The objective of this work is to provide a review of the mortality risk in dementia and potential influencing factors. In order to do so, studies on mortality in dementia based on population-based samples of the last 15 years published in PubMed, Web of Science and PSYNDEXplus were considered. Without exception, all types of dementia are associated with a considerably increased mortality risk. Moreover, the risk of death rises with advancing severity of the disorder. Often, a more favorable course of the disease can be found in Alzheimer’s disease. Further questions, such as the influence of age and sex, cannot be answered conclusively. Very little information can be found on aspects concerning comorbidity, APOE polymorphism or depressive symptomatology.

Numerous studies have focused on the effect of mild cognitive impairment in elderly people. However, the impact of mild cognitive impairment on mortality has rarely been considered so far. This paper reviews recent work on mild cognitive impairment and its mortality risk. Relevant articles were identified by a systematic search of the literature published since 1990 using the databases PubMed, Web of Science and PSYNDEXplus, bibliographies of articles identified and of earlier reviews. Those studies were considered which predominantly included persons aged 65 and over and which relied on population-based samples. Thus only eight studies could be identified. In general, the relative risk (RR) for subjects with mild cognitive impairment according to different concepts in comparison to non-affected persons varies from 1.0 to 1.9. However, only few studies are available, and a comparison of the literature is problematic, due to variations in criteria and methodology.

Objective: This study aimed to investigate whether mortality is higher for individuals suffering from Mild Cognitive Impairment (MCI). Methods: A community sample of 1,045 dementia-free individuals aged 75 years and over was examined using neuropsychological tests over a 4.5-year period. Data were analyzed with the Cox proportional hazards model after having been adjusted for age, gender, and incident dementia. Results: Association between MCI and mortality was examined subject to varied diagnostic criteria of MCI. We found an increased risk of death that was about 1.5 times higher for individuals with MCI when a cognitive performance of more than 1.5 standard deviation below the mean of age- and education-matched controls was required and the criterion of a cognitive complaint was excluded. Males were at about a 40% increased risk of death. Risk also increased with age by about 8% per year. Incident dementia showed a significant influence on mortality only if it became manifest by 1.5 years after the baseline measurement (follow-up 1). Conclusion: MCI is associated with increased mortality when certain diagnostic criteria are applied.

BackgroundPsychosocial interventions are essential tools in mental health care and rehabilitation. A range of interventions relevant to rehabilitation that are covered in a German DGPPN S3 guideline on psychosocial interventions are discussed.MethodsLiterature search and (mostly) systematic reviews were performed for a range of psychosocial interventions.FindingsMilieu therapy (MT) includes measures that impinge on therapeutic milieu/atmosphere in joint professional/user groups in the course of treatment. MT provides a context in which psychosocial interventions can be implemented. There is evidence of its effectiveness in improving mental health outcomes. Peer involvement (PI) and peer support are supported by promising evidence as innovative interventions in mental health care. Findings on case management (CM) are inconsistent. There are difficulties in defining CM. CM strengths include treatment satisfaction and continuity of care. With respect to integration in the labour market for people with severe mental illness supported employment (SE) has been shown to be more effective in achieving job placement. A proportion of SE users fail to find jobs on the general labour market. Other types of work rehabilitation are required, and there is room for pre-vocational training interventions.DiscussionPsychosocial interventions are strong interventions. The strength of the evidence is varied. The use of psychosocial interventions rests on experience, evidence and ethics.ConclusionsPsychosocial interventions are indispensable in building mental health care systems. Vocational interventions and residential services are mandatory. Peer involvement could help in moving mental health services forward.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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