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Zusammenfassung: Nicht medikamentöse Interventionen für Menschen mit Demenz sollen die Lebensqualität und das Wohlbefinden steigern, psychopathologische und Verhaltenssymptome lindern und auch den versorgenden Angehörigen Unterstützungsmöglichkeiten und Resilienz-Förderung bieten. Vor dem Hintergrund der ausbleibenden Erfolge im Bereich der pharmakologisch-therapeutischen Forschung haben diese Ansätze zunehmend an Bedeutung gewonnen. Es handelt sich um eine aktuelle Übersicht der wichtigsten nicht medikamentösen Interventionen für Menschen mit Demenz und diesbezügliche Empfehlungen zur therapeutischen Anwendung unter Berücksichtigung des aktuellen Forschungsstands und der AWMF-S3-Leitlinie «Demenzen». Die vielversprechendsten Interventionen aus diesem therapeutischen Spektrum sind Massnahmen zur Förderung zentraler kognitiver Funktionen, Angebote zur Steigerung und Stabilisierung des körperlichen Aktivitätsniveaus sowie kreativtherapeutische Angebote zur Förderung der Kommunikationsfähigkeit und sozialer Teilhabe. Inzwischen werden viele dieser psychosozialen Interventionen durch den Einsatz digitaler Zugänge weiterentwickelt. Gemeinsam ist ihnen, dass sie sich an den individuellen kognitiven und körperlichen Ressourcen der Betroffenen orientieren, Lebensqualität und Stimmung verbessern sowie Partizipation und Selbstwirksamkeit fördern sollen. Neben den psychosozialen Interventionen haben in den vergangenen Jahren auch ernährungsbezogene Ansätze («Medical Food») und nichtinvasive Neurostimulation Potenziale im Rahmen der nicht medikamentösen Demenz-Therapie erkennen lassen.

Die im Folgenden dargestellten Fallberichte beschreiben exemplarisch die Interventionsmodule im Rahmen des Innovationsfondsprojektes DAVOS. DAVOS (Depression im Altenpflegeheim: Verbesserung der Behandlung durch ein gestuftes kollaboratives Versorgungsmodell) wurde als innovatives, gestuftes und strukturiertes Case-Management-Programm zur Verbesserung der Depressionsbehandlung für Bewohnende von Altenpflegeeinrichtungen implementiert und hinsichtlich seiner Wirksamkeit unter Alltagsbedingungen evaluiert. Weder systematische Identifikation depressiver Symptomatik noch adäquate psychotherapeutische Versorgung der Betroffenen finden in den Pflegeeinrichtungen gegenwärtig statt. Die Fallberichte zeigen deutlich, welchen Zuwachs an Aktivität und Funktionsniveau, an Wohlbefinden und Lebensqualität man bei depressiven Pflegeheimbewohnenden durch eine optimierte psychotherapeutische Versorgung erzielen kann.

Non-pharmacological interventions for people with dementia are intended to improve quality of life and well-being, alleviate psychopathological and behavioral symptoms, and also offer caregivers support and opportunities to promote resilience. Against the background of the multiple failures in the field of pharmacological-therapeutic research, these approaches have become increasingly important.An up-to-date overview of the most important non-drug interventions for people with dementia and related recommendations for therapeutic use.Narrative review taking into account the current state of research and the recommendations of the Working Group of (German) Scientific Medical Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) S3 guideline "Dementia".The most important interventions from this therapeutic spectrum include cognitive stimulation to maintain cognitive functioning, physical activation and creative therapeutic activities to promote communication skills and social participation. In the meantime, access to these diverse psychosocial interventions has also been supplemented by digital technology. What these interventions have in common is that they are based on the individual cognitive and physical resources of those affected, improve quality of life and mood, and promote participation and self-efficacy. In addition to psychosocial interventions, nutrition-related approaches ("medical food") and non-invasive neurostimulation have recently also shown potential in the context of non-drug therapy for people with dementia.HINTERGRUND: Nichtmedikamentöse Interventionen für Menschen mit Demenz sollen die Lebensqualität und das Wohlbefinden steigern, psychopathologische und Verhaltenssymptome lindern und auch den versorgenden Angehörigen Unterstützungsmöglichkeiten und Resilienzförderung bieten. Vor dem Hintergrund der ausbleibenden Erfolge im Bereich der pharmakologisch-therapeutischen Forschung haben diese Ansätze zunehmend an Bedeutung gewonnen. ZIEL: Aktuelle Übersicht der wichtigsten nichtmedikamentösen Interventionen für Menschen mit Demenz und der diesbezüglichen Empfehlungen zur therapeutischen Anwendung.Narratives Review unter Berücksichtigung des aktuellen Forschungsstands und der S3-Leitlinie „Demenzen“ der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF).Die vielversprechendsten Interventionen aus diesem therapeutischen Spektrum sind Maßnahmen zur Förderung zentraler kognitiver Funktionen, Angebote zur Steigerung und Stabilisierung des körperlichen Aktivitätsniveaus sowie kreativtherapeutische Angebote zur Förderung von Kommunikationsfähigkeit und sozialer Teilhabe. Inzwischen werden viele dieser psychosozialen Interventionen durch den Einsatz digitaler Zugänge weiterentwickelt. Gemeinsam ist ihnen, dass sie sich an den individuellen kognitiven und körperlichen Ressourcen der Betroffenen orientieren, Lebensqualität und Stimmung verbessern sowie Partizipation und Selbstwirksamkeit fördern sollen. Neben den psychosozialen Interventionen haben in den vergangenen Jahren auch ernährungsbezogene Ansätze („medical food“) und die nichtinvasive Neurostimulation Potenziale im Rahmen der nichtmedikamentösen Demenztherapie erkennen lassen.

As some cognitive functions decline in old age, the ability to decide about important life events such as medical treatment is endangered. Environmental support to improve the comprehension of health-related information is therefore necessary. With a small-scale explorative approach, the present survey study aimed at investigating person-environment fit (PE-fit) of support provided during medical consultations. This fit was calculated by assessing the match between aids provided by five medical practitioners during medical consultations and aids most appreciated by the geriatric patients (N = 88). The results showed that the largest discrepancies of used and appreciated aids could be found concerning the opportunity to discuss decisions with relatives, the possibility to take notes, the use of objects, pictures and a keyword list. Female patients indicated a lower PE-fit. These findings highlight discrepancies between the use of specific aids and the wishes of patients and call for thoughtful use of aids during consultations with geriatric patients.

Mild cognitive impairment (MCI) is a clinical syndrome characterised by persistent cognitive deficits that do not yet fulfil the criteria of dementia. Delaying the onset of dementia using secondary preventive measures such as physical activity and exercise can be a safe way of reducing the risk of further cognitive decline and maintaining independence and improving quality of life. The aim is to systematically review the literature to assess the effectiveness of physical activity and exercise interventions to improve long-term patient-relevant cognitive and non-cognitive outcomes in people living with MCI, including meta-analyses if applicable.We will systematically search five electronic databases from 1995 onward to identify trials reporting on the effectiveness of physical activity and exercise interventions to improve long-term (12+ months) patient-relevant cognitive and non-cognitive outcomes in adults (50+ years) with MCI. Screening procedures, selection of eligible full-texts, data extraction and risk of bias assessment will be performed in dual-review mode. Additionally, the reporting quality of the exercise interventions will be assessed using the Consensus on Exercise Reporting Template. A quantitative synthesis will only be conducted if studies are homogeneous enough for effect sizes to be pooled. Where quantitative analysis is not applicable, data will be represented in a tabular form and synthesised narratively. People living with MCI will be involved in defining outcome measures most relevant to them in order to assess in how far randomised controlled trials report endpoints that matter to those concerned.Results will be disseminated to both scientific and lay audiences by creating a patient-friendly video abstract. This work will inform professionals in primary care about the effectiveness of physical activity and exercise interventions and support them to make evidence-based exercise recommendations for the secondary prevention of dementia in people living with MCI. No ethical approval required.CRD42021287166.

Zusammenfassung Hintergrund Die Starkung der Patientensicherheit als Thema im humanmedizinischen Studium wurde wiederholt, u.a. von der Weltgesundheitsorganisation, gefordert. Bei den Lehrenden herrscht jedoch Unsicherheit bei der Frage nach dem optimalen Zeitpunkt, diese Thematik in bestehende Curricula zu integrieren. Ziel dieses Artikels ist die Darstellung von Lernzielen sowie der Konzeption und Evaluation eines zweitagigen Wahlpflichtfaches zur Sicherheitskultur im fruhen vorklinischen Studienabschnitt der medizinischen Fakultat Frankfurt am Main. Nach unserem Kenntnisstand ist dies das in Deutschland zum fruhesten Zeitpunkt des Medizinstudiums angebotene Wahlpflichtfach zu diesem Thema. Methode Es wurden Lernziele formuliert, Lehrmethoden festgelegt und das Wahlpflichtfach zum Thema Sicherheitskultur im Wintersemester 2019/20 durchgefuhrt. Anhand eines Fragebogens erfolgte eine quantitative und qualitative Evaluation zur Akzeptanz des neuen Wahlpflichtfachs durch die teilnehmenden Studierenden. Weiterhin wurde untersucht, wie die Rollenspiele zum Erlangen der kommunikativen Lerninhalte bewertet wurden. Zustimmung und Ablehnung wurden auf einer sechsstufigen Likert-Skala ausgewertet. Ergebnisse Das resultierende Wahlpflichtfach bestehend aus einem thematischen Input per Filmausschnitt, Impulsvortragen, Rollenspielen und Diskussionsrunden wird dargestellt. 19 Medizinstudierende der Vorklinik haben teilgenommen. Die quantitativen und qualitativen Evaluationsergebnisse zeigen in der Gesamtheit positive Resultate (1,2 ± 0,5 nach Schulnoten) mit einer hohen wahrgenommenen Wichtigkeit des Themas. Die Studierenden beurteilten die didaktische Umsetzung der Lernziele als sehr gut und konnten verschiedene Fehlerquellen kennenlernen. Diskussion Das vorklinische Wahlpflichtfach erscheint geeignet, um Medizinstudierenden die Relevanz des Themas Patientensicherheit aufzuzeigen und sich konstruktiv fachlich damit auseinanderzusetzen. Es kann als Best-Practice-Beispiel fur die Entwicklung von vergleichbaren Lehrformate an medizinischen Fakultaten dienen. Schlussfolgerungen Auf Grund der Ergebnisse konnen wir konstatieren, dass schon die Vorklinik als fruher Zeitpunkt im Studium geeignet ist, fur die Bedeutung des Themas Patientensicherheit zu sensibilisieren.

Non-pharmacological interventions such as cognitive therapy, physical activity, and creative art approaches are important components of appropriate care for persons with dementia and their relatives. Although relationships and interpersonal interactions undoubtedly play an important role in all these activities, digital technologies have increasingly established themselves in this area in recent years. The following article describes non-pharmacological interventions for people with dementia (based on the German

People with dementia often require medical and nursing care and are regularly confronted with the need to make decisions in this respect; however, in practice uncertainty often exists as to whether a person with dementia is capable of providing consent, what procedures should be used to obtain informed consent, how to provide the necessary information and how capacity to consent can be assured. By providing structured practical recommendations, the S2k guidelines "Consent of persons with dementia to medical treatment" (coordinated by the Association of the Scientific Medical Societies of Germany, AWMF, registration number 108-001) provide a first attempt to summarize and update the relevant medical, legal, ethical and psychological requirements that should be satisfied in this respect. This article enables insights into the guidelines and an overview of the most important recommendations.Menschen mit Demenz sind häufig auf medizinische und pflegerische Maßnahmen angewiesen und werden regelmäßig mit diesbezüglichen Entscheidungen konfrontiert. In der Praxis besteht jedoch oft Unsicherheit darüber, ob ein Mensch mit Demenz einwilligungsfähig ist, welches Prozedere beim Einholen einer informierten Einwilligung zu durchlaufen ist, wie adäquat informiert werden kann und wie Einwilligungsfähigkeit ggf. hergestellt werden kann. In der S2k-Leitlinie „Einwilligung von Menschen mit Demenz in medizinische Maßnahmen“ (koordiniert durch die Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF-Registernr. 108 – 001) wurden die relevanten medizinischen, rechtlichen, ethischen und psychologischen Anforderungen erstmals auf dem aktuellen Stand zusammengefasst und in Form strukturierter Handlungsempfehlungen für die Praxis erschlossen. Der vorliegende Beitrag ermöglicht einen Ein- und Überblick in bzw. über die wichtigsten Empfehlungen der Leitlinie.

As some cognitive functions decline in old age, the ability to decide about important life events such as medical treatment is endangered. Environmental support to improve the comprehension of health-related information is therefore necessary. With a small-scale explorative approach, the present survey study aimed at investigating person-environment fit (PE-fit) of support provided during medical consultations. This fit was calculated by assessing the match between aids provided by five medical practitioners during medical consultations and aids most appreciated by the geriatric patients (N = 88). The results showed that the largest discrepancies of used and appreciated aids could be found concerning the opportunity to discuss decisions with relatives, the possibility to take notes, the use of objects, pictures and a keyword list. Female patients indicated a lower PE-fit. These findings highlight discrepancies between the use of specific aids and the wishes of patients and call for thoughtful use of aids during consultations with geriatric patients.Mit der Abnahme kognitiver Fähigkeiten im Alter ist die Fähigkeit, Entscheidungen über wichtige Lebensereignisse wie etwa medizinische Behandlungen zu fällen, gefährdet. Entscheidungsassistenz ist daher notwendig, um das Verständnis von gesundheitsrelevanten Informationen zu verbessern. Mit einem explorativen Ansatz zielte die vorliegende Befragungsstudie darauf ab, die Person-Umwelt-Passung in der ärztlichen Aufklärung zu untersuchen. Diese Passung wurde berechnet, indem die Übereinstimmung zwischen Hilfestellungen, die von 5 Ärzt:innen während der Aufklärung bereitgestellt wurden, mit den von ihren geriatrischen Patient:innen (N = 88) gewünschten Hilfsmitteln erfragt wurde. Die Ergebnisse zeigten, dass die größten Diskrepanzen zwischen verwendeten und gewünschten Hilfsmitteln bei der Möglichkeit, die Entscheidung mit Angehörigen zu besprechen, der Möglichkeit, sich Notizen zu machen und bei der Verwendung von Gegenständen, Bildern und einer Stichwortliste zu finden waren. Patientinnen gaben eine geringere Person-Umwelt-Passung an als Patienten. Diese Befunde verdeutlichen Diskrepanzen zwischen dem Einsatz bestimmter Hilfestellungen und den Wünschen von Patient:innen und legen einen bewussten Einsatz von Hilfsmitteln während ärztlicher Aufklärungen nahe.

The World Health Organization has called for more importance to be attached to the subject of patient safety in medical studies. However, teaching staff are unsure when the right time is to include this topic in existing medical school curricula. The aim of this article is to present the learning objectives, design and evaluation of a two-day elective on patient safety offered in the preclinical phase of medical studies at the Faculty of Medicine, University of Frankfurt am Main. To the best of our knowledge, no existing elective on safety culture has been provided at such an early stage of medical studies in Germany.After defining learning objectives and teaching methods, the safety culture elective was offered in the winter term 2019/20. Based on a questionnaire, a quantitative and qualitative evaluation of the students' acceptance of the elective was carried out. We also sought to investigate whether group role-play was considered an effective means of communicating the teaching content. Acceptance and rejection of the elective were evaluated on a six-point Likert scale.The resulting elective, consisting of topical input via film, an introductory speech, role-play and discussions, is presented. Nineteen students in the preclinical phase of their medical studies took part. Overall, the quantitative and qualitative evaluation delivered positive results (1.2±0.5), and the topic was perceived to very important. The students considered the didactic implementation and the learning objectives to be very good, and they became acquainted with different sources of error.The preclinical elective would appear to be suitable for demonstrating the importance of medical safety to medical students and teaching them how to deal with the topic constructively. It can be viewed as a best-practice example for the development of comparable learning formats at medical faculties.The results show that the preclinical phase is a suitable time to illustrate the importance of the subject of patient safety during medical studies.

ARTEMIS (ART Encounters: Museum Intervention Study) is an art-based intervention designed especially for people with dementia and their care partners that involves a combination of museum visits and artistic activity. This paper reports the results of a randomized wait-list controlled study on the influence of the ARTEMIS intervention on the emotional state, well-being, and quality of life of dementia patients. People with mild-to-moderate dementia (n = 44) and their care partners (n = 44) visited the Frankfurt Städel Museum once a week on six pre-arranged occasions. The intervention consisted of six different guided art tours (60 minutes), followed by art-making in the studio (60 minutes). Independent museum visits served as a control condition. A mixed-methods design was used to assess several outcomes including cognitive status, emotional well-being, self-rated aspects of quality of life, and subjective evaluations by informal caregivers. In a pre-post-assessment, we found significant improvements in participants’ self-rated quality of life (t = −3.15, p

Background Depression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents suffer from minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking deficit in health care and might results not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality and increased hospitalization rates. Methods The aim of the interdisciplinary research project DAVOS is to implement an innovative and stepped structural case management program to improve depression treatment in nursing home residents by a modularized intervention and to assess it in terms of its effectiveness. Intervention modules are in line with recommendations given by the German national treatment guidelines for depression (S3 guidelines). Ten nursing homes in Frankfurt, Germany, will participate in the project which aims to recruit a study population of N = 380. Persons (>60 years) that live in a nursing home, have no medical diagnosis of dementia and can provide their informed consent to participate are eligible for inclusion in the study. Residents with a clinical diagnosis of dementia, alcohol or substance related disorders or other serious psychiatric illnesses will be excluded. DAVOS is a controlled cluster-randomized study that employs a stepped-wedge design. Discussion Our main hypothesis is that the implementation of the intervention will lead to a decline in the prevalence of depression and a reduction in depression symptoms among the home residents. In addition, we expect the intervention to have a positive impact on secondary outcomes such as level of functioning, quality of life and social participation. The project’s results can make an important contribution towards improving the health care of nursing home residents suffering from late-life depression.

Metabolic changes have been suggested to contribute to dementia and its precursor mild cognitive impairment (MCI), yet previous results particularly for the “satiety hormone” leptin are mixed. Therefore, we aimed to determine if MCI patients show systematic differences in leptin, independent of sex, adipose mass, age, and glucose and lipid metabolism, and whether leptin levels correlated with memory performance and hippocampal integrity. Forty MCI patients (20 females, aged 67 years ± 7 SD) were compared to 40 healthy controls (HC) that were pair-wise matched for sex, age, and body fat. Memory performance was assessed using the auditory verbal learning test. Volume and microstructure of the hippocampus were determined using 3T-neuroimaging. Fasting serum markers of leptin, glucose and lipid metabolism, and other confounding factors were assayed. MCI patients, compared with HC, showed lower serum leptin, independent of sex, age, and body fat (P

Previous studies in older adults suggested beneficial effects of omega-3 fatty acid (FA) supplementation, aerobic exercise, or cognitive stimulation on brain structure and function. However, combined effects of these interventions in patients suffering from mild cognitive impairment (MCI) are unknown. Using a randomized interventional design, we evaluated the effect of combined omega-3 FA supplementation, aerobic exercise and cognitive stimulation (target intervention) versus omega-3 FA supplementation and non-aerobic exercise (control intervention) on cognitive function and gray matter volume in patients with MCI. Moreover, we analyzed potential vascular, metabolic or inflammatory mechanisms underlying these effects. Twenty-two MCI patients (8 females; 60-80years) successfully completed six months of omega-3 FA intake, aerobic cycling training and cognitive stimulation (n=13) or omega-3 FA intake and non-aerobic stretching and toning (n=9). Before and after the interventions, cognitive performance, magnetic resonance imaging of the brain at 3T (n=20), intima-media thickness of the internal carotid artery and serum markers of glucose control, lipid and B-vitamin metabolism, and inflammation were assessed. Intervention-related changes in gray matter volume of Alzheimer's disease (AD)-related brain regions, i.e., frontal, parietal, temporal and cingulate cortex were examined using voxel-based morphometry of high resolution T1-weighted images. After the intervention period, significant differences emerged in brain structure between groups: Gray matter volume decreased in the frontal, parietal and cingulate cortex of patients in the control intervention, while gray matter volume in these areas was preserved or even increased after the target intervention. Decreases in homocysteine levels in the target intervention group were associated with increases in gray matter volume in the middle frontal cortex (p=0.010). No significant differences in cognitive performance or other vascular, metabolic and inflammatory parameters were observed between groups. This pilot study provides preliminary evidence that omega-3 FA intake combined with aerobic exercise and cognitive stimulation prevents atrophy in AD-related brain regions in MCI patients, compared to omega-3 FA intake plus the control condition of stretching and toning. These promising findings should now be validated in a larger interventional trial.

Zusammenfassung. Demenzielle Erkrankungen sind zum jetzigen Zeitpunkt überwiegend nicht heilbar, nehmen aber aufgrund des demographischen Wandels stetig zu. Neben den pharmakologischen Behandlungsmethoden wird mit Hilfe psychosozialer Ansätze unter anderem versucht, das Wohlbefinden und die Lebensqualität der Betroffenen zu erhöhen und psychopathologische Begleiterscheinungen der Erkrankung abzumildern. Kreativtherapeutische Interventionen, wie Musik- oder Kunsttherapie, stellen hierbei inzwischen zunehmend eingesetzte Herangehensweisen dar. Aufgrund der gegenwärtigen wissenschaftlichen Evidenz können allerdings nur einzelne positive Effekte benannt werden, deren Generalisierbarkeit bisher jedoch eingeschränkt ist. Der vorliegende Artikel bietet eine Übersicht wichtiger Projekte und Studien der letzten Jahre zum Einsatz kunsttherapeutischer Methoden bei Demenz und stellt anschließend ein aktuelles Praxis-Forschungsprojekt vor, welches sich zum Ziel setzt, ein spezielles Kunstvermittlungsangebot für Menschen mit Demenz (MmD) und ihre Angehörigen im laufenden Museumsbetrieb zu implementieren und durch begleitende wissenschaftliche Evaluation einige Forschungslücken auf diesem Gebiet zu schließen. Das Kernstück der Studie bildet die interaktive Auseinandersetzung mit Kunst und Kunstwerken im Rahmen von regelmäßig stattfindenden Museumsbesuchen und anschließender Atelierarbeit. Mit Hilfe eines randomisierten Wartekontrollgruppendesigns sollen die psychologischen und sozialen Wirkungen dieser Intervention auf MmD und ihre Angehörigen eingehend untersucht werden.

Mit dieser Frage werden Hausarzte, Neurologen und Psychiater sowie Arzte, die im geriatrisch-gerontologischen Bereich tatig sind, immer wieder konfrontiert. Der altere Patient schildert eine Situation, in der ihm etwas, z. B. der Name eines Bekannten oder der Titel des kurzlich gesehenen Kinofilms, nicht eingefallen ist, oder er beschreibt, dass er seinen Autoschlussel standig suchen muss, weil er sich nicht daran erinnert, wo er ihn hingelegt hat. Die Sorge der Patienten ist durchaus verstandlich, wird man doch uber die Medien sehr viel mit den Begriffen „Demenz“, „Krankheit des Vergessens“ und „Alzheimer-Krankheit“ konfrontiert. Doch wann liegt tatsachlich eine Demenzerkrankung vor? Welche anderen Ursachen konnen fur eine zunehmende Vergesslichkeit verantwortlich sein? Und wie sieht eine umfassende Diagnostik aus? Der folgende Beitrag soll diese Fragen klaren.

Valentina A Tesky,1 Theresa Köbe,2 A Veronica Witte,2,3 Agnes Flöel,2 Jan Philipp Schuchardt,4 Andreas Hahn,4 Johannes Pantel1 1Geriatric Medicine, Institute of General Practice, Goethe University, Frankfurt, Germany; 2Department of Neurology, Charité – University Medicine Berlin, Berlin, Germany; 3Department of Neurology, Max Planck Institute of Human Cognitiveand Brain Sciences, University of Leipzig, Leipzig, Germany; 4Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University, Hannover, Germany Abstract: AKTIVA-MCI is a program for patients with mild cognitive impairment (MCI) that aims to enhance participation in cognitively stimulating leisure activities. Participation in cognitively stimulating activities seems to be a potential strategy for people with MCI delaying cognitive decline for a while. In total, 35 MCI patients were enrolled in the pilot study of whom 29 completed the whole program (16 female, 71.1±7.5 years; Mini Mental Status Examination score: 28±2.2). Daily activity protocols were used to measure the frequency of participation in cognitively stimulating activities during the program (12 sessions). Additional standardized psychometric tests and questionnaires were used to assess cognition, mood, and subjective memory decline. Analyses of the daily activity protocols showed that during the intervention participants increased the frequency of several cognitively stimulating leisure activities. Comparison of pre-post data indicates no changes in cognitive status, mood, and subjective memory decline. These findings indicate that the program is suitable for patients with MCI. Keywords: older people, MCI, pilot study, intervention study, cognitively stimulating leisure activities, training program, daily activity protocols

In phase 1, the subproject Gerontology aims to identify the country-specific demands and actual conditions governing informed consent procedures in clinical dementia research in the participating countries. About 90 people with early stage dementia, and 90 caregivers/legal guardians (all involved in clinical dementia research) will be included. For the recruitment of potential subjects, we contact dementia researchers in Germany, Spain, and Portugal and ask them to share our online-study with their study participants. Semi-structured online-interviews are conducted over a period of 6 months. Participants are interviewed in order to gather information on existing informed consent conditions in clinical dementia research. Furthermore, participants are asked to formulate and rate their needs, whereby the emphasis lays on the assessment of p-e fit indices in the domains of spatial and social needs versus existing conditions. Phase 1 will be finished in June 2017. The results of phase 1 will be presented.

In healthy older adults, resveratrol supplementation has been shown to improve long-term glucose control, resting-state functional connectivity (RSFC) of the hippocampus, and memory function. Here, we aimed to investigate if these beneficial effects extend to individuals at high-risk for dementia, i.e., patients with mild cognitive impairment (MCI). In a randomized, double-blind interventional study, 40 well-characterized patients with MCI (21 females; 50–80 years) completed 26 weeks of resveratrol (200 mg/d; n = 18) or placebo (1,015 mg/d olive oil; n = 22) intake. Serum levels of glucose, glycated hemoglobin A1c and insulin were determined before and after intervention. Moreover, cerebral magnetic resonance imaging (MRI) (3T) (n = 14 vs. 16) was conducted to analyze hippocampus volume, microstructure and RSFC, and neuropsychological testing was conducted to assess learning and memory (primary endpoint) at both time points. In comparison to the control group, resveratrol supplementation resulted in lower glycated hemoglobin A1c concentration with a moderate effect size (ANOVARM p = 0.059, Cohen's d = 0.66), higher RSFC between right anterior hippocampus and right angular cortex (p < 0.001), and led to a moderate preservation of left anterior hippocampus volume (ANOVARM p = 0.061, Cohen's d = 0.68). No significant differences in memory performance emerged between groups. This proof-of-concept study indicates for the first-time that resveratrol intake may reduce glycated hemoglobin A1c, preserves hippocampus volume, and improves hippocampus RSFC in at-risk patients for dementia. Larger trials with longer intervention time should now determine if these benefits can be validated and extended to cognitive function. DFG/Fl 379-10/1 DFG/Fl 379-11/1 DFG/EXC/257 BMBF/FKZ 0315673A BMBF/01EO0801 BMBF/01GQ1424A BMBF/01GQ1420B

Cognitive deficits are core symptoms in patients with schizophrenia (SZ) and major depressive disorder (MDD), but specific and approved treatments for cognitive deterioration are scarce. Experimental and clinical evidence suggests that aerobic exercise may help to reduce psychopathological symptoms and support cognitive performance, but this has not yet been systematically investigated. In the current study, we examined the effects of aerobic training on cognitive performance and symptom severity in psychiatric inpatients. To our knowledge, to date, no studies have been published that directly compare the effects of exercise across disease groups in order to acquire a better understanding of disease-specific versus general or overlapping effects of physical training intervention. Two disease groups (n = 22 MDD patients, n = 29 SZ patients) that were matched for age, gender, duration of disease and years of education received cognitive training combined either with aerobic physical exercise or with mental relaxation training. The interventions included 12 sessions (3 times a week) over a time period of 4 weeks, lasting each for 75 min (30 min of cognitive training + 45 min of cardio training/mental relaxation training). Cognitive parameters and psychopathology scores of all participants were tested in pre- and post-testing sessions and were then compared with a waiting control group. In the total group of patients, the results indicate an increase in cognitive performance in the domains visual learning, working memory and speed of processing, a decrease in state anxiety and an increase in subjective quality of life between pre- and post-testing. The effects in SZ patients compared with MDD patients were stronger for cognitive performance, whereas there were stronger effects in MDD patients compared with SZ patients in individual psychopathology values. MDD patients showed a significant reduction in depressive symptoms and state anxiety values after the intervention period. SZ patients reduced their negative symptoms severity from pre- to post-testing. In sum, the effects for the combined training were superior to the other forms of treatment. Physical exercise may help to reduce psychopathological symptoms and improve cognitive skills. The intervention routines employed in this study promise to add the current psychopathological and medical treatment options and could aid the transition to a multidisciplinary approach. However, a limitation of the current study is the short time interval for interventions (6 weeks including pre- and post-testing).

There is mounting evidence that aerobic exercise has a positive effect on cognitive functions in older adults. To date, little is known about the neurometabolic and molecular mechanisms underlying this positive effect. The present study used magnetic resonance spectroscopy and quantitative MRI to systematically explore the effects of physical activity on human brain metabolism and grey matter (GM) volume in healthy aging. This is a randomised controlled assessor-blinded two-armed trial (n=53) to explore exercise-induced neuroprotective and metabolic effects on the brain in cognitively healthy older adults. Participants (age >65) were allocated to a 12-week individualised aerobic exercise programme intervention (n=29) or a 12-week waiting control group (n=24). The main outcomes were the change in cerebral metabolism and its association to brain-derived neurotrophic factor (BDNF) levels as well as changes in GM volume. We found that cerebral choline concentrations remained stable after 12 weeks of aerobic exercise in the intervention group, whereas they increased in the waiting control group. No effect of training was seen on cerebral N-acetyl-aspartate concentrations, nor on markers of neuronal energy reserve or BDNF levels. Further, we observed no change in cortical GM volume in response to aerobic exercise. The finding of stable choline concentrations in the intervention group over the 3 month period might indicate a neuroprotective effect of aerobic exercise. Choline might constitute a valid marker for an effect of aerobic exercise on cerebral metabolism in healthy aging.

Aufgrund des demographischen Wandels erhoht sich die Anzahl von Menschen mit Demenz. Hiervon sind auch die in Deutschland lebenden Migranten betroffen. Das Ausuben kognitiv-stimulierender Freizeitaktivitaten zahlt zu den Schutzfaktoren gegen Demenz. Ziel der Pilotstudie war es daher zu uberprufen, ob altere turkische Migranten ebenfalls von dem fur deutschstammige Senioren bereits evaluierten Programm AKTIVA profitieren, das fur die Pravention von kognitiven Leistungseinbusen durch die Steigerung von kognitiv-stimulierenden Aktivitaten entwickelt wurde. Es handelt sich um eine Pilotstudie mit 15 Teilnehmern (13 Frauen, 60,2 ± 5,4 Jahre) und Pra-post-Follow-up-Messung. Turkische Migranten zeigten signifikante Interventionseffekte u. a. im Bereich der kognitiven Leistungsfahigkeit (FMMST = 3,93*; FADAS-Kog = 4,49*; FTMT A = 4,94*), die sich aber von den Trainingseffekten einer deutschstammigen Stichprobe unterschieden. Das AKTIVA-Programm kann auch in der turkischen Migrantenpopulation angewendet werden. Bei der Trainingsdurchfuhrung sind die speziellen Bedurfnisse dieser Bevolkerungsgruppe zu berucksichtigen.

Long-chain (> 20 C-atoms) polyunsaturated fatty acids (LC PUFAs) of both the omega-6 (n-6) and omega-3 (n-3) series are important for the functional integrity of brain and thereby cognition, memory and mood. Clinical studies observed associations between altered LC PUFA levels and neurodegenerative diseases such as Alzheimer´s disease and its prodromal stage, mild cognitive impairment (MCI). The present study examined the LC PUFA status of MCI patients with specific view on the relative LC n-3 PUFA levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in erythrocyte membranes (omega-3 index). 12 single nucleotide polymorphisms (SNPs) of the FADS1, FADS2, and FADS3 gene clusters were genotyped in 111 MCI patients and evaluated associations with PUFA levels in erythrocyte membranes (primary outcome). In addition, the associations between FADS SNPs and LC PUFA levels with serum lipid levels as well as depressive symptoms were examined (secondary outcomes). Minor allele carrier of rs174546, rs174548 (FADS1), rs3834458, rs1535, rs174574, rs174575, rs174576, and rs174578 (FADS2) showed significant higher n-6 and n-3 precursor PUFA levels (linoleic acid, and alpha-linolenic acid, respectively) and lower arachidonic acid (AA) levels in erythrocyte membranes compared to the major allele carriers. Differences in EPA and DHA levels were not significant. Minor allele carriers of rs174574, rs174576 and rs174578 (FADS2) and rs174455 (FADS3) exhibited significant higher triglyceride levels, whereas minor allele carriers for rs174449 and rs174455 (FADS3) exhibited significant higher total- and LDL-cholesterol levels compared to the more common variant. The mean omega-3 index of the study cohort was 6.19 ± 1.55 %. In more than 85 % of the patients, the omega-3 index was below 8 % and in 23 % below 5 %. Moreover, it was shown that a low DHA status and omega-3 index was associated with depressive symptoms (Beck’s depression-inventory). These findings indicate an association between several FADS genotypes for higher n-6 and n-3 precursor PUFA and lower AA levels in erythrocyte membranes in minor compared to major allele carriers. To what extent FADS genotypes and a lower conversion of LA and ALA to biologically important LC PUFAs such as AA, EPA and DHA contributes to cognitive decline should be investigated in further trials. Nevertheless, the omega-3 index in this cohort of MCI patients can be classified as insufficient.

Background: Low-normal concentrations of vitamin B-12 (VitB12) may be associated with worse cognition. However, previous evidence has been mixed, and the underlying mechanisms remain unclear.Objective: We determined whether serum VitB12 concentrations within the normal range were linked to memory functions and related neuronal structures in patients with mild cognitive impairment (MCI).Design: In a cross-sectional design, we assessed 100 amnestic MCI patients (52 women; age range: 50–80 y) with low- and high-normal VitB12 concentration (median split: 304 pmol/L) for memory functions with the use of the Auditory Verbal Learning Test. MRI was performed at 3 tesla (n = 86) for the estimation of the volume and microstructure of the hippocampus and its subfields as indicated by the mean diffusivity on diffusion-weighted images. With the use of a mediation analysis, we examined whether the relation between VitB12 and memory performance was partially explained by volume or microstructure.Results: MCI patients with low-normal VitB12 showed a significantly poorer learning ability (P = 0.014) and recognition performance (P = 0.008) than did patients with high-normal VitB12. Also, the microstructure integrity of the hippocampus was lower in patients with low-normal VitB12, mainly in the cornu ammonis 4 and dentate gyrus region (P = 0.029), which partially mediated the effect of VitB12 on memory performance (32–48%). Adjustments for age, sex, education, apolipoprotein E e4 status, and total homocysteine, folate, and creatinine did not attenuate the effects.Conclusions: Low VitB12 concentrations within the normal range are associated with poorer memory performance, which is an effect that is partially mediated by the reduced microstructural integrity of the hippocampus. Future interventional trials are needed to assess whether supplementation of VitB12 may improve cognition in MCI patients even in the absence of clinically manifested VitB12 deficiency. This trial was registered at clinicaltrials.gov as NCT01219244.

In diesem Kapitel wird eine von sechs thematischen Kunstfuhrungen mit anschliesender Kreativarbeit im Atelier vorgestellt, wie sie im Rahmen des Praxis-Forschungsprojekts ARTEMIS am Stadel Museum in Frankfurt am Main durchgefuhrt werden. Das Projekt richtet sich an Menschen mit Demenz und deren begleitende Angehorige.

To investigate the effects of leisure activities on cognitive performance of healthy older subjects, an innovative intervention program was developed. Frequent participation in cognitively stimulating activities (i.e., reading, playing chess, or playing music) is associated with reduced risk of dementia. AKTIVA (active cognitive stimulation – prevention in the elderly) is an intervention program designed to enhance cognitive stimulation in everyday life by increasing cognitive stimulating leisure activities. The present study determines the effects of AKTIVA on cognitive function, mood and attitude toward aging in a sample of older participants from the general population. Several measurement instruments were used including the Alzheimer’s Disease Assessment Scale (ADAS-Cog), the Trail-Making Test (TMT), and the Memory Complaint Questionnaire (MAC-Q). Initially, the sample consisted of 307 older persons (170 female, 72 ± 7 years). The intervention was evaluated with a randomized, controlled pre-post follow-up design. Participants were randomly assigned to one of three conditions: AKTIVA intervention (n = 126), AKTIVA intervention plus nutrition and exercise counseling (n = 84), no-intervention control group (n = 97). The AKTIVA intervention consisted of 8 weekly sessions and two booster sessions after a break of 4 months. Participation in the group program resulted in positive effects on cognitive function and attitude toward aging for subassembly groups. Older persons (≥ 75 years) showed enhanced speed of information processing (by TMT Version A) (F = 4.17*, p < .05); younger participants (< 75 years) showed an improvement in subjective memory decline (by MAC-Q) (F = 2.55*, p < .05). Additionally, AKTIVA enhanced the frequency of activities for leisure activities for subassembly groups. The results of this study suggest that the AKTIVA program can be used to increase cognitively stimulating leisure activities in the elderly. Further research is necessary to identify the long-term effects of this intervention particularly with respect to the prevention of dementia.