Alt und behindert: wie sich der demografische Wandel auf das Leben von Menschen mit Behinderung auswirkt

"Die Lebenserwartung steigt, die Gesellschaft altert. Damit sind immer mehr Menschen von altersbegleitenden Erkrankungen betroffen. Vor diesem Hintergrund steigt auch die Zahl der älteren Menschen, die bereits ihr Leben lang auf Unterstützung angewiesen sind. Bislang hatten in Deutschland wenige von ihnen Chancen auf ein langes Leben. Durch die Vernichtungspolitik der Nationalsozialisten fehlen in den Altersklassen der über 60-jährigen Menschen mit angeborenen Behinderungen weitgehend. Außerdem zogen viele Behinderungen früher stark erhöhte Sterberisiken nach sich. Doch unter verbesserten Lebensbedingungen ist die Lebenserwartung von Menschen mit geistiger oder mehrfacher Behinderung in den vergangenen Jahrzehnten rasch angestiegen. Diese Entwicklung hat Folgen für die Einrichtungen und Dienste der Behindertenhilfe. Sie müssen sich auf mehr ältere Menschen einstellen. Erstens, weil ihre Klienten und Nutzer altern. Zweitens, weil erwachsene Menschen mit Behinderungen, die in ihren Elternhäusern leben, vermehrt auf professionelle Hilfe angewiesen sein werden, wenn die Eltern nicht mehr für sie da sein können. Mehr ältere Nutzer bedeuten für die Fachleute der Behindertenhilfe, auf neue Bedarfslagen eingehen zu müssen: Die Senioren arbeiten nicht mehr in der Werkstatt für behinderte Menschen, sondern wollen ihre Freizeit genießen. Die Einrichtungen müssen sich außerdem auf einen steigenden Pflegebedarf ihrer alternden Belegschaft vorbereiten. Die Behindertenhilfe steht vor weiteren Herausforderungen, weil immer mehr Menschen mit psychischen Erkrankungen und Lernbehinderungen ihren Anspruch auf Hilfen geltend machen. Wie viele Menschen in Deutschland wegen einer Behinderung Unterstützung bedürfen, wird in keiner Statistik erhoben. Auch die Inanspruchnahme von Hilfen wird nicht detailliert und im Zeitverlauf erfasst. Deshalb lässt sich die Entwicklung des künftigen Bedarfs nur grob skizzieren. In verschiedenen Szenarien projiziert das Berlin-Institut in der Studie die denkbare zahlenmäßige Entwicklung sowohl von Personen mit Schwerbehindertenausweis als auch von Eingliederungshilfeberechtigten in Einrichtungen der Behindertenhilfe." (Autorenreferat

Lifestyle, cognitive aging, and brain correlates

Inter-individual differences in level and rate of cognitive decline typically seen in aging have been linked to inter-individual differences in lifestyle factors such as leisure activities, including physical activity. The general aim of this thesis was to further our understanding of how and why leisure activity engagement is related to aging-related changes in cognitive performance. Specifically, we sought to (a) identify lifestyle components that are associated with late-life cognitive performance, (b) identify brain correlates of these lifestyle components that are also relevant for cognitive performance, and (c) explore the relative importance of lifestyle- and health-related factors for predicting cognitive change, as well as interactive effects among these factors. In Study I and II, we investigated associations between 3-year changes in leisure activities and concurrent changes in cognitive performance and white matter microstructure in 563 (Study I) and 442 (Study II) participants aged 81 years and older. Study I documented changes in white matter microstructure in the corticospinal (CS) tract to be associated with changes in perceptual speed. In Study II, we observed that concurrent change in frequency of engagement in social activities (e.g. going out to eat in a restaurant, going to the movies, concerts, or the theater) was related to change in both white matter microstructure in the CS tract and in perceptual speed. Change in white matter microstructure in the CS tract statistically accounted for the association between changes in frequency of social leisure activities and perceptual speed. In Study III, we turned to D2/3 dopamine receptor (D2/3DR) availability as a potential brain correlate of lifestyle and cognition in aging. We investigated D2/3DR availability, cognitive performance, and physical activity in 178 healthy adults aged 64-67 years. Participants completed tests of working memory, episodic memory, and processing speed, and a leisure activity questionnaire. Subjective intensity, but not frequency, across the activities each individual performed was associated with D2/3DR availability in caudate nucleus as well as with episodic and working memory. Episodic memory was also related to D2/3DR availability in the caudate, forming a correlative triad with physical activity intensity and caudate D2/3DR availability. In Study IV, we applied a new data-mining technique called structural equation modelling trees and forests to investigate the relative importance of leisure activity engagement, physical activity, and other age- and health-related factors in predicting subsequent 6-year change in perceptual speed in 1046 participants aged 60 years and older. With regard to variable importance, a measure that subsumes main effects and interactions among predictors, frequency of leisure activities was not unimportant, although less important than age, retirement status, walking speed, and multimorbidity. Conceivably, the association between leisure activity engagement and subsequent cognitive decline is conditional upon age- and health-related factors included in the current analyses. Regarding aim (a), identifying lifestyle components related to cognitive aging, we identified change in social activities to be related to change in perceptual speed (Study II). We also found that subjective intensity, but not frequency, of physical activity was related to episodic and working memory (Study III). Regarding the relative importance of frequency of leisure activity engagement as a predictor of change in cognition, we observed some importance of all types of activities, except for physical activity, in predicting change in perceptual speed (Study IV). Concerning aim (b), identifying brain correlates of lifestyle components and cognitive performance, we observed white matter microstructural changes to be related to changes in both leisure activity and perceptual speed (Study II), and D2/3DR availability (Study III) to be related to both subjective physical activity intensity and episodic memory. Regarding aim (c), exploring the relative importance of lifestyle components as predictors of subsequent cognitive decline (Study IV), we found rather small effects of the lifestyle components investigated in Studies II and III, but still found leisure activities to be informative as predictors when using a data-mining approach that takes interactive effects with other predictors into account. The studies in this thesis contribute with new data on associations between lifestyle and cognitive aging, and on brain measures correlated with these two factors. Specifically, we are the first to show parallel changes in leisure activity, white matter microstructure, and perceptual speed. We are also the first to observe an association between physical activity intensity and D2/3DR availability. In sum, the present results indicate that engaging in social activities in very late life and physical activity intensity around retirement age are related to cognitive performance and associated brain parameters. Although the issue of causal directionality remains unresolved, leisure activities are correlates and informative predictors of cognitive decline

Latent Change Score Modeling as a Method for Analyzing the Antidepressant Effect of a Psychosocial Intervention in Alzheimer's Disease

Werheid K, Köhncke Y, Ziegler M, Kurz A. Latent Change Score Modeling as a Method for Analyzing the Antidepressant Effect of a Psychosocial Intervention in Alzheimer's Disease. Psychotherapy and Psychosomatics. 2015;84(3):159-166.Background: Developing and evaluating interventions for patients with age-associated disorders is a rising field in psychotherapy research. Its methodological challenges include the high between-subject variability and the wealth of influencing factors associated with longer lifetime. Latent change score modeling (LCSM), a technique based on structural equation modeling, may be well suited to analyzing longitudinal data sets obtained in clinical trials. Here, we used LCSM to evaluate the antidepressant effect of a combined cognitive behavioral/cognitive rehabilitation (CB/CR) intervention in Alzheimer's disease (AD). Methods: LCSM was applied to predict the change in depressive symptoms from baseline as an outcome of the CORDIAL study, a randomized controlled trial involving 201 patients with mild AD. The participants underwent either the CORDIAL CB/CR program or standard treatment. Using LCSM, the model best predicting changes in Geriatric Depression Scale scores was determined based on this data set. Results: The best fit was achieved by a model predicting a decline in depressive symptoms between before and after testing. Assignment to the intervention group as well as female gender revealed significant effects in model fit indices, which remained stable at 6- and 12-month follow-up examinations. The pre-post effect was pronounced for patients with clinically relevant depressive symptoms at baseline. Conclusions: LCSM confirmed the antidepressant effect of the CORDIAL therapy program, which was limited to women. The effect was pronounced in patients with clinically relevant depressive symptoms at baseline. Methodologically, LCSM appears well suited to analyzing longitudinal data from clinical trials in aged populations, by accounting for the high between-subject variability and providing information on the differential indication of the probed intervention

A strong dependency between changes in fluid and crystallized abilities in human cognitive aging

Theories of adult cognitive development classically distinguish between fluid abilities, which require effortful processing at the time of assessment, and crystallized abilities, which require the retrieval and application of knowledge. On average, fluid abilities decline throughout adulthood, whereas crystallized abilities show gains into old age. These diverging age trends, along with marked individual differences in rates of change, have led to the proposition that individuals might compensate for fluid declines with crystallized gains. Here, using data from two large longitudinal studies, we show that rates of change are strongly correlated across fluid and crystallized abilities. Hence, individuals showing greater losses in fluid abilities tend to show smaller gains, or even losses, in crystallized abilities. This observed commonality between fluid and crystallized changes places constraints on theories of compensation and directs attention toward domain-general drivers of adult cognitive decline and maintenance

A common polymorphism in the dopamine transporter gene predicts working memory performance and in vivo dopamine integrity in aging

Dopamine (DA) integrity is suggested as a potential cause of individual differences in working memory (WM) performance among older adults. Still, the principal dopaminergic mechanisms giving rise to WM differences remain unspecified. Here, 61 single-nucleotide polymorphisms, located in or adjacent to various dopamine-related genes, were assessed for their links to WM performance in a sample of 1313 adults aged 61–80 years from the Berlin Aging Study II. Least Absolute Shrinkage and Selection Operator (LASSO) regression was conducted to estimate associations between polymorphisms and WM. Rs40184 in the DA transporter gene, SLC6A3, showed allelic group differences in WM, with T-carriers performing better than C homozygotes (p<0.01). This finding was replicated in an independent sample from the Cognition, Brain, and Aging study (COBRA; baseline: n = 181, ages: 64–68 years; 5-year follow up: n = 129). In COBRA, in vivo DA integrity was measured with 11C-raclopride and positron emission tomography. Notably, WM as well as in vivo DA integrity was higher for rs40184 T-carriers at baseline (p<0.05 for WM and caudate and hippocampal D2-receptor availability) and at the 5-year follow-up (p<0.05 for WM and hippocampal D2 availability). Our findings indicate that individual differences in DA transporter function contribute to differences in WM performance in old age, presumably by regulating DA availability

Cardiovascular factors are related to dopamine integrity and cognition in aging

Objective: The aging brain undergoes several changes, including reduced vascular, structural, and dopamine (DA) system integrity. Such brain changes have been associated with age‐related cognitive deficits. However, their relative importance, interrelations, and links to risk factors remain elusive. Methods: The present work used magnetic resonance imaging and positron emission tomography with 11C‐raclopride to jointly examine vascular parameters (white‐matter lesions and perfusion), DA D2‐receptor availability, brain structure, and cognitive performance in healthy older adults (n = 181, age: 64–68 years) from the Cognition, Brain, and Aging (COBRA) study. Results: Covariance was found among several brain indicators, where top predictors of cognitive performance included caudate and hippocampal integrity (D2DR availability and volumes), and cortical blood flow and regional volumes. White‐matter lesion burden was negatively correlated with caudate DA D2‐receptor availability and white‐matter microstructure. Compared to individuals with smaller lesions, individuals with confluent lesions (exceeding 20 mm in diameter) had reductions in cortical and hippocampal perfusion, striatal and hippocampal D2‐receptor availability, white‐matter microstructure, and reduced performance on tests of episodic memory, sequence learning, and processing speed. Higher cardiovascular risk as assessed by treatment for hypertension, systolic blood pressure, overweight, and smoking was associated with lower frontal cortical perfusion, lower putaminal D2DR availability, smaller grey‐matter volumes, a larger number of white‐matter lesions, and lower episodic memory performance. Interpretation: Taken together, these findings suggest that reduced cardiovascular health is associated with poorer status for brain variables that are central to age‐sensitive cognitive functions, with emphasis on DA integrity

Dopamine D2 receptor availability is linked to hippocampal–caudate functional connectivity and episodic memory

D1 and D2 dopamine receptors (D1DRs and D2DRs) may contribute differently to various aspects of memory and cognition. The D1DR system has been linked to functions supported by the prefrontal cortex. By contrast, the role of the D2DR system is less clear, although it has been hypothesized that D2DRs make a specific contribution to hippocampus-based cognitive functions. Here we present results from 181 healthy adults between 64 and 68 y of age who underwent comprehensive assessment of episodic memory, working memory, and processing speed, along with MRI and D2DR assessment with [C-11]raclopride and PET. Caudate D2DR availability was positively associated with episodic memory but not with working memory or speed. Whole-brain analyses further revealed a relation between hippocampal D2DR availability and episodic memory. Hippocampal and caudate D2DR availability were interrelated, and functional MRI-based resting-state functional connectivity between the ventral caudate and medial temporal cortex increased as a function of caudate D2DR availability. Collectively, these findings indicate that D2DRs make a specific contribution to hippocampus-based cognition by influencing striatal and hippocampal regions, and their interactions