What Do We Know about Social and Non-Social Factors Influencing the Pathway from Cognitive Health to Dementia? A Systematic Review of Reviews.

The heterogeneous and multi-factorial nature of dementia requires the consideration of all health aspects when predicting the risk of its development and planning strategies for its prevention. This systematic review of reviews provides a comprehensive synthesis of those factors associated with cognition in the context of dementia, identifying the role of social aspects and evidencing knowledge gaps in this area of research. Systematic reviews and meta-analyses from 2009-2021 were searched for within Medline, PsycINFO, CINAHL Complete, Cochrane, and Epistemonikos. Reviewers independently screened, reviewed, and assessed the records, following the PRISMA-2020 guidelines. From 314 included studies, 624 cognitive-related factors were identified, most of them risk factors (61.2%), mainly belonging to the group of 'somatic comorbidities' (cardiovascular disease and diabetes) and 'genetic predispositions'. The protective factors (20%) were mainly related to lifestyle, pointing to the Mediterranean diet, regular physical activity, and cognitively stimulating activities. Social factors constituted 9.6% of all identified factors. Research on biological and medical factors dominates the reviewed literature. Greater social support and frequent contact may confer some protection against cognitive decline and dementia by delaying its onset or reducing the overall risk; however, overall, our findings are inconsistent. Further research is needed in the fields of lifestyle, psychology, social health, and the protective factors against cognitive decline and dementia.

Mapping the complexity of dementia: factors influencing cognitive function at the onset of dementia.

BACKGROUND: Dementia is a multi-factorial condition rather than a natural and inevitable consequence of ageing. Some factors related to dementia have been studied much more extensively than others. To gain an overview of known or suspected influential factors is a prerequisite to design studies that aim to identify causal relationships and interactions between factors. This article aims to develop a visual model that a) identifies factors related to cognitive decline that signal the onset of dementia, b) structures them by different domains and c) reflects on and visualizes the possible causal links and interactions between these factors based on expert input using a causal loop diagram. METHOD: We used a mixed-method, step-wise approach: 1. A systematic literature review on factors related to cognitive decline; 2. A group model building (GMB) workshop with experts from different disciplines; 3. Structured discussions within the group of researchers. The results were continuously synthesized and graphically transformed into a causal loop diagram. RESULTS: The causal loop diagram comprises 73 factors that were structured into six domains: physical (medical) factors (23), social health factors (21), psychological factors (14), environmental factors (5), demographic factors (5) and lifestyle factors (3). 57 factors were identified in the systematic literature review, additionally 16 factors, mostly of the social health cluster, were identified during the GMB session and the feedback rounds. CONCLUSION: The causal loop diagram offers a comprehensive visualisation of factors related to cognitive decline and their interactions. It supports the generation of hypotheses on causal relationships and interactions of factors within and between domains.

[Dealing with Ethical Aspects in Student Research Projects - Results of a Survey of Health Sciences Faculties in Germany]. / Umgang mit der ethischen Bewertung bei studentischen Forschungsarbeiten ­ Ergebnisse einer Befragung an gesundheitsbezogenen Fachbereichen in Deutschland.

INTRODUCTION: Research projects in the health sciences often involve ethically sensitive areas. The rise in the number of empirically oriented theses and concepts such as research-based learning has led to an increasing need for ethics approvals also for student research projects. There is no standardised procedure for dealing with student research projects in Germany. This can lead to research projects being carried out without an ethics approval, even though this might have been necessary. This study aims to investigate how different universities deal with ethical aspects in students' research. In addition, we present examples of existing approaches. METHODS: An online-based questionnaire was sent to 132 departments offering degree programmes in public health, health and nursing science, and psychology at 112 universities. Additionally, telephone interviews were conducted with the coordinators of four such degree programmes. RESULTS: Coordinators of 55 such degree programmes participated in the survey; 84% of the participating of these offered support to students with ethical questions concerning their research. However, only 39% provided a structured procedure for dealing with ethical assessments of research projects led by students. Several approaches were presented in depth by the coordinators of four degree programmes, among them the use of checklists, the establishment of internal ethics committees, and ethics advisory services. All respondents agreed on a need to deal with ethics approvals related to students' research projects. CONCLUSION: Structured procedures exist at some but not all degree programmes, faculties, and universities. Some of these procedures can serve as models for other universities.