Karin Wolf-Ostermann, Prof. Dr., wolf-ostermann@uni-bremen.de, Health Sciences Bremen, University of Bremen, Germany.

Henrik Wiegelmann, M.A., Health Sciences Bremen, University of Bremen, Germany, hwiegelmann@uni-bremen.de

Imke Seifert, M.A, Health Sciences Bremen, University of Bremen, Germany, imke.seifert@uni-bremen.de

Dorota Szczesniak, PhD, Department of Psychiatry, Wroclaw Medical University, Poland, dorota.szczesniak@umed.wroc.pl

Marta Lenart, Department of Psychiatry, Wroclaw Medical University, Poland, marta.lenart@umed.wroc.pl

Mateusz Luc, Department of Psychiatry, Wroclaw Medical University, Poland, mateusz.luc@student.umed.wroc.pl

Marcin Pawlowski, Department of Psychiatry, Wroclaw Medical University, Poland, marcin.pawlowski@student.umed.wroc.pl

Etienne Rouwette, Prof. Dr., Radboud University, Nijmegen, The Netherlands, e.rouwette@fm.ru.nl

Ansgar Gerhardus, Prof. Dr., Health Sciences Bremen, University of Bremen, Germany, ansgar.gerhardus@uni-bremen.de

Joanna Rymaszewska, Prof. Dr., Department of Psychiatry, Wroclaw Medical University, Poland, joanna.rymaszewska@umed.wroc.pl and on behalf of the SHARED Consortium

Over the past years the scientific discourse on health moved beyond unidimensional approaches, focusing on a more complex bio-psycho-social understanding. Regarding dementia and cognitive health, several studies have shown that various multidimensional factors (risk/protective) and their interactions, as well as existing individual and social resources, contribute to the heterogeneity observed for onset and further course of dementia. This presentation will a) give a systematic overview of causal factors in relation to the onset and progression of cognitive functioning and dementia b) show results of a first generic system dynamics model as Causal Loop Diagram (CLD) visualizing how different factors of the system are interrelated.

A mixed methods approach was used. First, we conducted a systematic literature review on factors influencing cognitive health with an emphasis on social factors. Second, the Group Model Building (GMB) approach was used to further elaborate the knowledge base from the literature review and to start building a Causal Loop Diagram as a first comprehensive system dynamics working model. In a final third phase we integrated both strands, agreed on the knowledge base by stepwise discursive consensus and created the CLD.

The CLD model includes 73 unique factors directly or indirectly influencing cognitive functioning. Those factors show the basic causal structure of the interplay of variables present in the development and trajectory of dementia. These factors could be grouped into six thematic/disciplinary clusters, such as personal factors, socioeconomic factors, lifestyle factors, neuro -bio-medical factors, environmental factors and social health factors. The model indicates a significant role of social health indicators for cognitive health in dementia.

The generic CLD model reflects the knowledge of a multidisciplinary group of researchers, merged with results from a systematic literature overview and supplemented by discussion and iterative feedback processes. The mixed methods approach as well as the integration of system thinking methods turned out to be a reasonable approach to develop and graphically represent the complex structure of factors influencing cognitive functioning in dementia. This model facilitates the development of novel hypotheses about causal relationships between social health and dementia.