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1. Determinants of health-related quality of life in older primary care patients: results of the longitudinal observational AgeCoDe Study.

Author

Eisele M, Kaduszkiewicz H, König HH, Lange C, Wiese B, Prokein J, Weyerer S, Werle J, Riedel-Heller SG, Luppa M, Heser K, Koppara A, Mösch E, Weeg D, Fuchs A, Pentzek M, Maier W, Scherer M, and Hajek A

Subjects
Aged, Aged, 80 and over, Chronic Disease psychology, Comorbidity, Depression psychology, Educational Status, Female, Germany epidemiology, Humans, Longitudinal Studies, Male, Prospective Studies, Quality of Life psychology, Chronic Disease epidemiology, Depression epidemiology, Health Services for the Aged, Primary Health Care
Abstract

Background: In older patients with chronic diseases, focusing on subjective, patient-relevant outcomes, such as health-related quality of life (HRQoL), is more pertinent than pursuing clinical or laboratory target values., Aim: To investigate factors influencing the course of HRQoL in older (aged ≥78 years) primary care patients and to derive non-pharmacological recommendations for improving their quality of life., Design and Setting: A population-based prospective longitudinal observational study featuring data analysis from waves 2 to 5 of the AgeCoDe study, which was conducted in six cities in Germany., Method: The HRQoL of 1968 patients over the course of 4.5 years was observed. Patients were, on average, aged 82.6 (±3.4) years and their HRQoL was measured using the EQ-5D visual analogue scale in a face-to-face assessment. Fixed-effects regression models were calculated to examine impact of change in potential influencing factors. This method allows unobserved heterogeneity to be controlled., Results: The course of the participants' HRQoL declined with increasing age, walking and incident hearing impairment. Increasing the number of physical activities improved the HRQoL. These findings were modified by sex, education level, and depression. Especially in females and patients with rather low education levels, increased physical activity improved the subjects' HRQoL, while hearing impairment decreased it. Moving to an institution only improved the HRQoL in patients without depression or those with a low level of education (primary education)., Conclusion: Motivating patients to increase their weekly physical activity and to focus on preserving their ability to walk are promising approaches to improving HRQoL in older age. Less-educated patients and those without depression can also benefit from moving into an institution (for example, a care or retirement home)., (© British Journal of General Practice 2015.)

Published
2015
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2. Complex coevolution of depression and health-related quality of life in old age.

Author

Hajek A, Brettschneider C, Ernst A, Lange C, Wiese B, Prokein J, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Bickel H, Mösch E, Heser K, Jessen F, Maier W, Scherer M, Riedel-Heller SG, and König HH

Subjects
Adult, Aged, Aged, 80 and over, Female, Humans, Male, Depression psychology, Health Status, Quality of Life psychology
Abstract

Purpose: To investigate the coevolution of depression and health-related quality of life (HRQoL) in old age., Methods: In a representative survey of the German general population aged 75 years and older, the course of HRQoL and depression was observed over 4.5 years (3 waves). HRQoL was assessed by the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, while the Geriatric Depression Scale was used to measure depression. A panel vector autoregressive model was used to account for the complex coevolution of depression and HRQoL. Unobserved heterogeneity was taken into account by taking the first differences., Results: We revealed a robust negative association between an initial change in HRQoL and a subsequent change in depression score, with substantial sex differences: In women there was a robust association, while in men the significance of this association depended on the model specification. Surprisingly, in the total sample and in both sexes, no robust association between an initial increase in depression and a subsequent change in HRQoL was found., Conclusion: Findings indicate that the direction of evolution from HRQoL to depression deserves more attention. Furthermore, treatment of depression in late life should aim at improving HRQoL in which remission of depressive symptoms is necessary but not sufficient.

Published
2015
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3. The role of spousal loss in the development of depressive symptoms in the elderly - implications for diagnostic systems.

Author

Sikorski C, Luppa M, Heser K, Ernst A, Lange C, Werle J, Bickel H, Mösch E, Wiese B, Prokein J, Fuchs A, Pentzek M, König HH, Brettschneider C, Scherer M, Maier W, Weyerer S, and Riedel-Heller SG

Subjects
Aged, Aged, 80 and over, Depression epidemiology, Female, Germany epidemiology, Humans, Incidence, Male, Bereavement, Depression diagnosis, Spouses
Abstract

Background: In the revised version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) the Mood Disorder Workgroup for DSM-V the bereavement exclusion criterion for the diagnosis of major depression has been eliminated., Aim: To investigate the impact of bereavement on the incidence of depression and depressive symptoms in the elderly., Method: Participants over 75 years from the longitudinal German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe) that were still married at baseline were investigated (n=1,193). Data from four follow-ups (time frame: 6 years) were investigated. The response rate at baseline was 50.3%. Three clinical endpoints were analyzed: depressive symptoms according to Geriatric Depression Scale (1) GDS≥6, (2) GDS≥10, and (3) Major Depression (MD). The effect of loss was investigated using random-effects regression models., Results: Experiencing a loss of spouse was predictive of a higher incidence in GDS≥6 (OR 4.52, 95% CI 2.6-7.9) and 10 (OR 5.59, 95% CI 1.8-17.0) even after adjusting for age, gender, impairment at baseline, and GDS score at baseline. Associations with MD were not significant (OR 1.77, 96% CI 0.9-3.5)., Conclusions: Older adults experiencing the loss of their spouse are more likely to display elevated levels of depressive symptoms, that may reach a concerning level of severity., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Published
2014
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4. Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe).

Author

Heser K, Tebarth F, Wiese B, Eisele M, Bickel H, Köhler M, Mösch E, Weyerer S, Werle J, König HH, Leicht H, Pentzek M, Fuchs A, Riedel-Heller SG, Luppa M, Prokein J, Scherer M, Maier W, and Wagner M

Subjects
Age of Onset, Aged, Aged, 80 and over, Alzheimer Disease etiology, Cognition Disorders epidemiology, Dementia etiology, Female, Follow-Up Studies, Germany epidemiology, Humans, Male, Middle Aged, Risk, Aging psychology, Alzheimer Disease epidemiology, Dementia epidemiology, Depression epidemiology, Depressive Disorder, Major epidemiology, Primary Health Care
Abstract

Background: Whether late-onset depression is a risk factor for or a prodrome of dementia remains unclear. We investigated the impact of depressive symptoms and early- v. late-onset depression on subsequent dementia in a cohort of elderly general-practitioner patients (n = 2663, mean age = 81.2 years)., Method: Risk for subsequent dementia was estimated over three follow-ups (each 18 months apart) depending on history of depression, particularly age of depression onset, and current depressive symptoms using proportional hazard models. We also examined the additive prediction of incident dementia by depression beyond cognitive impairment., Results: An increase of dementia risk for higher age cut-offs of late-onset depression was found. In analyses controlling for age, sex, education, and apolipoprotein E4 genotype, we found that very late-onset depression (aged ≥ 70 years) and current depressive symptoms separately predicted all-cause dementia. Combined very late-onset depression with current depressive symptoms was specifically predictive for later Alzheimer's disease (AD; adjusted hazard ratio 5.48, 95% confidence interval 2.41-12.46, p < 0.001). This association was still significant after controlling for cognitive measures, but further analyses suggested that it was mediated by subjective memory impairment with worries., Conclusions: Depression might be a prodrome of AD but not of dementia of other aetiology as very late-onset depression in combination with current depressive symptoms, possibly emerging as a consequence of subjectively perceived worrisome cognitive deterioration, was most predictive. As depression parameters and subjective memory impairment predicted AD independently of objective cognition, clinicians should take this into account.

Published
2013
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5. Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe)

Author

Heser, K., Tebarth, F., Leicht, H., Bohnau, Harald, Pinsdorf, Ursula, Busch, Thomas, Keller, Gisela, Fuchs-Romer, Susanne, Beisel, Wolfgang, Richter-Polynice, Birgitt, Cupsa, Florinela, Unkelbach, Roland Matthias, Schiller, Gerhard, Pentzek, M., Damanakis, Barbara, Frenkel, Michael, Ebeling, Klaus-Wolfgang, Berger, Pauline, Gillhausen, Kurt, Hellmessen, Uwe, Hummerich, Helga, Heede, Hans-Christian, Kormann, Boguslaw-Marian, Peters, Josef, Fuchs, A., Schott, Ulrich, Matzies, Dirk, Schumacher, Andre, Oliver Flettner, Tim, Thraen, Winfried, Siegmund, Harald, Levacher, Claus, Blankenstein, Tim, Lamborelle, Eliane, Hollstein, Ralf, Riedel-Heller, S. G., Hoffmann, Edna, Ghane, Ingeborg, Claß, Regine, Meier, Stefan-Wolfgang, Moers, Leo W, Wundram, Udo, Schmitt, Klaus, Missghian, Rastin, Spallek, Karin, Schlosser, Christiane, Luppa, M., Groß, Kathrin, Bouche, Winfried, Linn, Ursula, Bormann, Gundula, Schulze, Gerhard, Stelter, Klaus, Gatermann, Heike, Fischer-Radizi, Doris, Witt, Peter, Kavka, Stefanie, Prokein, J., Klotzl, Gunther, Baumho, Michael, Oberlander, Maren, Schiewe, Cornelia, Hufnagel, Jorg, Kressel, Marei, Kebschull, Michael, Wagner, Christine, Burkhardt, Fridolin, Hase, Martina, Scherer, M., Houcken, Karl-Heinz, Zebidi, Christiane, Brohan, Johann, Russ, Christiane, Bethge, Frank, Rughase-Block, Gisela, Lorenzen, Margret, Elsen, Arne, Korte, Daniela, Jedicke, Ursula, Group, Age CoDe Study, Zoras, Constantin, Pfeil-Woltmann, Gabriele, Kaiser, Martin, Bruns, Johannes, Homann, Joachim, Gorgon, Georg, Middendorf, Niklas, Menschke, Kay, Bayer, Hans H, Maier, Wolfgang, Jesse, Nadine, Dahlke, Marcus, Lipp, Thomas, Amm, Martina, Bauer, Horst, Rauchmaul, Gabriele, Ebert, Hans Jochen, Gabriel-Mu, Angelika, Taut, Hans-Christian, Voß, Hella, Scherer, Martin, Schmidt, Holger, Hager, Eva, Tunze, Bettina, Paschke, Thomas, Assmann, Heinz-Michael, Rahnefeld, Uwe, Striegler, Petra, Gierth, Marga, Boehm, Margret, Harnisch, Dagmar, Wiese, B., van den Bussche, Hendrik, Kornisch-Koch, Simone, Hambsch, Frank, Herzig, Cornelia, Georgi, Astrid, Schwarzmann, Erhard, Schinagl, Gerd, Pehnke, Ulrike, Dayab, Mohammed, Brosig, Michael, Sperling, Volkmar, Abholz, Heinz-Harald, Lebuser, Frank, Hagert, Detlef, Arnold, Gerhard, Bauer, Viet-Harold, Becker, Hartwig, Becker, Hermine, Besier, Werner, Grella, Hartmut, Grimm, Hans Heinrich, Heck, Petra, Bachmann, Cadja, Hemler, Werner, Henn, Eric, Mayer, Manfred, Orlovius, Gerhard, Renz, Helmut, Scheer, Georg, Schilp, Michael, Schmid, Angela, Schneider, Matthias, Uhle, Christian, Bickel, Horst, Weinga, Brigitte, Wochele, Eberhard, Wolfram, Bernhard, Hofmann, Andreas, Allwein, Eugen, Ruile, Helmut, Koeppel, Andreas, Dick, Peter, Holtz, Friedrich, Schmidt, Gabriel, Blank, Wolfgang, Fischer, Lutz-Ingo, Thaller, Johann, Bloß, Guntram, Kreuzer, Franz, Holthausen, Gunther, Ludwig Maier, Karl, Krebs, Walter, Mohr, Christoph, Koschine, Heinz, Ellersdorfer, Richard, Speth, Michael, Kleinhans, Maria, Koutsouva-Sack, Panagiota, Staudinger, Gabriele, Eiber, Johann, Thiel, Stephan, Gold, Cornelia, Nalbach, Andrea, Reichert, Kai, Neef, Martin, Eifflaender-Gorfer, Sandra, Fleischmann, Viktor, Mayer, Natalija, Spiegl, Andreas, Renner, Fritz, Weishappel-Ketisch, Eva, Kochems, Thomas, Hunger, Hartmut, Hofbeck, Marianne, Neumeier, Alfred, Goldhofer, Elfriede, Eisele, Marion, Bommer, Thomas, Vollmuth, Reinhold, Lanzinger, Klaus, Pauli, Ramona, Lindner, Jutta, Brandt, Gerlinde, Hohentanner, Otto, Porz, Peter, Zimmerhackl, Bernd, Hallwachs, Alexander, Ernst, Annette, Haseke, Claudia, Ploch, Andreas, Swobodnik, Monika, Jost, Detlev, Narr, Renate, Nehmann, Gabriele, Eder, Christiane, Pillin, Helmut, Loth, Frank, Fritz, Nicola, Fuchs, Angela, Rafferzeder, Michael, Zirpel, Dietmar, Romberg, Heinz-Peter, Liese, Hanna, Burfent, Inge, von Aswege, Johann, Honig, Wolf-Dietrich, Schu, Heribert, Marx, Manfred, Straimer, Annemarie, Eisele, M., Heser, Kathrin, Uhlenbrock, Arndt, Werner, Michael, Gobel-Schlatholt, Maria, Prechtel, Eberhard, Kaschell, Hans-Jurgen, Weckbecker, Klaus, Alfen, Theodor, Eimers-Kleene, Jorg, Fischer, Klaus, Weisbach, Wolf-Rudiger, Jessen, Frank, Tschoke, Martin, Fliedner, Michael, Hodgson, Binjamin, Hamkens, Werner, Ackermann, Angela, Kaduszkiewicz, Hanna, Kirsch, Michael, Miasnikov, Vladimir, Kormann, Marian, Kaufeler, Teresa, Lu, Dieter, Wirtz, Clemens, Kohler, Mirjam, Krug, Bernd-Uwe, Hutter, Petra, Lau, Dietrich, Schroder-Hoch, Ursula, Herzog, Wolfgang, Weidner, Klaus, Witt, Otto-Peter, Konig, Hans-Helmut, Titova, Ljudmila, Moritz, Andrea, Lipp, Ina, Koppara, Alexander, Muhlmann, Ute, Bra, Barbara, Ziehbold, Sabine, Lange, Carolin, Schmalbruch, Ina, Ka, Gunter, Bo, Hanna, Ludwig, Ingrid, Noky, Adolf, Leicht, Hanna, Perleberg, Helmut, Rieder, Carsten, Rosen, Michael, Kunzendorf, Gerhard, Wachter, Jurgen, Weingartner, Brigitte, Luck, Tobias, Willhauck, Hans-Georg, Herbst, Helga, Friedrich, Peter, Kirchner, Hans-Georg, Kirchner, Elke, Knauer, Luitpold, Bickel, H., Luppa, Melanie, Holtz, Karl-Friedrich, Schmid, Elmar, Kahmann, Ulf, nther Holthausen, Gu, Mosch, Edelgard, Reich, Paul, Stahl, Eberhard, Lunow, Reinhold, Undritz, Klaus, Voss, Bernd, Spreer, Achim, Brenig, Oliver, Eich, Ralf, Vossel, Angelika, Leggewie, Dieter, Olbrich, Julia, Schmidt, Angelika, Aghdai-Heuser, Nahid, Witten, Lutz, Igel, Michael, Hodgson, Benjamin, Hoff, Bernhard, Pentzek, Michael, Luttringhaus, Dieter, Opitz, Rolf, Bausch, Jurgen, Mecking, Dirk, Ganßauge, Friederike, Peters, Elmar, Wester, Alfons, Petersen, Werner, Prokein, Jana, Daase, Martin, Rusing, Martin, von Sethe, Christoph, Borngra, Wilmhard, Colling-Pook, Brigitte, Weidner, Ullrich, Rieger, Peter, Witte, Lutz, Busch, Hans-Wilhelm, Unger, Jurgen, Schumacher, Anna, Preis, Angela, Mann, Michael, Haeberle, Ernst, Kohler, Horst, Sliwiok, Helmut, Deest, Harald, Ackermann-Korner, Margret, Reinstorff, Dieter, Schluter, Christamaria, Heinrichs, Henrik, Riedel-Heller, Steffi, Dankwarth, Ole, Bose, Michael, Ryll, Ulricke, Bauer, Reinhard, Schnakenbeck, Sven, Beckmann, Karin, Callsen, Annegret, Schiewe, Ewa, Gehm, Holger, Lambert, Volker, Stein, Janine, Hinkel-Reineke, Karin, Stolzenbach, Carl-Otto, Berdin, Peter, Windler, Friedhelm, Weidnitzer, Sabine, Rosenkranz, Erika, Letzien, Norbert, Klossek, Doris, Liebsch, Martin, Steinmann, Susanne, Zwicker, Andrea, Hantel, Ulrike, Pilz, Monika, Kirschner, Volker, Arnold, Rainer, Poser, Ulrich, Barthel, Wolfgang, Blechinger, Fritz, Fritz, Reiner Walter, Junemann, Susanne, Köhler, M., Tebarth, Franziska, Kirsch, Gabriele, Kulinna, Jurgen, Legner-Gorke, Andreas, Lehr, Christa, Meer, Wolfgang, Panzer, Christina, Raabe, Achim, Schmidt-Back, Helga, Wagner, Michael, Gunter Stieglitz, Hans, von der Heide, Marie-Luise, Kirchner, Georg, Kastner, Jorg, Janssen, Ulrike, Standl, Albert, Gottl, Clemens, Franze, Marianne, Moser, Gerhard, Blumm, Almut, Weber, Petra, Poetsch, Wolfgang, Puppe, Heinrich, Weeg, Dagmar, Specht, Gerd, Badmann, Leonard, Leveringhaus, May, Posern, Michael, Potkowski, Ralph, Schwandner, Michael, Weigert, Rudolf, Huber, Christoph, Werle, Jochen, Weyerer, Siegfried, Wiese, Birgitt, Wolfsgruber, Steffen, Zimmermann, Thomas, Adrian, Claudia, Mösch, E., Gulle, Peter, Schutzendorf, Heribert, Benz, Elisabeth, Werner, Klaus-Michael, Weyerer, S., Stahlschmidt, Markus, Dorn, Jurgen, Menke, Helmut, Werle, J., Sievert, Erik, Krockert, Ulrich, Salingre, Gabriele, Morchen, Christian, Raab, Peter, Baszenski, Angela, Loth, Clarli, Knaak, Christian, Hotte, Peter, Pieper, Jorg, König, H-H, Wassermann, Dirk, Leyendecker, Hans Josef, Gohde, Gerhard, Simons, Barbara, Brunger, Achim, Petersen, Uwe, Wahl, Heike, Tewes, Rainer, Junghans-Kullmann, Doris, and Grimm-Kraft, Angela

Subjects
Male, Risk, epidemiology [Cognition Disorders], Aging, medicine.medical_specialty, epidemiology [Alzheimer Disease], etiology [Alzheimer Disease], epidemiology [Depressive Disorder, Major], epidemiology [Germany], epidemiology [Dementia], Prodrome, Alzheimer Disease, Germany, medicine, History of depression, psychology [Aging], Humans, Dementia, ddc:610, Age of Onset, Risk factor, Psychiatry, Applied Psychology, Depression (differential diagnoses), Aged, Aged, 80 and over, epidemiology [Depression], Depressive Disorder, Major, Primary Health Care, Depression, business.industry, Hazard ratio, Cognition, Middle Aged, medicine.disease, Psychiatry and Mental health, Female, etiology [Dementia], Age of onset, Cognition Disorders, business, Follow-Up Studies
Abstract

BackgroundWhether late-onset depression is a risk factor for or a prodrome of dementia remains unclear. We investigated the impact of depressive symptoms and early- v. late-onset depression on subsequent dementia in a cohort of elderly general-practitioner patients (n = 2663, mean age = 81.2 years).MethodRisk for subsequent dementia was estimated over three follow-ups (each 18 months apart) depending on history of depression, particularly age of depression onset, and current depressive symptoms using proportional hazard models. We also examined the additive prediction of incident dementia by depression beyond cognitive impairment.ResultsAn increase of dementia risk for higher age cut-offs of late-onset depression was found. In analyses controlling for age, sex, education, and apolipoprotein E4 genotype, we found that very late-onset depression (aged ⩾70 years) and current depressive symptoms separately predicted all-cause dementia. Combined very late-onset depression with current depressive symptoms was specifically predictive for later Alzheimer's disease (AD; adjusted hazard ratio 5.48, 95% confidence interval 2.41–12.46, p ConclusionsDepression might be a prodrome of AD but not of dementia of other aetiology as very late-onset depression in combination with current depressive symptoms, possibly emerging as a consequence of subjectively perceived worrisome cognitive deterioration, was most predictive. As depression parameters and subjective memory impairment predicted AD independently of objective cognition, clinicians should take this into account.

Published
2012
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