Effect of Life Review Therapy for Holocaust Survivors: A randomized controlled trial.

Despite the therapeutic needs of aging Holocaust survivors, no randomized controlled trial (RCT) of psychotherapy exists for this population, with very few on older adults in general. This RCT aimed to compare the efficacy of Life Review Therapy for Holocaust survivors (LRT-HS) relative to a supportive control group. Holocaust survivors with a probable diagnosis of full or subsyndromal posttraumatic stress disorder (PTSD) or depressive disorder were included. Exclusion criteria were probable dementia, acute psychotic disorder, and acute suicidality. The predefined primary endpoint was the course of PTSD symptom scores. In total, 49 of 79 consecutive individuals assessed for eligibility were randomized and included in the intent-to-treat analyses (LRT-HS: n = 24, control: n = 25; Mage = 81.5 years, SD = 4.81, 77.6% female). Linear mixed models revealed no statistically significant superiority of LRT-HS for PTSD symptoms at posttreatment, with moderate effect sizes, Time x Condition interaction: t(75) = 1.46, p = .148, dwithin = 0.70, dbetween = 0.41, but analyses were significant at follow-up, with large effect sizes, t(79) = 2.89, p = .005, dwithin = 1.20, dbetween = 1.00. LRT-HS superiority for depression was observed at posttreatment, t(73) = 2.58, p = .012, but not follow-up, t(76) = 1.08, p = .282, with moderate effect sizes, dwithin = 0.46-0.60, dbetween = 0.53-0.70. The findings show that even in older age, PTSD and depression following exposure to multiple traumatic childhood events can be treated efficaciously using an age-appropriate treatment that includes structured life review and narrative exposure.

Project DECIDE, part II: decision-making places for people with dementia in Alzheimer's disease: supporting advance decision-making by improving person-environment fit.

BACKGROUND: The UN Convention on the Rights of Persons with Disabilities, and the reformed guardianship law in Germany, require that persons with a disability, including people with dementia in Alzheimer's disease (PwAD), are supported in making self-determined decisions. This support is achieved through communication. While content-related communication is a deficit of PwAD, relational aspects of communication are a resource. Research in supported decision-making (SDM) has investigated the effectiveness of different content-related support strategies for PwAD but has only succeeded in improving understanding, which, although one criterion of capacity to consent, is not sufficient to ensure overall capacity to consent. The aim of the 'spatial intervention study' of the DECIDE project is to examine an innovative resource-oriented SDM approach that focuses on relational aspects. We hypothesise that talking to PwAD in their familiar home setting (as opposed to a clinical setting) will reduce the complexity of the decision-making process and enhance overall capacity to consent. METHODS: People with a suspected or confirmed diagnosis of dementia in Alzheimer's disease will be recruited from two memory clinics (N = 80). We will use a randomised crossover design to investigate the intervention effect of the decision-making place on capacity to consent. Besides reasoning capacity, which is part of overall capacity to consent and will be the primary outcome, various secondary outcomes (e.g., other aspects of capacity to consent, subjective task complexity, decisional conflict) and suspected moderating or mediating variables (e.g., meaning of home, demographic characteristics) will be assessed. DISCUSSION: The results of the study will be used to develop a new SDM strategy that is based on relational resources for PwAD. If a change in location achieves the anticipated improvement in capacity to consent, future research should focus on implementing this SDM strategy in a cost-effective manner in clinical practice. TRIAL REGISTRATION: DRKS00030799 .

Attachment styles and happiness in the elderly: the mediating role of reminiscence styles.

BACKGROUND: The current study aims to investigate the relationship between attachment styles and happiness through the mediating role of reminiscence styles in the elderly. METHODS: This was a correlational study of structural equations modelling (SEM) type. The statistical population included all the elderly aged at least 60 years living in Kermanshah province, Iran in 2021, among whom 380 (182 men and 198 women) were selected using convenience sampling method. Participants filled out the questionnaires of Adult Attachment Styles, Oxford Happiness, and Amani et al.'s Reminiscence Styles. RESULTS: The results indicated that secure attachment style has a positive and negative relationship with positive reminiscence (PR) and negative reminiscence (NR), respectively. However, the opposite held true for both avoidant and ambivalent attachment styles. It was also found that secure attachment style has a positive relationship, and avoidant and ambivalent attachment styles have a negative relationship with happiness. Moreover, participants' gender and age had no moderating effect on the mentioned relationships. The results of SEM indicated that secure and ambivalent attachment styles were associated with happiness through both PR and NR, and avoidant attachment style was associated with happiness only through NR. CONCLUSIONS: The findings emphasize the significance of the development of internal working models based on the kind of parent-child's reminiscences and narratives, and the lifelong effects of these models.

An Islamic Form of Logotherapy in the Treatment of Depression, Anxiety and Stress Symptoms in University Students in Iran.

Previous research demonstrated that spiritually sensitive psychotherapy is an effective treatment for clients with depression or anxiety, with outcomes equivalent to secular control interventions. The goal of this study was to evaluate the efficacy of spiritually sensitive logotherapy intervention in the treatment of depression, anxiety, and stress symptoms in university students in Iran. Sixty students with elevated depression symptoms (Beck Depression Inventory II, BDI-II, 22 or greater) were randomly assigned to either a twelve-session group logotherapy programme or a control group. Results showed that spiritually sensitive logotherapy significantly reduced depression, anxiety, and stress, and significantly more so than in the control group (e.g. interaction effect for BDI-II: F = 56.8, p < 0.001, with a large effect size).

Life review therapy for holocaust survivors (LRT-HS): study protocol for a randomised controlled trial.

BACKGROUND: The Holocaust was one of the most traumatic catastrophes in recorded human history. Survivors seeking psychotherapeutic help today, now in their seventies and older, often show symptoms of a posttraumatic stress disorder (PTSD), depression, or prolonged grief disorder. Established psychological treatments for PTSD (e.g. cognitive behaviour therapy, psychodynamic therapies) have been tested and assessed mainly with young and middle-aged adults; only very few studies examined them in old age. There is no therapy outcome study known to us for any treatment mode for Holocaust survivors. Moreover, there is a need for an age group-specific treatment of PTSD and other stress-related mental disorders. A narrative approach including life-review and narrative exposure seems to meet very well the natural need of older people to review their lives and is highly effective. However, most studies on the efficacy of life review therapy (LRT) focus on late-life depression. There is a lack of efficacy studies evaluating the effect of LRT on PTSD symptoms in older individuals that have experienced traumatic events. METHODS: The main goal of this study is to evaluate the effect of LRT for Holocaust survivors (LRT-HS) on symptoms of PTSD and related mental health problems (depression, anxiety, prolonged grief), compared to a supportive control group. A secondary goal is to identify the characteristics of participants that seem to especially benefit from the treatment. The proposed study is a randomised, controlled follow-up trial including Holocaust survivors with one or more trauma-related disorders. The LRT treatment consists of 20-25 sessions. Before and after the treatment phase, participants in both conditions will be assessed. Follow-up will take place 6 months after the treatment. A sample size of 80 is required (drop-out rate included). DISCUSSION: Efficacious treatments for trauma-related disorders in older people are of high importance, also because the probability of traumatisation and loss increases with age. Because this study is conducted with this specific group of multiply traumatised people, we are convinced that the results can easily transfer to other samples. TRIAL REGISTRATION: ISRCTN, ISRCTN12823306. Registered 31 March 2018 - Retrospectively registered (first participant 22 December 2017).

From fragments to identity: reminiscence, life review and well-being of holocaust survivors. An integrative review.

Objectives: Survivors of the Holocaust have reached an age during which it is common for them to look back on their lives. Previous research has shown that reminiscence can take on either adaptive ('self-positive') or detrimental ('self-negative') forms, which in turn are differently linked to psychological well-being. Thus, the question of "why" and "how" Holocaust survivors recall their autobiographical memories may hold important information about the underlying coping processes at play. This review aims to give insight into the current state of research on these questions.Method: A systematic literature search was conducted, looking for articles reporting quantitative and qualitative research on reminiscence and narrative styles, life review and well-being of Holocaust survivors. A methodological quality assessment was undertaken.Results: 23 articles met the criteria for inclusion. These articles focused either on reminiscence functions or on content and structure of life narratives. Such autobiographical reports were shaped by the experience of Holocaust. However, actual well-being was particularly determined by positive life events. Studies found evidence for resilience and ongoing effort to integrate the past into a coherent review. The link between reminiscence and health remains stable even after massive trauma. Contextual influences (such as culture) and age are discussed as possible covariates.Conclusions: The results show that Holocaust survivors are able to use reminiscence in a functional way, though they are increasingly more vulnerable as they reach very old age. The link between past suffering and present well-being gets stronger with age. Other stressful life experiences after the Holocaust must be considered as exacerbating factors. This review also presents the implications for therapy and open research questions are discussed.

Quality of the caregiving relationship and quality of life in mild Alzheimer's dementia.

BACKGROUND: The present study aims to investigate the quality of the dyadic relationship between mild Alzheimer patients and their caregivers. The main objective is to evaluate the consistency, agreement and validity of the German version of the Scale for Quality of the Current Relationship in Caregiving (SQCRC). The secondary objective was to examine the association of relationship quality with quality of life (QOL) in patients with mild Alzheimer's disease (AD) and their caregivers. METHODS: In this study, a sample of 50 patients diagnosed with mild AD and their primary caregivers were included. Participants underwent a full neuropsychological evaluation. The quality of the relationship between persons with AD and their caregivers was assessed using the SQCRC. Furthermore, other scales of relationship quality, well-being of the person with AD, and well-being of the caregiver were used. RESULTS: The results showed that the SQCRC has a good internal consistency and high validity. Also, relationship quality as rated by the AD patients (r = 0.37, P < 0.1) and their caregivers (r = 0.51, P < 0.1) was significantly correlated with QOL. CONCLUSIONS: The findings suggest that many persons with mild AD can rate their relationship quality and that the patient's self-rated relationship quality is a substantial predictor of their QOL.

Volunteers in a biography project with palliative care patients - a feasibility study.

BACKGROUND: Increasing the quality of life with short interventions for vulnerable patients is one of the objectives of palliative care. Biographical approaches are used in a range of different interventions which may require considerable resources of staff time and energy. This study evaluated the feasibility of training hospice volunteers in biographical interviews of patients confronted with a life-limiting disease. For the purpose of this study, we evaluated resources such as time needed for training, coordination and supervision, outcome such as completion of the intervention in appropriate time and risks such as causing distress in patients or volunteers as major determinants of feasibility. METHODS: Nine volunteers from a hospice service attended an advanced training with an introduction to palliative care, biography work, interview techniques, transcribing and writing. Volunteers interviewed a patient and developed a written narrative from the interview. Volunteers completed a questionnaire before training and were interviewed at the end of the project. The interviews were audiotaped, transcribed, and evaluated using descriptive and qualitative content analysis. RESULTS: Patients provided positive feedback from the intervention. Volunteers felt that their involvement was personally rewarding and were moved by the courage and confidence of the patients. There were no systematic problems or negative experiences reported neither by volunteers nor by patients. CONCLUSIONS: We found the use of volunteers for biography work with patients in palliative care feasible and effective in this study. Volunteers needed supervision and ongoing support in providing this intervention.

A Review of Biographical Work in Palliative Care.

AIM: We find several interventions in palliative care to cover psychosocial needs and to relieve distress of patients. There is a growing interest in therapies using biographical approaches, but discussion about interventions is sparse, and there is no concept for comprehensive and sustainable provision. Research on interventions with a single biographical approach is available, but there is no systematic review that tests a range of interventions. Therefore, we look at all studies using biographical approaches for patients and/or caregivers. METHODS: In May 2017, the electronic databases of Medline, PubMed, EMBASE, Central, and PsycINFO were searched for qualitative and quantitative empirical reports. Interventions for patients, dyads of patient and caregiver, and bereaved caregivers were included. Data analysis follows the guideline PRISMA. RESULTS: Twenty-seven studies were included - 12 using a quantitative evaluation and 15 using a qualitative evaluation. Interventions using biographical approach are widespread and show broad variations in comprehension and performance. The scope of interest lays on patient and family in trajectory of illness and bereavement. The most common interventions used were life review, short life review, dignity therapy, and bereaved life review. Biographical approaches increase quality of life and spiritual well-being and reduce depression. Interventions show effects independently of the number of sessions or provider. CONCLUSIONS: Transferability of concepts seems limited due to the implications of culture on themes emerging in interventions. In some case, there were predicting factors for responders and nonresponders. Further research is needed.

Preliminary evidence for an increased likelihood of a stable trajectory in mild cognitive impairment in individuals with higher motivational abilities.

BACKGROUND: Motivational abilities (MA), that describe skills in relation to goal-oriented behavior, have recently been found to be associated with neuropathological aging. Here we examine the impact of MA on the long-term course of mild cognitive impairment (MCI). METHODS: We followed-up N = 64 individuals diagnosed with MCI (Mage = 73 years, 44% female) for 3 years. MA were assessed by long-term informants of the participants using two scales: motivation and decision regulation [Volitional Components Questionnaires, VCQ, (Kuhl and Fuhrmann, Decomposing self-regulation and self-control: the volitional components inventory, 1998)]. Cognitive abilities were assessed with the Mini Mental State Examination (J Psychiatr Res 12:189-98, 1975). Survival analyses and multilevel modeling (MLM) were applied to determine the predicting effect of informant-rated MA at baseline on the likelihood of MCI stability and on the trajectory of cognitive abilities. RESULTS: Fifty percent (n = 32) of the MCI participants remained stable, while 32.8% (n = 21) and 17.2% (n = 11) converted to Alzheimer's disease (AD) or dropped-out, respectively. Survival analyses revealed that MCI cases with higher-rated MA at baseline were more likely to exert a stable course in MCI over 3 years (p = 0.036) when controlling for demographic characteristics and executive function. MLM analyses indicated that higher informant-rated MA at baseline were significantly related to higher cognitive abilities, even when controlling for MCI subtype (p = 0.030). CONCLUSIONS: This study provides preliminary longitudinal evidence for a lower risk of conversion to AD and higher cognitive abilities by higher rated MA at an early stage of MCI.

Caregiver perception of apathy in persons with mild cognitive impairment or Alzheimer's disease: a longitudinal study.

OBJECTIVE: Discrepancy between self- and caregiver apathy ratings was examined longitudinally for persons with mild cognitive impairment or Alzheimer's disease. Particular focus was on the distinction between the positive and negative caregiver bias and its predictive value for a clinical diagnosis of apathy. METHOD: Apathy rating discrepancy was based on the apathy evaluation scale. Dyads were categorized depending on whether the caregiver reported fewer deficits (positive caregiver bias) or more deficits (negative caregiver bias) than the cognitively impaired person did. RESULTS: Caregiver ratings and rating discrepancy showed a significant increase from baseline to follow-up. By contrast, self- and clinician ratings showed no change across the two time points. Ratings with a negative caregiver bias remained stable, while those with a positive caregiver bias showed a significant increase in the caregiver ratings but also a significant decrease in the self-ratings. A negative caregiver bias at baseline was significantly related to greater likelihood of having clinical apathy at follow-up, adjusted for an array of control variables. CONCLUSION: Positive and negative caregiver bias should be distinguished, as they seem to reflect distinct dyadic processes and are relevant for clinical outcome. Furthermore, negative rating discrepancies can be considered a risk factor for developing apathy.

Social network and cognitive functioning in old age : Self-efficacy as a mediator?

This study investigated self-efficacy (self-perceived and rated by an informant) as a mediator of the relationship between social network variables (including network size, frequency of social contacts, satisfaction with social contacts and social support) and cognitive impairment. Participants were 189 adults with a mean age of 75 years, 32 of whom suffered from mild cognitive impairment (MCI), 39 from early stage Alzheimer's disease (AD) and 118 who had no cognitive impairment. Binary logistic regression and linear regression models were used to assess the association between the predictor variables and cognitive impairment, controlling for several confounders. Network size was significantly associated with the cognitive status (mini mental status examination; ß = 0.15, p < 0.05) and with odds of cognitive impairment (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93-0.99). General self-efficacy rated by the informant mediated this relationship in both analyses. Possible underlying mechanisms, including neuroendocrine reactivity and health behavior are discussed.

Risk of dementia in older adults with low versus high occupation-based motivational processes: differential impact of frequency and proximity of social network.

OBJECTIVES: This study investigates the impact of occupation-based motivational processes and social network variables on the incidence of dementia over 8 years. METHOD: Data were derived from the Leipzig Longitudinal Study of the Aged (LEILA75+), a population-based longitudinal study of individuals aged 75 years and older (n=1692 at baseline). Motivational processes were estimated based on the main occupation using the Occupational Information Network database. RESULTS: In a Cox proportional hazard model, motivational processes were not associated with the risk of dementia (hazard ratio [HR]: 0.93, 95% confidence interval [CI]: 0.74-1.16). Individuals with a higher frequency of social contact at baseline had a significantly lower risk of dementia (HR: 0.96, 95% CI: 0.91-0.99), while proximity of social contacts was not linked to the risk of dementia (HR: 1.03, 95% CI: 0.98-1.08). In individuals with low indices of motivational processes, the frequency of social contacts was associated with a lower risk of dementia (HR: 0.94, 95% CI: 0.88-1.00). On the other hand, proximity of social contacts was linked to a higher risk of dementia in individuals with high indices of motivational processes (HR: 1.09, 95% CI: 1.01-1.19). DISCUSSION: Results indicate that the frequency and proximity of social contacts have a differential impact on the risk of dementia according to lower or higher indices of motivational processes, while the impact of motivational processes on risk of dementia could not be confirmed. Future studies should carefully disentangle different aspects of social interactions and their association with motivational processes.

Motivational processes in mild cognitive impairment and Alzheimer's disease: results from the Motivational Reserve in Alzheimer's (MoReA) study.

BACKGROUND: Brain reserve, i.e., the ability of the brain to tolerate age- and disease-related changes in a way that cognitive function is still maintained, is assumed to be based on the lifelong training of various abilities. The Motivational Reserve in Alzheimer's (MoReA) is a longitudinal study that aims to examine motivational processes as a protective factor in mild Alzheimer's dementia (AD) and mild cognitive impairment (MCI). This paper presents the results of motivational variables, frequency of diagnoses, and prediction of global cognition as well as depression in a one-year longitudinal study. METHODS: The sample consists of 64 subjects with MCI and 47 subjects with mild AD at baseline. At baseline, the physical/neurological examinations, standard clinical assessment, neuropsychological testing, and assessment of motivational variables were performed. At follow-up (FU) one year later, neuropsychological testing including cognition, functional abilities, behavioral and affective symptoms, and global clinical assessments of severity have been repeated. RESULTS: AD cases have lower motivational capacities as measured with a midlife motivation-related occupational score and informant-reported present motivational processes, but do not differ with regard to delay of gratification (DoG) and self-reported motivational processes. DoG and delay discounting (DD) were relatively stable during the measurement interval. However, 20 % of the MCI cases converted to mild AD at FU, and 17 % of the mild AD cases converted to moderate AD. The rate of depression of Alzheimer's disease was 9 at baseline and 21 % at FU, and the rate of apathy was 7 and 14 %, respectively. Global cognition at FU was mainly predicted by baseline global cognition but also by one of the motivational variables (scenario test). Depression at FU was predicted mainly by two motivational variables (self-reported and informant-reported motivational processes). CONCLUSIONS: This research might inform motivation-related strategies for prevention and early intervention with older people or people at risk for AD.

Does Trauma Impair Self-Control? Differences in Delaying Gratification Between Former Indentured Child Laborers and Nontraumatized Controls.

Traumatic experiences may affect an individual's ability to exercise self-control, which is an essential characteristic for successfully managing life. As a measure of self-control, we used the delay discounting paradigm, that is, the extent to which a person devalues delayed gratification. The aim of this study was to investigate the relationship between childhood trauma and delay discounting using a control group design with elderly participants with a mean age of 76.2 years. Swiss former indentured child laborers (n=103) who had been exposed to trauma during their childhood were compared with nontraumatized controls (n=50). The trauma exposure group showed a considerably higher preference for immediate smaller rewards than the controls, indicating their lower self-control. A hierarchical regression analysis revealed that a history of abuse, current self-efficacy, and education were significantly associated with delay discounting. Implications for future research are discussed.

Social relations and depression in late life-a systematic review.

OBJECTIVE: Social relations have become the focus of much research attention when studying depressive symptoms in older adults. Research indicates that social support and being embedded in a network may reduce the risk for depression. The aim of the review was to analyze the association of social relations and depression in older adults. METHODS: Electronic databases were searched systematically for potentially relevant articles published from January 2000 to December 2012. Thirty-seven studies met the inclusion criteria for this review. RESULTS: Factors of social relations were categorized into 12 domains. Factors regarding the qualitative aspects of social relations seem to be more consistent among studies and therefore provide more explicit results. Thus, social support, quality of relations, and presence of confidants were identified as factors of social relations significantly associated with depression. The quantitative aspects of social relations seem to be more inconsistent. Cultural differences become most obvious in terms of the quantitative aspects of social relations. CONCLUSION: Despite the inconsistent results and the methodological limitations of the studies, this review identified a number of factors of social relations that are significantly associated with depression. The review indicates that it is needful to investigate social relations in all their complexity and not reduce them to one dimension. Simultaneously, it is important to conduct longitudinal studies because studies with cross-sectional design do not allow us to draw conclusions on causality. Beyond that, cultural differences need to be considered.

The relationship between the meaning of life, psychological well-being, self-care, and social capital, with depression and death anxiety in the elderly living in nursing homes: The mediating role of loneliness.

The current study aims to investigate the meaning of life, psychological well-being, self-care, and social capital, with depression and death anxiety in the elderly living in nursing homes through the mediating role of loneliness. The statistical population included all the elderly aged at least 60 years living in Tehran, Qazvin and Zanjan, Iran in 2020, among whom 489 (273 men and 216 women) were selected using convenience sampling method. Participants filled out Steger's Meaning of Life, Ryff and Singer's Psychological Well-Being Scale, Söderhamn et al.'s Self-Care Ability, Nahapiet and Ghoshal's Social capital, Beck's depression, Templer's Death Anxiety, Russell et al.'s Loneliness questionnaires. The results indicated that meaning of life, psychological well-being, self-care, and social capital are negatively associated with loneliness, which in turn, is positively associated to depression. Furthermore, meaning of life, psychological well-being, self-care, and social capital are negatively associated with loneliness, which in turn, is positively associated to death anxiety. Moreover, the results of path analysis revealed that the hypothesized model of the current study has an excellent fit in the study sample. That is, meaning of life, psychological well-being, self-care, and social capital are related to depression and death anxiety through mediating role of loneliness.

Caregiver rating bias in mild cognitive impairment and mild Alzheimer's disease: impact of caregiver burden and depression on dyadic rating discrepancy across domains.

BACKGROUND: Caregivers of individuals with dementia are biased in their rating of mental health measures of the care receiver. This study examines caregiver burden and depression as predictors of this bias for mild cognitive impairment and mild Alzheimer's disease in different domains. METHODS: The sample consisted of 202 persons: 60 with mild cognitive impairment, 41 with mild Alzheimer's disease, and 101 caregivers. Discrepancy scores were calculated by subtracting the mean caregiver score from the respective mean patient score on the following assessment instruments: the Geriatric Depression Scale, Apathy Evaluation Scale, Bayer-Activities of Daily Living Scale, and Quality of Life-AD scale. Caregiver burden and depression were assessed by the Zarit Burden Interview and the Center for Epidemiologic Studies Depression Scale. RESULTS: Intraclass correlation coefficients were low for apathy (0.38), daily functioning (0.38), and quality of life (0.30) and moderate for depression (0.49). These domains showed negative rating discrepancies, which indicates caregiver rating bias for all four domains. Regression analyses revealed that caregiver burden significantly contributed to explaining these discrepancies in the domains apathy, daily functioning, and quality of life. CONCLUSION: Caregiver rating bias can be attributed to caregiver burden. When caregiver burden is present, data based on caregiver ratings should therefore be interpreted with caution.

Adjustment disorders: prevalence in a representative nationwide survey in Germany.

OBJECTIVES: This is the first study to estimate the prevalence of adjustment disorder (AjD) in the general population. A new conceptualisation of AjD as a stress response syndrome was applied, which allowed AjD to be assessed directly from its symptom profile, including intrusive, avoidance and failure-to-adapt symptoms (Maercker et al., Psychopathology 40:135-146, 2007). METHODS: Prevalence rates of distressing life events and AjD were estimated from a representative sample of the German general population (n = 2,512) with a broad age range (14-93 years). A questionnaire including a life events checklist and self-rating questions that assessed AjD symptoms and symptom duration were personally handed out by an interviewer. RESULTS: The prevalence of AjD fulfilling the criterion of clinically significant impairment was 0.9%; a further 1.4% of the sample was diagnosed with AjD without fulfilling the impairment criterion. In ~72.5% of AjD cases, symptoms had developed 6-24 months prior to assessment. AjD was most often associated with acute events such as moving or chronic stressors such as serious illness, conflicts at the respondent's job or with friends or neighbours (with ~5% conditional probability each). CONCLUSIONS: The results correspond with the few other studies that have examined the prevalence of AjD, even though a new conceptualisation of the disorder was used. Explorative results regarding the duration of AjD syndromes and symptoms call for further redefinition and empirical investigation of this under-researched mental condition.

Apathy: a separate syndrome from depression in dementia? A critical review.

Apathy and depression are the most prevalent neuropsychiatric symptoms in Alzheimer's disease and mild cognitive impairment. Despite much research on apathy and depression in dementia, the nosological position of apathy as a separate syndrome from depression remains debated. This literature review provides a critical analysis of the areas of clinical manifestation, symptomatology, assessment, prevalence and neuropathology. Evidence does not provide a clear view of the nosological position of apathy in dementia for symptoms and neuropathology. However, the ambiguity of the evidence may be attributed in large part to a lack of clarity in definition and etiology, clinical criteria and assessment overlap. Given the evidence, it is concluded that the argument in favor of apathy as a separate syndrome from depression in dementia is persuasive. Reaching a consensus on the definition and nosological position of apathy within dementia is vital to provide patients and caregivers with the support they require, increase understanding of risk factors, and enable comparisons across research and practice.