measured-response

Another excellent post from Dr Crippen imploring people to face the implications of non-adherence to immunisation.

It’s my view that here immunisation is concerned, herd immunity being a commons, the indivualised concept of infomed choice is a nonsense. If we are going to pretend that parents are going to engage with the evidence such that they make a rational decision, the least we can do is give imformation about the collective consequences. Frankly, I think some sort of coercion is required; no single drop of rain believes it is to blame for the flood.

I think I need to order one of these:

Related Articles

[Executive functions and prospective memory performance in old age: an analysis of event-based and time-based prospective memory]

Z Gerontol Geriatr. 2003 Feb;36(1):35-41

Authors: Kliegel M, Ramuschkat G, Martin M

The goal of the present study was to examine the role of executive functions in age-related differences in prospective memory. Therefore, in a sample of 40 young ( M=24.8; SD=2.0) and 40 old adults ( M=69.3; SD=5.6), event- and time-based prospective memory as well as five executive functions were assessed. Results show that age differences in prospective memory performance depend largely on age-related individual differences in executive functions. Furthermore, the results indicate several executive functions to differentially predict prospective memory performance. The event-based prospective memory task requires inhibition to avoid distraction from irrelevant items. The time-based prospective memory task requires the flexible shifting of cognitive sets. Overall, the data support the assumption that age differences in prospective memory performance are closely related to executive functioning. In addition, time- and event-based prospective memory seem to rely on different executive processes.

PMID: 12616406 [PubMed - indexed for MEDLINE]

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MMSE cross-domain variability predicts cognitive decline in centenarians.

Gerontology. 2004 Jan-Feb;50(1):39-43

Authors: Kliegel M, Sliwinski M

BACKGROUND: Early detection of dementia is one of the key issues in cognitive gerontology. However, so far the detection of early stages in cognitive decline has been rather unreliable. One central limitation of current assessment strategies is that they rely on information about a person's level of performance obtained from a single assessment. OBJECTIVE: In the first part of the present paper, we propose three strategies for overcoming this limitation by using information from several measurement occasions to improve diagnostic reliability. METHODS: In the second part, we present one exemplary empirical analysis of one of these approaches reporting data from the Heidelberg Centenarian Study. RESULTS: In this sample of very old individuals tested at baseline and at a follow-up 18 months later, the intra-individual cross-domain variability across MMSE subscales [1]at baseline predicted cognitive decline (i.e. change in an external cognitive functioning rating from baseline to follow-up) much better than baseline mean MMSE scores. CONCLUSIONS: In conclusion, we discuss the advantage of performance variability as a predictor for cognitive decline.

PMID: 14654726 [PubMed - indexed for MEDLINE]

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[Learning in old age: The importance of self-initiated structuring]

Z Gerontol Geriatr. 2003 Dec;36(6):421-8

Authors: Kliegel M, Altgassen M, Martin M, Kruse A

The purpose of the present study was to assess the role of memory, inhibition efficiency and self-initiated structuring of learning material in predicting age-related effects in learning performance. 47 young ( M = 23.3; SD = 3.8) and 52 old adults ( M = 64.5; SD = 5.2) took part in the current study. Tests assessing memory span, inhibition efficiency and a recall test requiring the participants to structure their learning material were administered. The results reveal that most of the age-related variance in learning performance can be explained by inhibition efficiency, memory span and-particularly-by the quality of structuring learning material. Furthermore, the results indicate that in order to recall the content of categories it is important to remember the categories formed during the learning period. The study emphasizes the importance of teaching strategies for organizing learning material in the context of cognitive trainings for the elderly.

PMID: 14685731 [PubMed - indexed for MEDLINE]

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[Similarities and differences between self-rated and proxy-rated health in extreme old age]

Z Gerontol Geriatr. 2003 Dec;36(6):429-36

Authors: Schönemann-Gieck P, Rott Ch, Martin M, D'Heureuse V, Kliegel M, Becker G

Especially in old age, the global well-being of persons is strongly influenced by their health situation. Due to functional limitations, research on the development of persons in extreme old age often uses proxy ratings of health instead of self-ratings common in younger age groups. However, it is not known whether self- and proxy-ratings provide comparable information about the health status of extremely old persons. The current study with 53 centenarians and 53 proxies examines similarities and differences between self and proxy-ratings of health. The results indicate a high degree of similarity in some health ratings, an overestimation of ADL capacities by the centenarians, and that self-ratings to a large degree reflect the current mood levels of individuals. Findings are discussed with respect to the differences in the kind of information used for general health ratings.

PMID: 14685732 [PubMed - indexed for MEDLINE]

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[Functional competence and nursing care in centenarians. The importance of the cognitive status]

Z Gerontol Geriatr. 2003 Dec;36(6):437-46

Authors: Becker G, Rott C, D'Heureuse V, Kliegel M, Schönemann-Gieck P

The maintenance of autonomy and independence in the oldest old population is at high risk due to the inevitable aging process, which primarily affects functional and cognitive capacities. In this study, we investigate centenarians to assess the extent in which they have lost their ability to live independently. This is done with a classification system for dependency that considers both functional and cognitive limitations and determines the level of functional competence in this population. Based on this system, we evaluate the necessity for nursing care and investigate to which extent their actual needs are covered by the German Long-term Care Insurance. An important and relevant question is whether this system even addresses the evaluation of cognitive impairment. For this reason, 85 centenarians and their proxies were assessed with standardized instruments and the results show a severe loss of independence. The necessity for at least daily contact with nursing care was identified in 91 percent of the centenarians due to their dramatically limited capacities. Forty-four percent of the centenarians need more support than they actually receive from the German Long-term Care Insurance. Therefore, considering cognitive impairment is a crucial component in the evaluation, which would lead to more support by the official system in 20 percent of the centenarians. The considerable differences between the granted and the necessary nursing care demonstrate that co-operation from family members must be heavily relied upon.

PMID: 14685733 [PubMed - indexed for MEDLINE]

Related Articles

Cognitive status and development in the oldest old: a longitudinal analysis from the Heidelberg Centenarian Study.

Arch Gerontol Geriatr. 2004 Sep-Oct;39(2):143-56

Authors: Kliegel M, Moor C, Rott C

In the present study, we investigated cognitive status, cognitive development and the effect of mortality on cognitive changes in very old age. Analyzing data from the population-based Heidelberg Centenarian Study, results revealed that centenarians differed quite strongly in their cognitive capacities. While about half of the population showed moderate to severe cognitive impairment, one quarter was found to be cognitively intact. Moreover, analyzing cognitive change over a period of 1.5 years, centenarians' cognitive performance was revealed to be rather stable. Finally, only a small effect of mortality on cognitive status and changes was detected, supporting a recent hypothesis that the terminal decline or drop in cognitive functioning decreases in very old age.

PMID: 15249151 [PubMed - indexed for MEDLINE]

Subjective cognitive complaints, memory performance, and depressive affect in old age: a change-oriented approach.

Int J Aging Hum Dev. 2003;57(4):339-66

Authors: Zimprich D, Martin M, Kliegel M

The question of whether and how subjective cognitive complaints are related to actual cognitive performance represents a central issue in applied cognitive aging research. Until recently, however, many studies have failed to find a strong association between subjective cognitive complaints and actual cognitive performance. In our study, we examine two alternative explanations: a) for methodological reasons, strong associations exist only when latent changes rather than differences are examined, and b) strong associations exist only between changes in depression and complaints, not between changes in cognitive performance and complaints. With 427 participants (M = 63 years) and two measurements, we examine both the relation between functioning, complaints, and depressive affect at each measurement point, and the relation between changes in functioning, changes in complaints, and changes in depressive affect between the measurement points with latent difference variables. The results indicate that there are substantial relations between changes in functioning, changes in depression, and changes in complaints.

PMID: 15195982 [PubMed - indexed for MEDLINE]

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Cognitive impairment decreases postural control during dual tasks in geriatric patients with a history of severe falls.

J Am Geriatr Soc. 2003 Nov;51(11):1638-44

Authors: Hauer K, Pfisterer M, Weber C, Wezler N, Kliegel M, Oster P

OBJECTIVES: To investigate the influence of dual tasks, cognitive strategies, and fear of falling on postural control in geriatric patients with or without cognitive impairment and with a history of falls resulting in injury. DESIGN: Experimental three-group design. SETTING: Geriatric hospital. PARTICIPANTS: Twenty young healthy adults (mean age+/-standard deviation=25.4+/-4.4), 20 geriatric patients with a history of severe falls without cognitive impairment (mean age=82.6+/-5.5, mean Mini-Mental State Examination (MMSE) score=27.8+/-2.0) and 20 geriatric patients with a history of severe falls and cognitive impairment (mean age=83.2+/-5.5, mean MMSE=19.2+/-3.3). MEASUREMENTS: Motor performance: sway area and lateral and anterior-posterior sway angles. Cognition: semiautomated calculation steps (serial 2 forward) and nonautomated calculation derived from MMSE (serial 7 retro). Motor and cognitive performances were examined as single and dual tasks. Strategy decision, fear of falling, and subjective perception of motor and cognitive performance were assessed as covariates for dual-task performances. RESULTS: Motor performance decreased significantly during all dual tasks in geriatric patients with cognitive impairment and a history of falls resulting in injury. Cognitive performance was different depending on the task and group. Choice of cognitive strategies or fear of falling did not influence the dual-task performances. CONCLUSION: Even simple additional tasks substantially decrease postural stability due to attention-related cognitive deficits in cognitively impaired geriatric patients with a history of severe falls. The findings may help to explain the increased incidence and severity of falls in geriatric patients with cognitive impairment and a history of falls resulting in injury.

PMID: 14687396 [PubMed - indexed for MEDLINE]

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Planning and realization of complex intentions in traumatic brain injury and normal aging.

Brain Cogn. 2004 Oct;56(1):43-54

Authors: Kliegel M, Eschen A, Thöne-Otto AI

The realization of delayed intentions (i.e., prospective memory) is a highly complex process composed of four phases: intention formation, retention, re-instantiation, and execution. The aim of this study was to investigate if executive functioning impairments are related to problems in the formation, re-instantiation, and execution of a delayed complex intention. In this context, it was another aim of the study to investigate the executive functioning hypothesis of cognitive aging in prospective memory performance. It was, therefore, explored if age-related prospective memory decline leads to similar decrements in the process of prospective remembering as executive functioning-related decline in young patients with traumatic brain injury. A group of patients with traumatic brain injury with retrospective memory within normal limits but impaired executive functions, a group of healthy older and a group of healthy younger adults completed a complex prospective memory task that allows for the separate assessment of the four phases of the prospective memory process. All groups showed a similarly high performance in the intention retention phase, whereas the patients with deficits in executive functioning and the older participants performed worse than the healthy young participants in the intention formation, re-instantiation and execution phases. The importance of executive functioning for prospective remembering in traumatic brain injury and normal aging is discussed.

PMID: 15380875 [PubMed - indexed for MEDLINE]

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Life-long intellectual activities mediate the predictive effect of early education on cognitive impairment in centenarians: a retrospective study.

Aging Ment Health. 2004 Sep;8(5):430-7

Authors: Kliegel M, Zimprich D, Rott C

The purpose of this study was to examine the hypothesis of whether early education and/or maintaining intellectual activities over the life-course have the power to protect against cognitive impairment even in extremely old adults. Ninety centenarians from the population-based Heidelberg Centenarian Study were assessed with a modified version of the Mini Mental State Exam (MMSE). Data about education, occupational status, and life-long intellectual activities in four selected domains were obtained. Results demonstrated that 52% of the sample showed mild-to-severe cognitive impairment. Analyzing the influence of early education, occupational status, and intellectual activities on cognitive status we applied several (logistic) regression analyses. Results revealed independent, significant and strong influence of both formal school education and intellectual activities on the cognitive status in very late life, even after controlling for occupational status. However, about one fourth of the effect of early education on cognitive status was exerted indirectly via the assessed intellectual activities. In summary, the present study provides first evidence for the conclusion that even with regard to cognitive performance in very old age, both early education and life-long intellectual activities seem to be of importance.

PMID: 15511741 [PubMed - indexed for MEDLINE]

Related Articles

Importance effects on performance in event-based prospective memory tasks.

Memory. 2004 Sep;12(5):553-61

Authors: Kliegel M, Martin M, McDaniel MA, Einstein GO

In the present study we manipulated the importance of performing two event-based prospective memory tasks. In Experiment 1, the event-based task was assumed to rely on relatively automatic processes, whereas in Experiment 2 the event-based task was assumed to rely on a more demanding monitoring process. In contrast to the first experiment, the second experiment showed that importance had a positive effect on prospective memory performance. In addition, the occurrence of an importance effect on prospective memory performance seemed to be mainly due to the features of the prospective memory task itself, and not to the characteristics of the ongoing tasks that only influenced the size of the importance effect. The results suggest that importance instructions may improve prospective memory if the prospective task requires the strategic allocation of attentional monitoring resources.

PMID: 15615314 [PubMed - indexed for MEDLINE]

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Cold simple intravenous infusions preceding special endovascular cooling for faster induction of mild hypothermia after cardiac arrest--a feasibility study.

Resuscitation. 2005 Mar;64(3):347-51

Authors: Kliegel A, Losert H, Sterz F, Kliegel M, Holzer M, Uray T, Domanovits H

OBJECTIVE: Mild therapeutic hypothermia has shown to improve neurological outcome after cardiac arrest. Our study investigated the efficacy and safety of cold simple intravenous infusions for induction of hypothermia after cardiac arrest preceding further cooling and maintenance of hypothermia by specialised endovascular cooling. METHODS: All patients admitted after cardiac arrest of presumed cardiac aetiology were screened. Patients enrolled received 2000 ml of ice-cold (4 degrees C) fluids via peripheral venous catheters. As soon as possible endovascular cooling was applied even if the cold infusions were not completed. The target temperature was defined as 33 +/- 1 degrees C. All temperatures recorded were measured via bladder-temperature probes. The primary endpoint was the time from return of spontaneous circulation to reaching the target temperature. Secondary endpoints were changes in haemodynamic variables, oxygenation, haemoglobin, clotting variables and neurological outcome. RESULTS: Out of 167 screened patients 26 (15%) were included. With a total amount of 24 +/- 7 ml/kg cold fluid at 4 degrees C the temperature could be lowered from 35.6 +/- 1.3 degrees C on admission to 33.8 +/- 1.1 degrees C. The target temperature was reached 185 +/- 119 min after return of spontaneous circulation, 135 +/- 112 min after start of infusion, and 83 +/- 85 min after start of endovascular cooling. Except for two patients showing radiographic signs of mild pulmonary edema no complications attributable to the infusions could be observed. Thirteen patients (50%) survived with favourable neurological outcome. CONCLUSION: Our results indicate that induction of mild hypothermia with infusion of cold fluids preceding endovascular cooling is safe and effective.

PMID: 15733765 [PubMed - in process]

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Planning and realisation of complex intentions in patients with Parkinson's disease.

J Neurol Neurosurg Psychiatry. 2005 Nov;76(11):1501-5

Authors: Kliegel M, Phillips LH, Lemke U, Kopp UA

BACKGROUND: There is some evidence that patients with Parkinson's disease may impaired in prospective memory performance (planning and self initiated realisation of delayed intentions). Little is known about the effect of the disease on distinct phases of prospective memory and the potential mechanisms underlying these effects. OBJECTIVE: To investigate intention formation, intention retention, intention initiation, and intention execution of patients with Parkinson's disease and test for the mediating influence of working memory, inhibition, short term retrospective memory, and divided attention. METHODS: 16 patients with Parkinson's disease and 16 age and education matched normal controls were given a complex event based prospective memory task which differentiates four phases of prospective remembering. In addition, participants completed tasks assessing potential cognitive mediators. RESULTS: On the prospective remembering task, Parkinson patients were impaired in the intention formation phase and showed a trend towards impairment in the intention initiation. In contrast, there were no impairments of retrospective intention retention or the fidelity with which the patients executed their previously developed plan. The group effects were related to interindividual differences in working memory span. CONCLUSIONS: The results suggest that the planning phase of prospective remembering is specifically impaired in Parkinson's disease, and that the impairment is related to working memory deficit. In contrast, even when complex intentions have to be remembered, the retrospective storage of intentions to be performed is not impaired.

PMID: 16227539 [PubMed - indexed for MEDLINE]