. However, its length of 190 items prevents its routine application in clinical settings. This study evaluates a new 36-item short form of the VCQ. 1018 inpatients of a psychosomatic rehabilitation clinic completed the VCQ and several measures of psychopathology, personality, and cognitive ability. Exploratory factor analysis identified six factors. Confirmatory factor analysis showed that the VCQ-36 shared several volitional components with the original VCQ. Most of the self-regulation competences correlated negatively with psychopathological measures such as depression, as well as with neuroticism, social inhibitedness, and excitability, and positively with extraversion. Impulse control was also negatively associated with neuroticism and excitability. No meaningful correlation with cognitive ability was observed. The VCQ-36 is a reliable and valid instrument for assessing volitional competences and is well suited for routine application in clinical settings.

Based on a new psychopathological model of adjustment disorders (AJD), we propose that AJDs are particular forms of stress response syndromes, in which intrusions, avoidance of reminders, and failure to adapt are core symptoms. We aim to demonstrate that these AJD symptom groups constitute a disorder that is distinct from posttraumatic stress disorder (PTSD), complicated grief disorder, major depressive disorder, and subsyndromal depression, by estimating their prevalence and comorbidities. A representative sample of elderly persons from Zurich, aged 65 to 96 years, was assessed by standardized interviews or self-report questionnaires. Index events for AJD were indicated by 52% of the sample set, with a 2.3% current prevalence of AJD. Prevalence rates for other disorders were 0.7% PTSD, 4.2% subsyndromal PTSD, 4.2% complicated grief disorder, 2.3% major depressive disorder, and 9.3% subsyndromal depression. The comorbidity rate for AJD and other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition disorders is 46%, and that between AJD and subsyndromal disorders is 38%. Use of mental health care for AJD is low. This article concludes that the new concept of AJD constitutes a meaningful psychopathological model and thus warrants a place in standardized psychiatric taxonomies. Although this study was restricted to a sample of the elderly, it provides evidence regarding AJD prevalence, comorbidity, and associated health care use, all of which indicate its utility.

Background: Although skills of will (volitional competences), such as self-motivation or emotion regulation, are particularly necessary for patients with psychiatric and psychosomatic disorders, it is unknown whether volitional deficits can be reduced and thereby the efficacy of psychotherapy increased. We investigated the effect of a group therapy for improving volitional competence in an inpatient rehabilitation program. Methods: In a controlled clinical trial, patients from a rehabilitation clinic participated either in the volition group therapy in addition to the standard cognitive behavioral therapy (volition group, VG) or in the standard cognitive behavioral therapy (standard group, SG). Patients were tested for volitional competence, depressive symptoms, total psychiatric symptomatology, and physical complaints prior to, at the end of inpatient therapy and after 6 months of follow-up (n = 242). Results: At the end of inpatient therapy, better improvement in volitional competence was observed in the VG than in the SG [e.g. self-motivation: effect size (ES) 0.96 vs. 0.39; ANCOVA: F(1, 209) = 16.58; p < 0.001]. Patients with greater volitional improvements had a better rehabilitation outcome. In the VG, depressive symptoms as well as total psychiatric symptomatology decreased significantly more than in the SG [ES: 1.18 vs. 0.87, F(1, 207) = 4.68, p < 0.05, and ES 1.12 vs. 0.73, F(1, 205) = 4.68, p < 0.05, respectively], but not physical complaints [ES: 0.62 vs. 0.48, F(1, 207) = 1.08, n.s.]. Conclusions: Effect size increased in patients with initially low volitional competence and high motivation to participate in a volitional training. These results might lead to a more systematic assessment and training of volitional competence.

Background To date, there are mainly two diagnostic systems that have been proposed for the diagnosis of Complicated Grief [Horowitz, M.J., Siegel, B., Holen, A., Bonanno, G.A., Milbrath, C., Stinson, C.H., 1997. Diagnostic criteria for complicated grief disorder. American Journal of Psychiatry 154, 904–910; Prigerson, H.G., Shear, M.K., Jacobs, S.C., Reynolds, C.F., Maciejewski, P.K., Davidson, J.R., Rosenheck, R., Pilkonis, P.A., Wortman, C.B., Williams, J.B., Widiger, T.A., Frank, E., Kupfer, D.J., Zisook, S., 1999. Consensus criteria for traumatic grief: A preliminary empirical test. British Journal of Psychiatry 174, 67–73]. There is also no data about prevalence rates of Complicated Grief in a representative sample. The purpose of this study was to compare the diagnostic systems with regard to prevalence, conditional probabilities, and agreement. Methods In a sample of elderly persons, features of bereavement, diagnoses of Complicated Grief and related symptoms were assessed. Agreement between the diagnostic systems was determined by kappa statistics. Results 18.9% of the sample had experienced a major bereavement, in average 15 years before measurement. The prevalence rates were 4.2% (Horowitz et al.) and 0.9% (Prigerson et al.). The agreement was poor (kappa = .13), i.e. the minority of cases received both diagnoses. The conditional probabilities of developing CG after experiencing a major bereavement were 22.2% (Horowitz et al.) and 4.6% (Prigerson et al.). Limitations The findings are constrained to an elderly, urban population. Screening instruments, no clinical interviews, were used to assess psychopathology. Conclusions The Horowitz et al. criteria set is more inclusive and less strict than the Prigerson et al. criteria set. The importance of functional impairment and the number of symptoms needed account for this difference. Further research should integrate diagnostic systems in order to achieve international standardization of diagnostic criteria for Complicated Grief.

In some regions of the world, torture continues to be a largescale phenomenon. In order to make reliable statements about its consequences and thus, among other things, also to gain political arguments against torture, the examined datasets should be as comprehensive as possible and the methodology as sophisticated as possible. Otherwise, this area is exposed to the latent or open accusation that one cannot conduct good research with benevolence alone. In reviews or meta-analyses, various groups of authors have undertaken a summary of the results of individual studies in order to reach such methodologically reliable statements. Of particular value in theoretical and methodological terms, moreover, are culturally sensitive approaches that apply those sophisticated methods. Steel et al. (2009) presented a systematic review and meta-analysis. Their goal was to assess the most reliable estimates on prevalences of posttraumatic stress disorder (PTSD) and depressive disorder after torture and other potential traumatic events in refugee and post-conflict mental health settings. Particular emphasis was put on methodological factors that may explain differences of PTSD or depression estimates in primary studies (0–99% for PTSD, 3–85% for depression). Torture and torture sequelae were measured in most studies by the Harvard Trauma Questionnaire (Mollica et al., 1992), an instrument that is now available in almost 50 languages. The meta-regression analyses included 181 primary studies comprising approximately 82,000 persons from 40 countries. Methodological variance accounted for 13% and 28% in PTSD and depression, respectively. Methodological variance resulted from nonrandom sampling (9%), small sample sizes (43–55%), and self-report questionnaires (25–34%), which were all associated with higher prevalences of the disorders. Diagnostic time frame resulted in additional attributable variance (22%/31%), with 12-month or lifetime prevalence estimates reporting lower rates of disorders. In this way, methodologically sound prevalences for torture-related PTSD and depression were indicated, which can currently be seen as the most reliable and valid in the whole of the specialist literature. These are 30% for PTSD and 31% for depression (also conditional probabilities). Unfortunately, Steel et al. (2009) did not indicate any value for the area of overlap or the comorbidity. If one compares the conditional probability for PTSD in the refugee samples with other conditional probabilities following traumatic events from other studies, 30% is high, but not the highest value (cf. Maercker, Forstmeier, Wagner, Glaesmer, &

If, as suggested, creative (insight) problem solving is less systematic and employs less planning than analytical problem solving, the former requires substantially less working memory (WM) than the latter. Subjects simultaneously solved problems and counted auditory stimuli (concurrent WM task), in response to which ERPs were recorded. Counting disrupted analytical, but not creative performance. Peak and time-window average P300 were more frontal during analytical problem solving as compared to insight or counting tones only (control). A PCA extracted two factors in the P3 range, one frontal and one broad left-lateralized, which distinguished analytical from creative problem solving. The findings indicate distinct processing pathways for the two types of tasks with more WM involvement in analytical tasks.

OBJECTIVES: To examine whether delay discounting (DD) develops differently within individuals diagnosed with mild cognitive impairment (MCI) or mild Alzheimer's disease (AD). METHOD: We set out to study trajectories of DD in N = 111 older adults (Mage = 75.2 years, range: 55-94, 53% female) with MCI (n = 64) or mild AD (n = 47). Data were repeatedly assessed on three measurement times over a period of 2 years. RESULTS: Results indicated a meaningful difference in the trajectories of DD between MCI and mild AD (t = 2.99, p = .004), with AD patients displaying higher DD rates compared with MCI. Lower intelligence (t = -2.50, p = .013) was related to higher DD. We also found reward-dependent group differences in DD (small: p = .079; medium: p = .258; large: p = .007). Age, functional ability, general cognitive ability, living situation, and marital status were not meaningfully linked to DD (all non significant). Further explorative analyses revealed an increase in DD in patients whose cognitive symptoms had progressed at time 2, compared with more stable courses of mild AD or MCI (diagnosed at time 2). DISCUSSION: Our results point toward an increase in DD as a function of advanced cognitive decline.