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Nagel LC, Tesky VA, Schall A, Müller T, König J, Pantel J, Stangier U. Compliance with CBT referral in nursing home residents diagnosed with depression: Results from a feasibility study. Heliyon 2024; 10:e23379. [PMID: 38148800 PMCID: PMC10750160 DOI: 10.1016/j.heliyon.2023.e23379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/27/2023] [Accepted: 12/01/2023] [Indexed: 12/28/2023] Open
Abstract
Objectives Patient-level factors that influence compliance with a recommendation for CBT in nursing home residents diagnosed with depression were identified. Methods Within a cluster-randomized trial on stepped care for depression in nursing homes (DAVOS-study, Trial registration: DRKS00015686), participants received an intake interview administered by a licensed psychotherapist. If psychotherapy was required, patients were offered a referral for CBT. Sociodemographic characteristics, severity of depression, loneliness, physical health, antidepressant medication, prior experience with psychotherapy, and attitudes towards own aging were assessed. A binary regression determined predictors of compliance with referral. Results Of 123 residents receiving an intake interview, 80 were recommended a CBT. Forty-seven patients (58.8 %) followed the recommendation. The binary logistic regression model on compliance with recommended CBT was significant, χ2(9) = 21.64, p = .010. Significant predictors were age (Odds Ratio (OR) = 0.9; 95 % Confidence Interval (CI) = 0.82, 0.99; p = .024) and depression (OR = 1.33; 95 % CI = 1.08, 1.65; p = .008). Conclusion Within the implemented setting compliance rate was comparable to other age groups. Future interventions should include detailed psychoeducation on the benefits of psychotherapy on mild depressive symptoms in older age and evidence-based interventions to address the stigma of depression. Interventions such as reminiscence-based methods or problem-solving could be useful to increase compliance with referral, especially in very old patients (80+). Language barriers and a culturally sensitive approach should be considered when screening residents.
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Affiliation(s)
| | | | - Arthur Schall
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Tanja Müller
- Frankfurt Forum for Interdisciplinary Ageing Research, Goethe University, Frankfurt, Germany
| | - Jochem König
- Department of Medicine, Johannes Gutenberg University, Mainz, Germany
| | - Johannes Pantel
- Department of General Medicine, Goethe University, Frankfurt, Germany
| | - Ulrich Stangier
- Department of Clinical Psychology, Goethe University, Frankfurt, Germany
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Dieckelmann M, González-González AI, Banzer W, Berghold A, Jeitler K, Pantel J, Pregartner G, Schall A, Tesky VA, Siebenhofer A. Effectiveness of exercise interventions to improve long-term outcomes in people living with mild cognitive impairment: a systematic review and meta-analysis. Sci Rep 2023; 13:18074. [PMID: 37872230 PMCID: PMC10593841 DOI: 10.1038/s41598-023-44771-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
Although exercise guidelines now recommend exercise for patients with MCI, the long-term effects of exercise in patients with MCI has not been reviewed systematically. The aim was to assess (1) the effectiveness of exercise and physical activity (EXPA) interventions in improving long-term patient-relevant cognitive and non-cognitive outcomes in people with mild cognitive impairment, (2) how well the included trials reported details of the intervention, and (3) the extent to which reported endpoints were in line with patient preferences that were assessed in patient workshops. Following PRISMA guidelines, we performed a systematic review and meta-analysis including randomized controlled trials. A total of ten studies were included after searching in six electronic sources from 1995 onwards. There is a trend that 6 + -month EXPA interventions improve global cognition 12 months after initiation. Evidence on long-term effects of EXPA interventions on non-cognitive health outcomes could not be meaningfully pooled and the individual studies reported mixed results. Workshop participants considered freedom from pain and stress, mood, motivation and self-efficacy to be important, but these outcomes were rarely addressed. Too little information is available on intervention details for EXPA programs to be replicated and confidently recommended for patients with MCI. PROSPERO registration in December, 2021 (CRD42021287166).
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Affiliation(s)
- Mirjam Dieckelmann
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Ana I González-González
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Winfried Banzer
- Institute for Occupational, Social and Environmental Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Klaus Jeitler
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
| | - Johannes Pantel
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Arthur Schall
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Valentina A Tesky
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Andrea Siebenhofer
- Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz, Austria
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Tesky VA, Schall A, Pantel J. [Non-pharmacological Therapies of Dementia - an Update]. Ther Umsch 2023; 80:234-241. [PMID: 37203165 DOI: 10.1024/0040-5930/a001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Non-pharmacological Therapies of Dementia - an Update Abstract: 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. This is an up-to-date overview of the most important non-drug interventions for people with dementia and related recommendations for therapeutic use according to the current state of research and the recommendations of AWMF S3 guideline "dementia". The most important interventions from this therapeutic spectrum are cognitive stimulation to maintain cognitive functioning, physical activation, and creative therapeutic offers 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.
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Affiliation(s)
- Valentina A Tesky
- Arbeitsbereich Altersmedizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Deutschland
| | - Arthur Schall
- Arbeitsbereich Altersmedizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Deutschland
| | - Johannes Pantel
- Arbeitsbereich Altersmedizin, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Deutschland
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Tesky VA, Schall A, Pantel J. [Non-pharmacological interventions for people with dementia]. Inn Med (Heidelb) 2023; 64:139-146. [PMID: 36520205 DOI: 10.1007/s00108-022-01446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND 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. OBJECTIVE An up-to-date overview of the most important non-drug interventions for people with dementia and related recommendations for therapeutic use. MATERIAL AND METHODS 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". RESULTS AND CONCLUSIONS 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.
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Affiliation(s)
- Valentina A Tesky
- Institut für Allgemeinmedizin, Arbeitsbereich Altersmedizin mit Schwerpunkt Psychogeriatrie und klinische Gerontologie, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Arthur Schall
- Institut für Allgemeinmedizin, Arbeitsbereich Altersmedizin mit Schwerpunkt Psychogeriatrie und klinische Gerontologie, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Johannes Pantel
- Institut für Allgemeinmedizin, Arbeitsbereich Altersmedizin mit Schwerpunkt Psychogeriatrie und klinische Gerontologie, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
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Dieckelmann M, Gonzalez-Gonzalez AI, Banzer W, Berghold A, Jeitler K, Pantel J, Schall A, Tesky VA, Siebenhofer A. Effectiveness of exercise and physical activity interventions to improve long-term patient-relevant cognitive and non-cognitive outcomes in people living with mild cognitive impairment: a protocol of a systematic review and meta-analysis. BMJ Open 2022; 12:e063396. [PMID: 35998967 PMCID: PMC9403149 DOI: 10.1136/bmjopen-2022-063396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION 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. METHODS AND ANALYSIS 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. ETHICS AND DISSEMINATION 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. PROSPERO REGISTRATION NUMBER CRD42021287166.
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Affiliation(s)
- Mirjam Dieckelmann
- Institute of General Practice, Goethe-Universitat Frankfurt am Main, Frankfurt, Germany
| | - Ana Isabel Gonzalez-Gonzalez
- Institute of General Practice, Goethe-Universitat Frankfurt am Main, Frankfurt, Germany
- Atención Primaria y Promoción de la Salud (RICAPPS), Red de Investigación en Cronicidad, Madrid, Spain
| | - Winfried Banzer
- Institute for Occupational, Social and Environmental Medicine, Goethe University, Frankfurt, Germany
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Klaus Jeitler
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Johannes Pantel
- Institute of General Practice, Goethe-Universitat Frankfurt am Main, Frankfurt, Germany
| | - Arthur Schall
- Institute of General Practice, Goethe-Universitat Frankfurt am Main, Frankfurt, Germany
| | - Valentina A Tesky
- Institute of General Practice, Goethe-Universitat Frankfurt am Main, Frankfurt, Germany
| | - Andrea Siebenhofer
- Institute of General Practice, Goethe-Universitat Frankfurt am Main, Frankfurt, Germany
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
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Schall A, Tesky VA, Pantel J. [Non-pharmacological interventions in dementia: an overview with special consideration of digital offerings]. Dtsch Med Wochenschr 2022; 147:165-171. [PMID: 35158379 DOI: 10.1055/a-1542-6174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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 AWMF S3 dementia guideline), and additionally provides examples of selected digital approaches for this particular target group. As the aim of the interventions is to support persons with dementia in living autonomously and maintaining societal and cultural participation, all the interventions share a consideration for individual resources and the promotion of available potential. Empirical evidence on digital activities remains scarce, so it is not yet possible to make clear recommendations. When using them, it should therefore be borne in mind that although they may represent a valuable supplement, they can never replace human attention. Furthermore, limitations in their practical application, such as unfamiliarity when using digital technologies or excessive demands of cognitively limited users, as well as important ethical aspects (e. g., data protections, personality rights, dignity and self-determination in old age) should not be ignored.
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Poth A, Baumgardt M, Tesky VA, Pantel J, Oswald F, Haberstroh J. Person-environment fit of environmental support provided during medical consultations with older patients. Z Gerontol Geriatr 2021; 55:123-128. [PMID: 34468843 PMCID: PMC8921063 DOI: 10.1007/s00391-021-01961-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 07/28/2021] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Aoife Poth
- Interdisciplinary Ageing Research (IAW), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, 60323, Frankfurt, Germany
- Psychological Ageing Research (PAR), Faculty II-Education, Architecture, Arts, University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany
| | - Meret Baumgardt
- Interdisciplinary Ageing Research (IAW), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, 60323, Frankfurt, Germany
| | - Valentina A Tesky
- Institute of General Practice in Frankfurt am Main, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Johannes Pantel
- Institute of General Practice in Frankfurt am Main, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Frank Oswald
- Interdisciplinary Ageing Research (IAW), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, 60323, Frankfurt, Germany
| | - Julia Haberstroh
- Psychological Ageing Research (PAR), Faculty II-Education, Architecture, Arts, University of Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Germany.
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Haberstroh J, Tesky VA, Pantel J. [Capacity to consent of people with dementia : Insights into the S2k AWMF guidelines 108-001]. Nervenarzt 2021; 92:721-728. [PMID: 34181051 DOI: 10.1007/s00115-021-01158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Julia Haberstroh
- Psychologische Alternsforschung, Fakultät II - Dep. Erziehungswissenschaft-Psychologie, Institut für Psychologie, Universität Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Deutschland.
| | - Valentina A Tesky
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Johannes Pantel
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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Sawicki OA, Müller A, Pommée M, Blazejewski T, Schneider K, Kreuzmair L, Schwarz M, Tesky VA, Gerlach FM, Müller BS. [Design and evaluation of a preclinical medical elective titled "Safety culture in healthcare: Every error counts!"]. Z Evid Fortbild Qual Gesundhwes 2021; 161:57-62. [PMID: 33640287 DOI: 10.1016/j.zefq.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/06/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION 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. METHODS 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. RESULTS 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. DISCUSSION 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. CONCLUSION The results show that the preclinical phase is a suitable time to illustrate the importance of the subject of patient safety during medical studies.
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Affiliation(s)
- Olga A Sawicki
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland.
| | - Angelina Müller
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Marina Pommée
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Tatjana Blazejewski
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Kyra Schneider
- Stabsstelle Patientensicherheit & Qualität, Universitätsklinikum, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Lorenz Kreuzmair
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Mitja Schwarz
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Valentina A Tesky
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Ferdinand M Gerlach
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Beate S Müller
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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Haberstroh J, Tesky VA, Pantel J. [Capacity to consent of people with dementia : Insights into the S2k AWMF guidelines 108-001]. Z Gerontol Geriatr 2020; 54:167-175. [PMID: 33289856 DOI: 10.1007/s00391-020-01820-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Julia Haberstroh
- Psychologische Alternsforschung, Fakultät II - Dep. Erziehungswissenschaft-Psychologie, Institut für Psychologie, Universität Siegen, Adolf-Reichwein-Str. 2a, 57068, Siegen, Deutschland.
| | - Valentina A Tesky
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Johannes Pantel
- Institut für Allgemeinmedizin, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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Tesky VA, Schall A, Schulze U, Stangier U, Oswald F, Knopf M, König J, Blettner M, Arens E, Pantel J. Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the effectiveness of a novel case management approach to improve treatment (the DAVOS project). Trials 2019; 20:424. [PMID: 31296264 PMCID: PMC6625077 DOI: 10.1186/s13063-019-3534-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Depression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have 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 result not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality, and increased hospitalization rates. Methods The aims of the interdisciplinary research project DAVOS are to implement an innovative and stepped structural case management program to improve depression treatment for 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 380. The recruitment will continue throughout the trial (open cohort). Persons (>60 years) who 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 toward improving the health care of nursing home residents who have late-life depression. Trial registration DRKS, DRKS00015686, Oct. 10, 2018.
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Affiliation(s)
- Valentina A Tesky
- Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. .,Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany.
| | - Arthur Schall
- Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany
| | - Ulrike Schulze
- Hessian Institute of Nursing Research (HessIP), Frankfurt University of Applied Sciences (Frankfurt UAS), Nibelungenplatz 3, Frankfurt am Main, 60318, Germany
| | - Ulrich Stangier
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, Frankfurt am Main, 60486, Germany
| | - Frank Oswald
- Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany.,Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany
| | - Monika Knopf
- Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Mainz, 55131, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Mainz, 55131, Germany
| | - Elisabeth Arens
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, Frankfurt am Main, 60486, Germany
| | - Johannes Pantel
- Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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12
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Schall A, Tesky VA, Adams AK, Pantel J. Art museum-based intervention to promote emotional well-being and improve quality of life in people with dementia: The ARTEMIS project. Dementia 2017; 17:728-743. [DOI: 10.1177/1471301217730451] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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 < .05). In a situational assessment of emotional well-being immediately before and after each of the museum sessions, we were able to demonstrate statistically significant positive changes with medium effect sizes (dcorr = .74–.77). Furthermore, the total Neuropsychiatric Inventory score as well as the affective (depressed mood and anxiety) and apathy subscales were significantly lower after the ARTEMIS intervention (tNPI total = 2.43; tNPI affective = 2.24; tNPI apathy = 2.52; p < .05). The results show that art museum-based art interventions are able to improve the subjective well-being, mood, and quality of life in people with dementia. This promising psychosocial approach deserves further attention in future studies and consideration in community-based dementia care programs.
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Affiliation(s)
- Arthur Schall
- Geriatric Medicine, Institute of General Practice, Goethe University, Germany; Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Germany
| | - Valentina A Tesky
- Geriatric Medicine, Institute of General Practice, Goethe University, Germany; Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Germany
| | - Ann-Katrin Adams
- Geriatric Medicine, Institute of General Practice, Goethe University, Germany; Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Germany
| | - Johannes Pantel
- Geriatric Medicine, Institute of General Practice, Goethe University, Germany; Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Germany
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Tesky VA, Köbe T, Witte AV, Flöel A, Schuchardt JP, Hahn A, Pantel J. Feasibility and first results of a group program to increase the frequency of cognitively stimulating leisure activities in people with mild cognitive impairment (AKTIVA-MCI). Clin Interv Aging 2017; 12:1459-1469. [PMID: 28979108 PMCID: PMC5602436 DOI: 10.2147/cia.s139146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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.
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Affiliation(s)
- Valentina A Tesky
- Geriatric Medicine, Institute of General Practice, Goethe University, Frankfurt, Germany
| | - Theresa Köbe
- Department of Neurology, Charité – University Medicine Berlin, Berlin, Germany
| | - A Veronica Witte
- Department of Neurology, Charité – University Medicine Berlin, Berlin, Germany
- Department of Neurology, Max Planck Institute of Human Cognitive and Brain Sciences, University of Leipzig, Leipzig, Germany
| | - Agnes Flöel
- Department of Neurology, Charité – University Medicine Berlin, Berlin, Germany
| | - Jan Philipp Schuchardt
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University, Hannover, Germany
| | - Andreas Hahn
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University, Hannover, Germany
| | - Johannes Pantel
- Geriatric Medicine, Institute of General Practice, Goethe University, Frankfurt, Germany
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Tesky VA, Lata NÁ, Seoane JA, Carvalho AS, Gather J, Hernández‐Marrero P, Knebel M, Oswald F, Pantel J, Scholten M, Vollmann J, Wied T, Haberstroh J. [P3–472]: AN INNOVATIVE APPROACH TO ENHANCE THE INFORMED CONSENT PROCESS FOR PEOPLE WITH DEMENTIA: THE ENSURE PROJECT. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Valentina A. Tesky
- Institute of General Practice, Goethe UniversityFrankfurt am MainGermany
| | | | | | - Ana Sofia Carvalho
- Instituto de Bioética, Universidade Católica PortuguesaPortoPortugal
- UNESCO Chair in BioethicsInstitute of Bioethics, Universidade Católica PortuguesaPortoPortugal
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine, Ruhr UniversityBochumGermany
| | - Pablo Hernández‐Marrero
- Instituto de Bioética, Universidade Católica PortuguesaPortoPortugal
- UNESCO Chair in BioethicsInstitute of Bioethics, Universidade Católica PortuguesaPortoPortugal
| | - Maren Knebel
- Section of Geriatric PsychiatryUniversity Hospital HeidelbergHeidelbergGermany
- Interdisciplinary Ageing Research, Faculty of Educational SciencesGoethe UniversityFrankfurt am MainGermany
| | - Frank Oswald
- Interdisciplinary Ageing Research, Faculty of Educational SciencesGoethe UniversityFrankfurt am MainGermany
| | - Johannes Pantel
- Institute of General Practice, Goethe UniversityFrankfurt am MainGermany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr UniversityBochumGermany
| | - Jochen Vollmann
- Institute for Medical Ethics and History of Medicine, Ruhr UniversityBochumGermany
| | - Theresa Wied
- Interdisciplinary Ageing Research, Faculty of Educational SciencesGoethe UniversityFrankfurt am MainGermany
| | - Julia Haberstroh
- Interdisciplinary Ageing Research, Faculty of Educational SciencesGoethe UniversityFrankfurt am MainGermany
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15
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Matura S, Tesky VA, Pilatus U, Hattingen E, Fleckenstein J, Vogt L, Banzer W, Deichmann R, Lienerth B, Pantel J. [P2–573]: EFFECTS OF AEROBIC EXERCISE ON BRAIN METABOLISM AND GREY MATTER VOLUME IN OLDER ADULTS: RESULTS OF THE SMART TRIAL. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Silke Matura
- Institute of General Practice, Goethe UniversityFrankfurt am MainGermany
| | - Valentina A. Tesky
- Institute of General Practice, Goethe UniversityFrankfurt am MainGermany
| | - Ulrich Pilatus
- Institute of Neuroradiology, Goethe University HospitalFrankfurt am MainGermany
| | | | | | - Lutz Vogt
- Institute of Sports Sciences, Goethe UniversityFrankfurt am MainGermany
| | - Winfried Banzer
- Institute of Sports Sciences, Goethe UniversityFrankfurt am MainGermany
| | | | | | - Johannes Pantel
- Institute of General Practice, Goethe UniversityFrankfurt am MainGermany
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16
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Matura S, Fleckenstein J, Deichmann R, Engeroff T, Füzéki E, Hattingen E, Hellweg R, Lienerth B, Pilatus U, Schwarz S, Tesky VA, Vogt L, Banzer W, Pantel J. Effects of aerobic exercise on brain metabolism and grey matter volume in older adults: results of the randomised controlled SMART trial. Transl Psychiatry 2017; 7:e1172. [PMID: 28934191 PMCID: PMC5538117 DOI: 10.1038/tp.2017.135] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/21/2017] [Accepted: 05/08/2017] [Indexed: 01/29/2023] Open
Abstract
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.
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Affiliation(s)
- S Matura
- Institute of General Practice, Goethe University, Frankfurt/Main, Germany,Institut für Allgemeinmedizin, Goethe Universität, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany. E-mail:
| | - J Fleckenstein
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Frankfurt/Main, Germany
| | - R Deichmann
- Brain Imaging Center, Frankfurt/Main, Germany
| | - T Engeroff
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Frankfurt/Main, Germany
| | - E Füzéki
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Frankfurt/Main, Germany
| | - E Hattingen
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt/Main, Germany
| | - R Hellweg
- Neurobiology and Neurotrophins Laboratory, Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - B Lienerth
- Brain Imaging Center, Frankfurt/Main, Germany
| | - U Pilatus
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt/Main, Germany
| | - S Schwarz
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Frankfurt/Main, Germany
| | - V A Tesky
- Institute of General Practice, Goethe University, Frankfurt/Main, Germany
| | - L Vogt
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Frankfurt/Main, Germany
| | - W Banzer
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Frankfurt/Main, Germany
| | - J Pantel
- Institute of General Practice, Goethe University, Frankfurt/Main, Germany
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17
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Köbe T, Witte AV, Schnelle A, Tesky VA, Pantel J, Schuchardt JP, Hahn A, Bohlken J, Grittner U, Flöel A. Impact of Resveratrol on Glucose Control, Hippocampal Structure and Connectivity, and Memory Performance in Patients with Mild Cognitive Impairment. Front Neurosci 2017; 11:105. [PMID: 28326010 PMCID: PMC5339301 DOI: 10.3389/fnins.2017.00105] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/20/2017] [Indexed: 11/13/2022] Open
Abstract
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 (ANOVARMp = 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 (ANOVARMp = 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.
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Affiliation(s)
- Theresa Köbe
- Department of Neurology, Charité - University Medicine BerlinBerlin, Germany; NeuroCure Cluster of Excellence, Charité - University Medicine BerlinBerlin, Germany
| | - A Veronica Witte
- Department of Neurology, Charité - University Medicine BerlinBerlin, Germany; NeuroCure Cluster of Excellence, Charité - University Medicine BerlinBerlin, Germany; Department of Neurology, Max Planck Institute of Human Cognitive and Brain SciencesLeipzig, Germany; SFB 1052 Obesity Mechanism Subproject A1, University of LeipzigLeipzig, Germany
| | - Ariane Schnelle
- Department of Neurology, Charité - University Medicine BerlinBerlin, Germany; NeuroCure Cluster of Excellence, Charité - University Medicine BerlinBerlin, Germany
| | - Valentina A Tesky
- Department of General Medicine, Goethe-University Frankfurt am Main, Germany
| | - Johannes Pantel
- Department of General Medicine, Goethe-University Frankfurt am Main, Germany
| | - Jan-Philipp Schuchardt
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University Hannover, Germany
| | - Andreas Hahn
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University Hannover, Germany
| | - Jens Bohlken
- Medical Practice Bohlken for Neurology and Psychiatry Berlin, Germany
| | - Ulrike Grittner
- Biostatistics and Clinical Epidemiology, Charité - University Medicine Berlin Berlin, Germany
| | - Agnes Flöel
- Department of Neurology, Charité - University Medicine BerlinBerlin, Germany; NeuroCure Cluster of Excellence, Charité - University Medicine BerlinBerlin, Germany; Center for Stroke Research Berlin, Charité - University Medicine BerlinBerlin, Germany; Department of Neurology, University Medicine GreifswaldGreifswald, Germany
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18
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Witte AV, Köbe T, Graunke A, Schuchardt JP, Hahn A, Tesky VA, Pantel J, Flöel A. Impact of leptin on memory function and hippocampal structure in mild cognitive impairment. Hum Brain Mapp 2016; 37:4539-4549. [PMID: 27511061 DOI: 10.1002/hbm.23327] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 06/08/2016] [Accepted: 07/18/2016] [Indexed: 12/12/2022] Open
Abstract
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 < 0.001). Glucose and lipid markers did not attenuate these results. Moreover, MCI patients exhibited poorer memory and lower volume and microstructural integrity within hippocampal subfields. While leptin and memory were not significantly correlated, mediation analyses indicated that lower leptin contributed to poorer memory through its negative effect on right hippocampus volume and left hippocampus microstructure. We demonstrated that MCI is associated with lower serum leptin independent of sex, age, body fat, glucose, and lipid metabolism. Our data further suggest that inefficient leptin signaling could partly contribute to decreases in memory performance through changes in hippocampus structure, a hypothesis that should now be verified in longitudinal studies. Hum Brain Mapp 37:4539-4549, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- A Veronica Witte
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Max-Planck-Institute of Human Cognitive and Brain Sciences, Stephanstraße 1A, 04103, Leipzig, Germany
| | - Theresa Köbe
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Anders Graunke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jan Philipp Schuchardt
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University, Am Kleinen Felde 30, 30167, Hannover, Germany
| | - Andreas Hahn
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University, Am Kleinen Felde 30, 30167, Hannover, Germany
| | - Valentina A Tesky
- Institute of General Practice, Goethe-University, Frankfurt Am Main, 60590, Germany
| | - Johannes Pantel
- Institute of General Practice, Goethe-University, Frankfurt Am Main, 60590, Germany
| | - Agnes Flöel
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
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19
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Köbe T, Witte AV, Schnelle A, Grittner U, Tesky VA, Pantel J, Schuchardt JP, Hahn A, Bohlken J, Rujescu D, Flöel A. Vitamin B-12 concentration, memory performance, and hippocampal structure in patients with mild cognitive impairment. Am J Clin Nutr 2016; 103:1045-54. [PMID: 26912492 DOI: 10.3945/ajcn.115.116970] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 01/11/2016] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Theresa Köbe
- Department of Neurology, NeuroCure Cluster of Excellence
| | - A Veronica Witte
- Department of Neurology, NeuroCure Cluster of Excellence, Department of Neurology, Max Planck Institute of Human Cognitive and Brain Sciences, Leipzig, Germany; Sonderforschungsbereich 1052 Obesity Mechanism Subproject A1, University of Leipzig, Leipzig, Germany
| | | | | | - Valentina A Tesky
- Institute of General Practice, Goethe-University, Frankfurt am Main, Germany
| | - Johannes Pantel
- Institute of General Practice, Goethe-University, Frankfurt am Main, Germany
| | - Jan Philipp Schuchardt
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University; Hannover, Germany
| | - Andreas Hahn
- Department of Nutrition Physiology and Human Nutrition, Gottfried Wilhelm Leibniz University; Hannover, Germany
| | - Jens Bohlken
- Practice Bohlken for Neurology and Psychiatry, Berlin, Germany; and
| | - Dan Rujescu
- Department of Psychiatry, Psychotherapy and Psychosomatic, University Medicine, Halle/Saale, Germany
| | - Agnes Flöel
- Department of Neurology, NeuroCure Cluster of Excellence, Center for Stroke Research Berlin, Charité - University Medicine Berlin, Berlin, Germany;
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Matura S, Tesky VA, Pilatus U, Hattingen E, Fleckenstein J, Vogt L, Banzer W, Deichmann R, Lienerth B, Pantel J. P1‐148: Smart‐sport and cerebral metabolism in old age: An mrs/MRI study. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Silke Matura
- Institute of General PracticeGoethe UniversityFrankfurt am MainGermany
| | | | - Ulrich Pilatus
- Institute of NeuroradiologyGoethe University HospitalFrankfurt am MainGermany
| | - Elke Hattingen
- Institute of NeuroradiologyGoethe University HospitalFrankfurt am MainGermany
| | | | - Lutz Vogt
- Institute of Sports SciencesGoethe UniversityFrankfurt am MainGermany
| | - Winfried Banzer
- Institute of Sports SciencesGoethe UniversityFrankfurt am MainGermany
| | | | | | - Johannes Pantel
- Department of General MedicineGoethe UniversityFrankfurt am MainGermany
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21
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Schall A, Tesky VA, Pantel J. P3‐272: Art encounters: A museum intervention study (ARTEMIS) to promote emotional well‐being and improve quality of life in people with dementia and their informal caregivers. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Fleckenstein J, Matura S, Engeroff T, Füzéki E, Tesky VA, Pilatus U, Hattingen E, Deichmann R, Vogt L, Banzer W, Pantel J. SMART: physical activity and cerebral metabolism in older people: study protocol for a randomised controlled trial. Trials 2015; 16:155. [PMID: 25872789 PMCID: PMC4403840 DOI: 10.1186/s13063-015-0662-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Physical activity exerts a variety of long-term health benefits in older adults. In particular, it is assumed to be a protective factor against cognitive decline and dementia. Methods/design Randomised controlled assessor blinded 2-armed trial (n = 60) to explore the exercise- induced neuroprotective and metabolic effects on the brain in cognitively healthy older adults. Participants (age ≥ 65), recruited within the setting of assisted living facilities and newspaper advertisements are allocated to a 12-week individualised aerobic exercise programme intervention or a 12-week waiting control group. Total follow-up is 24 weeks. The main outcome is the change in cerebral metabolism as assessed with Magnetic Resonance Spectroscopic Imaging reflecting changes of cerebral N-acetyl-aspartate and of markers of neuronal energy reserve. Imaging also measures changes in cortical grey matter volume. Secondary outcomes include a broad range of psychometric (cognition) and movement-related parameters such as nutrition, history of physical activity, history of pain and functional diagnostics. Participants are allocated to either the intervention or control group using a computer-generated randomisation sequence. The exercise physiologist in charge of training opens sealed and opaque envelopes and informs participants about group allocation. For organisational reasons, he schedules the participants for upcoming assessments and exercise in groups of five. All assessors and study personal other than exercise physiologists are blinded. Discussion Magnetic Resonance Spectroscopic Imaging gives a deeper insight into mechanisms of exercise-induced changes in brain metabolism. As follow-up lasts for 6 months, this study is able to explore the mid-term cerebral metabolic effects of physical activity assuming that an individually tailored aerobic ergometer training has the potential to counteract brain ageing. Trial registration NCT02343029 (clinicaltrials.gov; 12 January 2015).
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Affiliation(s)
- Johannes Fleckenstein
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Ginnheimer Landstrasse 39, Frankfurt am Main, 60487, Germany.
| | - Silke Matura
- Institute of General Practice, Goethe University, Frankfurt/Main, Germany.
| | - Tobias Engeroff
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Ginnheimer Landstrasse 39, Frankfurt am Main, 60487, Germany.
| | - Eszter Füzéki
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Ginnheimer Landstrasse 39, Frankfurt am Main, 60487, Germany.
| | - Valentina A Tesky
- Institute of General Practice, Goethe University, Frankfurt/Main, Germany.
| | - Ulrich Pilatus
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt, Germany.
| | - Elke Hattingen
- Institute of Neuroradiology, Goethe University Hospital Frankfurt, Frankfurt, Germany.
| | | | - Lutz Vogt
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Ginnheimer Landstrasse 39, Frankfurt am Main, 60487, Germany.
| | - Winfried Banzer
- Department of Sports Medicine, Institute of Sports Sciences, Goethe University, Ginnheimer Landstrasse 39, Frankfurt am Main, 60487, Germany.
| | - Johannes Pantel
- Institute of General Practice, Goethe University, Frankfurt/Main, Germany.
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Tesky VA, Thiel C, Banzer W, Pantel J. Effects of a Group Program to Increase Cognitive Performance Through Cognitively Stimulating Leisure Activities in Healthy Older Subjects. GeroPsych 2011. [DOI: 10.1024/1662-9647/a000035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
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.
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Affiliation(s)
- Valentina A. Tesky
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital at the Goethe-University Frankfurt/Main, Germany
| | - Christian Thiel
- Department of Sports Medicine, Johann Wolfgang Goethe-University Frankfurt/Main, Germany
| | - Winfried Banzer
- Department of Sports Medicine, Johann Wolfgang Goethe-University Frankfurt/Main, Germany
| | - Johannes Pantel
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital at the Goethe-University Frankfurt/Main, Germany
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Thiel C, Vogt L, Tesky VA, Meroth L, Jakob M, Sahlender S, Pantel J, Banzer W. Cognitive intervention response is related to habitual physical activity in older adults. Aging Clin Exp Res 2011; 24:47-55. [PMID: 21406956 DOI: 10.3275/7569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS This study analysed the associations between physical activity and the effects of cognitive training on perceived cognitive functioning and life satisfaction in older adults. METHODS A sample of 114 intervention group participants (65-89 yrs) received weekly group sessions of cognitive stimulation for two months. This sample was stratified into groups according to habitual physical activity (PA) and matched with 45 controls. Participants completed the Memory Complaint Questionnaire (MAC-Q), Nuremberg Self-Rating List (NSL) and Alzheimer Disease Assessment Scale - Cognitive Subscale (ADAS-Cog) at three time-points (baseline, 2 months, and 6-month follow-up). RESULTS At baseline, groups did not differ in absolute MAC-Q, NSL or ADAS-Cog scores. NSL difference scores (follow-up score minus baseline NSL score) of the three cognitive intervention groups (>6.95h MVPA/ wk; 3.64-6.95h MVPA/wk; <3.64h MVPA/wk) and controls were -3.8±7.3, -2.5±11.0, +0.3±12.0 and +0.1±9.1 over 2 months, and -4.2±7.6, -4.0±14.0, -1.8±7.7 and +0.5±9.7 over 6 months, respectively. MAC-Q difference scores were -1.1±2.9, -1.1±3.4, -0.3±3.9 and +0.3±2.7 over 2 months, and -1.5±3.2, -0.8±2.9, -0.3±2.9 and +0.3±2.2 over 6 months. The groups significantly (p<0.05) differed on NSL and MAC-Q difference scores. Specifically, the more active groups differed from controls, and in some cases from the least active group. Groups did not differ on ADAS-Cog difference scores. CONCLUSIONS Our findings indicate a relation between amount of physical activity and the effects of a cognitive stimulation intervention on perceived cognitive functioning and life satisfaction. Physically more active persons may gain more benefit from cognitive stimulation than the physically less active.
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Affiliation(s)
- Christian Thiel
- Department of Sports Medicine, Goethe University, Frankfurt/Main, Germany.
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Tesky VA, Banzer W, Pantel J. O1‐01‐07: Cognitive stimulation with leisure activities for prevention of cognitive decline and dementia: The aktiva study. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Valentina A. Tesky
- Department of Psychiatry Psychosomatic Medicine and Psychotherapy University of FrankfurtFrankfurt am Main Germany
| | - Winfried Banzer
- Institut für Sportwissenschaften der Goethe-Universität, Abteilung für SportmedizinFrankfurt am Main Germany
| | - Johannes Pantel
- Zentrum für Psychiatrie, Klinikum der Goethe-UniversitätFrankfurt am Main Germany
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26
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Tesky VA, Banzer W, Pantel J. P1‐007: The AKTIVA‐study: Trend analyses of an intervention program to enhance cognitively stimulating activities in older adults. Alzheimers Dement 2010. [DOI: 10.1016/j.jalz.2010.05.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Valentina A. Tesky
- Department of Psychiatry Psychosomatic Medicine and Psychotherapy University of FrankfurtFrankfurt am Main Germany
| | - Winfried Banzer
- Institut für Sportwissenschaften der Goethe-Universität, Abteilung für SportmedizinFrankfurt am Main Germany
| | - Johannes Pantel
- Zentrum für Psychiatrie, Klinikum der Goethe-UniversitätFrankfurt am Main Germany
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27
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Tesky VA, Banzer W, Pantel J. AKTIVA: aktive kognitive Stimulation – Vorbeugung im Alter. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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