Sg Riedel-Heller

Age- and gender-specific prevalence of depression in latest-life – Systematic review and meta-analysis

OBJECTIVE The objective of the study is to systematically analyze the prevalence of depression in latest life (75+), particularly focusing on age- and gender-specific rates across the latest-life age groups. DESIGN Relevant articles were identified by systematically searching the databases MEDLINE, Web of Science, Cochrane Library and Psycinfo and relevant literature from 1999 onwards was reviewed. Studies based on the community-based elderly population aged 75 years and older were included. Quality of studies was assessed. Meta-analysis was performed using random effects model. RESULTS 24 studies reporting age- and gender-specific prevalence of depression were found. 13 studies had a high to moderate methodical quality. The prevalence of major depression ranged from 4.6% to 9.3%, and that of depressive disorders from 4.5% to 37.4%. Pooled prevalence was 7.2% (95% CI 4.4-10.6%) for major depression and 17.1% (95% CI 9.7-26.1%) for depressive disorders. Potential sources of high heterogeneity of prevalence were study design, sampling strategy, study quality and applied diagnostics of latest life depression. CONCLUSIONS Despite the wide variation in estimates, it is evident that latest life depression is common. To reduce variability of study results, particularly sampling strategies (inclusion of nursing home residents and severe cognitively impaired individuals) for the old age study populations should be addressed more thoroughly in future research.

Whom to ask for help in case of a mental disorder? Preferences of the lay public.

Background: Although socio-cultural factors have been recognised as an important predictor in shaping help-seeking behaviour, few attempts have been made in this regard to specify the nature and impact of socio-cultural factors such as attitudes and belief systems prevalent in society. Methods: We investigated the lay publics attitudes toward help-seeking regarding psychiatric disorders, and their determinants, in a cross-sectional national survey in Germany (n=1564), using structured interviews with vignettes depicting a person either suffering from depression or from schizophrenia. Two distinct methodological approaches (rating vs ranking) were applied. Results: Public opinion considers mental health professionals helpful in treating schizophrenia but not in the treatment of depression. For depression, public opinion clearly favours the lay support system and believes in involving the family physician if the former resource is exhausted. Determinants of help-seeking recommendations were problem definition, perception of the cause of distress and anticipated prognosis, as well as resentment against mental health professionals. Conclusion: Our results suggest that attitudes and belief systems prevalent in society have a major impact on help-seeking behaviour, both through transmission to the person suffering from mental distress via his/her social network and through the persons own attitudes formed in the process of socialization. Implications are pointed out for the daily work of mental health care providers, health care planning and public discussion of mental health issues.

Subclassifications for mild cognitive impairment: prevalence and predictive validity.

BACKGROUND Mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. Recently published results of the Current Concepts in MCI Conference suggested subclassifications for MCI (MCI-amnestic, MCI-multiple domains slightly impaired, MCI-single nonmemory domain) based on the recognized heterogeneity in the use of the term. These subclassifications have not been empirically validated to date. METHOD A community sample of 1045 dementia-free individuals aged 75 years and over was examined by neuropsychological testing in a three-wave longitudinal study. The prevalences and the predictive validities for the subclassifications of MCI and their modifications (original criteria except for the report of subjective decline in cognitive function) were determined. RESULTS The prevalence was 1 to 15% depending on the subset employed. Subjects with a diagnosis of MCI progressed to dementia at a rate of 10 to 55% over 2.6 years, depending on the subset employed. MCI-amnestic achieved the highest positive predictive power (PPP). ROC curves of the subclassifications for MCI indicate that all but one subset for MCI failed to predict dementia (MCI-multiple domains slightly impaired-modified: AUC=0.585, P<0.01, 95% CI, 0.517-0.653). The use of modified criteria for MCI (original criteria except for the report of subjective decline in cognitive function) is associated with a higher diagnostic sensitivity but also with a reduction in diagnostic specificity and PPP. CONCLUSIONS Modified criteria should be applied if a concept for MCI with a high sensitivity is required and the original criteria (including subjective cognitive complaint) if a concept with high specificity and high PPP is required.

The state of mental health in old-age across the old European Union - a systematic review

Objective:  The paper provides the first syllabus on the prevalence of mental disorders in old‐age focusing on surveys conducted in the 15 countries, which comprised the ‘old’ European Union.

Cost‐of‐illness studies of dementia: a systematic review focusing on stage dependency of costs

Quentin W, Riedel‐Heller SG, Luppa M, Rudolph A, König H‐H. Cost‐of‐illness studies of dementia: a systematic review focusing on stage dependency of costs.

Mild cognitive impairment1: prevalence and predictive validity according to current approaches

Objectives – Mild cognitive impairment is associated with an increased risk of developing dementia. However, there is no consensus on diagnostic criteria and different concepts have rarely been evaluated in population‐based samples. This paper compares the prevalences and predictive validities for different concepts in a population‐based study. The aim was to identify a concept with the best relation of sensitivity and specificity in the prediction of dementia.

Risk factors for incident mild cognitive impairment – results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe)

Luck T, Riedel‐Heller SG, Luppa M, Wiese B, Wollny A, Wagner M, Bickel H, Weyerer S, Pentzek M, Haller F, Moesch E, Werle J, Eisele M, Maier W, van den Bussche H, Kaduszkiewicz H for the AgeCoDe Study Group. Risk factors for incident mild cognitive impairment – results from the German Study on Ageing, Cognition and Dementia in Primary Care Patients (AgeCoDe).

What to do about mental disorder--help-seeking recommendations of the lay public.

Objective: Sociocultural factors have been recognized as an important predictor in shaping help‐seeking behaviour.

The long-term cost-effectiveness of obesity prevention interventions: systematic literature review.

Obesity prevention provides a major opportunity to improve population health. As health improvements usually require additional and scarce resources, novel health technologies (interventions) should be economically evaluated. In the prevention of obesity, health benefits may slowly accumulate over time and it can take many years before an intervention has reached full effectiveness. Decision‐analytic simulation models (DAMs), which combine evidence from diverse sources, can be utilized to evaluate the long‐term cost‐effectiveness of such interventions. This literature review summarizes long‐term economic findings (defined as ≥40 years) for 41 obesity prevention interventions, which had been evaluated in 18 cost‐utility analyses, using nine different DAMs. Interventions were grouped according to their method of delivery, setting and risk factors targeted into behavioural (n = 21), community (n = 12) and environmental interventions (n = 8). The majority of interventions offered good value for money, while seven were cost‐saving. Ten interventions were not cost‐effective (defined as >50,000 US dollar), however. Interventions that modified a target populations environment, i.e. fiscal and regulatory measures, reported the most favourable cost‐effectiveness. Economic findings were accompanied by a large uncertainty though, which complicates judgments about the comparative cost‐effectiveness of interventions.

Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe).

BACKGROUND Whether late-onset depression is a risk factor for or a prodrome of dementia remains unclear. We investigated the impact of depressive symptoms and early- v. late-onset depression on subsequent dementia in a cohort of elderly general-practitioner patients (n = 2663, mean age = 81.2 years). METHOD Risk for subsequent dementia was estimated over three follow-ups (each 18 months apart) depending on history of depression, particularly age of depression onset, and current depressive symptoms using proportional hazard models. We also examined the additive prediction of incident dementia by depression beyond cognitive impairment. RESULTS An increase of dementia risk for higher age cut-offs of late-onset depression was found. In analyses controlling for age, sex, education, and apolipoprotein E4 genotype, we found that very late-onset depression (aged ≥ 70 years) and current depressive symptoms separately predicted all-cause dementia. Combined very late-onset depression with current depressive symptoms was specifically predictive for later Alzheimers disease (AD; adjusted hazard ratio 5.48, 95% confidence interval 2.41-12.46, p < 0.001). This association was still significant after controlling for cognitive measures, but further analyses suggested that it was mediated by subjective memory impairment with worries. CONCLUSIONS Depression might be a prodrome of AD but not of dementia of other aetiology as very late-onset depression in combination with current depressive symptoms, possibly emerging as a consequence of subjectively perceived worrisome cognitive deterioration, was most predictive. As depression parameters and subjective memory impairment predicted AD independently of objective cognition, clinicians should take this into account.