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Wenn in der Medizin vom demografischen Wandel gesprochen wird [1], wird zumeist von einer rasanten Zunahme der Hochaltrigen gesprochen, bei denen aufgrund der differenziellen altersassoziierten Inzidenzraten in erster Linie eine Zunahme an Demenzerkrankungen, kardiovaskulären Erkrankungen, Krebserkrankungen und allgemeiner Multimorbidität und Gebrechlichkeit zu erwarten ist [2]. Dies ist unstrittig richtig, aber nur ein Teil der Folgen des demografischen Wandels für die psychiatrische Versorgung. Diese muss weiterhin die gesamte adulte Lebensspanne im Blick haben, da sonst Versorgungsengpässe bei ohnehin vulnerablen Patienten verstärkt werden, mit Folgen für die Morbidität und Mortalität auf Bevölkerungsebene [3].
Theoretical models and preceding studies have described age-related alterations in neuronal activation of frontoparietal regions in a working memory (WM)load-dependent manner. However, to date, underlying neuronal mechanisms of these WM load-dependent activation changes in aging remain poorly understood. The aim of this study was to investigate these mechanisms in terms of effective connectivity by application of dynamic causal modeling with Bayesian Model Selection. Eighteen healthy younger (age: 20-32 years) and 32 older (60-75 years) participants performed an n-back task with 3 WM load levels during functional magnetic resonance imaging (fMRI). Behavioral and conventional fMRI results replicated age group by WM load interactions. Importantly, the analysis of effective connectivity derived from dynamic causal modeling, indicated an age-and performance-related reduction in WM load-dependent modulation of connectivity from dorsolateral prefrontal cortex to inferior parietal lobule. This finding provides evidence for the proposal that age-related WM decline manifests as deficient WM load-dependent modulation of neuronal top-down control and can integrate implications from theoretical models and previous studies of functional changes in the aging brain.
Ziel der Studie Erfassung der Strukturen zur Frühdiagnostik von Demenzen an Krankenhäusern in Deutschland.
Methodik Fragebogenerhebung.
Ergebnisse 14 % von 1758 kontaktierten Einrichtungen antworteten. 52 % berichteten über ein entsprechendes Angebot, zum großen Teil mit leitlinienorientierten Verfahren, wie Liquordiagnostik. Das Diagnosespektrum umfasste zu 46 % Demenzen und zu 41 % Diagnosen der leichten oder subjektiven kognitiven Störung.
Schlussfolgerung Leitlinienbasierte Diagnostik und Früherkennungskonzepte sind in Gedächtnisambulanzen weitgehend etabliert.
Objective: The purpose of this systematic review and meta-analysis was to examine the effects of exercise on depression and anxiety in people living with HIV (PLWH), and to evaluate, through subgroup analysis, the effects of exercise type, frequency, supervision by exercise professionals, study quality, and control group conditions on these outcomes. Method: A literature search was conducted through four electronic databases from inception to February 2019. Considered for inclusion were randomized controlled trials (RCTs) investigating exercise interventions and depression or anxiety as outcomes in people living with HIV (>= 18 years of age). Ten studies were included (n = 479 participants, 49.67% females at baseline), and the standardized mean difference (SMD) and heterogeneity were calculated using random-effect models. An additional pre-post meta-analysis was also conducted. Results: A large effect in favor of exercise when compared to controls was found for depression (SMD = -0.84, 95%CI = [-1.57, -0.11], p = 0.02) and anxiety (SMD = -1.23, 95%CI = [-2.42, 0.04], p = -0.04). Subgroup analyses for depression revealed large effects on depression for aerobic exercise only (SMD = -0.96, 95%CI = [-1.63, -0.30], p = 0.004), a frequency of >= 3 exercise sessions per week (SMD = -1.39, 95%CI = [-2.24, -0.54], p < 0.001), professionally supervised exercise (SMD = -1.40, 95%CI = [-2.46, -0.17], p = 0.03]), and high-quality studies (SMD = -1.31, 95%CI = [-2.46, -0.17], p = 0.02). Conclusion: Exercise seems to decrease depressive symptoms and anxiety in PLWH, but other larger and high-quality studies are needed to verify these effects.
Der demografische Wandel wird nicht nur mit einer rasanten Zunahme der Hochaltrigen einhergehen [1], was für die gerontopsychiatrische Versorgung aufgrund der altersassoziierten Inzidenzraten in erster Linie eine Zunahme an Demenzerkrankungen und Patienten mit Multimorbidität und Gebrechlichkeit bedeutet [2], sondern auch mit einer Zunahme jüngerer alter Menschen vom 65. bis 75. Lebensjahr, was für die Gerontopsychiatrie eine Zunahme der Patienten mit Abhängigkeitserkrankungen, Erkrankungen aus dem schizophrenen Formenkreis und affektiven Erkrankungen bedeutet. Soziale Faktoren werden hier mehr und mehr eine zentrale Rolle spielen, da neben der Qualität der medizinischen Versorgung insbesondere die individuelle soziale Situation der Patienten mit einer erhöhten Morbidität und Mortalität einhergehen wird [3].
Background: Pavlovian processes are thought to play an important role in the development, maintenance and relapse of alcohol dependence, possibly by influencing and usurping on- going thought and behavior. The influence of Pavlovian stimuli on on-going behavior is paradigmatically measured by Pavlovian-to-instrumental-transfer (PIT) tasks. These involve multiple stages and are complex. Whether increased PIT is involved in human alcohol
dependence is uncertain. We therefore aimed to establish and validate a modified PIT paradigm that would be robust, consistent, and tolerated by healthy controls as well as by patients suffering from alcohol dependence, and to explore whether alcohol dependence is associated with enhanced Pavlovian-Instrumental transfer.
Methods: 32 recently detoxified alcohol-dependent patients and 32 age and gender matched healthy controls performed a PIT task with instrumental go/no-go approach behaviours. The task involved both Pavlovian stimuli associated with monetary rewards and losses, and images of drinks.
Results: Both patients and healthy controls showed a robust and temporally stable PIT effect. Strengths of PIT effects to drug-related and monetary conditioned stimuli were highly correlated. Patients more frequently showed a PIT effect and the effect was stronger in response to aversively conditioned CSs (conditioned suppression), but there was no group difference in response to appetitive CSs.
Conclusion: The implementation of PIT has favorably robust properties in chronic alcohol- dependent patients and in healthy controls. It shows internal consistency between monetary and drug-related cues. The findings support an association of alcohol dependence with an increased propensity towards PIT.
Objectives. Recent work suggests that a genetic variation associated with increased dopamine metabolism in the prefrontal cortex (catechol-O-methyltransferase Val158Met; COMT) amplifies age-related changes in working memory performance. Research on younger adults indicates that the influence of dopamine-related genetic polymorphisms on working memory performance increases when testing the cognitive limits through training. To date, this has not been studied in older adults. Method. Here we investigate the effect of COMT genotype on plasticity in working memory in a sample of 14 younger (aged 24-30 years) and 25 older (aged 60-75 years) healthy adults. Participants underwent adaptive training in the n-back working memory task over 12 sessions under increasing difficulty conditions. Results. Both younger and older adults exhibited sizeable behavioral plasticity through training (P < .001), which was larger in younger as compared to older adults (P < .001). Age-related differences were qualified by an interaction with COMT genotype (P < .001), and this interaction was due to decreased behavioral plasticity in older adults carrying the Val/Val genotype, while there was no effect of genotype in younger adults. Discussion. Our findings indicate that age-related changes in plasticity in working memory are critically affected by genetic variation in prefrontal dopamine metabolism.
Rationale: Advances in neurocomputational modeling suggest that valuation systems for goal-directed (deliberative) on one side, and habitual (automatic) decision-making on the other side may rely on distinct computational strategies for reinforcement learning, namely model-free vs. model-based learning. As a key theoretical difference, the model-based system strongly demands cognitive functions to plan actions prospectively based on an internal cognitive model of the environment, whereas valuation in the model-free system relies on rather simple learning rules from operant conditioning to retrospectively associate actions with their outcomes and is thus cognitively less demanding. Acute stress reactivity is known to impair model-based but not model-free choice behavior, with higher working memory capacity protecting the model-based system from acute stress. However, it is not clear which impact accumulated real life stress has on model-free and model-based decision systems and how this influence interacts with cognitive abilities. Methods: We used a sequential decision-making task distinguishing relative contributions of both learning strategies to choice behavior, the Social Readjustment Rating Scale questionnaire to assess accumulated real life stress, and the Digit Symbol Substitution Test to test cognitive speed in 95 healthy subjects. Results: Individuals reporting high stress exposure who had low cognitive speed showed reduced model-based but increased model-free behavioral control. In contrast, subjects exposed to accumulated real life stress with high cognitive speed displayed increased model-based performance but reduced model-free control. Conclusion: These findings suggest that accumulated real life stress exposure can enhance reliance on cognitive speed for model-based computations, which may ultimately protect the model-based system from the detrimental influences of accumulated real life stress. The combination of accumulated real life stress exposure and slower information processing capacities, however, might favor model-free strategies. Thus, the valence and preference of either system strongly depends on stressful experiences and individual cognitive capacities.