@article{RappMellMajicetal.2013,
  author    = {Rapp, Michael Armin and Mell, Thomas and Majic, Tomislav and Treusch, Yvonne and Nordheim, Johanna and Niemann-Mirmehdi, Mechthild and Gutzmann, Hans and Heinz, Andreas},
  title     = {Agitation in Nursing Home Residents With Dementia (VIDEANT Trial) - Effects of a Cluster-Randomized, Controlled, Guideline Implementation Trial},
  series = {Journal of the American Medical Directors Association},
  volume    = {14},
  journal   = {Journal of the American Medical Directors Association},
  number    = {9},
  publisher = {Elsevier},
  address   = {New York},
  issn      = {1525-8610},
  doi       = {10.1016/j.jamda.2013.05.017},
  pages     = {690 -- 695},
  year      = {2013},
  abstract  = {Objective: To test the effect of a complex guideline-based intervention on agitation and psychotropic prescriptions. Design, Setting, Participants: Cluster randomized controlled trial (VIDEANT) with blinded assessment of outcome in 18 nursing homes in Berlin, Germany, comprising 304 dementia patients. Intervention: Training, support, and activity therapy intervention, delivered at the level of each nursing home, focusing on the management of agitation in dementia. Control group nursing homes received treatment as usual. Measurements: Levels of agitated and disruptive behavior (Cohen-Mansfield agitation inventory [CMAI]) as the primary outcome. Number of neuroleptics, antidepressants, and cholinesterase inhibitors (ChEIs) prescribed in defined daily dosages (DDDs). Results: Of 326 patients screened, 304 (93.3\%) were eligible and cluster-randomized to 9 intervention (n = 163) and 9 control (n = 141) nursing homes. Data were collected from 287 (94.4\%) patients at 10 months. At 10 months, compared with controls, nursing home residents with dementia in the intervention group exhibited significantly less agitation as measured with the CMAI (adjusted mean difference, 6.24; 95\% CI 2.03-14.14; P = .009; Cohen's d = 0.43), received fewer neuroleptics (P < .05), more ChEIs (P < .05), and more antidepressants (P < .05). Conclusion: Complex guideline-based interventions are effective in reducing agitated and disruptive behavior in nursing home residents with dementia. At the same time, increased prescription of ChEIs and antidepressants together with decreased neuroleptic prescription suggests an effect toward guideline-based pharmacotherapy.},
  language  = {en}
}
@misc{MellWartenburgerMarschneretal.2009,
  author    = {Mell, Thomas and Wartenburger, Isabell and Marschner, Alexander and Villringer, Arno and Reischies, Friedel M. and Heekeren, Hauke R.},
  title     = {Altered function of ventral striatum during reward-based decision making in old age},
  url       = {http://nbn-resolving.de/urn:nbn:de:kobv:517-opus-45235},
  year      = {2009},
  abstract  = {Normal aging is associated with a decline in different cognitive domains and local structural atrophy as well as decreases in dopamine concentration and receptor density. To date, it is largely unknown how these reductions in dopaminergic neurotransmission affect human brain regions responsible for reward-based decision making in older adults. Using a learning criterion in a probabilistic object reversal task, we found a learning stage by age interaction in the dorsolateral prefrontal cortex (dIPFC) during decision making. While young adults recruited the dlPFC in an early stage of learning reward associations, older adults recruited the dlPFC when reward associations had already been learned. Furthermore, we found a reduced change in ventral striatal BOLD signal in older as compared to younger adults in response to high probability rewards. Our data are in line with behavioral evidence that older adults show altered stimulus-reward learning and support the view of an altered fronto-striatal interaction during reward-based decision making in old age, which contributes to prolonged learning of reward associations.},
  language  = {en}
}
@article{MellHeekerenMarschneretal.2005,
  author    = {Mell, Thomas and Heekeren, Hauke R. and Marschner, Alexander and Wartenburger, Isabell and Villringer, Arno and Reischies, Friedel M.},
  title     = {Effect of aging on stimulus-reward association learning},
  issn      = {0028-3932},
  year      = {2005},
  abstract  = {The flexible learning of stimulus-reward associations when required by situational context is essential for everyday behavior. Older adults experience a progressive decline in several cognitive functions and show deficiencies in neuropsychological tasks requiring flexible adaptation to external feedback, which could be related to impairments in reward association learning. To study the effect of aging on stimulus-reward association learning 20 young and 20 older adults performed a probabilistic object reversal task (pORT) along with a battery of tests assessing executive functions and general intellectual abilities. The pORT requires learning and reversing associations between actions and their outcomes. Older participants collected fewer points, needed more trials to reach the learning criterion, and completed less blocks successfully compared to young adults. This difference remained statistically significant after correcting for the age effect of other tests assessing executive functions. This suggests that there is an age-related difference in reward association learning as measured using the pORT, which is not closely related to other executive functions with respect to the age effect. In human aging, structural alterations of reward detecting structures and functional changes of the dopaminergic as well as the serotonergic system might contribute to the deficit in reward association learning observed in this study. (C) 2004 Elsevier Ltd. All rights reserved},
  language  = {en}
}
@article{MellJacobFuhretal.2017,
  author    = {Mell, Thomas and Jacob, Louis and Fuhr, Ida and Dick, Sandra and Rapp, Michael Armin and Kostev, Karel},
  title     = {Patterns of benzodiazepine prescribing by neuropsychiatrists and general practitioners for elderly patients in Germany in 2014},
  series = {International journal of clinical pharmacology and therapeutics},
  volume    = {55},
  journal   = {International journal of clinical pharmacology and therapeutics},
  publisher = {Dustri-Verlag Dr. Karl Feistle},
  address   = {Deisenhofen-M{\"u}nchen},
  issn      = {0946-1965},
  doi       = {10.5414/CP202904},
  pages     = {466 -- 471},
  year      = {2017},
  abstract  = {Background: The patterns of benzodiazepine prescriptions in older adults are of general and scientific interest as they are not yet well understood. The aim of this study was to compare the prescription patterns of benzodiazepines in elderly people in Germany to determine the share or proportion treated by general practitioners (GP) and neuropsychiatrists (NP). Methods: This study included 31,268 and 6,603 patients between the ages of 65 and 100 with at least one benzodiazepine prescription in 2014 from GP and NP, respectively. Demographic data included age, gender, and type of health insurance coverage. The share of elderly people with benzodiazepine prescriptions was estimated in different age and disease groups for both GP and NP patients. The share of the six most commonly prescribed drugs was also calculated for each type of practice. Results: The share of people taking benzodiazepines prescribed by GP increased from 3.2\% in patients aged between 65 and 69 years to 8.6\% in patients aged between 90 and 100 years, whereas this share increased from 5.4\% to 7.1\% in those seen by NP. Benzodiazepines were frequently used by patients suffering from sleep disorders (GP: 33.9\%; NP: 5.5\%), depression (GP: 17.9\%; NP: 29.8\%), and anxiety disorders (GP: 14.5\%; NP: 22.8\%). Lorazepam (30.3\%), oxazepam (24.7\%), and bromazepam (24.3\%) were the three most commonly prescribed drugs for GP patients. In contrast, lorazepam (60.4\%), diazepam (14.8\%), and oxazepam (11.2\%) were those more frequently prescribed to NP patients. Conclusion: Prescription patterns of benzodiazepine in the elderly varied widely between GP and NP.},
  language  = {en}
}
@article{MarschnerMellWartenburgeretal.2005,
  author    = {Marschner, Alexander and Mell, Thomas and Wartenburger, Isabell and Villringer, Arno and Reischies, Friedel M. and Heekeren, Hauke R.},
  title     = {Reward-based decision-making and aging},
  issn      = {0361-9230},
  year      = {2005},
  language  = {en}
}
@article{HeekerenWartenburgerMarschneretal.2007,
  author    = {Heekeren, Hauke R. and Wartenburger, Isabell and Marschner, Alexander and Mell, Thomas and Villringer, Arno and Reischies, Friedel M.},
  title     = {Role of ventral striatum in reward-based decision making},
  issn      = {0959-4965},
  year      = {2007},
  language  = {en}
}