[Effects of combined cognitive and physical training on cognition of healthy older adults: a literature review]. / Effekte kombinierten kognitiven und physischen Trainings auf die Kognition gesunder älterer Menschen: ein Literaturüberblick.

There is significant evidence for the positive effects of cognitive and physical training on cognition in healthy older adults. Recently, it has been discussed whether stronger effects could be reached with a combination of both interventions. This review analyses the current state of research about this topic. Four randomised controlled trials (RCTs) and four controlled trials were found. Three of these studies (none of which were RCTs) in fact showed the superiority of combined training when compared to single interventions. However, even if positive evidence exists, the current state of research has to be evaluated as insufficient due to the small number of studies, the lack of evidence from RCTs and the lack of comparability of study designs, types of interventions, and test intervals used so far. Gaps in the current state of research are identified, relevant aspects of future studies are listed and possible neurobiological mechanisms of training effects are discussed.

Efficacy of nonsurgical therapy for urinary incontinence.

OBJECTIVE: to assess the efficacy of aggressive nonsurgical therapy for urinary incontinence in women and to determine if it is advantageous to perform invasive urodynamic testing prior to initiating treatment. STUDY DESIGN: We subjectively assessed 202 incontinent women three months to four years following nonsurgical therapy for urinary incontinence. Therapy in all patients included behavioral modification in the form of timed voiding and pelvic floor exercises. Depending on the suspected diagnosis and menopausal state, patients were also treated with various combinations of pharmacologic agents and estrogen replacement therapy. Based on initial evaluation, patient preference and referring physician preference, 100 women were started on therapy after a minimal evaluation, while 102 women were treated based on invasive urodynamic testing. A subjective assessment of treatment outcome was made via a telephone interview in which patients were asked standardized questions. RESULTS: One hundred nineteen cases (59%) were subjectively improved or cured with nonsurgical therapy. Performing urodynamic testing prior to initiating therapy did not increase the overall success rate: 69 of 100 patients (69%) treated on the basis of history, physical examination and a minimal office evaluation were improved or cured, while only 50 of 102 patients (49%) having electronic multichannel urodynamic testing were improved or cured. CONCLUSION: All women with urinary incontinence should be initially offered nonsurgical therapy since a large percentage will obtain satisfactory results. It is not beneficial or cost-effective to perform electronic urodynamic testing prior to initiating therapy.