Soziale Aspekte bei Demenz: Kumulative Dissertation zur Erlangung des akademischen Grades Dr. rer. nat.

Durch den demografischen Wandel, der mit einer Alterung der Gesellschaft einhergeht, wird es neue Herausforderungen in Bezug auf Alterserkrankungen geben. Demenz ist die am häufigsten vorkommende Erkrankung im Alter, bei der es zu einem zunehmenden Abbau der kognitiven Funktionsfähigkeit kommt. Dieser wiederum führt i. d. R. zu einem Verlust der Selbstständigkeit und zum frühzeitigen Tod. Aktuell gibt es keine Heilungsmöglichkeiten für demenzielle Erkrankungen. Daher ist es umso wichtiger, wirkungsvolle Präventions- und Interventionsmaßnahmen zu entwickeln. Grundvoraussetzung dafür ist ein umfassendes Verständnis über die Risikofaktoren der Erkrankung, aber auch über die Symptomatik in den verschiedenen Bereichen. Aktuell ist nur wenig darüber bekannt, welche Rolle soziale Aspekte bei der Entstehung von Demenz spielen und wie sich soziale Aspekte über das gesamte Krankheitsspektrum hinweg verändern. Ein Grund dafür ist, dass es kaum geeignete Instrumente zur Erfassung sozialer Aspekte, wie z. B. Sozialfunktionen, speziell für Personen mit Demenz gibt. Daher wurde in einer ersten Arbeit eine umfassende Literaturrecherche nach der Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISAM)-Leitlinie durchgeführt, um geeignete Instrumente zur Erfassung der Sozialfunktionen bei Demenz zusammenzutragen. Von 5.307 gefundenen Artikeln wurden 8 für die Übersichtsarbeit ausgewählt, die insgesamt drei Instrumente zur Messung der sozialen Funktionsfähigkeit bei Menschen mit Demenz beschreiben: die Nurses' Observation Scale for Geriatric Patients (NOSGER; Skala „Sozialverhalten“), die Socioemotional Dysfunction Scale (SDS) und die Social Functioning in Dementia Scale (SF-DEM). Die Validität aller drei Instrumente war insgesamt akzeptabel. Die Reliabilität der NOSGER-Skala „Sozialverhalten“ und der SF-DEM war hoch. Informationen über die Benutzerfreundlichkeit der Instrumente waren kaum vorhanden. Insgesamt hat sich die im angloamerikanischen Raum entwickelte Social Functioning in Dementia Scale (deutsch: „Sozialfunktionen bei Demenz“-Fragebogen; kurz: SF-DEM) als besonders geeignet für die Erfassung von Sozialfunktionen bei Demenz herausgestellt. Auf diesem Ergebnis fußt die zweite Arbeit. Ihr Ziel bestand darin, den SF-DEM für den deutschen Sprachraum zu adaptieren und ihn psychometrisch zu überprüfen. Dazu wurde zunächst ein mehrstufiger, teambasierter Übersetzungsprozess auf Grundlage des Translation, Review, Adjudication, Pretesting and Documentation (TRAPD)-Modells durchgeführt. Zweitens wurden Dyaden befragt, bestehend aus Personen mit leichter Demenz und jeweils einem Angehörigen, um die interne Konsistenz, Test-Retest-Reliabilität, Interrater-Reliabilität, Konstruktvalidität und Akzeptanz der deutschen Version des SF-DEM zu testen. Die interne Konsistenz der Selbst- und Fremdberichtversion liegt auf einem akzeptablen Niveau. Die Interrater-Reliabilität war für beide Versionen ausgezeichnet und die Test-Retest-Reliabilität moderat. Die Ergebnisse der Fremdberichtversion korrelierten stark mit der Größe des sozialen Netzwerkes, gemessen mit der Lubben Social Network Scale (Lubben et al., 2006; LSNS-6) und der Lebensqualität in Bezug auf Ehe und Freundschaften, erhoben mit dem „Lebensqualität bei Demenz“ - Fragebogen (Stypa et al., 2020; QoL-AD). Darüber hinaus wurde der SF-DEM von den Teilnehmern akzeptiert. Damit lässt sich zusammenfassend festhalten, dass die deutsche Version des SF-DEM ein valides, reliables und akzeptables Instrument zur Erfassung der Sozialfunktionen bei Menschen mit Demenz ist. Weitere Untersuchungen sollten die psychometrischen Eigenschaften bei Personen mit mittleren und schweren Demenzen über das gesamte Krankheitsspektrum hinweg untersuchen. Die dritte Arbeit untersucht den Zusammenhang zwischen sozialer Isolation und Demenz. Es wurden Competing Risk-Analysen anhand der Daten aus der AgeCoDe-Studie berechnet und kein Zusammenhang zwischen sozialer Isolation und dem Auftreten von Demenz bei Hochaltrigen gefunden. Damit weicht unser Ergebnis von denen anderer Untersuchungen ab. Die Unterschiede in den Ergebnissen lassen sich jedoch durch methodische Unterschiede erklären. Darunter zählen z. B. die verwendete Analysestrategie, die Form des Outcomes, die Länge des Nachbeobachtungszeitraumes und die Eigenschaften der untersuchten Stichprobe. Zusammenfassend lässt sich festhalten, dass momentan nur wenig über soziale Aspekte in Bezug auf demenzielle Erkrankungen bekannt ist. Zukünftige Studien könnten vielversprechende Ergebnisse liefern, die wichtig sind für eine bessere Diagnostik und Früherkennung von Demenz, aber auch für die Entwicklung von Interventions- und Präventionskonzepten. Beide Punkte sind von großer Bedeutung, da es momentan noch keine Möglichkeit zur Heilung demenzieller Erkrankungen gibt. Die Arbeiten, aus denen sich diese Dissertation zusammensetzt, legen einen wichtigen Grundstein für zukünftige Untersuchungen auf diesem Gebiet.:Tabellenverzeichnis ii Abbildungsverzeichnis ii Abkürzungsverzeichnis ii 1. Einleitung 1 1.1. Demenz: Definition und Charakteristika 2 1.1.1. Soziale Veränderungen 3 1.2. Epidemiologie 5 1.2.1. Krankheitskosten 7 1.2.2. Risikofaktoren 9 1.2.3. Konsequenzen im Kontext sozialer Aspekte 12 1.3. Diagnose und Screening 13 1.3.1. Beurteilung der sozialen Kognitionen und BPSD 13 1.4. Ziele der Dissertation 15 2. Empirische Studien 17 2.1. Instruments to assess social functioning in individuals with dementia: a systematic review 17 2.2. Psychometric evaluation of the German version of the Social Functioning in Dementia Scale (SF-DEM) 37 2.3. Social isolation and incident dementia in the oldest-old – A competing risk analysis 49 3. Allgemeine Diskussion 61 3.1. Implikationen für zukünftige Studien 64 3.2 Schlussfolgerung 65 Zusammenfassung 67 Literaturverzeichnis 71 Appendix A: Erklärung zum Promotionsbeitrag 77 Appendix B: Eigenständigkeitserklärung 91 Appendix C: Lebenslauf 92 Appendix D: Wissenschaftliche Beiträge 93 Appendix E: Danksagung 9

Psychometric Evaluation of the German Version of the Social Functioning in Dementia Scale

BACKGROUND: Dementia is one of the most common and most severe disorder in old age. In addition to cognitive decline and functional impairment, changes in social functioning occur in the course of dementia. Currently, there is no valid instrument in German language to assess social functioning in individuals with dementia. OBJECTIVE: We aim to adapt and psychometrically evaluate a German version of the Social Functioning in Dementia Scale (SF-DEM). METHODS: First, a multi-step and team-based translation process based on the TRAPD model was performed. Second, we interviewed dyads of individuals with mild dementia and caregivers to test the internal consistency, test-retest reliability, interrater reliability, construct validity, and acceptance of the German version of the SF-DEM. RESULTS: The internal consistency of the patient-rated (α= 0.72) and the caregiver-rated (α= 0.76) SF-DEM is at an acceptable level. The interrater reliability was excellent for both versions (patients: ICC = 0.98, CI [0.95-0.99]; caregiver: ICC = 0.95, CI [0.89-0.98]) and the test-retest reliability was moderate (patients: ICC = 0.57, CI [0.26-0.77]; caregiver: ICC = 0.58, CI [0.27-0.78]). Caregiver-rated SF-DEM correlated strong with LSNS-6 (rs = 0.60, p < 0.01), QoL-AD (marriage: rs = 0.61, p < 0.01; friends: rs = 0.51, p = 0.01). In addition, the SF-DEM was accepted by the participants. CONCLUSION: The German SF-DEM is a valid, reliable, and acceptable instrument to assess social functioning in individuals with dementia. Further research should address the psychometric properties in individuals with more severe dementia

Valuing end-of-life care:translation and content validation of the ICECAP-SCM measure

Background: The evaluation of care strategies at the end of life is particularly important due to the globally increasing proportion of very old people in need of care. The ICECAP-Supportive Care Measure is a self-complete questionnaire developed in the UK to evaluate palliative and supportive care by measuring patient’s wellbeing in terms of ‘capability’. It is a new measure with high potential for broad and international use. The aims of this study were the translation of the ICECAP-Supportive Care Measure from English into German and the content validation of this version. Methods: A multi-step and team-based translation process based on the TRAPD model was performed. An expert survey was carried out to assess content validity. The expert panel (n = 20) consisted of four expert groups: representative seniors aged 65+, patients aged 65+ living in residential care, patients aged 65+ receiving end-of-life care, and professionals in end-of-life care. Results: The German version of the ICECAP-Supportive Care Measure showed an excellent content validity on both item- and scale-level. In addition, a high agreement regarding the length of the single items and the total length of the questionnaire as well as the number of answer categories was reached. Conclusions: The German ICECAP-SCM is a valid tool to assess the quality of life at the end of life that is suitable for use in different settings. The questionnaire may be utilized in multinational clinical and economic evaluations of end-of-life care

Acute anxiety and autonomic arousal induced by CO 2 inhalation impairs prefrontal executive functions in healthy humans

Funder: The Wallitt Foundation; Eton College; and NIHR Cambridge Biodmedical Centre (BRC) Mental Health theme.Funder: Cambridge Vice-Chanchellor's Award and Fitzwilliam College scholarshipFunder: Medical Research Council (G1000183)Abstract: Acute anxiety impacts cognitive performance. Inhalation of air enriched with carbon dioxide (CO2) in healthy humans provides a novel experimental model of generalised anxiety, but has not previously been used to assess cognition. We used inhalation of 7.5% CO2 to induce acute anxiety and autonomic arousal in healthy volunteers during neuropsychological tasks of cognitive flexibility, emotional processing and spatial working memory in a single-blind, placebo-controlled, randomized, crossover, within-subjects study. In Experiment 1 (n = 44), participants made significantly more extra-dimensional shift errors on the Cambridge Neuropsychological Test Automated Battery (CANTAB) Intra-Extra Dimensional Set Shift task under CO2 inhalation compared with ‘normal’ air. Participants also had slower latencies when responding to positive words and made significantly more omission errors for negative words on the CANTAB Affective Go/No-go task. In Experiment 2 (n = 28), participants made significantly more total errors and had poorer heuristic search strategy on the CANTAB Spatial Working Memory task. In both experiments, CO2 inhalation significantly increased negative affect; state anxiety and fear; symptoms of panic; and systolic blood pressure/heart rate. Overall, CO2 inhalation produced robust anxiogenic effects and impaired fronto-executive functions of cognitive flexibility and working memory. Effects on emotional processing suggested a mood-congruent slowing in processing speed in the absence of a negative attentional bias. State-dependent effects of anxiety on cognitive-emotional interactions in the prefrontal cortex warrant further investigation

Acute anxiety and autonomic arousal induced by CO2 inhalation impairs prefrontal executive functions in healthy humans.

Acute anxiety impacts cognitive performance. Inhalation of air enriched with carbon dioxide (CO2) in healthy humans provides a novel experimental model of generalised anxiety, but has not previously been used to assess cognition. We used inhalation of 7.5% CO2 to induce acute anxiety and autonomic arousal in healthy volunteers during neuropsychological tasks of cognitive flexibility, emotional processing and spatial working memory in a single-blind, placebo-controlled, randomized, crossover, within-subjects study. In Experiment 1 (n = 44), participants made significantly more extra-dimensional shift errors on the Cambridge Neuropsychological Test Automated Battery (CANTAB) Intra-Extra Dimensional Set Shift task under CO2 inhalation compared with 'normal' air. Participants also had slower latencies when responding to positive words and made significantly more omission errors for negative words on the CANTAB Affective Go/No-go task. In Experiment 2 (n = 28), participants made significantly more total errors and had poorer heuristic search strategy on the CANTAB Spatial Working Memory task. In both experiments, CO2 inhalation significantly increased negative affect; state anxiety and fear; symptoms of panic; and systolic blood pressure/heart rate. Overall, CO2 inhalation produced robust anxiogenic effects and impaired fronto-executive functions of cognitive flexibility and working memory. Effects on emotional processing suggested a mood-congruent slowing in processing speed in the absence of a negative attentional bias. State-dependent effects of anxiety on cognitive-emotional interactions in the prefrontal cortex warrant further investigation

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass