Zusammenfassung
Bei der Entstehung der Demenzen spielen verschiedene genetische wie Umweltfaktoren eine Rolle. Epidemiologische Studien zu Risikofaktoren haben sich bisher vorwiegend auf den Einfluss soziodemographischer Faktoren wie Alter, Geschlecht, Bildung, positive Familienanamnese und „life style”-Faktoren wie Alkohol- und Tabakkonsum konzentriert.
Der Einfluss psychosozialer Faktoren auf das Risiko, an einer Demenz zu erkranken, wird in der Literatur bisher wenig diskutiert. Unsere Arbeit gibt eine systematische Übersicht über alle publizierten wissenschaftlichen Arbeiten zur Bedeutung dieser Risikofaktoren.
Ein positiver statistischer Zusammenhang mit dem Risiko an einer Demenz zu erkranken, wurde gefunden für Personen, die alleine leben, keine engen sozialen Bindungen haben, nie verheiratet waren, an keinen sozialen - oder Freizeitaktivitäten teilnehmen. Neuere Studien berichten, dass die Demenz vom Alzheimer-Typ negativ mit der Vielfältigkeit von Aktivitäten und Intensität intellektueller Aktivitäten assoziiert ist und positiv mit psychosozialer und physischer Inaktivität, unproduktivem Arbeitsstil und dem Zusammenleben mit einem dominanten Partner.
Abstract
In the etiology of dementia several genetic and various environmental factors are assumed to interact. Most epidemiological studies on risk factors have focused on „constitutional” factors like age, sex, birth order, dementia in the family and „life style” factors like smoking and alcohol consumption.
Only few studies have investigated the role of psychosocial factors at work and during leisure time on the risk to develop dementia. Our paper gives a systematic review of all published results of controlled studies about psychosocial risk factors.
A positive association has been observed between dementia and living alone, having no close social ties, not participating in social and leisure activities, and never having married. Recent studies have found that Alzheimer's disease in particular is negatively associated with diversity of activities and intensity of intellectual activities and positively associated with psychosocial inactivity, unproductive working style, living with a dominant spouse and with physical inactivity.
Literatur
-
1
Bickel H, Cooper B.
Incidence and relative risk of dementia in an urban elderly population: findings of a prospective field study.
Psychol Med.
1994;
24 (1)
179-192
-
2
Mortimer J, Graves A.
Education and other socioeconomic determinants of dementia and Alzheimer's disease.
Neurology.
1993;
43 (suppl 4)
39-44
-
3 Diamond N. Enriching heredity: the impact of environment on the anatomy of the brain. New York: Free Press 1988
-
4 Mortimer J. Do psychosocial riskfactors contribute to Alzheimer's disease?. In: Henderson A, Henderson J, editors. Etiology of dementia of Alzheimer's type New York: John Wiley & Sons 1988: 39-52
-
5
Satz P.
Brain reserve capacity on symptom onset after brain injury: a formulation and review of evidence of threshold theory.
Neuropsychology.
1993;
3
273-293
-
6
Stern Y, Alexander G, Prohovnik I. et al .
Inverse relationship between education and parietotemporal perfusion deficit in Alzheimer's disease.
Ann Neurol.
1992;
32
371-375
-
7
Alexander G, Furey M, Grady C. et al .
Association of premorbid intellectual function with cerebral metabolism in Alzheimer's disease: implication for the cognitive reserve hypothesis.
Am J Psychiatr.
1997;
154
165-175
-
8
Kondo K, Niino M, Shido K.
A case-control study of Alzheimer's disease in Japan - significance of life-styles.
Dementia.
1994;
5 (6)
314-326
-
9
Fabrigoule C, Letenneur L, Dartigues J F, Zarrouk M, Commenges D, Barberger-Gateau P.
Social and leisure activities and risk of dementia: a prospective longitudinal study.
J Am Geriatr Soc.
1995;
43 (5)
485-490
-
10
Kropiunigg U, Sebek K, Leonhardsberger A, Schemper M, Dal Bianco P.
Psychosocial risk factors for Alzheimer's disease.
Psychother Psychosom Med Psychol.
1999;
49 (5)
153-159
-
11
Helmer C, Damon D, Letenneur L, Fabrigoule C, Barberger-Gateau P, Lafont S, Fuhrer R, Antonucci T, Commenges D, Orgogozo J M, Dartigues J F.
Marital status and risk of Alzheimer's disease: a French population- based cohort study.
Neurology.
1999;
53 (9)
1953-1958
-
12
Laurin D, Verreault R, Lindsay J, MacPherson K, Rockwood K.
Physical activity and risk of cognitive impairment and dementia in elderly persons.
Arch Neurol.
2001;
58 (3)
498-504
-
13
Friedland R P, Fritsch T, Smyth K A, Koss E, Lerner A J, Chen C H, Petot G J, Debanne S M.
Patients with Alzheimer's disease have reduced activities in midlife compared with healthy control-group members.
Proc Natl Acad Sci U S A.
2001;
98 (6)
3440-3445
-
14
Fratiglioni L, Wang H X, Ericsson K, Maytan M, Winblad B.
Influence of social network on occurrence of dementia: a community- based longitudinal study.
Lancet.
2000;
355 (9212)
1315-1319
-
15
Evans D A, Hebert L E, Beckett L A, Scherr P A, Albert M S, Chown M J, Pilgrim D M, Taylor J O.
Education and other measures of socioeconomic status and risk of incident Alzheimer disease in a defined population of older persons.
Arch Neurol.
1997;
54 (11)
1399-1405
-
16
Schmand B, Smit J H, Geerlings M I, Lindeboom J.
The effects of intelligence and education on the development of dementia. A test of the brain reserve hypothesis.
Psychol Med.
1997;
27 (6)
1337-1344
-
17
De Ronchi D, Fratiglioni L, Rucci P, Paternico A, Graziani S, Dalmonte E.
The effect of education on dementia occurrence in an Italian population with middle to high socioeconomic status.
Neurology.
1998;
50 (5)
1231-1238
-
18
Munoz D G, Ganapathy G R, Eliasziw M, Hachinski V.
Educational attainment and socioeconomic status of patients with autopsy-confirmed Alzheimer disease.
Arch Neurol.
2000;
57 (1)
85-89
-
19
Cobb J L, Wolf P A, Au R, White R, D'Agostino R B.
The effect of education on the incidence of dementia and Alzheimer's disease in the Framingham Study.
Neurology.
1995;
45 (9)
1707-1712
-
20
Paykel E S, Brayne C, Huppert F A, Gill C, Barkley C, Gehlhaar E, Beardsall L, Girling D M, Pollitt P, O'Connor D.
Incidence of dementia in a population older than 75 years in the United Kingdom.
Arch Gen Psychiatry.
1994;
51 (4)
325-332
-
21
Erkinjuntti T, Haltia M, Palo J, Sulkava R, Paetau A.
Accuracy of the clinical diagnosis of vascular dementia: a prospective clinical and post-mortem neuropathological study.
J Neurol Neurosurg Psychiatry.
1988;
51 (8)
1037-1044
-
22
Katzman R.
Education and the prevalence of dementia and Alzheimer's disease.
Neurology.
1993;
43 (1)
13-20
-
23
del Ser T, Hachinski V, Merskey H, Munoz D G.
An autopsy-verified study of the effect of education on degenerative dementia.
Brain.
1999;
122 (Pt 12)
2309-2319
T. Bernhardt
Klinik für Psychiatrie und Psychotherapie I
Heinrich-Hoffmann-Str. 10
60528 Frankfurt
