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BACKGROUND: Recent trends on measurement of well-being have elevated the scientific standards and rigor associated with approaches for national and international comparisons of well-being. One major theme in this has been the shift toward multidimensional approaches over reliance on traditional metrics such as single measures (e.g. happiness, life satisfaction) or economic proxies (e.g. GDP). METHODS: To produce a cohesive, multidimensional measure of well-being useful for providing meaningful insights for policy, we use data from 2006 and 2012 from the European Social Survey (ESS) to analyze well-being for 21 countries, involving approximately 40,000 individuals for each year. We refer collectively to the items used in the survey as multidimensional psychological well-being (MPWB). RESULTS: The ten dimensions assessed are used to compute a single value standardized to the population, which supports broad assessment and comparison. It also increases the possibility of exploring individual dimensions of well-being useful for targeting interventions. Insights demonstrate what may be masked when limiting to single dimensions, which can create a failure to identify levers for policy interventions. CONCLUSIONS: We conclude that both the composite score and individual dimensions from this approach constitute valuable levels of analyses for exploring appropriate policies to protect and improve well-being.
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Características Culturales , Felicidad , Satisfacción Personal , Calidad de Vida/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
There is no universally agreed definition of well-being as a subjective experience, but Huppert and So (2013) adopted and systematically applied the definition of well-being as positive mental health-the opposite of the common mental disorders described in standard mental health classifications (e.g., Diagnostic and Statistical Manual of Mental Disorders). We extended their theoretical approach to include multi-item scales, using 2 waves of nationally representative U.S. adult samples to develop, test, and validate our multidimensional measure of well-being (WB-Pro). This resulted in a good-fitting a priori (48-item, 15-factor) model that was invariant over time, education, gender, and age; showed good reliability (coefficient αs .81-.93), test-retest correlation (.73-.85; M = .80), and convergent/discriminant validity based on a multitrait-multimethod analysis, and relations with demographic variables, selected psychological measures, and other multidimensional and purportedly unidimensional well-being measures. Further, we found that items from 2 widely used, purportedly unidimensional well-being measures loaded on different WB-Pro factors consistent with a priori predictions based on the WB-Pro factor structure, thereby calling into question their claimed unidimensionality and theoretical rationale. Because some applications require a short global measure, we used a machine-learning algorithm to construct 2 global well-being short versions (five- and 15-item forms) and tested these formative measures in relation to the full-form and validity criteria (to download short and long versions see https://ippe.acu.edu.au/research/research-instruments/wb-pro). The WB-Pro appears to be one of the most comprehensive measures of subjective well-being, based on a sound conceptual model and empirical support, with broad applicability for research and practice, as well as providing a framework for evaluating the breadth of other well-being measures. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Salud Mental , Satisfacción Personal , Adulto , Emociones , Empatía , Análisis Factorial , Femenino , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Optimismo , Autonomía Personal , Psicometría , Reproducibilidad de los Resultados , Resiliencia Psicológica , Autoimagen , Encuestas y CuestionariosRESUMEN
Cytomegalovirus (CMV) is a common herpesvirus infection and stimulates the expansion of very large numbers of CMV-specific T cells that reduce the CD4/CD8 ratio and suppress the number of naïve T cells. CMV infection has been associated with frailty and impaired survival. We investigated the correlates of CMV and the impact of the CMV infection on mortality within a cohort of 511 individuals aged at least 65 years who were followed up for 18 years. The mean age of the participants was 74 years of which 70% were CMV-seropositive. CMV was strongly linked to socio-economic status, and CMV infection increased the annual mortality rate by 42% (Hazard ratio = 1.42, 95% CI: 1.11-1.76 after adjusting for age, sex and baseline socio-economic and health variables) corresponding to 3.7 years lower life expectancy from age 65. Infection was associated with a near doubling of cardiovascular deaths, whereas there was no increase in mortality from other causes. These results show that CMV infection markedly increases the mortality rate in healthy older individuals due to an excess of vascular deaths. These findings may have significant implications for the study of immune senescence and if confirmed more generally could have important implications for measures to optimize the health of the elderly.
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Envejecimiento , Relación CD4-CD8 , Infecciones por Citomegalovirus/mortalidad , Citomegalovirus/inmunología , Factores de Edad , Anciano , Anciano de 80 o más Años , Anticuerpos Antivirales/sangre , Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Enfermedades Cardiovasculares/mortalidad , Infecciones por Citomegalovirus/sangre , Infecciones por Citomegalovirus/inmunología , Femenino , Anciano Frágil , Humanos , Masculino , Análisis de SupervivenciaRESUMEN
Governments around the world are recognising the importance of measuring subjective well-being as an indicator of progress. But how should well-being be measured? A conceptual framework is offered which equates high well-being with positive mental health. Well-being is seen as lying at the opposite end of a spectrum to the common mental disorders (depression, anxiety). By examining internationally agreed criteria for depression and anxiety (DSM and ICD classifications), and defining the opposite of each symptom, we identify ten features of positive well-being. These combine feeling and functioning, i.e. hedonic and eudaimonic aspects of well-being: competence, emotional stability, engagement, meaning, optimism, positive emotion, positive relationships, resilience, self esteem, and vitality. An operational definition of flourishing is developed, based on psychometric analysis of indicators of these ten features, using data from a representative sample of 43,000 Europeans. Application of this definition to respondents from the 23 countries which participated in the European Social Survey (Round 3) reveals a four-fold difference in flourishing rate, from 41% in Denmark to less than 10% in Slovakia, Russia and Portugal. There are also striking differences in country profiles across the 10 features. These profiles offer fresh insight into cultural differences in well-being, and indicate which features may provide the most promising targets for policies to improve well-being. Comparison with a life satisfaction measure shows that valuable information would be lost if well-being was measured by life satisfaction. Taken together, our findings reinforce the need to measure subjective well-being as a multi-dimensional construct in future surveys.
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OBJECTIVE: This study aims to investigate the evidence of the efficacy of mindfulness-based stress reduction (MBSR) in improving stress, depression and anxiety in breast cancer patients. METHODS: An extensive systematic electronic review (PubMed, Embase, CINAHL, PsyArticles, PsycINFO, Scopus, Ovid, Web of Science and The Cochrane Library) and a hand search were carried out from 15 October 2011 to 30 November 2011 to retrieve relevant articles using 'mindfulness' or 'mindfulness-based stress reduction' and 'breast cancer' as keywords. Information about the baseline characteristics of the participants, interventions and findings on perceived stress, depression and anxiety was extracted from each study. RESULTS: Nine published studies (two randomised controlled trials, one quasi-experimental case-control study and six one-group, pre-intervention and post-intervention studies) up to November 2011 that fulfilled the inclusion criteria were analysed. The pooled effect size (95% CI) for MBSR on stress was 0.710 (0.511-0.909), on depression was 0.575 (0.429-0.722) and on anxiety was 0.733 (0.450-1.017). CONCLUSION: On the basis of these findings, MBSR shows a moderate to large positive effect size on the mental health of breast cancer patients and warrants further systematic investigation because it has a potential to make a significant improvement on mental health for women in this group.
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Ansiedad/terapia , Neoplasias de la Mama/psicología , Depresión/terapia , Terapias Mente-Cuerpo/métodos , Atención Plena , Estrés Psicológico/terapia , Ansiedad/psicología , Depresión/psicología , Femenino , HumanosRESUMEN
A key issue in the field of inclusive design is the ability to provide designers with an understanding of people's range of capabilities. Since it is not feasible to assess product interactions with a large sample, this paper assesses a range of proxy measures of design-relevant capabilities. It describes a study that was conducted to identify which measures provide the best prediction of people's abilities to use a range of products. A detailed investigation with 100 respondents aged 50-80 years was undertaken to examine how they manage typical household products. Predictor variables included self-report and performance measures across a variety of capabilities (vision, hearing, dexterity and cognitive function), component activities used in product interactions (e.g. using a remote control, touch screen) and psychological characteristics (e.g. self-efficacy, confidence with using electronic devices). Results showed, as expected, a higher prevalence of visual, hearing, dexterity, cognitive and product interaction difficulties in the 65-80 age group. Regression analyses showed that, in addition to age, performance measures of vision (acuity, contrast sensitivity) and hearing (hearing threshold) and self-report and performance measures of component activities are strong predictors of successful product interactions. These findings will guide the choice of measures to be used in a subsequent national survey of design-relevant capabilities, which will lead to the creation of a capability database. This will be converted into a tool for designers to understand the implications of their design decisions, so that they can design products in a more inclusive way.
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Participación de la Comunidad , Diseño de Equipo , Artículos Domésticos , Sistemas Hombre-Máquina , Anciano , Anciano de 80 o más Años , Cognición , Utensilios de Comida y Culinaria , Bases de Datos como Asunto , Diseño de Equipo/psicología , Ergonomía/psicología , Femenino , Audición , Humanos , Masculino , Persona de Mediana Edad , Personalidad , Desempeño Psicomotor , Lectura , Análisis de Regresión , Autoinforme , Percepción del Habla , Análisis y Desempeño de Tareas , Teléfono , Visión OcularRESUMEN
BACKGROUND: Little is known about the long-term consequences of positive wellbeing in childhood in the general population. We used the MRC National Survey of Health and Development (the British 1946 birth cohort) to test associations between adolescent positive wellbeing and social functioning in midlife. METHOD: Temperament and behaviour at ages 13 and 15 years were rated by school teachers on a range of criteria. These mostly referred to absence or presence of conduct and emotional problems, but four items allowed positive ratings: 'very popular with other children', 'unusually happy and contented', 'makes friends extremely easily' and 'extremely energetic, never tired'. In addition, at age 16 years survey members self-completed the Maudsley Personality Inventory, from which a summary measure of extraversion was derived, as this was previously found to be associated with midlife positive wellbeing in this cohort. RESULTS: Being a happy child, defined as receiving at least two of the above teacher ratings, was positively associated with midlife functioning and wellbeing, specifically a low probability of lifetime emotional problems, a high frequency of contact with friends or relatives, engagement in social activities, and to a lesser extent feeling satisfied with accomplishments in working life. These associations were independent of father's social class, childhood cognition, educational attainment, and midlife occupational social class. There were no independent associations between being a happy child and educational or occupational attainment, being married, engagement in prosocial activities, taking leadership in community activities, and with life satisfaction in general or with family life. Extraversion was associated with a low probability of lifetime emotional problems, high engagement in social activities, being married, general midlife life satisfaction, and satisfaction with family life, but not with social contact, prosocial activity, leadership activity, or work satisfaction. While childhood conduct and emotional problems were associated with few of the social and life satisfaction outcomes, the former were negatively associated with educational and occupational attainment, and positively with divorce, whereas the latter were negatively associated with being married. CONCLUSIONS: Prospectively rated childhood wellbeing has long-term beneficial links to adult functioning; our results also support the view that positive wellbeing has a unique impact on these outcomes, and does not merely represent the absence of mental ill-health.
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The aim of this study is to assess the effective measurement range of Ryff's Psychological Well-being scales (PWB). It applies normal ogive item response theory (IRT) methodology using factor analysis procedures for ordinal data based on a limited information estimation approach. The data come from a sample of 1,179 women participating in a midlife follow-up of a national birth cohort study in the UK. The PWB scales incorporate six dimensions: autonomy, positive relations with others, environmental mastery, personal growth, purpose in life and self-acceptance. Scale information functions were calculated to derive standard errors of measurement for estimated scores on each dimension. Construct variance was distinguished from method variance by inclusion of method factors from item wording (positive versus negative). Our IRT analysis revealed that the PWB measures well-being most accurately in the middle range of the score distribution, i.e. for women with average well-being. Score precision diminished at higher levels of well-being, and low well-being was measured more reliably than high well-being. A second-order well-being factor loaded by four of the dimensions achieved higher measurement precision and greater score accuracy across a wider range than any individual dimension. Future development of well-being scales should be designed to include items that are able to discriminate at high levels of well-being.
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Normal aging brings with it changes in dopaminergic and memory functions. However, little is known about how these 2 changes are related. In this study, we identify a link between dopamine, episodic memory networks, and aging, using pharmacological functional magnetic resonance imaging. Young and older adults received a D2-like agonist (Bromocriptine, 1.25 mg), a D2-like antagonist (Sulpiride, 400 mg), and Placebo, in a double-blind crossover procedure. We observed group differences, during memory encoding, in medial temporal, frontal, and striatal regions and moreover, these regions were differentially sensitive across groups to dopaminergic perturbation. These findings suggest that brain systems underlying memory show age-related changes and that dopaminergic function may be key in understanding these changes. That these changes have behavioral consequences was suggested by the observation that drug modulations were most pronounced in older subjects with poorer recognition memory. Our findings provide direct evidence linking ageing, memory, and dopaminergic change.
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Envejecimiento/fisiología , Encéfalo/fisiología , Dopamina/metabolismo , Memoria/fisiología , Adolescente , Adulto , Anciano , Envejecimiento/efectos de los fármacos , Análisis de Varianza , Encéfalo/irrigación sanguínea , Encéfalo/efectos de los fármacos , Mapeo Encefálico , Estudios Cruzados , Domperidona/farmacología , Antagonistas de Dopamina/farmacología , Método Doble Ciego , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Imagen por Resonancia Magnética/métodos , Masculino , Memoria/efectos de los fármacos , Persona de Mediana Edad , Modelos Estadísticos , Pruebas Neuropsicológicas , Oxígeno/sangre , Estimulación Luminosa/métodos , Prolactina/sangre , Adulto JovenRESUMEN
CONTEXT: Patients with Addison's disease reproducibly self-report impairment in specific dimensions of general well-being questionnaires, suggesting particular deficiencies in health-related quality-of-life (HRQoL). OBJECTIVE: We sought to develop an Addison's disease-specific questionnaire (AddiQoL) that could better quantify altered well-being and treatment effects. Design, Setting, Patients, Intervention, and Outcomes: We reviewed the literature to identify HRQoL issues in Addison's disease and interviewed patients and their partners in-depth to explore various symptom domains. A list of items was generated, and nine expert clinicians and five expert patients assessed the list for impact and clarity. A preliminary questionnaire was presented to 100 Addison's outpatients; the number of items was reduced after analysis of the distribution of the responses. The final questionnaire responses were assessed by Cronbach's alpha and Rasch analysis. RESULTS AND INTERPRETATION: Published studies of HRQoL in Addison's disease indicated reduced vitality and general health perception and limitations in physical and emotional functioning. In-depth interviews of 14 patients and seven partners emphasized the impact of the disease on the emotional domain. Seventy HRQoL items were generated; after the expert consultation process and pretesting in 100 patients, the number of items was reduced to 36. Eighty-six patients completed the final questionnaire; the responses showed high internal consistency with Cronbach's alpha 0.95 and Person Separation Index 0.94 (Rasch analysis). CONCLUSIONS: We envisage AddiQoL having utility in trials of hormone replacement and management of patients with Addison's disease, analogous to similar questionnaires in GH deficiency (AGHDA) and acromegaly (AcroQoL).
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Enfermedad de Addison/psicología , Calidad de Vida , Encuestas y Cuestionarios , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Lewy bodies (LBs) appear in the brains of nondemented individuals and also occur in a range of neurodegenerative disorders, such as dementia with Lewy bodies (DLB) and Parkinson's disease. A number of people with a definite diagnosis of Alzheimer's disease (AD) also exhibit these intraneuronal inclusions in allo- and/or neocortical areas. The latter, referred to as Lewy body variant of AD (LBV), bears a clinical resemblance to AD in terms of age at onset, duration of illness, cognitive impairment, and illness severity. Since the presence of LBs is accompanied by neuronal cytoskeleton changes, it is possible that the latter may influence neuronal connectivity via alterations to the synaptic network. To address this, we examined the expression of synaptic proteins (synaptophysin, syntaxin, SNAP-25, and alpha-synuclein) and two cytoskeletal proteins (tau and MAP2) in the brain tissue of subjects enrolled in a population-based autopsy study (n = 47). They were divided into groups with no memory problems (control group, n = 15), LBV (n = 5), AD devoid of LBs (n = 17), cerebrovascular dementia (n = 3), and mixed dementia (n = 7). The LBV and AD groups had a similar degree of cognitive impairment and neuropathological staging in terms of Braak staging and CERAD score. In comparison with the control group and the dementia groups without LBs, the LBV group had significantly lower levels of syntaxin and SNAP-25 (23%) in the neocortex, and depletion of MAP2 (64%), SNAP-25 (34%), and alpha-synuclein (44%) proteins in the medial temporal lobes. These findings suggest that the t-SNARE complex deficit present in LBV may be associated with the presence of LB-related pathology and may explain the more profound cholinergic loss seen in these patients.
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Enfermedad de Alzheimer/metabolismo , Enfermedad por Cuerpos de Lewy/metabolismo , Proteínas Asociadas a Microtúbulos/análisis , Neocórtex/química , Proteínas SNARE/análisis , Lóbulo Temporal/química , alfa-Sinucleína/análisis , Anciano , Anciano de 80 o más Años , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Cuerpos de Lewy/metabolismo , Masculino , Neocórtex/patología , Fosforilación , Sinaptosomas/metabolismo , Proteínas tau/metabolismoRESUMEN
Key neuropathological changes associated with late-onset dementia are not fully understood. Population-based longitudinal studies offer an opportunity to step back and examine which pathological indices best link to clinical state. CC75C is a longitudinal study of the population aged 75 and over at baseline in Cambridge, UK. We report on the first 213 participants coming to autopsy with sufficient information for an end of life dementia diagnosis. Clinical diagnosis was ascertained by examining retrospective informant interviews, survey responses, and death certificates according to DSM-IV criteria. The neuropathological protocol was based on the Consortium to Establish a Registry of Alzheimer's Disease (CERAD). Clinical dementia was present in 113 participants (53%): 67% with Alzheimer's disease, 4% vascular dementia, 22% mixed dementia, and 1% dementia with Lewy bodies. As Alzheimer-type pathology was common, the mutually blinded clinical and neuropathological diagnoses were not strongly related. Multivariable analysis identified associations between dementia during life and entorhinal cortex neuritic plaques, hippocampal diffuse plaques, neocortical neurofibrillary tangles, white matter pallor, Lewy bodies, and hippocampal atrophy. These results were consistent in those with clinical Alzheimer's disease. Vascular pathologies, especially microinfarcts, were more common in those with clinical diagnoses including vascular dementia. Alzheimer-type and cerebrovascular pathology are both common in the very old. A greater burden of these pathologies, Lewy bodies, and hippocampal atrophy, are associated with a higher risk of, but do not define, clinical dementia in old age.
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Enfermedad de Alzheimer/patología , Encéfalo/patología , Demencia/epidemiología , Demencia/patología , Vigilancia de la Población/métodos , Donantes de Tejidos , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/epidemiología , Áreas de Influencia de Salud , Estudios de Cohortes , Femenino , Humanos , Masculino , Reino Unido/epidemiologíaRESUMEN
BACKGROUND: Cognitive function is a key determinant of independence and quality of life among older adults. Compared to adults in England, US adults have a greater prevalence of cardiovascular risk factors and disease that may lead to poorer cognitive function. We compared cognitive performance of older adults in the US and England, and sought to identify sociodemographic and medical factors associated with differences in cognitive function between the two countries. METHODS: Data were from the 2002 waves of the US Health and Retirement Study (HRS) (n = 8,299) and the English Longitudinal Study of Ageing (ELSA) (n = 5,276), nationally representative population-based studies designed to facilitate direct comparisons of health, wealth, and well-being. There were differences in the administration of the HRS and ELSA surveys, including use of both telephone and in-person administration of the HRS compared to only in-person administration of the ELSA, and a significantly higher response rate for the HRS (87% for the HRS vs. 67% for the ELSA). In each country, we assessed cognitive performance in non-hispanic whites aged 65 and over using the same tests of memory and orientation (0 to 24 point scale). RESULTS: US adults scored significantly better than English adults on the 24-point cognitive scale (unadjusted mean: 12.8 vs. 11.4, P < .001; age- and sex-adjusted: 13.2 vs. 11.7, P < .001). The US cognitive advantage was apparent even though US adults had a significantly higher prevalence of cardiovascular risk factors and disease. In a series of OLS regression analyses that controlled for a range of sociodemographic and medical factors, higher levels of education and wealth, and lower levels of depressive symptoms, accounted for some of the US cognitive advantage. US adults were also more likely to be taking medications for hypertension, and hypertension treatment was associated with significantly better cognitive function in the US, but not in England (P = .014 for treatment x country interaction). CONCLUSION: Despite methodological differences in the administration of the surveys in the two countries, US adults aged >/= 65 appeared to be cognitively healthier than English adults, even though they had a higher burden of cardiovascular risk factors and disease. Given the growing number of older adults worldwide, future cross-national studies aimed at identifying the medical and social factors that might prevent or delay cognitive decline in older adults would make important and valuable contributions to public health.
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Envejecimiento/psicología , Trastornos del Conocimiento/epidemiología , Trastornos del Conocimiento/psicología , Cognición , Estado de Salud , Anciano , Anciano de 80 o más Años , Envejecimiento/patología , Trastornos del Conocimiento/diagnóstico , Estudios de Cohortes , Estudios Transversales , Inglaterra/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Pruebas Neuropsicológicas , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: the investigation of cognitive decline in the older population has been hampered by analytical considerations. Most studies of older people over prolonged periods suffer from loss to follow-up, yet this has seldom been investigated fully to date. Such considerations limit our understanding of how basic variables such as education can affect cognitive trajectories. METHODS: we examined cognitive trajectories in a population-based cohort study in Cambridge, UK, of people aged 75 and over in whom multiple interviews were conducted over time. Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Socio-demographic variables were measured, including educational level and social class. An age-based quadratic latent growth model was fitted to cognitive scores. The effect of socio-demographic variables was examined on all latent variables and the probability of death and dropout. RESULTS: at baseline, age, education, social class and mobility were associated with cognitive performance. Education and social class were not related to decline or its rate of change. In contrast, poor mobility was associated with lower cognitive performance, increased cognitive decline and increased rate of change of cognitive decline. Gender, age, mobility and cognitive ability predicted death and dropout CONCLUSIONS: contrary to much of the current literature, education was not related to rate of cognitive decline or change in this rate as measured by MMSE. Higher levels of education do not appear to protect against cognitive decline, though if the MMSE is used in the diagnostic process, individuals with less education may be diagnosed as having dementia somewhat earlier.
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Trastornos del Conocimiento/epidemiología , Escolaridad , Factores de Edad , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Progresión de la Enfermedad , Inglaterra/epidemiología , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Vigilancia de la Población , Escalas de Valoración Psiquiátrica , Medición de Riesgo , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: As estrogens have been shown to have several potentially beneficial effects on the central nervous system, it is biologically plausible that maintaining high levels of estrogens in postmenopausal women by means of estrogen replacement therapy (ERT) could be protective against cognitive decline in women with Alzheimer's disease (AD) or other dementia syndromes. OBJECTIVES: To investigate the effects of ERT (estrogens only) or HRT (estrogens combined with a progestagen) compared with placebo in randomized controlled trials (RCTs) on cognitive function of postmenopausal women with dementia. SEARCH STRATEGY: The Cochrane Dementia and Cognitive Improvement Group Specialized Register, which contains records from many medical databases, The Cochrane Library, EMBASE, MEDLINE, CINAHL, PsycINFO and LILACS were searched on 7 November 2007 using the terms ORT, PORT, ERT, HRT, estrogen*, oestrogen* and progesterone*. SELECTION CRITERIA: All double-blind randomized controlled trials (RCTs) into the effect of ERT or HRT for cognitive function with a treatment period of at least two weeks in postmenopausal women with AD or other types of dementia. DATA COLLECTION AND ANALYSIS: Abstracts of the references retrieved by the searches were read by two reviewers (EH and KY) independently in order to discard those that were clearly not eligible for inclusion. The two reviewers studied the full text of the remaining references and independently selected studies for inclusion. Any disparity in the ensuing lists was resolved by discussion with all reviewers in order to arrive at the final list of included studies. The selection criteria ensured that the blinding and randomization of the included studies was adequate. The two reviewers also assessed the quality of other aspects of the included trials. One reviewer (EH) extracted the data from the studies, but was aided and checked by JB from Cochrane. MAIN RESULTS: A total of seven trials including 351 women with AD were analysed. Because different drugs were used at different studies it was not possible to combine more than two studies in any analysis.On a clinical global rating, clinicians scored patients taking CEE as significantly worse compared with the placebo group on the Clinical Dementia Rating scale after 12 months (overall WMD = 0.35, 95% CI = 0.01 to 0.69, z = 1.99, P < 0.05).Patients taking CEE had a worse performance on the delayed recall of the Paragraph Test (overall WMD = -0.45, 95% CI = -0.79 to -0.11, z = 2.60, P < 0.01) after one month than those taking placebo. They had a worse performance on Finger Tapping after 12 months (WMD = -3.90, 95% CI = -7.85 to 0.05, z = 1.93, P < 0.05).Limited positive effects were found for the lower dosage of CEE (0.625 mg/day) which showed a significant improvement in MMSE score only when assessed at two months, and disappeared after correction for multiple testing. No significant effects for MMSE were found at longer end points (3, 6 and 12 months of treatment). With a dosage of 1.25 mg/d CEE, short-term significant effects were found for Trial-Making test B at one month and Digit Span backward at four months. After two months of transdermal diestradiol (E2) treatment, a highly significant effect was observed for the word recall test (WMD = 6.50, 95% CI = 4.04 to 8.96, z = 5.19, P < 0.0001). No other significant effects were found for other outcomes measured. AUTHORS' CONCLUSIONS: Currently, HRT or ERT for cognitive improvement or maintenance is not indicated for women with AD.
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Cognición/efectos de los fármacos , Demencia/tratamiento farmacológico , Terapia de Reemplazo de Hormonas , Cognición/fisiología , Trastornos del Conocimiento/prevención & control , Terapia de Reemplazo de Estrógeno , Femenino , Humanos , Memoria/efectos de los fármacos , Posmenopausia/sangre , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Patients with cancer have relatively high rates of anxiety and distress, adversely affecting their well-being and quality of life. Recent studies indicate that addressing these symptoms could result in better response to cancer treatment. Researchers have found that interventions that focus on increasing mental awareness and the frequency of positive experiences may have a greater impact on reducing psychological morbidity and increasing quality of life than interventions that target relief of psychological symptoms. AIM: To develop and test a brief, easy to use intervention that could improve well-being and quality of life in cancer patients. METHODS: We developed a simple well-being intervention that made few demands on patient time and required little training resource. Participants were randomly assigned to an intervention group or a deferred entry group. Measures of anxiety, depression, well-being and quality of life were administered at baseline and at follow-ups. RESULTS: Twenty-two women with metastatic breast cancer and 24 men with metastatic prostate cancer were recruited from oncology clinics. Thirteen women and 14 men completed the study. Both qualitative and quantitative data showed that the intervention was acceptable to users. There was statistically significant improvement in quality of life scores on WHOQOL-BREF post-intervention (p=0.046). Compliance with the intervention was good. CONCLUSIONS: This brief well-being intervention appears to be a promising technique for improving quality of life of cancer patients, without making undue demands on staff resources or patient time. If further studies confirm its effectiveness, it could prove to be a cost-effective intervention.
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Adaptación Psicológica , Ansiedad/terapia , Terapia Conductista/métodos , Neoplasias de la Mama/psicología , Depresión/terapia , Meditación , Neoplasias de la Próstata/psicología , Psicoterapia Breve/métodos , Calidad de Vida/psicología , Autocuidado/métodos , Autocuidado/psicología , Rol del Enfermo , Anciano , Ansiedad/psicología , Concienciación , Depresión/psicología , Progresión de la Enfermedad , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Motivación , Cooperación del Paciente/psicología , Encuestas y CuestionariosRESUMEN
Psychological science has usually approached the treatment of disorder through research on individual combinations of risk and protective factors (including life experiences, thinking styles, behaviors, social relationships and genes) and the application of interventions that focus on improvements in the individual. However, we can do better than this. Not only should we be aiming to enhance well-being rather than merely reducing disorder, but we should also be doing so for the majority of people rather than the few who have a disorder. In this article, I focus on the mental health spectrum and make the case for a broad population-based approach. I argue that a very small shift in the population mean of the underlying symptoms or risk factors can do more to enhance well-being and reduce disorder than would any amount of intervention with individuals who need help. Examples from research on alcohol abuse and psychological distress are presented to illustrate the value of a population-based approach.
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Countries must learn how to capitalize on their citizens' cognitive resources if they are to prosper, both economically and socially. Early interventions will be key.
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Trastornos Mentales/economía , Salud Mental , Adolescente , Adulto , Anciano de 80 o más Años , Envejecimiento/psicología , Niño , Desarrollo Infantil , Costo de Enfermedad , Depresión/economía , Humanos , Discapacidades para el Aprendizaje/economía , Trastornos Mentales/prevención & control , Trastornos Mentales/psicología , Factores de Riesgo , Reino Unido , Trabajo/psicologíaRESUMEN
BACKGROUND: depression is associated with poor cognitive function, though little is known about the relationship between psychological well-being and cognitive function. OBJECTIVE: to investigate whether psychological well-being is associated with levels of cognitive function. DESIGN: nationally representative population-based cohort study. SETTING AND PARTICIPANTS: 11,234 non-institutionalised adults aged 50 years and over of the English Longitudinal Study of Ageing in 2002. METHODS: psychological well-being was measured using the CASP-19, and cognitive function was assessed using neuropsychological tests of time orientation, immediate and delayed verbal memory, prospective memory, verbal fluency, numerical ability, cognitive speed and attention. The relation of psychological well-being to cognitive function was modelled using linear regression. RESULTS: on a global cognitive score combining all cognitive tests, those in the fifth quintile of psychological well-being scored an average of 0.30 SD units higher than those in the lowest quintile (95% CI 0.24-0.35) after adjustment for depressive symptoms and sociodemographics. This association remained after additional adjustment for physical health and health behaviours. The same pattern of association was observed for men and women, and across all cognitive domains. CONCLUSIONS: in a large population of community living adults, higher levels of psychological well-being were associated with better cognitive function.
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Cognición/fisiología , Salud Mental , Satisfacción Personal , Anciano , Anciano de 80 o más Años , Atención/fisiología , Estudios de Cohortes , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Lineales , Estudios Longitudinales , Masculino , Memoria/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Orientación/fisiologíaRESUMEN
BACKGROUND: The relationship between stroke risk and cognitive function has not previously been examined in a large community living sample other than the Framingham cohort. The objective of this study was to examine the relationship between 10-year risk for incident stroke and cognitive function in a large population-based sample. METHODS: Participants were 7377 adults aged 50 years and over of the 2002 wave of the English Longitudinal Study of Ageing, a prospective cohort study. A modified version of the Framingham Stroke Risk Profile (incorporating age, sex, systolic blood pressure, antihypertensive medication, diabetes, smoking status, cardiovascular disease, and atrial fibrillation) was used to assess 10-year risk of stroke. Linear regression models were used to determine the cross-sectional relationship of stroke risk to global cognitive function and performance in multiple cognitive domains. RESULTS: In unadjusted models 10 percentage point increments of 10-year stroke risk were associated with poor global cognitive function (-0.40 SD units, 95% CI -0.43 - -0.38), and lowered performance in all cognitive domains. After statistical adjustment for age, sex, testing interval and other correlates of cognitive function the association with stroke risk was attenuated though remained significant for global cognitive function (-0.06 SD units, 95% CI -0.09 - -0.03), immediate and delayed verbal memory, semantic verbal fluency and processing speed. CONCLUSION: In individuals free from a history of stroke or dementia, high subclinical cerebrovascular disease burden was associated with worse cognitive function in multiple domains.