Applied Gerontopsychiatry and Neuropsychology

Subjective cognitive decline (SCD) with and without pathological biomarker changes are viewed as early, preclinical stages with an increased likelihood of dementia development (Jessen et al, 2014, Mitchell et al, 2014). SCD expresses itself as subjectively perceived cognitive loss in the absence of impairments in neuropsychological standard test procedures (Jessen et al., 2014). In particular, memory loss, which is mainly associated with progression to Alzheimer's dementia, is not identified with the common standard procedures comprising delayed recall with a 20-30 minutes retrieval interval.

The determination of long-term consolidation can be seen as a further paradigm for determining such subtle cognitive changes, which takes into account a higher rate of forgetting (accelerated long-term forgetting; ALF) with significantly longer retrieval intervals (days to months). ALF describes a process in which memory material that has been learned and retained for short periods of time (up to 30 minutes) has a very high rate of being forgotten over the following hours and weeks. ALF could thus precede explicit memory impairment as measured with standard tests. Correspondingly, high-risk groups for dementia development could be given preventive measures at an early stage with the help of this potential early cognitive marker.

For this purpose, clinical, cognitive and MRI data of the longitudinal DELCODE observation study will be analyzed in collaboration with PD Dr. R. Goya-Maldonado (Forschungsgruppe Labor für Systemische Neurowissenschaften und Bildgebung in der Psychiatrie; SNIP-Labor).

Despite substantial efforts worldwide, pharmacotherapeutic treatment options for dementia are still very restricted. For Alzheimer’s disease, the most common cause of dementia, available medication is approved only for conditions of dementia in which patients already suffer from severe cognitive decline. Thus, treatment starts in an already advanced diseased state and is limited to short delays of disease progression. Since in Alzheimer’s disease pathophysiological changes begin years to decades before formal criteria for dementia are met, or even before first clinical symptoms arise, more recent approaches focus on earlier, pre-dementia stages of Alzheimer’s disease, such as MCI. In search of new and preventive treatment options – and to  accelerate their access – the repurposing/repositioning of already approved medication for novel indications has been recognized as a promising and attractive strategy. Our studies based on large databases show that long-term treatment with SSRIs may delay the progression from MCI to dementia by up to three years. Future (national/international) database analyses and a proof-of-mechanism study aim at identifying individual antidepressants and their mechanism of action.

Besides cognitive deterioration, the prevalence of sensory deficits, like hearing impairment/loss, increases with older age. Additionally, hearing loss has also a considerable impact on psychological well-being which might in turn also negatively influence cognitive functioning. Moreover, hearing loss has been identified as a potentially modifiable risk factor for the development of cognitive impairment and dementia. At the same time, it is still unclear if treatment with hearing aids might prevent or delay the progression of cognitive deficits to dementia or if they exert any positive effect on cognitive functioning and/or psychological well-being.

The major aim of the research project AD-HEARING is to investigate if and how routine care with hearing aids improves cognitive functioning and well-being. From an overarching perspective this study should help (1) to improve psychoeducation in hearing impaired patients with respect to the cognitive and psychological impact of hearing impairment, (2) to achieve better adherence/compliance rates for the use of hearing aids, and (3) to boost health care across sectors to provide patients early with specific treatment options (memory clinic, psychotherapy etc.).

In close collobaration with the department of otolaryngology at the UMG (Prof. Dr. Nicola Strenzke), this project is headed by PD Dr. Claudia Bartels, PD Dr. Michael Belz, and PD Dr. Mona Abdel-Hamid at the department of psychiatry and psychotherapy. AD-HEARING was supported by a grant from the Deutsche Alzheimer Gesellschaft e.V. with a funding amount of 102.242€. The study ran from 01.01.2021 - 30.09.2023 and currently, final data analyses are in preparation.

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Further information :

• [in German] https://www.deutsche-alzheimer.de/forschungsfoerderung
• [in German] https://www.deutsche-alzheimer.de/fileadmin/Alz/pdf/Forschungsfoerderung/2020_Goettingen_AD_HEARING_111220.pdf

Treatment of dementia should combine pharmacotherapy and psychosocial interventions in an overall treatment plan, addressing patients and their caregivers. Among psychosocial (group) interventions, promising effects have been shown for neuro-rehabilitation, cognitive stimulation, cognitive-behavioral and reminiscence therapy. However, such programs in early disease stages are not routinely available. A group therapy for mild dementia that adapts and extends thematic modules from an evaluated individual therapy in a dyadic/triadic setting, and that also involves caregivers, has been implemented in our clinical routine care since 2013. A retrospective analysis of clinical routine data revealed antidepressant effects in pre-/post-treatment comparisons, comparable to those in the individual setting and – what is even more – irrespective of gender. Future analyses should also address the caregiver perspective and compare caregiver outcomes with data from caregiver support groups (without direct patient involvement).

Antidepressant Effects of a Multimodal Group Therapy Program for Mild Dementia: A Retrospective Evaluation of Clinical Routine Data.Bartels C, Abdel-Hamid M, Wiltfang J, Schneider A, Belz M. J Alzheimers Dis. 2022;90(4):1725-1737. doi: 10.3233/JAD-220578.PMID: 36336930

FIDEM Göttingen (early information and support in dementia) is a regional network project coordinated by PD Dr. Claudia Bartels and includes general practitioners, counselling services, occupational therapists, and other non-medical organizations (e.g. day care, nursing care, caregiver support groups, self-help groups etc.). With the implementation of a close collaborative structure, the project aims at (1) improving the care situation of patients with dementia still living at home and their relatives, (2) disburding general practitioners, and (3) enhancing the awareness for non-medical offers of support in Göttingen. Since 2017, seven regional FIDEM networks have been established, consisting of approx. 30 general practitioners and approx. 50 non-medical institutions. A quantitative evaluation showed high satisfaction ratings and considerable relief in workload, such encouraging its continuation and transfer to other regions in Germany.

[Evaluation of satisfaction with and relief vs. workload by a general practitioner-centered dementia care project: early information and support in dementia (FIDEM) in Göttingen, Germany]. Demmer I, Belz M, Oberbach L, Hummers E, Wiltfang J, Bartels C. Nervenarzt. 2023 Nov;94(11):1034-1042. doi: 10.1007/s00115-023-01557-6. Epub 2023 Oct 5. PMID: 37796324