In-vivo imaging markers of neuronal changes related to Alzheimer’s disease (AD) are ideally suited to be employed as diagnostic markers for early and differential diagnosis of AD as well as for the assessment of neurobiological effects of medical treatments in clinical trials. Novel molecular imaging techniques enable in-vivo detection of cerebral amyloid pathology, whereas magnetic resonance imaging (MRI)-based techniques, such as volumetric MRI and diffusion tensor imaging (DTI), provide structural lesion markers that allow tracking disease progression from preclinical through predementia to clinically manifest stages of AD. However, a widespread clinical use of these imaging biomarkers is hampered by considerable multi-centric variability related to differences in scanner hardware and acquisition protocols, but also by the lack of internationally agreed upon standards for analytic design and employed quantitative metrics. Several strategies for reducing multicenter variability in imaging measures have been proposed, including homogenization of the acquisition settings across scanner platforms, stringent quality assurance procedures, and artifact removal by means of post-acquisition image processing techniques. In addition, selection of appropriate statistical models to account for remaining multicenter variability in the data can further improve the accuracy and reproducibility of study results. The first projects for international standardization of image analysis methods and derived quantitative metrics have emerged recently for volumetric MRI measures. In contrast, the standardization and establishment of DTI-derived measures within a multicenter context are less well developed. Although molecular imaging techniques are already widely used in multicenter settings, sources of variability across sites and appropriate methods to reduce multicenter effects are still not explored in detail. Comparability of neuroimaging measures as AD biomarkers in worldwide clinical settings will finally depend on the establishment of internationally agreed upon standards for image acquisition, quality assurance, and employed quantitative metrics.

Bei der Entwicklung dieses Lehrbuchs haben alle Beteiligten gemeinsam das Ziel verfolgt, das neue Standardwerk der deutschsprachigen Geriatrie zu präsentieren. Es beleuchtet die ganze Palette der Erkrankungen im höheren Lebensalter und der geriatrischen Syndrome, darunter Ernährungs- und Stoffwechselstörungen, Mobilitätsstörungen, Infektionskrankheiten, Tumorerkrankungen, Herz-Kreislauf- und Gefäßerkrankungen, neurologische Erkrankungen, die verschiedenen Formen des kognitiven Abbaus sowie Sarkopenie und Frailty. Zu weiteren wesentlichen Themen gehören das funktionelle Assessment, die Polypharmazie sowie die Palliativmedizin des älteren Patienten. Das Buch vermittelt ein Verständnis von Geriatrie als interdisziplinäre und interprofessionelle Komplexitätsmedizin mit dem Anspruch, ältere Patienten bestmöglich zu behandeln und auf diese Weise ihre Lebensqualität zu erhalten oder zu verbessern. Abschließend werden biologische, epidemiologische und politische Aspekte des Alterns reflektiert. Mit einem modernen, systematischen Aufbau, zahlreichen didaktischen Elementen und anschaulichen Abbildungen ist das Werk ideal für den Einsatz in Klinik und Praxis. In über 130 Kapiteln werden Schlüsselkonzepte der Diagnostik und Behandlung sowie alle relevanten Fragen und Problemstellungen behandelt. Dieses Buch wird Freude an der Geriatrie vermitteln, inspirieren und als Nachschlagewerk für die tägliche Arbeit dienen. Die vier Herausgeber wurden von einem Team von Sektionsherausgebern unterstützt, die anerkannte Experten auf dem Fachgebiet der Geriatrie und der Altersmedizin sind. Die mehr als 200 Autorinnen und Autoren wurden aufgrund ihrer wissenschaftlichen Expertise und ihrer praktischen Erfahrung eingebunden. Ohne die Fachvertreter der benachbarten Disziplinen wäre es nicht möglich gewesen, den hohen Ansprüchen dieser Publikation gerecht zu werden. Dieses neue Standardwerk ist an eine umfangreiche Leserschaft gerichtet: Fachärztinnen und -ärzte für Geriatrie, die eine verlässliche Referenz suchen, Ärztinnen und Ärzte in Weiterbildung bis hin zu allen ärztlichen Kolleginnen und Kollegen, die mit der Versorgung älterer Patienten befasst sind.

Seelsorgerinnen und Seelsorger kommen bei der Ausübung ihres Berufs mitunter mit schwierigen psychiatrischen und psychologischen Krisen und Akutsituationen in Berührung. Wie kann man damit gut umgehen? Das praxisorientierte Handbuch reflektiert leibseelische Erkrankungen pastoraltheologisch und behandelt psychiatrische Grundlagen, u.a. Grundwissen über die Entstehung, Verbreitung und Folgen leibseelischer Erkrankungen; Darstellung typischer pastoraler Situationen, in denen einem solche Notlagen begegnen können; rechtliche Aspekte; spezialisierte Berufsgruppen und Institutionen. Außerdem vermittelt es psychiatrisches Wissen zu den typischen Krankheitsbildern, u.a. Depression und affektive Störungen, Suizidalität, Erschöpfung und Nervenzusammenbruch, Angsterkrankungen, Zwänge, Abhängigkeits- und Impulskontrollstörungen, psychotische Erkrankungen inklusive wahnhafter Störungen, Probleme mit der sexuellen Identität und Präferenz, Traumatisierung und Missbrauch.

Abstract: The utility of amyloid positron emission tomography (PET) for the etiological diagnosis of dementia and its impact on functional status of patients in routine care are currently unclear. Here, we describe the design of ENABLE, a randomized controlled two-armed coverage with evidence development (CED) study in Germany. Approximately 1126 patients with mild to moderate dementia of unclear etiology will be randomly assigned to either an amyloid PET or a no amyloid PET group. Patients will be followed-up for 24 months. The study has been registered at the German Clinical Trials Register (https://drks.de/search/de/trial/DRKS00030839) with the registration code DRKS00030839. The primary endpoint of ENABLE is the ability to perform functional activities of daily living at 18 months. Secondary endpoints include change in diagnosis, diagnostic confidence, and cognitive and clinical outcomes of patients. We expect that the CED study ENABLE will inform about patient relevant effects of amyloid PET in routine care. Furthermore, we anticipate that ENABLE will support physicians' and payers' decisions on provision of health care for patients with dementia. Highlights Study design focuses on the usefulness of amyloid positron emission tomography (PET) in routine care. Study design addresses the patient-relevant effect of amyloid PET. Patient representatives were involved in the creation of the study design. The study will help improve routine care for people with dementia

Abstract: Cognition emerges from coordinated processing among distributed cortical brain regions, enabled through interconnected white matter networks. Cortical disconnection caused by age-related decline in white matter integrity (WMI) is likely to contribute to age-related cognitive decline. Physical activity (PA) has been suggested to have beneficial effects on white matter structure. However, its potential to counteract age-related decline in WMI is not yet well established. The present explorative study analyzed if PA was associated with WMI in cognitively healthy older adults and if this association was modulated by age. Forty-four cognitively healthy older individuals (aged 60-88 years) with diffusion-tensor imaging (DTI) and PA measurements were included from the AgeGain study. Voxelwise analysis using Tract-Based Spatial Statistics (TBSS) demonstrated that PA was associated with WMI in older adults. However, results emphasized that this association was restricted to high age. The association between PA and WMI was found in widespread white matter regions suggesting a global rather than a regional effect. Supplementary analyses demonstrated an association between the integrity of these regions and the performance in memory [verbal learning and memory test (VLMT)] and executive functioning (Tower of London).Results of the present explorative study support the assumption that PA is associated with WMI in older adults. However, results emphasize that this association is restricted to high age. Since cognitive decline in the elderly is typically most pronounced in later stages of aging, PA qualifies as a promising tool to foster resilience against age-related cognitive decline, via the preservation of the integrity of the brains WM

Abstract: Background: Normal aging is associated with working memory decline. A decrease in working memory performance is associated with age-related changes in functional activation patterns in the dorsolateral prefrontal cortex (DLPFC). Cognitive training can improve cognitive performance in healthy older adults. We implemented a cognitive training study to assess determinants of generalization of training gains to untrained tasks, a key indicator for the effectiveness of cognitive training. We aimed to investigate the association of resting-state functional connectivity (FC) of DLPFC with working memory performance improvement and cognitive gains after the training. Method: A sample of 60 healthy older adults (mean age: 68 years) underwent a 4-week neuropsychological training, entailing a working memory task. Baseline resting-state functional MRI (rs-fMRI) images were acquired in order to investigate the FC of DLPFC. To evaluate training effects, participants underwent a neuropsychological assessment before and after the training. A second follow-up assessment was applied 12 weeks after the training. We used cognitive scores of digit span backward and visual block span backward tasks representing working memory function. The training group was divided into subjects who had and who did not have training gains, which was defined as a higher improvement in working memory tasks than the control group (N = 19). Results: A high FC of DLPFC of the right hemisphere was significantly associated with training gains and performance improvement in the visuospatial task. The maintenance of cognitive gains was restricted to the time period directly after the training. The training group showed performance improvement in the digit span backward task. Conclusion: Functional activation patterns of the DLPFC were associated with the degree of working memory training gains and visuospatial performance improvement. Although improvement through cognitive training and acquisition of training gains are possible in aging, they remain limited