[Cognitive effects of combined memory and psychomotor training in elderly adults]. / Efectos cognitivos de un entrenamiento combinado de memoria y psicomotricidad en adultos mayores.

INTRODUCTION: As part of the normal ageing process, cognitive deterioration clearly takes place in memory, attention and the information processing speed (IPS). Among the intervention strategies commonly used, combined programmes like those involving memory and psychomotor skills have the greatest beneficial effects on cognition in the short and long term. AIM: To evaluate the effects of a combined memory and psychomotor training programme entitled 'Independence in Older age' (SIMA) on the cognitive performance of a population sample of healthy elderly adults. SUBJECTS AND METHODS: A cross-sectional study was conducted on 95 elderly adults (49 in the intervention group and 46 in the control group) before and after a 20-session training programme. Both intergroup (intervention group versus control group) and intragroup (each group individually) cognitive performance was analysed. The two groups were paired by age, sex and schooling. RESULTS: The intergroup analysis following the training showed statistically and clinically significant differences in two IPS variables: conflict and interference in the colour-word test, which had a size effect of -1.31 and -1.38, respectively; the performance of the group of trained elderly adults was better than that of the controls. Likewise, in the intragroup analysis significant differences were found in these two variables in the group that received the intervention, with a size effect of -1.27 and -1.15. CONCLUSION: Findings show positive effects of combined SIMA memory and psychomotor training, especially in selective attention and the IPS with a healthy elderly adult population.

[Non-medicamentous therapy and prevention of Alzheimer disease]. / Nichtmedikamentöse Therapie und Prävention der Alzheimer Krankheit.

An overview of prevalence data and empirically documented risk factors of a dementia is followed by a short description of intervention strategies. After this, prevalence data from the SIMA Study are presented and results of the multivariate analyses of early indicators and risk factors are discussed. The last section is dedicated to the risk decreasing effects of a combined memory and psychomotor training program which was developed within the study's scope.

[Can age and aging be measured?]. / Sind Alter und Altern messbar?

Are age and aging measurable? Yes, of course they are, if all types of quantification are included. Nevertheless, a lot of questions have to be discussed with regard to different concepts of age, e.g., chronological age, biological age, subjective age, mean age, life expectancy, etc. Even the question when someone should be labeled old cannot be answered without reference to a priori hypotheses and demographic development. Beyond that, aging is not a standardized process. Aging is dependent on multiple individual and environmental conditions and there is a large interindividual variability which is often underestimated. Research on these aging processes is itself dependent on the instruments used, e.g., the methods of a longitudinal or cross-sectional study. Aging is a multifaceted and quite individual process.

The SIMA-project: effects of 1 year cognitive and psychomotor training on cognitive abilities of the elderly.

In an interdisciplinary project on maintaining and supporting independent living in old age, (a) competence training, (b) memory training and (c) psychomotor training as well as (d) combined competence and psychomotor training and (e) combined memory and psychomotor training was performed with n = 309 elderly of 75 to 89 years of age for 9 months. Regardless of treatment conditions, an age-related decline of health and subjective well-being was found 1 year after the end of the training. The specific training measures each led to highly significant specific improvements of the trained functions. A favorable influence of competence training on everyday coping and hence on active strategies for staying independent as well as of memory training on all cognitive functions and especially on memory performance was found. While global psychomotor performance was not significantly improved, effects of psychomotor training on specific functions were detected. In addition, the combined psychomotor and memory training led to an improvement of psychomotor performance and to a reduction of symptoms of dementia, even though neither psychomotor training alone nor memory training alone resulted in such effects. Neurophysiological changes leading to a provision of reserve-capacity of CNS-performance are among other effects assumed as an explanation.

Functional rating scales and psychometric assessment in Alzheimer's disease: applications in pharmacological trials.

New findings on cognitive aging show that decline in brain functions is not part of a general decline of functioning in old age. We know now that with increasing age there is a differentiation of cognitive functions into two independent dimensions (fluid and crystallized functions). This two-dimensional model allows a more precise description of the cognitive aging process and of pathological changes. While crystallized cognitive abilities can be improved by training till late in life, fluid cognitive functions are subject to a progressive decrease starting as early as age 30, becoming most evident in cases of organic mental disorders. Thus, pathological aging is not necessarily accompanied by global loss of functions. Different abilities undergo changes in different ways, a fact taken into consideration by modern methods of psychometric evaluation. Beyond the aging processes mentioned previously, cognitive and behavioral changes in the elderly may be considered to be early indicators of organic mental disorders. The Nuremberg Self-Evaluation List seems to be a promising approach to diagnosis.

Psychometrics in aging and dementia: advances in geropsychological assessments.

Description, explanation and prediction of changes occurring in old age, which are based on intervention, are outlined as a basic goal in gerontological research. Appropriate psychological assessment techniques are necessary to reach this goal. The Nuremberg Gerontopsychological Inventory (NAI) is introduced as a set of psychological measurements which enable reliable, valid and sensitive evaluation of intervention-induced changes in old age. Four independent assessment levels, i.e. standardized performance tests, observer-ratings, self-ratings and a personality rating are the core components of this inventory. All assessment techniques are adapted for elderly subjects. Standard scores are available for the age range 55-90 years. Interrelations between the applied independent assessment levels are reported and taken to link different aspects of intervention-induced changes. Measuring psychological performance thus gains practical significance, e.g. in terms of activities-of-daily-living. From 14 independent studies the drug sensitivity of the applied measurements is shown. Finally, some recommendations for future psychometrical research are given.

Psychometrics in the treatment of ischemic cerebrovascular diseases.

The question on which level of evaluation treatment effects have to be based on, proves the relevance of independent psychological measurements. The Nuremberg Gerontopsychological Inventory NAI is introduced as a symptomatic-oriented approach for the assessment of therapeutically induced changes. It contains four distinct ways of treatment evaluations: (1) the level of assessment of cognitive functioning; (2) subject-rated well-being; (3) observer-rated activities-of-daily-living (e.g. by a nurse), and (4) examiner-rated personality traits. For all test procedures, norm scores as well as detailed test characteristics are computed. Interrelations between the independent data levels proved to be essential for a valid estimation of treatment effects.

[Activities of daily living and the speed/power components of test performance]. / Alltagsaktivitäten (ADL) und die Speed-/Power-Komponenten von Testleistungen.

By using the Nuremberg Gerontopsychological Inventory (NAI) two hypothesis have been tested on N = 329 subjects in the age between 55 and 93: a) Test performance of older people can be reduced to a speed-/power-model, b) speed tests are more apt to predict activities of daily living than power tests are. Both assumptions can be confirmed. A two-factorial speed/power-solution can be shown. To predict changes in the activities of daily living an advance in using speed-dependent tests is turned out.

[On the meaning of psychometrically operationalized therapeutic effects in the treatment of brain insufficiency phenomena caused by old age demonstrated by the "Nürnberger-Alters-Inventar" (author's transl)]. / Uber die Relevanz psychometrisch operationalisierter Therapic-Effekte bei der Behandlung altersbedingter Insuffizienzerscheinungen des Gehirns am Beispiel des Nürnberger-Alters-Inventars.

The drug effects of dihydroergotoxine (Hydergin) and piracetam were examined in a sample of 44 old-age home residents, 76 years average age, using performance tests, nurse-ratings for the need of care and self-evaluation measures of the "Nürnberger Alters-Inventar" (NAI). Within a subsample of 18 patients, selected according to certain EEG-criteria, EEG day profiles were assessed. The medication lasted for 6 weeks. 2 mg dihydroergotoxine or 0.8 g piracetam, respectively, were applied three times a day. Initial effects were observed for both medications after 3 weeks in terms of improvements in the cognitive performance, for the activities of daily living and need of care, respectively, and for subjective, physical, functional and social self-evaluations. After 6 weeks, at the end of the study, these effects were confirmed only for dihydroergotoxine, whereas the piracetam subjects could not stabilize these improvements. The psychometric results were corroberated by the EEG-data. Correlations between the independent levels of psychometric assessment did demonstrate the meaning of the performance measures in terms of activities of daily living and subjective well-being.

[Anxiolysis and reduction of subjectively scaled "strain" in cognitive stress by means of pindolol]. / Anxiolyse und Reduktion der subjektiv skalierten "Anspannung" bei kognitivem Stress durch Pindolol.

Based upon suggestions of Lader (1976) about a diagnostic scale of various anxiety states it is discussed if beta-blockers influence mainly the peripheric vegetative symptoms of anxiety and stress and tranquilizers mainly cognitive anxiety. Results of a study in 51 labile volunteers between 19 and 26 years of age are reported. After a six weeks treatment with pindolol compared to chlordiazepoxide and placebo a significant reduction of trait anxiety after beta-blocker treatment was observed. These effects resembled those usually seen after tranquilizer application.

[The effect of treatment on performance and self-appraisal in geriatric patients (author's transl)]. / Therapeutische Beeinflussung von Leistung und Selbstbild bei geriatrischen Patienten.

On the background of the wellknown favorable effects on the social behavior, mood and activation, a six-week treatment with Hydergin of 34 inhabitants of an old people's home led to a significant improvement in the results of psychometric performance tests and to a realistic self-appraisal with consequent greater adaptation. Hydergin was thus shown to be distinctly superior in its observed favorable therapeutic effects to chlordiazepoxide which sometimes rather intensifies the unrealistic self-appraisal of people living in old people's homes.

[Psychometric procedures and questionnaires in geronto-psychological research]. / Psychometrische Verfahren und Fragebogen für gerontopsychologische Untersuchungen.

This paper presents the Nuremberg-Geriatric Inventory (NAI), a test and questionnaire battery for geronto-psychological and pharmacological problems. This inventory consists of three modified subtests of the Wechsler-Adult-Intelligence-Scale (WAIS), a maze-pathway, a modified Trail Making test (ZVT), a psychological rating scale, a rating scale for activities-of-daily-living, a self-rating and a questionnaire, containing problems of growing old. The objectivity, reliability and validity of all tests and scales are described, as well as some norms for different groups of patients. First experiences and results using this inventory in longitudinal studies and pharmacological investigations are reported.

[Long-term treatment of cerebrovascular changes in the elderly (author's transl)]. / Langzeittherapie altersbedingter Insuffizienzerscheinungen des Gehirns.

A prospective study over 15 months in 100 elderly patients with signs of cerebro-vascular impairment demonstrated by psychometric testing that Hydergine (an ergot alkaloid preparation: 4.5 mg daily) compensated the signs of dementia, present in the placebo group, and in some patients actually brought about a significant improvement in mental activity. Similar compensatory effect was also demonstrable in cerebral haemodynamics: in the placebo group there was a progressive increase in cerebral circulation time, an expression of decreased cerebral blood flow, while with Hydergine cerebral circulation time was shortened and stabilized. Serial EEGs, obtained in parallel with psychometric and circulation time tests, demonstrated a marked increase in the 8-10 Hz pattern which corresponds to the physiological alpha activity in this age group. Furthermore, there was a diminished variability in performance in the tested frequency bands with Hydergine, the opposite tendency being obtained in the placebo group.