Publications by authors named "Mandy Roheger"

15 Publications

  • Page 1 of 1

Prognostic Factors and Models for Changes in Cognitive Performance After Multi-Domain Cognitive Training in Healthy Older Adults: A Systematic Review.

Front Hum Neurosci 2021 27;15:636355. Epub 2021 Apr 27.

Department of Medical Psychology | Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, Cologne, Germany.

Cognitive Training (CT) may contribute to the maintenance and even enhancement of cognitive functions in healthy older adults. However, the question who benefits most from multi-domain CTs is still highly under-investigated. The goal is to investigate prognostic factors and models for changes in cognitive test performance in healthy older adults after a multi-domain CT. The data bases MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched up to July 2019. Studies investigating prognostic factors and/or models on cognitive outcomes (global cognition, memory, attention, executive functions, language, visuo-spatial abilities) after conducting a multi-domain CT in healthy older adults were included. Risk of Bias was assessed using the QUIPS and the PROBAST tool. 23 prognostic factor and model studies were included. Results indicate a high heterogeneity regarding the conducted multi-domain CTs, the investigated prognostic factors, the investigated outcomes, and the used statistical approaches. Age and neuropsychological performance at study entry were the most investigated predictors, yet they show inconsistent results. Data on prognostic factors and models of changes after multi-domain CT are still too rare and inconsistent to draw clear conclusions due to statistical shortcomings and low reporting quality. Approaches for future research are outlined. https://www.crd.york.ac.uk/prospero/, ID: CRD42020147531.
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http://dx.doi.org/10.3389/fnhum.2021.636355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110835PMC
April 2021

Nothing wrong about change: the adequate choice of the dependent variable and design in prediction of cognitive training success.

BMC Med Res Methodol 2020 12 7;20(1):296. Epub 2020 Dec 7.

Department of Neurology, University Medicine Greifswald, Walther-Rathenau Str. 49, 17489, Greifswald, Germany.

Background: Even though investigating predictors of intervention success (e.g Cognitive Training, CT) is gaining more and more interest in the light of an individualized medicine, results on specific predictors of intervention success in the overall field are mixed and inconsistent due to different and sometimes inappropriate statistical methods used. Therefore, the present paper gives a guidance on the appropriate use of multiple regression analyses to identify predictors of CT and similar non-pharmacological interventions.

Methods: We simulated data based on a predefined true model and ran a series of different analyses to evaluate their performance in retrieving the true model coefficients. The true model consisted of a 2 (between: experimental vs. control group) × 2 (within: pre- vs. post-treatment) design with two continuous predictors, one of which predicted the success in the intervention group and the other did not. In analyzing the data, we considered four commonly used dependent variables (post-test score, absolute change score, relative change score, residual score), five regression models, eight sample sizes, and four levels of reliability.

Results: Our results indicated that a regression model including the investigated predictor, Group (experimental vs. control), pre-test score, and the interaction between the investigated predictor and the Group as predictors, and the absolute change score as the dependent variable seemed most convenient for the given experimental design. Although the pre-test score should be included as a predictor in the regression model for reasons of statistical power, its coefficient should not be interpreted because even if there is no true relationship, a negative and statistically significant regression coefficient commonly emerges.

Conclusion: Employing simulation methods, theoretical reasoning, and mathematical derivations, we were able to derive recommendations regarding the analysis of data in one of the most prevalent experimental designs in research on CT and external predictors of CT success. These insights can contribute to the application of considered data analyses in future studies and facilitate cumulative knowledge gain.
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http://dx.doi.org/10.1186/s12874-020-01176-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720538PMC
December 2020

A Systematic Review on Predictors of Working Memory Training Responsiveness in Healthy Older Adults: Methodological Challenges and Future Directions.

Front Aging Neurosci 2020 14;12:575804. Epub 2020 Oct 14.

Department of Medical Psychology | Neuropsychology & Gender Studies, Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.

Research on predictors of working memory training responsiveness, which could help tailor cognitive interventions individually, is a timely topic in healthy aging. However, the findings are highly heterogeneous, reporting partly conflicting results following a broad spectrum of methodological approaches to answer the question "who benefits most" from working memory training. The present systematic review aimed to systematically investigate prognostic factors and models for working memory training responsiveness in healthy older adults. Four online databases were searched up to October 2019 (MEDLINE Ovid, Web of Science, CENTRAL, and PsycINFO). The inclusion criteria for full texts were publication in a peer-reviewed journal in English/German, inclusion of healthy older individuals aged ≥55 years without any neurological and/or psychiatric diseases including cognitive impairment, and the investigation of prognostic factors and/or models for training responsiveness after targeted working memory training in terms of direct training effects, near-transfer effects to verbal and visuospatial working memory as well as far-transfer effects to other cognitive domains and behavioral variables. The study design was not limited to randomized controlled trials. A total of 16 studies including = 675 healthy older individuals with a mean age of 63.0-86.8 years were included in this review. Within these studies, five prognostic model approaches and 18 factor finding approaches were reported. Risk of bias was assessed using the Quality in Prognosis Studies checklist, indicating that important information, especially regarding the domains study attrition, study confounding, and statistical analysis and reporting, was lacking throughout many of the investigated studies. Age, education, intelligence, and baseline performance in working memory or other cognitive domains were frequently investigated predictors across studies. Given the methodological shortcomings of the included studies, no clear conclusions can be drawn, and emerging patterns of prognostic effects will have to survive sound methodological replication in future attempts to promote precision medicine approaches in the context of working memory training. Methodological considerations are discussed, and our findings are embedded to the cognitive aging literature, considering, for example, the cognitive reserve framework and the compensation vs. magnification account. The need for personalized cognitive prevention and intervention methods to counteract cognitive decline in the aging population is high and the potential enormous. PROSPERO, ID CRD42019142750.
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http://dx.doi.org/10.3389/fnagi.2020.575804DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591761PMC
October 2020

Predictors of changes after reasoning training in healthy adults.

Brain Behav 2020 12 27;10(12):e01861. Epub 2020 Sep 27.

Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.

Objectives: To investigate predictors of performance changes and their time course in healthy older adults.

Design: A post hoc analysis of a RCT investigating the effect of reasoning cognitive training (ReaCT) compared to an active control group (CG) during a time course.

Setting And Participants: An online, home-based RCT including n = 4,310 healthy participants (ReaCT: n = 2,557; CG: n = 1,753) aged 50 years and older.

Methods: Multiple regression analyses were conducted to investigate predictors (age, sex, education, severity of depression, number of training sessions the participants attended, and neuropsychological baseline values) of the outcome measures grammatical reasoning, working memory, digit vigilance, verbal short-term memory, and verbal learning at 6 weeks, 3, and 6 months.

Results: Being female and lower education predicted improvements in grammatical reasoning scores at 6 weeks and 3 months of training.

Conclusion And Implication: Identifying predictors for nonpharmacological interventions may help to set up a personalized medicine approach in order to prevent cognitive decline in healthy older adults.
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http://dx.doi.org/10.1002/brb3.1861DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7749593PMC
December 2020

Prognostic factors for change in memory test performance after memory training in healthy older adults: a systematic review and outline of statistical challenges.

Diagn Progn Res 2020 21;4. Epub 2020 May 21.

1Department of Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 68, 50937 Cologne, Germany.

Background: The goal is to investigate prognostic factors for change in memory test performance in healthy older adults and to report and discuss the different statistical procedures used for investigating this topic in the literature.

Methods: Prognostic factors were here understood as any measures that were investigated to estimate change in memory test performance. MEDLINE, Web of Science Core Collection, CENTRAL, and PsycInfo were searched up to November 2019. Prognostic factor and prognostic factor finding studies investigating prognostic factors on verbal and non-verbal short- and long-term memory after conducting memory training in healthy older adults were included. Risk of bias was assessed using the QUIPS tool.

Results: Our search yielded 12,974 results. We included 29 studies that address prognostic factors of change in memory test performance, including sociodemographic, (neuro-)psychological, genetic, and biological parameters. Studies showed high variation and methodological shortcomings with regard to the assessment, statistical evaluation, and reporting of the investigated prognostic factors. Included studies used different types of dependent variables (change scores vs. post-test scores) when defining change in memory test performance leading to contradictory results. Age was the only variable investigated throughout most of the studies, showing that older adults benefit more from training when using the change score as the dependent variable.

Conclusion: Overall, there is a need for adequate reporting in studies of prognostic factors for change in memory test performance. Because of inconsistencies and methodological shortcomings in the literature, conclusions regarding prognostic factors remain uncertain. As a tentative conclusion, one may say that the higher the age of the participant, the more profound the improvement in memory test performance will be after memory training.

Trial Registration: CRD42019127479.
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http://dx.doi.org/10.1186/s41512-020-0071-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240921PMC
May 2020

Lower cognitive baseline scores predict cognitive training success after 6 months in healthy older adults: Results of an online RCT.

Int J Geriatr Psychiatry 2020 09 1;35(9):1000-1008. Epub 2020 Jun 1.

Institute of Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.

Background: Identifying predictors for general cognitive training (GCT) success in healthy older adults has many potential uses, including aiding intervention and improving individual dementia risk prediction, which are of high importance in health care. However, the factors that predict training improvements and the temporal course of predictors (eg, do the same prognostic factors predict training success after a short training period, such as 6 weeks, as well as after a longer training period, such as 6 months?) are largely unknown.

Methods: Data (N = 4,184 healthy older individuals) from two arms (GCT vs. control) of a three-arm randomized controlled trial were reanalyzed to investigate predictors of GCT success in five cognitive tasks (grammatical reasoning, spatial working memory, digit vigilance, paired association learning, and verbal learning) at three time points (after 6 weeks, 3 months, and 6 months of training). Possible investigated predictors were sociodemographic variables, depressive symptoms, number of training sessions, cognitive baseline values, and all interaction terms (group*predictor).

Results: Being female was predictive for improvement in grammatical reasoning at 6 weeks in the GCT group, and lower cognitive baseline scores were predictive for improvement in spatial working memory and verbal learning at 6 months.

Conclusion: Our data indicate that predictors seem to change over time; remarkably, lower baseline performance at study entry is only a significant predictor at 6 months training. Possible reasons for these results are discussed in relation to the compensation hypothesis. J Am Geriatr Soc 68:-, 2020.
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http://dx.doi.org/10.1002/gps.5322DOI Listing
September 2020

Parallel and serial task processing in the PRP paradigm: a drift-diffusion model approach.

Psychol Res 2021 Jun 25;85(4):1529-1552. Epub 2020 Apr 25.

Department of Psychology, University of Cologne, Richard-Strauss-Straße 2, 50931, Cologne, Germany.

Even after a long time of research on dual-tasking, the question whether the two tasks are always processed serially (response selection bottleneck models, RSB) or also in parallel (capacity-sharing models) is still going on. The first models postulate that the central processing stages of two tasks cannot overlap, producing a central processing bottleneck in Task 2. The second class of models posits that cognitive resources are shared between the central processing stages of two tasks, allowing for parallel processing. In a series of three experiments, we aimed at inducing parallel vs. serial processing by manipulating the relative frequency of short vs. long SOAs (Experiments 1 and 2) and including no-go trials in Task 2 (Experiment 3). Beyond the conventional response time (RT) analyses, we employed drift-diffusion model analyses to differentiate between parallel and serial processing. Even though our findings were rather consistent across the three experiments, they neither support unambiguously the assumptions derived from the RSB model nor those derived from capacity-sharing models. SOA frequency might lead to an adaptation to frequent time patterns. Overall, our diffusion model results and mean RTs seem to be better explained by participant's time expectancies.
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http://dx.doi.org/10.1007/s00426-020-01337-wDOI Listing
June 2021

Structured Cognitive Training Yields Best Results in Healthy Older Adults, and Their ApoE4 State and Baseline Cognitive Level Predict Training Benefits.

Cogn Behav Neurol 2019 06;32(2):76-86

Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention.

Background: Cognitive training has been shown to improve cognitive functions in healthy older adults. However, little is known about which specific variables are responsible for the improvement.

Objective: Our aim was to evaluate whether healthy older adults benefit more from a structured cognitive training program than an unstructured brain jogging program and to identify possible predictors for training success, including apolipoprotein E4 (apoE4).

Methods: In a randomized controlled trial, participants completed either a 6-week structured cognitive training program (n=35) or a 6-week unstructured brain jogging program (n=35). A control group received no training and was not part of the randomization procedure (n=35). Overall, 105 participants were included in the training data analyses, focusing on verbal memory, attention, and executive functions. Data from an additional 45 previously trained, healthy older adults were used for the predictor analysis.

Results: A significant Time×Training interaction in favor of the structured cognitive training program was found in verbal memory. Low baseline performance on neuropsychological tests was a significant predictor for benefits in verbal memory, attention, and executive functions. A subgroup analysis (n=35) revealed that only noncarriers of the apoE4 allele showed significant gains in long-term verbal memory and attention.

Conclusions: Our results support the greater effectiveness of structured cognitive training on verbal memory compared with brain jogging and no training. The success of this type of training program may be predicted by sociodemographic, cognitive, and genetic variables.
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http://dx.doi.org/10.1097/WNN.0000000000000195DOI Listing
June 2019

Predicting short- and long-term cognitive training success in healthy older adults: who benefits?

Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2020 05 15;27(3):351-369. Epub 2019 May 15.

Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Medical Faculty and University Hospital of Cologne, Cologne, Germany.

Identifying factors predicting effects of cognitive trainings (CT) is important for developing trainings for individuals with specific profiles. The objective of the present study was to evaluate predictors of CT success in several cognitive domains directly after and 1 year after a 7-week group CT in healthy older adults. Sociodemographic variables, baseline cognitive performance, physical activity parameters, apolipoprotein E-4 (apoE-4), levels of insulin-like growth factor 1 (IGF-1), brain-derived neurotrophic factor (BDNF), and vascular endothelial growth factor (VEGF) were analysed as possible predictors of CT success. Outcomes were assessed directly after training  and 1 year after CT. Results indicate that lower initial baseline performance was a significant predictor for CT success in most of the investigated domains. All tested predictors (except age and BDNF) predicted CT success in different domains. Our data indicate that healthy older adults with lower cognitive baseline scores show stronger benefits of a CT group intervention.
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http://dx.doi.org/10.1080/13825585.2019.1617396DOI Listing
May 2020

Basic Diagnostic Work-Up Is More Complete in Rural than in Urban Areas for Patients with Dementia: Results of a Swedish Dementia Registry Study.

J Alzheimers Dis 2019 ;69(2):455-462

Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.

Background: Life in rural areas differs from life in urban areas not only in geographical conditions, but also in health care structure.

Objective: Our aim is to compare the diagnostic process and the management of dementia in rural and urban areas of Sweden.

Methods: We performed a cross-sectional study of patients with dementia living in rural (n = 16,428), intermediate (n = 18,033), and urban (n = 23,680) areas in Sweden including patients registered from 2007 through 2014 in the Swedish Dementia Registry (SveDem). Descriptive statistics are shown. Odds ratios with 95% CI are presented for basic diagnostic examinations in rural compared to intermediate and urban areas, adjusted for age, sex, type of care (primary versus specialist), and comorbidities. Analyses were also stratified for diagnostic care unit (primary versus specialist).

Results: Patients who lived in rural areas were more likely to receive a complete basic examination, MMSE examination, Clock test, blood analysis, and neuro-imaging, compared to patients living in urban areas, and also compared to patients living in intermediate areas. Sex differences were seen in nearly all domains, with men receiving more diagnostic work-up than women. Stratified analyses show that in primary care, the complete basic examination is less frequently performed in urban and intermediate areas compared to rural areas.

Conclusion: There are differences in diagnostic work-up for dementia between rural, intermediate, and urban areas in Sweden. These results should be considered in future healthcare decisions to ensure equality of health care across rural and urban areas.
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http://dx.doi.org/10.3233/JAD-190017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6597969PMC
September 2020

Cognitive Stimulation for Individuals with Parkinson's Disease Dementia Living in Long-Term Care: Preliminary Data from a Randomized Crossover Pilot Study.

Parkinsons Dis 2018 2;2018:8104673. Epub 2018 Dec 2.

Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Kerpenerstraβe 62, 50937 Cologne, Germany.

Background: While the efficacy of cognitive stimulation (CS) has been demonstrated in patients with dementia, no study has included patients with Parkinson's disease dementia (PDD).

Objective: For the first time, this randomized crossover pilot study examined the feasibility and potential effects of CS in PDD.

Methods: All residents of a PDD-specific long-term care unit in the Netherlands that were eligible for the study (=12) were randomly allocated to group A (=6) receiving CS (eight weeks, twice weekly for 60 minutes) or group B (=6) receiving usual care (control group, CG). The CG participated in CS afterwards, resulting in an experimental group (EG), consisting of =12. Pre- and postassessments and a six-week follow-up (FU) were conducted for cognition, neuropsychiatric symptoms, quality of life (QoL), and activities of daily living (ADL) outcomes.

Results: Between-group analysis with difference scores from pre- to posttest revealed a group difference for global cognition (CERAD total score) favoring the EG, with a moderate effect size and a value just failing to reach statistical significance (=0.067; = 0.43). A further statistical trend was observed for neuropsychiatric symptoms, again with a moderate effect size (=0.075; = 0.42). Within-group analyses indicated improvement only in the EG with large effects also just failing to reach significance for global cognition (short term, =0.060; = 0.70) as well as for depression (long term, =0.072; = 0.61). ADL deteriorated significantly at FU in the EG (=0.014; = 0.71).

Conclusions: Although our data are preliminary due to the small sample size, this study shows that CS is feasible and potentially effective for cognitive and noncognitive outcomes in PDD patients. Randomized controlled trials with larger sample sizes are needed to confirm these promising results.
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http://dx.doi.org/10.1155/2018/8104673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304852PMC
December 2018

Effects of a Cognitive Training With and Without Additional Physical Activity in Healthy Older Adults: A Follow-Up 1 Year After a Randomized Controlled Trial.

Front Aging Neurosci 2018 18;10:407. Epub 2018 Dec 18.

Department of Neurology, University Hospital Cologne, Cologne, Germany.

Combining cognitive training (CT) with physical activity (CPT) has been suggested to be most effective in maintaining cognition in healthy older adults, but data are scarce and inconsistent regarding long-term effects (follow-up; FU) and predictors of success. To investigate the 1-year FU effects of CPT versus CT and CPT plus counseling (CPT+C), and to identify predictors for CPT success at FU. We included 55 healthy older participants in the data analyses; 18 participants (CPT group) were used for the predictor analysis. In a randomized controlled trial, participants conducted a CT, CPT, or CPT+C for 7 weeks. Overall cognition, verbal, figural, and working memory, verbal fluency, attention, planning, and visuo-construction. While within-group comparisons showed cognitive improvements for all types of training, only one significant interaction × favoring CPT in comparison to CPT+C was found for overall cognition and verbal long-term memory. The most consistent predictor for CPT success (in verbal short-term memory, verbal fluency, attention) was an initial low baseline performance. Lower education predicted working memory gains. Higher levels of insulin-like growth factor 1 (IGF-1) and lower levels of brain-derived neurotrophic factor at baseline (BDNF) predicted alternating letter verbal fluency gains. Within-group comparisons indicate that all used training types are helpful to maintain cognition. The fact that cognitive and sociodemographic data as well as nerve growth factors predict long-term benefits of CPT contributes to the understanding of the mechanisms underlying training success and may ultimately help to adapt training to individual profiles. WHO ICTRP (http://apps.who.int/trialsearch/), identifier DRKS00005194.
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http://dx.doi.org/10.3389/fnagi.2018.00407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6305338PMC
December 2018

Progression of Cognitive Decline in Parkinson's Disease.

J Parkinsons Dis 2018 ;8(2):183-193

German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.

Background: Cognitive dysfunction is one of the most prevalent non-motor symptoms in Parkinson's disease (PD), often experienced as more debilitating for patients and caregivers than motor problems. Therefore, a deeper understanding of the course of cognitive decline and the identification of valid progression markers for Parkinson's disease dementia (PDD) is essential.

Objective: This systematic review summarizes the current state of knowledge on cognitive decline over time by reporting effect sizes of cognitive changes in neuropsychological tests.

Methods: 1368 studies were identified by a PubMed database search and 25 studies by additionally scanning previous literature. After screening all records, including 69 full-text article reviews, 12 longitudinal studies on the progression of cognitive decline in PD met our criteria (e.g., sample size ≥50 patients).

Results: Only a few studies monitored cognitive decline over a longer period (>4 years). Most studies focused on the evaluation of change in global cognitive state by use of the Mini-Mental State Examination, whereas the use of neuropsychological tests was highly heterogenic among studies. Only one study evaluated patients' cognitive performance in all specified domains (executive function, attention & working memory, memory, language, and visual-spatial function) allowing for diagnosis of cognitive impairment according to consensus guidelines. Medium to strong effect sizes could only be observed in studies with follow-up intervals of four years or longer.

Conclusions: The results emphasize the need for the assessment of larger PD cohorts over longer periods of follow-up with a comprehensive neuropsychological battery.
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http://dx.doi.org/10.3233/JPD-181306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004891PMC
October 2019

Mortality and nursing home placement of dementia patients in rural and urban areas: a cohort study from the Swedish Dementia Registry.

Scand J Caring Sci 2018 Dec 14;32(4):1308-1313. Epub 2018 Apr 14.

Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.

Background: Life in rural and urban areas differs in regard to social support and health care. Our aim was to examine the association between nursing home placement and survival of patients with dementia living in urban vs. rural areas.

Methods: We performed a longitudinal cohort study of patients with dementia at time of diagnosis (n = 58 154) and at first follow-up (n = 21 522) including patients registered from 2007 through 2014 in the Swedish Dementia Registry (SveDem). Descriptive statistics are shown. Odds ratios with 95% CI are presented for nursing home placement and hazard ratios for survival analysis.

Results: In age- and sex-adjusted analyses, patients living in urban areas were more likely to be in nursing homes at the time of dementia diagnosis than patients in rural areas (1.49, 95% CI: 1.29-1.73). However, there were no differences in rural vs urban areas in either survival after dementia diagnosis (urban: 0.99, 0.95-1.04, intermediate: 1.00, 0.96-1.04), or nursing home placement at first follow-up (urban: 1.00, 0.88-1.13; intermediate: 0.95, 0.85-1.06).

Conclusion: Persons with dementia living in rural areas are less likely to live in a nursing home than their urban counterparts at the time of dementia diagnosis, but these differences disappear by the time of first follow-up. Differences in access to nursing homes between urban and rural settings could explain these findings. Results should be considered in the future healthcare decisions to ensure equality of health care across rural and urban areas.
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http://dx.doi.org/10.1111/scs.12574DOI Listing
December 2018

Cognitive interventions in patients with dementia living in long-term care facilities: Systematic review and meta-analysis.

Arch Gerontol Geriatr 2017 Nov 29;73:204-221. Epub 2017 Jul 29.

Medical Psychology | Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University Hospital Cologne, Kerpenerstraße 62, 50937 Cologne, Germany. Electronic address:

Background: Previous reviews and meta-analyses demonstrated effects of cognitive interventions in dementia, but none specifically considered residents with dementia in long-term care (LTC) facilities.

Objective: To analyse the efficacy of cognitive interventions in institutionalised individuals with dementia.

Methods: After identifying 27 articles, a systematic review was performed. A meta-analysis was calculated for 15 studies of the randomized controlled trials regarding effects on relevant outcomes. Fixed-effects meta-analyses were conducted using standardized mean differences (SMD) of changes from baseline pooled using the inverse variance method.

Results: When comparing cognitive interventions to passive control groups, the meta-analysis revealed significant moderate effects on global cognition (SMD=0.47, 95% CI 0.27-0.67), autobiographical memory (0.67, 0.02-1.31), and behavioral and psychological symptoms in dementia (BPSD; 0.71, 0.06-1.36). Significant small effects were detected for quality of life (QoL; 0.37, 0.05-0.70). Moderate effects on activities of daily living (0.28; -0.02 to 0.58) failed to reach significance; no effects were found on depression (0.22; -0.08 to 0.51). Significant moderate effects of global cognition (0.55; 0.22-0.89) and depression (0.64; 0.21-1.07) were also found for cognitive interventions contrasting active control groups. No harmful events related to the participation in the interventions were observed.

Conclusion: Cognitive interventions are safe and effective for residents with dementia in LTC. However, while it seems clear that cognitive benefits can specifially be assigned to these forms of intervention, further research is necessary to clarify whether the effects on BPSD and QoL reflect unspecific changes due to additional attention. Furthermore, future studies will have to determine which intervention type yields the largest benefits.
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http://dx.doi.org/10.1016/j.archger.2017.07.017DOI Listing
November 2017