Ziel: Untersucht wurden Umfang, Konsummuster und Störungen im Zusammenhang mit dem Gebrauch von Alkohol, Tabak, illegalen Drogen und Medikamenten. Methodik: Die Stichprobe des Epidemiologischen Suchtsurveys (ESA) 2012 wurde zufällig aus den Einwohnermelderegistern gezogen und umfasste 9084 Personen im Alter zwischen 18 und 64 Jahren. Die Befragung erfolgte schriftlich, telefonisch bzw. über das Internet; die Antwortrate lag bei 53.6 %. Ergebnisse: Bezogen auf die letzten 30 Tage zeigten 57.3 % der Befragten einen risikoarmen und 14.2 % einen riskanten Alkoholkonsum. Insgesamt 30.2 % gaben an, in diesem Zeitraum geraucht zu haben. In den letzten 12 Monaten haben 4.5 % der Befragten Cannabis, 0.8 % Kokain und 0.7 % Amphetamine konsumiert. Schmerzmittel waren die am häufigsten eingenommenen Medikamente (12-Monats-Prävalenz: 61.9 %). Schätzungen zur Substanzabhängigkeit nach DSM-IV ergaben Prävalenzwerte von 3.4 % für Alkohol, 10.8 % für Tabak, 0.5 % für Cannabis, 0.2 % für Kokain, 0.1 % für Amphetamine und 3.4 % für Schmerzmittel. Schlussfolgerungen: Die hohe Verbreitung psychischer Störungen durch Alkohol und Tabak macht die Dringlichkeit der Umsetzung effizienter Präventionsmaßnahmen deutlich. Störungen im Zusammenhang mit Medikamenten sollten stärker beachtet werden.

Objectives Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders and to detect reverse influence, a focus on longitudinal studies using multivariate analysis is required. Design A systematic literature search was conducted by searching the databases MEDLINE, Cochrane, PsycINFO and Web of Science for all relevant articles published from January 2000 to the end of March 2020. The following inclusion criteria were used: prospective design, nationally or regionally representative sample, published in English or German, analyzed risk factors for depression of individuals 65+ identified by multivariate analysis, and provided validity of diagnostic instrument. All results of multivariate analysis were reported and summarized. Results Thirty articles were identified. Heterogeneous results were found for education, female gender, self-rated health, cognitive impairment and older age, although significant in several studies. Findings hinted at a protective quality of physical activity. In terms of physical health, chronic disease and difficulty initiating sleep homogeneously increased risk of depression. Mobility impairment resulted as a risk factor in three studies. IADL impairment and vision impairment were mostly identified as significant risk factors. Alcohol consumption and smoking behavior yielded heterogenous results. Psychosocial factors were assessed similarly in multiple studies and yielded heterogenous results. Limitations Research was limited to articles published in English or German. Length of follow up was not considered for the presentation of results. Adjustments for and inclusion of different variables in the studies may distort results. Conclusion Our findings demonstrate the necessity of refined, more comparable assessment tools for evaluating potential risk factors.

Background With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. Methods and findings We harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = −0.1, SE = 0.01), APOE*4 carriage (B = −0.31, SE = 0.11), depression (B = −0.11, SE = 0.06), diabetes (B = −0.23, SE = 0.10), current smoking (B = −0.20, SE = 0.08), and history of stroke (B = −0.22, SE = 0.09) were independently associated with poorer cognitive Determinants of cognition in diverse ethno-regional groups

PurposeTo perform a systematic review and quantitative synthesis of studies on recent trends in dementia incidence in high-income countries (HIC), considering study quality.MethodsPubMed and Web of Science were searched for eligible studies, that is, population-based/community-based prospective cohort studies investigating dementia incidence with similar methods over time, published after 1990. Study selection, data extraction, and quality assessment were performed independently by two investigators. Random-effect meta-analysis and meta-regression were used to estimate incidence change (IC) and to explore associations with study attributes. PRISMA standards were followed.ResultsThe systematic review included seven studies (42,485 individuals), and the meta-analysis included five studies of sufficient quality. Relating dementia incidence of later cohorts to earlier cohorts (reference) yielded a nonsignificant decrease across HIC (IC =0.82; 95% CI 0.51–1.33), with high heterogeneity (I2=94.9%, P<0.001) and without publication bias (Egger’s t=–1.77; P=0.18). Excluding the Japanese Hisayama study, the only study suggesting an increase, indicated borderline evidence for a decrease across Western HIC (IC =0.69; 95% CI 0.47–1.00; I2=88.1%, P<0.001; Egger’s t=–0.34, P=0.77), again with high heterogeneity. Meta-regression did not reveal an association of incidence rate with calendar year or study attributes; however, analyses were low powered.ConclusionThere is evidence of favorable trends in dementia incidence in Western HIC (stabilizing/decreasing). Reverse trends may occur in HIC of other regions, as exemplified by Japan. However, study number was small and heterogeneity was high. Further cohort studies using consistent methods are needed to draw definite conclusions. Our work may inform such future studies.

Background Subjective cognitive decline (SCD) is recognized as a risk stage for Alzheimer’s disease (AD) and other dementias, but its prevalence is not well known. We aimed to use uniform criteria to better estimate SCD prevalence across international cohorts. Methods We combined individual participant data for 16 cohorts from 15 countries (members of the COSMIC consortium) and used qualitative and quantitative (Item Response Theory/IRT) harmonization techniques to estimate SCD prevalence. Results The sample comprised 39,387 cognitively unimpaired individuals above age 60. The prevalence of SCD across studies was around one quarter with both qualitative harmonization/QH (23.8%, 95%CI = 23.3–24.4%) and IRT (25.6%, 95%CI = 25.1–26.1%); however, prevalence estimates varied largely between studies (QH 6.1%, 95%CI = 5.1–7.0%, to 52.7%, 95%CI = 47.4–58.0%; IRT: 7.8%, 95%CI = 6.8–8.9%, to 52.7%, 95%CI = 47.4–58.0%). Across studies, SCD prevalence was higher in men than women, in lower levels of education, in Asian and Black African people compared to White people, in lower- and middle-income countries compared to high-income countries, and in studies conducted in later decades. Conclusions SCD is frequent in old age. Having a quarter of older individuals with SCD warrants further investigation of its significance, as a risk stage for AD and other dementias, and of ways to help individuals with SCD who seek medical advice. Moreover, a standardized instrument to measure SCD is needed to overcome the measurement variability currently dominant in the field.