Motivationale Reservekapazität: Leichte kognitive Beeinträchtigung und Alzheimerdemenz

Motivationale Fähigkeiten im mittleren Lebensalter sind mit psychischer und körperlicher Gesundheit assoziiert. In einer Querschnitts- und einer Längsschnittstudie wurde der Zusammenhang motivationaler Fähigkeiten mit dem Risiko einer leichten kognitiven Beeinträchtigung (MCI) und Alzheimer-Demenz (AD) untersucht. Die Ergebnisse geben Hinweise darauf, dass motivationale Reservekapazität möglicherweise als protektiver Faktor gegen die Manifestation kognitiver Beeinträchtigung im höheren Lebensalter wirkt

Therapie bei älteren Menschen

Störungsmodelle in der Alterspsychotherapie beziehen neben schulenspezifischen Störungs- und Behandlungsmodellen auch gerontologische Konzepte mit ein. Daher werden zunächst das Alters- und störungsspezifische Rahmenmodell sowie das Modell der selektiven Optimierung mit Kompensation dargestellt. Sie zeigen, dass nicht nur erschwerende Faktoren (wie Multimorbidität, Verluste, Fähigkeitseinschränkungen) sondern auch erleichternden Faktoren (wie Bewältigungs- und Lebenserfahrung, angepasste Wohlbefindensregulation) relevant sind. Allgemeine altersbezogene Modifizierungen psychotherapeutischer Techniken werden beschrieben. Interventionen in der Alterspsychotherapie sind zum einen Modifikationen bestehender Verfahren, die in diesem Kapitel für die Behandlung von Demenz, Depression, Angst und Traumafolgen dargestellt werden. Zum anderen gibt es speziell für diese Altersgruppe neu entwickelte Verfahren. Hier wird die Lebensrückblicksintervention beschrieben, die gut in einen psychotherapeutischen Gesamtbehandlungsplan eingebettet werden kann. Ein Fallbeispiel illustriert das Vorgehen dieser Intervention. Schließlich gibt es einige Störungen und Probleme, die in jüngeren Altersgruppen nicht vorhanden sind, von denen hier die Demenz sowie Fallangst und ihre Behandlung dargestellt werden

Motivational reserve: lifetime motivational abilities contribute to cognitive and emotional health in old age

The authors recently developed the concept of motivational reserve, which implies a set of motivational abilities that provide individuals with resilience to neuropathological damage. This study investigated how lifetime motivational abilities are associated with current cognitive status, mild cognitive impairment, and psychological well-being in old age. A community sample of 147 participants without dementia between 60 and 94 years of age, stratified for age group, sex, and education, completed motivation and well-being questionnaires and cognitive tests. A new procedure was used to estimate their midlife motivational and cognitive abilities on the basis of their main occupation using the Occupational Information Network (O*NET) system. O*NET-estimated motivational abilities predicted cognitive status, psychological well-being, and odds of mild cognitive impairment, even when age, sex, education, and cognitive ability were controlled. Although O*NET-estimated cognitive abilities were not significant predictors, scores on a measure of crystallized intelligence were associated with current cognitive status and odds of mild cognitive impairment. Findings suggest that motivational reserve acts as a protective factor against the manifestation of cognitive impairment and emotional problems in later life

Apathy: a separate syndrome from depression in dementia? A critical review

Apathy and depression are the most prevalent neuropsychiatric symptoms in Alzheimer's disease and mild cognitive impairment. Despite much research on apathy and depression in dementia, the nosological position of apathy as a separate syndrome from depression remains debated. This literature review provides a critical analysis of the areas of clinical manifestation, symptomatology, assessment, prevalence and neuropathology. Evidence does not provide a clear view of the nosological position of apathy in dementia for symptoms and neuropathology. However, the ambiguity of the evidence may be attributed in large part to a lack of clarity in definition and etiology, clinical criteria and assessment overlap. Given the evidence, it is concluded that the argument in favor of apathy as a separate syndrome from depression in dementia is persuasive. Reaching a consensus on the definition and nosological position of apathy within dementia is vital to provide patients and caregivers with the support they require, increase understanding of risk factors, and enable comparisons across research and practic

Delay of gratification in old age: assessment, age-related effects, and clinical implications

Delay of gratification (DoG), the ability to reject immediately available smaller rewards in favor of later larger rewards, has been a topic of continuous research interest for almost 60 years. Although numerous studies have explored this construct and its effects on wellbeing, social behavior, cognitive abilities, and academic success in children, DoG studies in adulthood and old age are scarce. Instead, delay discounting (DD), that is, the degree to which individuals devalue delayed rewards, has been used in samples of adults and older individuals, and is of particular interest in clinical studies. Findings from DD research suggest that the preference for delayed rewards increases from childhood to early adulthood, and then decreases from middle age to old age. The main aim of this review is to elucidate the importance of DoG in adulthood and old age. First, the review explores the theoretical status of DoG by specifying the relationships and distinctions between DoG and related constructs. Second, it provides an overview of DoG measurements, from traditional to novel. Third, the effects of DoG on development and wellbeing are explored. Fourth, age-related differences in DoG are summarized. Lastly, the review closes with conclusions, clinical implications, and the outlook for possible further research direction

The delay of gratification test for adults: Validating a behavioral measure of self-motivation in a sample of older people

Most previous delay of gratification tests were developed for children and are inappropriate for application in adults. The authors therefore developed the Delay of Gratification Test for Adults (DoG-A), which includes four types of reward that are meaningful to adults, namely snacks, real money, hypothetical money, and magazines. Four subscores and two composite scores can be calculated. This study is the first to evaluate the DoG-A and to investigate its association with external variables. A community sample of 147 cognitively healthy participants aged between 60 and 94years completed a questionnaire and cognitive tests measuring delay discounting, self-regulation, motivational self-concept, personality, wellbeing, and cognitive function. The intercorrelations of the subscales were low to medium and the internal consistency of the composite scores was moderate (α=.4), indicating relative domain independence of the four reward types. The nomological net established by investigating the relations of the DoG-A with other constructs proved to be fairly meaningful. The correlations of all subscales with the delay discounting rate were significant and moderate. The Snacks subscale showed the most consistent pattern of results in terms of moderate positive correlations with self-reported motivation regulation, optimism, dutifulness, and deliberation. The Snacks subscale also correlated with various measures of wellbeing. A regression analysis showed that DoG Snacks remained a significant predictor of wellbeing when self-reported self-regulation and other variables were controlled. These findings indicate that the DoG-A yields an interpretable behavioral measure of self-motivation and offers a developmentally adequate extension of the delay of gratification paradigm for use with adult

Improving volitional competence is crucial for the efficacy of psychosomatic therapy: A controlled clinical trial

Background: Although skills of will (volitional competences), such as self-motivation or emotion regulation, are particularly necessary for patients with psychiatric and psychosomatic disorders, it is unknown whether volitional deficits can be reduced and thereby the efficacy of psychotherapy increased. We investigated the effect of a group therapy for improving volitional competence in an inpatient rehabilitation program. Methods: In a controlled clinical trial, patients from a rehabilitation clinic participated either in the volition group therapy in addition to the standard cognitive behavioral therapy (volition group, VG) or in the standard cognitive behavioral therapy (standard group, SG). Patients were tested for volitional competence, depressive symptoms, total psychiatric symptomatology, and physical complaints prior to, at the end of inpatient therapy and after 6 months of follow-up (n = 242). Results: At the end of inpatient therapy, better improvement in volitional competence was observed in the VG than in the SG [e.g. self-motivation: effect size (ES) 0.96 vs. 0.39; ANCOVA: F(1, 209) = 16.58; p < 0.001]. Patients with greater volitional improvements had a better rehabilitation outcome. In the VG, depressive symptoms as well as total psychiatric symptomatology decreased significantly more than in the SG[ES:1.18vs.0.87,F(1,207) = 4.68,p < 0.05, and ES 1.12 vs. 0.73, F(1, 205) = 4.68, p < 0.05, respectively], but not physical complaints [ES: 0.62 vs. 0.48, F(1,207) = 1.08, n.s.]. Conclusions: Effect size increased in patients with initially low volitional competence and high motivation to participate in a volitional training. These results might lead to a more systematic assessment and training of volitional competence

Traumatic experiences and post-traumatic stress disorder among elderly Germans: results of a representative population-based survey

Background: Only a few population-based studies on the epidemiology of post-traumatic stress disorders (PTSDs) are available to date. Most of the existing studies are from the U.S.A. Against the background of World War II, the extent and long-term effects of war-related traumatic experiences in the German elderly population are of special interest. Nevertheless, population-based data on this topic are lacking to date. Methods: This study examines the occurrence of traumatic experiences and the prevalence rates of PTSD according to DSM-IV and of partial PTSD in a randomly selected sample of the German general population aged 60 years and over (N = 814) using self-rating instruments. Results: PTSD is apparent in 3.4%; when partial post-traumatic stress syndromes are included, a total of 7.2% of the aged population are involved. The most common individual symptoms resulting from war-induced trauma are avoidance of thoughts and feelings, sleep disturbances, distressing dreams and intrusive thoughts. The most frequently mentioned traumatic experiences of the generation examined in this study were war-related trauma experienced as children or in early adulthood during World War II. As a person's age increases, so does the prevalence of war-related traumatic experiences. There are some gender differences in traumatic experiences, but not in post-traumatic symptoms. Conclusion: The results emphasize the importance of war-related traumatic experiences from World War II in the German elderly population and their impact on the prevalence of PTSD more than 60 years late

Adjustment disorders: prevalence in a representative nationwide survey in Germany

Objectives: This is the first study to estimate the prevalence of adjustment disorder (AjD) in the general population. A new conceptualisation of AjD as a stress response syndrome was applied, which allowed AjD to be assessed directly from its symptom profile, including intrusive, avoidance and failure-to-adapt symptoms (Maercker et al., Psychopathology 40:135-146, 2007). Methods: Prevalence rates of distressing life events and AjD were estimated from a representative sample of the German general population (n=2,512) with a broad age range (14-93years). A questionnaire including a life events checklist and self-rating questions that assessed AjD symptoms and symptom duration were personally handed out by an interviewer. Results: The prevalence of AjD fulfilling the criterion of clinically significant impairment was 0.9%; a further 1.4% of the sample was diagnosed with AjD without fulfilling the impairment criterion. In ~72.5% of AjD cases, symptoms had developed 6-24months prior to assessment. AjD was most often associated with acute events such as moving or chronic stressors such as serious illness, conflicts at the respondent's job or with friends or neighbours (with ~5% conditional probability each). Conclusions: The results correspond with the few other studies that have examined the prevalence of AjD, even though a new conceptualisation of the disorder was used. Explorative results regarding the duration of AjD syndromes and symptoms call for further redefinition and empirical investigation of this under-researched mental conditio

Effect of Life Review Therapy for Holocaust Survivors: A randomized controlled trial

Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT‐HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent‐to‐treat analyses (LRT‐HS: n = 24, control: n = 25; M$_{age}$ = 81.5 years, SD = 4.81, 77.6% female). Linear mixed models revealed no statistically significant superiority of LRT‐HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition interaction: t(75) = 1.46, p = .148, d$_{within}$ = 0.70, d$_{between}$ = 0.41, but analyses were significant at follow‐up, with large effect sizes, t(79) = 2.89, p = .005, d$_{within}$ = 1.20, d$_{between}$ = 1.00. LRT‐HS superiority for depression was observed at posttreatment, t(73) = 2.58, p = .012, but not follow‐up, t(76) = 1.08, p = .282, with moderate effect sizes, d$_{within}$ = 0.46–0.60, d$_{between}$ = 0.53–0.70. The findings show that even in older age, PTSD and depression following exposure to multiple traumatic childhood events can be treated efficaciously using an age‐appropriate treatment that includes structured life review and narrative exposure