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Knudtzon SL, Nordengen K, Grøntvedt GR, Jarholm J, Eliassen IV, Selnes P, Pålhaugen L, Espenes J, Gísladóttir B, Waterloo K, Fladby T, Kirsebom BE. Age-adjusted CSF t-tau and NfL do not improve diagnostic accuracy for prodromal Alzheimer's disease. Neurobiol Aging 2024; 141:74-84. [PMID: 38838442 DOI: 10.1016/j.neurobiolaging.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 05/01/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
Cerebrospinal fluid total-tau (t-tau) and neurofilament light chain (NfL) are biomarkers of neurodegeneration and are increased in Alzheimer's disease (AD). In order to adjust for age-related increases in t-tau and NfL, cross-sectional age-adjusted norms were developed based on amyloid negative cognitively normal (CN) adults aged 41-78 years (CN, n = 137). The age-adjusted norms for t-tau and NfL did not improve receiver operating curve based diagnostic accuracies in individuals with mild cognitive impairment (MCI) due to AD (AD-MCI, n = 144). Furthermore, while NfL was correlated with higher age in AD-MCI, no significant correlation was found for t-tau. The cox proportional hazard models, applied in 429 participants with baseline t-tau and NfL, showed higher hazard ratio of progression to MCI or dementia without age-adjustments (HR = 3.39 for t-tau and HR = 3.17 for NfL), as compared to using our norms (HR = 2.29 for t-tau and HR = 1.89 for NfL). Our results indicate that utilizing normative reference data could obscure significant age-related increases in these markers associated with neurodegeneration and AD leading to a potential loss of overall diagnostic accuracy.
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Affiliation(s)
- Stephanie Lindgård Knudtzon
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Kaja Nordengen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gøril Rolfseng Grøntvedt
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Neurology and Clinical Neurophysiology, University Hospital of Trondheim, Trondheim, Norway
| | - Jonas Jarholm
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingvild Vøllo Eliassen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Per Selnes
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Lene Pålhaugen
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jacob Espenes
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Berglind Gísladóttir
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Clinical Molecular Biology (EpiGen), Medical Division, Akershus University Hospital and University of Oslo, Oslo, Norway
| | - Knut Waterloo
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bjørn-Eivind Kirsebom
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway; Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Lerfald M, Allore H, Nilsen TIL, Eldholm RS, Martinez-Velilla N, Selbæk G, Ernstsen L. Longitudinal Patterns of Systolic Blood Pressure, Diastolic Blood Pressure, Cardiorespiratory Fitness, and Their Association With Dementia Risk: The HUNT Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae161. [PMID: 38894618 PMCID: PMC11266981 DOI: 10.1093/gerona/glae161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND High blood pressure and poor cardiorespiratory fitness are independent risk factors for dementia. However, few studies have examined if combined longitudinal patterns of these modifiable risk factors are associated with dementia risk. METHODS In this prospective cohort study, we used data from the population-based Trøndelag Health (HUNT) Study, Norway. We applied group-based multidimensional trajectory modeling to identify age-specific multidimensional trajectories of SBP, DBP, and estimated cardiorespiratory fitness across 3 surveys (HUNT1, 1984-1986 to HUNT3, 2006-2008). Dementia was diagnosed in the HUNT4 70+ substudy in 2017-2019. We used multivariate logistic regression to estimate odds ratios (ORs) and risk differences (RDs) of dementia. RESULTS In total, 7 594 participants (54.9% women) were included, with a mean age of 44.7 (SD 6.3) years at HUNT1. Dementia was diagnosed in 1 062 (14.0%) participants. We identified 2 multidimensional trajectories throughout adulthood within 3 age groups: one with higher systolic blood pressure (SBP) and diastolic blood pressure (DBP), and lower estimated cardiorespiratory fitness (the poorer group), and one with lower SBP and DBP, and higher cardiorespiratory fitness (the better group). After adjustment for sex, apolipoprotein E ε4 status, education, marital status, and diabetes, the better group had consistently lower risk of dementia in all age groups with the lowest OR in the middle-aged group of 0.63 (95% confidence intervals [95% CI]: 0.51, 0.78) with corresponding RD of -0.07 (95% CI: -0.10, -0.04). CONCLUSIONS Having a beneficial multidimensional trajectory of SBP, DBP, and cardiorespiratory fitness in adulthood was associated with reduced dementia risk. Aiming for optimal SBP, DBP, and estimated cardiorespiratory fitness throughout adulthood may reduce dementia risk.
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Affiliation(s)
- Maren Lerfald
- Faculty of Medicine and Health Science, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Tom I L Nilsen
- Faculty of Medicine and Health Science, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rannveig S Eldholm
- Department of Geriatrics, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Faculty of Medicine and Health Science, Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Ernstsen
- Faculty of Medicine and Health Science, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Denos M, Asante EO, Eldholm RS, Selbæk G, Skjellegrind HK, Mai XM, Chen Y, Sun YQ. The association between clinically evaluated cognitive function and oral health in Norwegian older adults: The HUNT Study. J Am Geriatr Soc 2024. [PMID: 39051868 DOI: 10.1111/jgs.19103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/25/2024] [Accepted: 06/30/2024] [Indexed: 07/27/2024]
Affiliation(s)
- Marion Denos
- Center for Oral Health Services and Research Mid-Norway (TkMidt), Trondheim, Norway
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ernest Obeng Asante
- Center for Oral Health Services and Research Mid-Norway (TkMidt), Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Rannveig Sakshaug Eldholm
- Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Geriatrics, Clinic of Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Håvard Kjesbu Skjellegrind
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Xiao-Mei Mai
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Yi-Qian Sun
- Center for Oral Health Services and Research Mid-Norway (TkMidt), Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pathology, Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim, Norway
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Myhre J, Lichtwarck B. How and why does it work? A video-based qualitative analysis of case conferences to reduce BPSD through the lens of Habermas's theory of communicative action. BMC Psychiatry 2024; 24:520. [PMID: 39039488 PMCID: PMC11265080 DOI: 10.1186/s12888-024-05959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Case conferences are described as a goal-oriented, systematic method that team members can use to exchange professional opinions and develop treatment actions for a particular care problem. However, not all case conferences have proven to be effective. The Norwegian Targeted Interdisciplinary Model for the Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) is an effective multicomponent model based on case conferences that informs approaches to behavioural and psychological symptoms in residents with dementia in nursing homes. Our aim was to explore how TIME case conferences structured based on cognitive behavioural therapy (CBT) contributed to person-centred actions and how the specific inductive structure of the TIME may have contributed to the effectiveness of the model. METHODS We used video observation of six case conferences and analysed these videos by performing a thematic cross-case analysis of the transcripts from the videos and by iteratively watching the videos. According to Habermas's theory of communicative action, we emphasized the case conference content, i.e., what was talked about in the case conferences, and the display of communication between the participants in the case conferences. RESULTS Our findings showed that the theoretical principles behind the TIME, including both person-centred care and the inductive structure of CBT, reflected many aspects of Habermas's theory of communicative actions. In particular, the TIME case conferences emphasized the lifeworld perspective for both residents and staff and contributed to what Habermas labelled communicative rationality as a means to develop shared understanding among staff and create person-centred action. CONCLUSIONS One causal assumption of how and why the TIME case conferences contributed to the effectiveness of the TIME in reducing BPSD in nursing homes is that the specific inductive structure of the case conferences with the column technique based on the ABC method together with PCC, emphasized the importance of the lifeworld for both the resident and the staff. Even though case conferences have been highlighted as useful, it is not indifferent how these case conferences are structured and conducted. CLINICAL TRIAL REGISTRATION The trial TIME was registered January 6, 2016, with clinicaltrials.gov (NCT02655003).
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Affiliation(s)
- Janne Myhre
- The Research Centre for Age-Related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Ottestad, Norway.
- Department of Health and Nursing Science, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, INN University, Elverum, Norway.
- Norwegian Centre for Violence and Traumatic Stress Studies, (NKVTS), Oslo, Norway.
| | - Bjørn Lichtwarck
- The Research Centre for Age-Related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Ottestad, Norway
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Wertman E. Essential New Complexity-Based Themes for Patient-Centered Diagnosis and Treatment of Dementia and Predementia in Older People: Multimorbidity and Multilevel Phenomenology. J Clin Med 2024; 13:4202. [PMID: 39064242 PMCID: PMC11277671 DOI: 10.3390/jcm13144202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Dementia is a highly prevalent condition with devastating clinical and socioeconomic sequela. It is expected to triple in prevalence by 2050. No treatment is currently known to be effective. Symptomatic late-onset dementia and predementia (SLODP) affects 95% of patients with the syndrome. In contrast to trials of pharmacological prevention, no treatment is suggested to remediate or cure these symptomatic patients. SLODP but not young onset dementia is intensely associated with multimorbidity (MUM), including brain-perturbating conditions (BPCs). Recent studies showed that MUM/BPCs have a major role in the pathogenesis of SLODP. Fortunately, most MUM/BPCs are medically treatable, and thus, their treatment may modify and improve SLODP, relieving suffering and reducing its clinical and socioeconomic threats. Regrettably, the complex system features of SLODP impede the diagnosis and treatment of the potentially remediable conditions (PRCs) associated with them, mainly due to failure of pattern recognition and a flawed diagnostic workup. We suggest incorporating two SLODP-specific conceptual themes into the diagnostic workup: MUM/BPC and multilevel phenomenological themes. By doing so, we were able to improve the diagnostic accuracy of SLODP components and optimize detecting and favorably treating PRCs. These revolutionary concepts and their implications for remediability and other parameters are discussed in the paper.
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Affiliation(s)
- Eli Wertman
- Department of Neurology, Hadassah University Hospital, The Hebrew University, Jerusalem 9190500, Israel;
- Section of Neuropsychology, Department of Psychology, The Hebrew University, Jerusalem 9190500, Israel
- Or’ad: Organization for Cognitive and Behavioral Changes in the Elderly, Jerusalem 9458118, Israel
- Merhav Neuropsychogeriatric Clinics, Nehalim 4995000, Israel
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Ustad A, Sverdrup K, Tangen GG, Døhl Ø, Vereijken B, Thingstad P, Skjæret-Maroni N. Daily physical activity in older adults across levels of care: the HUNT Trondheim 70 + study. Eur Rev Aging Phys Act 2024; 21:20. [PMID: 39014310 PMCID: PMC11253329 DOI: 10.1186/s11556-024-00355-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 07/06/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND Physical activity (PA) is imperative for healthy ageing and is a modifiable lifestyle factor. Accurate, clinically meaningful estimates of daily PA among older adults can inform targeted interventions to maintain function and independence. This study describes daily PA in older adults across levels of care as a first step contributing to the limited evidence on potential associations between PA and the use of care services. METHODS This study used data from the Trondheim 70 + cohort in the population-based Norwegian HUNT Study. In total, 1042 participants aged 70 years or older with valid activity data were included. PA was assessed using two accelerometers over 7 consecutive days and was classified into PA (walking, standing, running, and cycling) and sedentary behavior (sitting and lying). Data on received care services were retrieved from municipal registers and participants were classified into four levels of care: 1) independently living (81.9%), 2) independently living with low-level home care services (6.5%), 3) recipients of home care services (6.0%), and 4) nursing home residents (5.7%). Time spent in the activity types and duration of bouts are presented across levels of care. RESULTS Participants mean age was 77.5 years (range: 70.1-105.4, 55% female) and PA was lower with higher age. Across levels of care, significant group differences were found in the total time spent in PA, particularly in walking and standing. Daily PA, duration of active bouts, and number of daily walking bouts were lower for participants receiving higher levels of care. Standing was the dominant type of PA and walking appeared predominantly in short bouts at all care levels. CONCLUSIONS This is the first population-based study using device-measured PA to describe daily PA across levels of care. The results showed that low-intensity activities constitute the primary component of everyday PA, advocating for placing greater emphasis on the significant role these activities play in maintaining daily PA at older age. Furthermore, the study demonstrated that activity types and bout durations are related to the ability to live independently among older adults. Overall, these findings can contribute to better target interventions to maintain function and independence in older adults.
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Affiliation(s)
- Astrid Ustad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Edvard Griegs Gate 8, 7030, Trondheim, Norway.
| | - Karen Sverdrup
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Gro Gujord Tangen
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Oslo, Norway
| | - Øystein Døhl
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Edvard Griegs Gate 8, 7030, Trondheim, Norway
- Department of Finance, Trondheim Municipality, Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Edvard Griegs Gate 8, 7030, Trondheim, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Edvard Griegs Gate 8, 7030, Trondheim, Norway
- Department of Health and Welfare, Trondheim Municipality, Trondheim, Norway
| | - Nina Skjæret-Maroni
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Edvard Griegs Gate 8, 7030, Trondheim, Norway
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Sokołowski DR, Pani J, Hansen TI, Håberg AK. Participation and engagement in online cognitive testing. Sci Rep 2024; 14:14800. [PMID: 38926515 PMCID: PMC11208174 DOI: 10.1038/s41598-024-65617-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/21/2024] [Indexed: 06/28/2024] Open
Abstract
Web-based testing of cognitive abilities allows for large-scale assessments without geographical constraints. Yet, the extent to which it can reach populations beyond the typical demographic groups recruited for cognitive studies is unclear. This study focused on comparing the characteristics of individuals from a general population study (HUNT4) who chose to participate in a cognitive study (HUNT4-Hjernetrim) with those who did not. Additionally, we investigated participants' engagement and user experience. We obtained data on socio-demographics, health conditions (both physical and mental), self-reported cognitive or learning difficulties, and lifestyle factors of Hjernetrim participants and non-participants from the HUNT4 database. Hjernetrim involved 13 cognitive tests, administered through the online platform Memoro. We used logistic regressions to assess participation biases and linear regressions to assess participants' engagement and user experience. Of 65,851 HUNT4 participants invited via regular mail to Hjernetrim, 5634 (9.4%, aged 13-97, 54% women) participated. The best represented in the sample were 50-79-year-olds, women, tertiary educated, living alone, from urban areas, not occupationally active, and reporting memory complaints. Individuals who were aged 80+, had motor or vision impairments, and teenagers with learning disabilities, were underrepresented. Participants were more likely to have mental health problems, have or survived cancer and less likely to have cardiovascular disease. Participants logged on mainly during weekdays, the preferred time of day varied by age. On average, participants used 42 min and completed 78% of the tasks. Using PCs provided the most complete data. In terms of user experiences, 65% were positive while 14% were negative or reported technical difficulties. Overall, the study demonstrated that web-based methodology allowed for a relatively well-represented sample that included groups typically difficult to reach. The presence of somatic and mental diseases had a variable influence on participation. Participants finished most tests and reported positive experiences overall.
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Affiliation(s)
- Daniel Radosław Sokołowski
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Fred Kavli Building, 3rd floor, south, Olav Kyrres gate 9, 7030, Trondheim, Norway
- MiDT National Norwegian Research Center, St. Olav's University Hospital, Trondheim, Norway
| | - Jasmine Pani
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Fred Kavli Building, 3rd floor, south, Olav Kyrres gate 9, 7030, Trondheim, Norway
- MiDT National Norwegian Research Center, St. Olav's University Hospital, Trondheim, Norway
| | - Tor Ivar Hansen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Fred Kavli Building, 3rd floor, south, Olav Kyrres gate 9, 7030, Trondheim, Norway
- MiDT National Norwegian Research Center, St. Olav's University Hospital, Trondheim, Norway
| | - Asta Kristine Håberg
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Fred Kavli Building, 3rd floor, south, Olav Kyrres gate 9, 7030, Trondheim, Norway.
- MiDT National Norwegian Research Center, St. Olav's University Hospital, Trondheim, Norway.
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Shajahan S, Peters R, Carcel C, Woodward M, Harris K, Anderson CS. Hypertension and Mild Cognitive Impairment: State-of-the-Art Review. Am J Hypertens 2024; 37:385-393. [PMID: 38214550 DOI: 10.1093/ajh/hpae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Mid-life hypertension is associated with cognitive decline and dementia in later life. Reducing high blood pressure (BP) with antihypertensive agents is a well-researched strategy to prevent dementia and mild cognitive impairment (MCI). However, there is still limited direct evidence to support the approach, and particularly for the treatment of the very old and those with existing MCI. METHODS This review presents an overview of the current evidence for the relationship between MCI and hypertension, and of the potential pathophysiological mechanisms related to cognitive decline and incidence dementia in relation to aging. RESULTS Although observational data are near consistent in showing an association between mid-life hypertension and MCI and/or dementia, the evidence in relation to hypertension in younger adults and the very old (age >80 years) is much more limited. Most of the commonly available antihypertensive agents appear to provide beneficial effects in reducing the risk dementia, but there is limited evidence to support such treatment in those with existing MCI. CONCLUSIONS Further studies are needed to determine the optimal levels of BP control across different age groups, especially in adults with MCI, and which class(es) of antihypertensive agents and duration of treatment best preserve cognitive function in those at risk of, or with established, MCI.
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Affiliation(s)
- Sultana Shajahan
- Brain Health Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ruth Peters
- Brain Health Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Cheryl Carcel
- Brain Health Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Woodward
- Brain Health Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Professorial Unit, The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
| | - Katie Harris
- Brain Health Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Craig S Anderson
- Brain Health Program, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, New South Wales, Australia
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Edwin TH, Håberg AK, Zotcheva E, Bratsberg B, Jugessur A, Engdahl B, Bowen C, Selbæk G, Kohler HP, Harris JR, Tom SE, Krokstad S, Mekonnen T, Stern Y, Skirbekk VF, Strand BH. Trajectories of Occupational Cognitive Demands and Risk of Mild Cognitive Impairment and Dementia in Later Life: The HUNT4 70+ Study. Neurology 2024; 102:e209353. [PMID: 38630959 PMCID: PMC11175637 DOI: 10.1212/wnl.0000000000209353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/13/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The cognitive reserve hypothesis posits that cognitively stimulating work delays the onset of mild cognitive impairment (MCI) and dementia. However, the effect of occupational cognitive demands across midlife on the risk of these conditions is unclear. METHODS Using a cohort study design, we evaluated the association between registry-based trajectories of occupational cognitive demands from ages 30-65 years and clinically diagnosed MCI and dementia in participants in the HUNT4 70+ Study (2017-19). Group-based trajectory modeling identified trajectories of occupational cognitive demands, measured by the routine task intensity (RTI) index (lower RTI indicates more cognitively demanding occupation) from the Occupational Information Network. Multinomial regression was implemented to estimate the relative risk ratios (RRRs) of MCI and dementia, after adjusting for age, sex, education, income, baseline hypertension, obesity, diabetes, psychiatric impairment, hearing impairment, loneliness, smoking status, and physical inactivity assessed at HUNT1-2 in 1984-1986 and 1995-1997. To handle missing data, we used inverse probability weighting to account for nonparticipation in cognitive testing and multiple imputation. RESULTS Based on longitudinal RTI scores for 305 unique occupations, 4 RTI trajectory groups were identified (n = 7,003, 49.8% women, age range 69-104 years): low RTI (n = 1,431, 20.4%), intermediate-low RTI (n = 1,578, 22.5%), intermediate-high RTI (n = 2,601, 37.1%), and high RTI (n = 1,393, 19.9%). Participants in the high RTI group had a higher risk of MCI (RRR 1.74, 95% CI 1.41-2.14) and dementia (RRR 1.37, 95% CI 1.01-1.86), after adjusting for age, sex, and education compared with participants in the low RTI group. In a sensitivity analysis, controlling for income and baseline health-related factors, the point estimates were not appreciably changed (RRR 1.66, 95% CI 1.35-2.06 for MCI, and RRR 1.31, 95% CI 0.96-1.78 for dementia). DISCUSSION People with a history of cognitively stimulating occupations during their 30s, 40s, 50s, and 60s had a lower risk of MCI and dementia older than 70 years, highlighting the importance of occupational cognitive stimulation during midlife for maintaining cognitive function in old age. Further research is required to pinpoint the specific occupational cognitive demands that are most advantageous for maintaining later-life cognitive function.
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Affiliation(s)
- Trine H Edwin
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Asta K Håberg
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Ekaterina Zotcheva
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Bernt Bratsberg
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Astanand Jugessur
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Bo Engdahl
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Catherine Bowen
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Geir Selbæk
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Hans-Peter Kohler
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Jennifer R Harris
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Sarah E Tom
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Steinar Krokstad
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Teferi Mekonnen
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Yaakov Stern
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Vegard F Skirbekk
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
| | - Bjørn H Strand
- From the Department of Geriatric Medicine (T.H.E., G.S., B.H.S.), Oslo University Hospital; Department for Physical Health and Aging (A.K.H., E.Z., B.E., T.M., V.F.S., B.H.S.), Norwegian Institute of Public Health, Oslo; Department of Neuromedicine and Movement Science (A.K.H.), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; Norwegian National Centre for Ageing and Health (E.Z., G.S., V.F.S., B.H.S.), Vestfold Hospital Trust, Tønsberg; Centre for Fertility and Health (B.B., A.J., J.R.H., V.F.S.), Norwegian Institute of Public Health; Ragnar Frisch Center for Economic Research (B.B.), Oslo; Department of Global Public Health and Primary Care (A.J.), University of Bergen, Norway; Independent Researcher (C.B.), Vienna, Austria; Faculty of Medicine (G.S.), University of Oslo, Norway; Population Aging Research Center and Department of Sociology (H.-P.K.), University of Pennsylvania, Philadelphia; Cognitive Neuroscience Division (S.E.T., Y.S.), Department of Neurology, Columbia University, New York; Department of Epidemiology (S.E.T.), Columbia University, Mailman School of Public Health; HUNT Research Centre (S.K.), Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim; and Levanger Hospital (S.K.), Nord-Trøndelag Hospital Trust, Norway
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10
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Ibsen TL, Strand BH, Bergh S, Livingston G, Lurås H, Mamelund SE, Voshaar RO, Rokstad AMM, Thingstad P, Gerritsen D, Selbæk G. A longitudinal cohort study on the use of health and care services by older adults living at home with/without dementia before and during the COVID-19 pandemic: the HUNT study. BMC Health Serv Res 2024; 24:485. [PMID: 38641570 PMCID: PMC11027287 DOI: 10.1186/s12913-024-10846-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/11/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Older adults and people with dementia were anticipated to be particularly unable to use health and care services during the lockdown period following the COVID-19 pandemic. To better prepare for future pandemics, we aimed to investigate whether the use of health and care services changed during the pandemic and whether those at older ages and/or dementia experienced a higher degree of change than that observed by their counterparts. METHODS Data from the Norwegian Trøndelag Health Study (HUNT4 70 + , 2017-2019) were linked to two national health registries that have individual-level data on the use of primary and specialist health and care services. A multilevel mixed-effects linear regression model was used to calculate changes in the use of services from 18 months before the lockdown, (12 March 2020) to 18 months after the lockdown. RESULTS The study sample included 10,607 participants, 54% were women and 11% had dementia. The mean age was 76 years (SD: 5.7, range: 68-102 years). A decrease in primary health and care service use, except for contact with general practitioners (GPs), was observed during the lockdown period for people with dementia (p < 0.001) and those aged ≥ 80 years without dementia (p = 0.006), compared to the 6-month period before the lockdown. The use of specialist health services decreased during the lockdown period for all groups (p ≤ 0.011), except for those aged < 80 years with dementia. Service use reached levels comparable to pre-pandemic data within one year after the lockdown. CONCLUSION Older adults experienced an immediate reduction in the use of health and care services, other than GP contacts, during the first wave of the COVID-19 pandemic. Within primary care services, people with dementia demonstrated a more pronounced reduction than that observed in people without dementia; otherwise, the variations related to age and dementia status were small. Both groups returned to services levels similar to those during the pre-pandemic period within one year after the lockdown. The increase in GP contacts may indicate a need to reallocate resources to primary health services during future pandemics. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov, with the identification number NCT04792086.
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Affiliation(s)
- Tanja Louise Ibsen
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway.
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Sverre Bergh
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-Related Functional Decline and Disease (AFS), Innlandet Hospital Trust, Ottestad, Norway
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Svenn-Erik Mamelund
- Centre for Research On Pandemics & Society (PANSOC), at Oslo Metropolitan University, Oslo, Norway
| | - Richard Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne Marie Mork Rokstad
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health and Social Services, Trondheim Municipality, Trondheim, Norway
| | - Debby Gerritsen
- Department of Primary and Community Care, Research Institute for Medical Innovation, Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, Netherlands
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health (Ageing and Health), Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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11
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Brandvold M, Rustøen T, Hagen M, Stubberud J, van den Boogaard M, Hofsø K. Inter-rater agreement between patient- and proxy-reported cognitive functioning in intensive care unit patients: A cohort study. Aust Crit Care 2024:S1036-7314(24)00057-2. [PMID: 38614955 DOI: 10.1016/j.aucc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Health status, including cognitive functioning before critical illness, is associated with long-term outcomes in intensive care unit survivors. Premorbid data are therefore of importance in longitudinal studies. Few patients can self-report at intensive care admission. Consequently, proxy assessments of patients' health status are used. However, it remains unclear how accurately proxies can report on an intensive care patient's cognitive status. OBJECTIVES The aim of this study was to examine the agreement between patient- and proxy-reporting of the Cognitive Failures Questionnaire and to compare the agreement between proxy reports using the latter questionnaire and the Informant Questionnaire of Cognitive Decline in the Elderly as a reference. METHODS The present cohort study is part of a longitudinal multicentre study collecting both patient and proxy data using questionnaires and clinical data from medical records during intensive care unit stays. Agreement on patient and proxy pairs was examined using intraclass correlation coefficient (ICC), Spearman's correlation, percentage agreement, and Gwet's AC1 statistics. Agreement between the proxy-reported questionnaires was examined using percentage agreement and Gwet's AC1 statistics. RESULTS In total, we collected 99 pairs of patient-proxy assessments and 158 proxy-proxy assessments. The ICC for the sum scores revealed moderate agreement (n = 99; ICC = 0.59; 99% confidence interval [CI]: [0.30-0.76]) between patient and proxy. Agreement on items was poor (AC1 = 0.13; 99% CI: [0.01-0.24]) to moderate (AC1 = 0.55; 99% CI: [0.43-0.68]). Agreement using cut-off scores (>43) to indicate cognitive impairment was very good (89.9%, AC1 = 0.87; 99% CI: [0.79-0.95]). Agreement between the proxy-reported Cognitive Failures Questionnaire (>43) and the reference questionnaire (≥3.5) was also very good (n = 158; 85%, AC1 = 0.82; 99% CI: [0.74-0.90]). CONCLUSIONS Proxy assessments of the Cognitive Failures Questionnaire (>43) may be used to indicate cognitive impairment if patients are unable to self-report. Agreement was high between the two questionnaires determined by proxies, showing that these can be used interchangeably to assess cognitive functioning if proxy reporting is needed.
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Affiliation(s)
- Malin Brandvold
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway; Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O.box 1089 Blindern, 0318 Oslo, Norway.
| | - Tone Rustøen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway; Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O.box 1089 Blindern, 0318 Oslo, Norway
| | - Milada Hagen
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway; Faculty of Health Sciences, Department of Public Health, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass 0130 Oslo, Norway
| | - Jan Stubberud
- Department of Psychology, University of Oslo, P.O. Box 1094 Blindern, 0317 Oslo, Norway; Department of Research, Lovisenberg Diaconal Hospital, P.O. Box 4970 Nydalen, 0440 Oslo, Norway
| | - Mark van den Boogaard
- Radboud University Medical Center, Department of Intensive Care, P.O. Box 91016500 HB Nijmegen, the Netherlands
| | - Kristin Hofsø
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggata 15b, 0456 Oslo, Norway; Department of Postoperative and Intensive Care Nursing, Division of Emergencies and Critical Care, Oslo University Hospital, P.O. Box 4950, Nydalen, 0424 Oslo, Norway
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Wang HL, Siow R, Schmauck-Medina T, Zhang J, Sandset PM, Filshie C, Lund Ø, Partridge L, Bergersen LH, Juel Rasmussen L, Palikaras K, Sotiropoulos I, Storm-Mathisen J, Rubinsztein DC, Spillantini MG, De Zeeuw CI, Watne LO, Vyhnalek M, Veverova K, Liang KX, Tavernarakis N, Bohr VA, Yokote K, Saarela J, Nilsen H, Gonos ES, Scheibye-Knudsen M, Chen G, Kato H, Selbæk G, Fladby T, Nilsson P, Simonsen A, Aarsland D, Lautrup S, Ottersen OP, Cox LS, Fang EF. Meeting Summary of The NYO3 5th NO-Age/AD Meeting and the 1st Norway-UK Joint Meeting on Aging and Dementia: Recent Progress on the Mechanisms and Interventional Strategies. J Gerontol A Biol Sci Med Sci 2024; 79:glae029. [PMID: 38289789 PMCID: PMC10917444 DOI: 10.1093/gerona/glae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Indexed: 02/01/2024] Open
Abstract
Unhealthy aging poses a global challenge with profound healthcare and socioeconomic implications. Slowing down the aging process offers a promising approach to reduce the burden of a number of age-related diseases, such as dementia, and promoting healthy longevity in the old population. In response to the challenge of the aging population and with a view to the future, Norway and the United Kingdom are fostering collaborations, supported by a "Money Follows Cooperation agreement" between the 2 nations. The inaugural Norway-UK joint meeting on aging and dementia gathered leading experts on aging and dementia from the 2 nations to share their latest discoveries in related fields. Since aging is an international challenge, and to foster collaborations, we also invited leading scholars from 11 additional countries to join this event. This report provides a summary of the conference, highlighting recent progress on molecular aging mechanisms, genetic risk factors, DNA damage and repair, mitophagy, autophagy, as well as progress on a series of clinical trials (eg, using NAD+ precursors). The meeting facilitated dialogue among policymakers, administrative leaders, researchers, and clinical experts, aiming to promote international research collaborations and to translate findings into clinical applications and interventions to advance healthy aging.
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Affiliation(s)
- He-Ling Wang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, Lørenskog, Norway
| | - Richard Siow
- School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Tomas Schmauck-Medina
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, Lørenskog, Norway
| | - Jianying Zhang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, Lørenskog, Norway
- Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - Per Morten Sandset
- Department of Haematology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | | | - Linda Partridge
- Max Planck Institute for Biology of Ageing, Cologne, Germany
- Department of Genetics, Evolution and Environment, Institute of Healthy Ageing, University College London (UCL), London, UK
| | - Linda Hildegard Bergersen
- Brain and Muscle Energy Group, Institute of Oral Biology, University of Oslo, Oslo, Norway
- Center for Healthy Aging, Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lene Juel Rasmussen
- Department of Cellular and Molecular Medicine, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Konstantinos Palikaras
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Sotiropoulos
- Institute of Biosciences and Applications NCSR “Demokritos,”Athens, Greece
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, Braga, Portugal
| | - Jon Storm-Mathisen
- Division of Anatomy, Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - David C Rubinsztein
- Department of Medical Genetics, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
- UK Dementia Research Institute, University of Cambridge, Cambridge, UK
| | | | - Chris I De Zeeuw
- Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Leiv Otto Watne
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
| | - Martin Vyhnalek
- International Clinical Research Centre, St. Anne’s University Hospital, Brno, Czech Republic
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Katerina Veverova
- Department of Neurology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | | | - Nektarios Tavernarakis
- Institute of Molecular Biology and Biotechnology Foundation for Research and Technology, Heraklion, Greece
- Medical School, University of Crete, Heraklion, Greece
| | - Vilhelm A Bohr
- Department of Cellular and Molecular Medicine, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Laboratory of Molecular Gerontology, National Institute on Aging, National Institutes of Health, Baltimore, Maryland, USA
| | - Koutaro Yokote
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Janna Saarela
- Centre for Molecular Medicine Norway (NCMM), University of Oslo, Oslo, Norway
- Institute for Molecular Medicine Finland (FIMM), HiLIFE, University of Helsinki, Helsinki, Finland
| | - Hilde Nilsen
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway
| | - Efstathios S Gonos
- National Helenic Research Foundation, Institute of Biology, Medicinal Chemistry and Biotechnology, Athens, Greece
| | - Morten Scheibye-Knudsen
- Department of Cellular and Molecular Medicine, Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Tracked.bio, Copenhagen, Denmark
| | - Guobing Chen
- Guangdong-Hong Kong-Macau Great Bay Area Geroscience Joint Laboratory, Guangzhou, China
- Department of Microbiology and Immunology, School of Medicine; Institute of Geriatric Immunology, School of Medicine, Jinan University, Guangzhou, China
| | - Hisaya Kato
- Department of Endocrinology, Hematology, and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Geir Selbæk
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Tormod Fladby
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Per Nilsson
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Anne Simonsen
- Department of Molecular Medicine, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Molecular Cell Biology, Institute for Cancer Research, Oslo University Hospital Montebello, Oslo, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
| | - Sofie Lautrup
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, Lørenskog, Norway
| | - Ole Petter Ottersen
- Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway
- Karolinska Institutet, Stockholm, Sweden
| | - Lynne S Cox
- Department of Biochemistry, University of Oxford, Oxford, UK
| | - Evandro F Fang
- Department of Clinical Molecular Biology, University of Oslo and Akershus University Hospital, Lørenskog, Norway
- The Norwegian Centre on Healthy Ageing (NO-Age), Oslo, Norway
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Norman RM, Sjetne IS. Associations between nursing home care environment and unfinished nursing care explored. Secondary analysis of cross-sectional data. Geriatr Nurs 2024; 56:55-63. [PMID: 38241877 DOI: 10.1016/j.gerinurse.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/30/2023] [Accepted: 12/31/2023] [Indexed: 01/21/2024]
Abstract
Understanding unfinished nursing care and its relationship with modifiable care environment factors is crucial for the service delivery to long-term frail patients. This secondary analysis aimed to explore the associations between characteristics of the care environment and unfinished nursing care, as reported by nursing care workers in Norwegian nursing homes. Of 931 respondents (37% response rate) from 66 nursing homes, six care environment characteristics correlated with at least two types of unfinished nursing care. Resources and Multidisciplinary collaboration showed a positive association with all four unfinished care categories. Input and acknowledgement, Professional, or Interpersonal leadership were not associated to unfinished care. In summary, our findings suggest that nursing care workers reporting positive care environment descriptions also reported lower frequencies of unfinished nursing care. This study offers insights crucial for human resource management which ultimately can be used to improve patient outcomes in nursing homes.
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Affiliation(s)
- Rebecka Maria Norman
- Norwegian Institute of Public Health, PO Box 222, Skøyen NO-0213 Oslo, Norway; Lovisenberg Diaconal University College, Lovisenberggata 15b NO-0456 Oslo, Norway.
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Risvoll H, Risør T, Halvorsen KH, Waaseth M, Stub T, Giverhaug T, Musial F. General practitioners' role in safeguarding patients with dementia in their use of dietary supplements. A qualitative study. Scand J Prim Health Care 2024; 42:16-28. [PMID: 37982720 PMCID: PMC10851825 DOI: 10.1080/02813432.2023.2283182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/08/2023] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVE The use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners' (GPs') experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group. DESIGN Qualitative individual interview study conducted February - December 2019. Data were analysed using systematic text condensation. SETTING Primary healthcare clinics in Norway. SUBJECTS Fourteen Norwegian GPs. FINDINGS None of the informants were dismissive of patients using DS. They were aware of the possible direct risks and had observed them in patients. Most GPs showed little awareness of potential indirect risks to patients with dementia who use DS. They acknowledged the need for caretaking of these patients. Although there were differences in practice styles, most of the GPs wished to help their patients safeguarding DS use but found it difficult due to the lack of quality assurance of product information. Furthermore, there were no effective ways for the GPs to document DS use in the patients' records. Several suggestions for improvement were given by the GPs, such as increased attention from GPs, inclusion of DS in the prescription software, and stricter regulatory systems for DS from the authorities. CONCLUSION The GPs had initially little awareness of this safety risk, but there were differences in practice style and attitudes towards DS. The GPs did not perceive themselves as main responsible for safe use of DS in patient with dementia. The most important reason to disclaim responsibility was lack of information about the products. One suggestion for improvement was better integration of DS in patients' medical record.
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Affiliation(s)
- Hilde Risvoll
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- NLSH Vesterålen, Department of Neurology, Stokmarknes, Norway
- Valnesfjord Helsesportsenter, Valnesfjord, Norway
| | - Torsten Risør
- Section for General Practice, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
- Section for General Practice & Research Unit for General Practice, Department of Public Health, University of Copenhagen, København K, Denmark
| | - Kjell H. Halvorsen
- IPSUM research group, Department of Pharmacy, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Marit Waaseth
- IPSUM research group, Department of Pharmacy, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Trine Stub
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Trude Giverhaug
- Center for Profession and Quality, University Hospital of North Norway, Tromsø, Norway
| | - Frauke Musial
- NAFKAM, Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway
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Molvik I, Kjelvik G, Selbæk G, Rokstad AMM. Exploring the lived experience: impact of dementia diagnosis on individuals with cognitive impairment - a qualitative study. BMC Geriatr 2024; 24:121. [PMID: 38302870 PMCID: PMC10832106 DOI: 10.1186/s12877-024-04665-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE Although knowledge about the experience of being diagnosed with dementia is limited, with the expected rise in dementia's prevalence in the coming decades, such knowledge is pivotal for the people diagnosed, their families, and healthcare planners. Thus, the aim of our study was to explore the experience of living with cognitive impairment and dementia and the impact of being diagnosed with dementia. METHOD A qualitative design was applied. Participants were recruited based on age-adjusted values below threshold values on the Montreal Cognitive Assessment Scale (i.e. 70-79 years, < 22; 80-89 years, < 21; 90 + years, < 20), and the sample ultimately included 15 participants: six with and nine without a documented dementia diagnosis. Qualitative content analysis was performed on the transcribed interviews in four steps to identify codes, categories, and the overall theme. RESULTS Three major categories emerged from the interviews: (1) experiences with changes, (2) experiences with being diagnosed with dementia, and (3) existential experience. All participants with and most participants without a dementia diagnosis experienced changes in cognition. CONCLUSION Our findings imply that being diagnosed with dementia is a relief because it explains observed cognitive and functional decreases and reduces confusion, shame and stigma. However, it also raises concerns about an unknown future. Most participants not diagnosed with dementia reported having little or no difficulty with everyday living and leading a fulfilling life. Those findings emphasise the significance of timely versus early diagnosis.
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Affiliation(s)
- Inger Molvik
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
- Ageing and Health, Postboks 2136, Tønsberg, 3103, Norway.
| | - Grete Kjelvik
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Anne Marie Mork Rokstad
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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Angelsen A, Nakrem S, Zotcheva E, Strand BH, Strand LB. Health-promoting behaviors in older adulthood and intrinsic capacity 10 years later: the HUNT study. BMC Public Health 2024; 24:284. [PMID: 38267907 PMCID: PMC10809656 DOI: 10.1186/s12889-024-17840-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND With the global population growing older, there is a need for more knowledge of how to improve and/or maintain functional capacities to promote healthy ageing. In this study we aimed to assess the effect of several known health-promoting behaviors in old age with intrinsic capacity ten years later. METHODS This was a prospective cohort study looking at participants that were ≥ 65 years at the time of the third wave of the Trøndelag Health Study (HUNT3, 2006-2008) who also took part in the 70 + sub-study of the fourth wave (HUNT4 70+, 2017-2019). Self-reported behavior data from short questionnaires, including diet and physical activity, were collected in HUNT3, and data on the five domains of intrinsic capacity defined by the World Health Organization were collected in HUNT4 70+. A composite index was created for both healthy life and intrinsic capacity, awarding points for how well participants adhered to guidelines for healthy living and their level of functional impairment, respectively. Ordinal logistic regression was used to assess the relationship between health-promoting behaviors and intrinsic capacity. RESULTS Of 12,361 participants in HUNT3 ≥ 65 years, 4699 (56.5% women) also participated in HUNT4 70+. On the health-promoting behaviors, lowest adherence to healthy living guidelines were seen for fruit and vegetables intake (47.2%), milk intake (46.7%) and physical activity (31.1%). On intrinsic capacity domains, highest impairment was seen in the domains of locomotion (29.7%), hearing (11.1%) and vitality (8.3%). A higher adherence to guidelines for healthy living was associated with higher intrinsic capacity 10 years later. A one-point increase in the healthy life index was associated with a 1.15 (95% confidence interval 1.10-1.21) times increased odds of being in a higher intrinsic capacity category. CONCLUSION Health-promoting behaviors in old age are associated with better intrinsic capacity ten years later. In clinical settings assessment of health-promoting behaviors could potentially be done using short questionnaires.
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Affiliation(s)
- Aslaug Angelsen
- Norwegian University of Science and Technology, Trondheim, Norway.
| | - Sigrid Nakrem
- Norwegian University of Science and Technology, Trondheim, Norway
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Oxbøll AB, Jørgensen K, Nielsen TR, Christiansen SD, Nielsen A, Waldorff FB, Waldemar G. Diagnostic accuracy of BASIC-Q for detection of cognitive impairment in a primary care setting - a cross-validation study. BMC Geriatr 2024; 24:53. [PMID: 38212693 PMCID: PMC10785536 DOI: 10.1186/s12877-024-04675-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES This study aims to evaluate the diagnostic accuracy and reliability of a new, brief questionnaire, 'Brief Assessment of Impaired Cognition- Questionnaire' (BASIC-Q) for detection of cognitive impairment, primarily developed for use in primary care. BASIC-Q has three components: Self-report, Informant report, and Orientation. Self-report and Orientation are completed by the individual and Informant report is answered by a close relative. METHODS We included 275 participants ≥ 70 years, without a prior diagnosis of dementia, and with a close relative who agreed to participate as an informant. Participants were included prospectively in 14 general practices in urban and rural Denmark using a convenience sampling method. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the informant-completed Functional Activities Questionnaire (FAQ) and reported memory concern were used as a reference standard for the classification of the participants' cognitive function. RESULTS BASIC-Q demonstrated a fair to good diagnostic accuracy to differentiate between people with cognitive impairment and normal cognition with an area under the ROC curve (AUC) of 0.84 (95% CI 0.79-0.89) and a sensitivity and specificity of 0.80 (95% CI 0.72-0.87) and 0.71 (95% CI 0.63-0.78). A prorated BASIC-Q score derived from BASIC-Q without Informant report had significantly lower classification accuracy than the full BASIC-Q. The test-retest reliability of BASIC-Q was good with an intraclass correlation coefficient of 0.84. CONCLUSION BASIC-Q is a brief, easy-to-use questionnaire for identification of cognitive impairment in older adults. It demonstrated fair to good classification accuracy in a general practice setting and can be a useful case-finding tool when suspecting dementia in primary health care.
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Affiliation(s)
- Anne-Britt Oxbøll
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark.
| | - Kasper Jørgensen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - T Rune Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Sofie D Christiansen
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ann Nielsen
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
| | - Frans B Waldorff
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Copenhagen University Hospital- Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Moradi S, Engdahl B, Johannessen A, Selbæk G, Aarhus L, Haanes GG. Hearing loss, hearing aid use, and performance on the Montreal cognitive assessment (MoCA): findings from the HUNT study in Norway. Front Neurosci 2024; 17:1327759. [PMID: 38260012 PMCID: PMC10800991 DOI: 10.3389/fnins.2023.1327759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose To evaluate the associations between hearing status and hearing aid use and performance on the Montreal Cognitive Assessment (MoCA) in older adults in a cross-sectional study in Norway. Methods This study utilized data from the fourth wave of the Trøndelag Health Study (HUNT4, 2017-2019). Hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz (or PTA4) in the better hearing ear were used to determine participants' hearing status [normal hearing (PTA4 hearing threshold, ≤ 15 dB), or slight (PTA4, 16-25 dB), mild (PTA4, 26-40 dB), moderate (PTA4, 41-55 dB), or severe (PTA4, ≥ 56 dB) hearing loss]. Both standard scoring and alternate MoCA scoring for people with hearing loss (deleting MoCA items that rely on auditory function) were used in data analysis. The analysis was adjusted for the confounders age, sex, education, and health covariates. Results The pattern of results for the alternate scoring was similar to that for standard scoring. Compared with the normal-hearing group, only individuals with moderate or severe hearing loss performed worse in the MoCA. In addition, people with slight hearing loss performed better in the MoCA than those with moderate or severe hearing loss. Within the hearing loss group, hearing aid use was associated with better performance in the MoCA. No interaction was observed between hearing aid use and participants' hearing status with performance on the MoCA test. Conclusion While hearing loss was associated with poorer performance in the MoCA, hearing aid use was found to be associated with better performance in the MoCA. Future randomized control trials are needed to further examine the efficacy of hearing aid use on the MoCA performance. When compared with standard scoring, the alternate MoCA scoring had no effect on the pattern of results.
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Affiliation(s)
- Shahram Moradi
- Research Group for Disability and Inclusion, Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway Campus Porsgrunn, Porsgrunn, Norway
- Research Group for Health Promotion in Settings, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Tønsberg, Norway
| | - Bo Engdahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Aud Johannessen
- Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway Campus Vestfold, Horten, Norway
- Norwegian National Centre for Ageing and Health, Tønsberg, Norway
| | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Tønsberg, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Lisa Aarhus
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
- Medical Department, Diakonhjemmet Hospital, Oslo, Norway
| | - Gro Gade Haanes
- Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway Campus Vestfold, Horten, Norway
- USN Research Group of Older Peoples’ Health, University of South-Eastern Norway Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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Xiong B, Bailey DX, Prudon P, Pascoe EM, Gray LC, Graham F, Henderson A, Martin-Khan M. Identification and information management of cognitive impairment of patients in acute care hospitals: An integrative review. Int J Nurs Sci 2024; 11:120-132. [PMID: 38352291 PMCID: PMC10859579 DOI: 10.1016/j.ijnss.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024] Open
Abstract
Objectives Recognition of the cognitive status of patients is important so that care can be tailored accordingly. The objective of this integrative review was to report on the current practices that acute care hospitals use to identify people with cognitive impairment and how information about cognition is managed within the healthcare record as well as the approaches required and recommended by policies. Methods Following Whittemore & Knafl's five-step method, we systematically searched Medline, CINAHL, and Scopus databases and various grey literature sources. Articles relevant to the programs that have been implemented in acute care hospitals regarding the identification of cognitive impairment and management of cognition information were included. The Mixed Methods Appraisal Tool and AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) Checklist were used to evaluate the quality of the studies. Thematic analysis was used to present and synthesise results. This review was pre-registered on PROSPERO ( CRD42022343577). Results Twenty-two primary studies and ten government/industry publications were included in the analysis. Findings included gaps between practice and policy. Although identification of cognitive impairment, transparency of cognition information, and interaction with patients, families, and carers (if appropriate) about this condition were highly valued at a policy level, sometimes in practice, cognitive assessments were informal, patient cognition information was not recorded, and interactions with patients, families, and carers were lacking. Discussion By incorporating cognitive assessment, developing an integrated information management system using information technology, establishing relevant laws and regulations, providing education and training, and adopting a national approach, significant improvements can be made in the care provided to individuals with cognitive impairment.
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Affiliation(s)
- Beibei Xiong
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Daniel X. Bailey
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Royal Brisbane & Women’s Hospital, Brisbane, Australia
| | - Paul Prudon
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Elaine M. Pascoe
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Leonard C. Gray
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Frederick Graham
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Dementia and Delirium, Division of Medicine, Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Amanda Henderson
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Nursing Practice Development Unit, Princess Alexandra Hospital, Brisbane, Australia
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Brisbane, Australia
- Griffith Health, Griffith University, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, The University of the Sunshine Coast, Brisbane, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- Department of Health and Life Sciences, University of Exeter, Exeter, United Kingdom
- School of Nursing, University of Northern British Columbia, Prince George, Canada
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20
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Gjøra L, Strand BH, Bergh S, Bosnes I, Johannessen A, Livingston G, Skjellegrind HK, Selbæk G. Prevalence and Determinants of Diagnosed Dementia: A Registry Linkage Study Linking Diagnosis of Dementia in the Population-Based HUNT Study to Registry Diagnosis of Dementia in Primary Care and Hospitals in Norway. J Alzheimers Dis 2024; 99:363-375. [PMID: 38701153 DOI: 10.3233/jad-240037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background A timely diagnosis of dementia can be beneficial for providing good support, treatment, and care, but the diagnostic rate remains unknown and is probably low. Objective To determine the dementia diagnostic rate and to describe factors associated with diagnosed dementia. Methods This registry linkage study linked information on research-based study diagnoses of all-cause dementia and subtypes of dementias, Alzheimer's disease, and related dementias, in 1,525 participants from a cross-sectional population-based study (HUNT4 70+) to dementia registry diagnoses in both primary-care and hospital registries. Factors associated with dementia were analyzed with multiple logistic regression. Results Among those with research-based dementia study diagnoses in HUNT4 70+, 35.6% had a dementia registry diagnosis in the health registries. The diagnostic rate in registry diagnoses was 19.8% among home-dwellers and 66.0% among nursing home residents. Of those with a study diagnosis of Alzheimer's disease, 35.8% (95% confidence interval (CI) 32.6-39.0) had a registry diagnosis; for those with a study diagnosis of vascular dementia, the rate was 25.8% (95% CI 19.2-33.3) and for Lewy body dementias and frontotemporal dementia, the diagnosis rate was 63.0% (95% CI 48.7-75.7) and 60.0% (95% CI 43.3-75.1), respectively. Factors associated with having a registry diagnosis included dementia in the family, not being in the youngest or oldest age group, higher education, more severe cognitive decline, and greater need for help with activities of daily living. Conclusions Undiagnosed dementia is common, as only one-third of those with dementia are diagnosed. Diagnoses appear to be made at a late stage of dementia.
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Affiliation(s)
- Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Department of Physical Health and Ageing, Norwegian institute of Public Health, Oslo, Norway
| | - Sverre Bergh
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Research Centre for Age-related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | - Ingunn Bosnes
- Department of Psychiatry, Namsos Hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Aud Johannessen
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Håvard Kjesbu Skjellegrind
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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21
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Zhang M, Jiao H, Wang C, Qu Y, Lv S, Zhao D, Zhong X. Physical activity, sleep disorders, and type of work in the prevention of cognitive function decline in patients with hypertension. BMC Public Health 2023; 23:2431. [PMID: 38057774 PMCID: PMC10699000 DOI: 10.1186/s12889-023-17343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/26/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Hypertensive patients are likelier to have cognitive function decline (CFD). This study aimed to explore physical activity level, sleep disorders, and type of work that influenced intervention effects on cognitive function decline in hypertensive patients and to establish a decision tree model to analyze their predictive significance on the incidence of CFD in hypertensive patients. METHODS This cross-sectional study recruited patients with essential hypertension from several hospitals in Shandong Province from May 2022 to December 2022. Subject exclusion criteria included individuals diagnosed with congestive heart failure, valvular heart disease, cardiac surgery, hepatic and renal dysfunction, and malignancy. Recruitment is through multiple channels such as hospital medical and surgical outpatient clinics, wards, and health examination centers. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), and sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Moreover, we obtained information on the patients' type of work through a questionnaire and their level of physical activity through the International Physical Activity Questionnaire (IPAQ). RESULTS The logistic regression analysis results indicate that sleep disorder is a significant risk factor for CFD in hypertension patients(OR:1.85, 95%CI:[1.16,2.94]), mental workers(OR:0.12, 95%CI: [0.04,0.37]) and those who perform both manual and mental workers(OR: 0.5, 95%CI: [0.29,0.86]) exhibit protective effects against CFD. Compared to low-intensity, moderate physical activity(OR: 0.53, 95%CI: [0.32,0.87]) and high-intensity physical activity(OR: 0.26, 95%CI: [0.12,0.58]) protects against CFD in hypertension patients. The importance of predictors in the decision tree model was ranked as follows: physical activity level (54%), type of work (27%), and sleep disorders (19%). The area under the ROC curves the decision tree model predicted was 0.72 [95% CI: 0.68 to 0.76]. CONCLUSION Moderate and high-intensity physical activity may reduce the risk of developing CFD in hypertensive patients. Sleep disorders is a risk factor for CFD in hypertensive patients. Hypertensive patients who engage in mental work and high-intensity physical activity effectively mitigate the onset of CFD in hypertensive patients.
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Affiliation(s)
- Mengdi Zhang
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Huachen Jiao
- Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 42, Wenhua West Road, Lixia District, Jinan, Shandong, China.
| | - Cong Wang
- Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No. 42, Wenhua West Road, Lixia District, Jinan, Shandong, China
| | - Ying Qu
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shunxin Lv
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dongsheng Zhao
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xia Zhong
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
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22
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Myrstad C, Engdahl BL, Costafreda SG, Krokstad S, Lin F, Livingston G, Strand BH, Øhre B, Selbæk G. Hearing impairment and risk of dementia in The HUNT Study (HUNT4 70+): a Norwegian cohort study. EClinicalMedicine 2023; 66:102319. [PMID: 38192588 PMCID: PMC10772264 DOI: 10.1016/j.eclinm.2023.102319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 01/10/2024] Open
Abstract
Background Hearing impairment is strongly associated with future dementia. No studies have reported objectively measured hearing impairment in a cohort with a long period of follow-up (>20 years), and few have reported follow-up over 10 years. Hence, there is a need for high quality studies with sufficient follow-up time and data to account for reverse causality and confounding. We aimed to address this knowledge gap. Methods This cohort study used individual participant data from The Trøndelag Health Study (HUNT) in Norway. All current residents aged at least 20 years in the former Norwegian Nord-Trøndelag County were invited to participate in four decennial surveys: HUNT1 (1984-1986), HUNT2 (1995-1997), HUNT3 (2006-2008), and HUNT4 (2017-2019) with individuals aged at least 70 years included in a substudy, known as HUNT4 70+. Here, we report the findings of this substudy. HUNT4 70+ comprised 7135 participants who were assessed for dementia using the Diagnostic and Statistical Manual of Mental Disorders 5 criteria and who had audiometry between 1996 and 1998. The primary objective was to investigate, with gold standard audiometric testing and dementia diagnostic assessment, whether hearing impairment was an independent risk factor for all-cause dementia. The secondary objective was to investigate if a risk also applied to Alzheimer dementia and non-Alzheimer dementia. We analysed the association using Poisson regression and adjusted for confounders. This study is registered with ClinicalTrials.gov (NCT04284384). Findings At baseline, 1058 (15%) individuals had acquired hearing impairment with a hearing threshold of at least 25 decibel (dB) and, at follow-up, 1089 (15%) had dementia. In the total group, people with hearing impairment had a relative risk (RR) 1.04 (95% confidence interval (CI) 1.00-1.09) per 10 dB increase in hearing thresholds. For individuals younger than 85 years at follow-up the RR was 1.12 (95% CI 1.05-1.21). Associations between hearing impairment and Alzheimer dementia and non-Alzheimer dementia were similar. There was no association for individuals aged at least 85 years. Interpretation We found a moderate association between objectively measured hearing impairment and dementia in the younger age group (<85 years). The findings of no association in the older age group (≥85 years) might be due to the competing risk of death. The present study adds to the literature showing that acquired hearing impairment is a risk for dementias over a period which is too long for reverse causation, and with thorough consideration of confounders. Further research is needed to investigate associations between the different aetiologies of hearing loss and dementia subtypes, and risk differences for sexes. Funding The Norwegian National Centre for Ageing and Health with a grant from Health South-East.
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Affiliation(s)
- Christian Myrstad
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bo Lars Engdahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Sergi Gonzales Costafreda
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Steinar Krokstad
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Frank Lin
- Cochlear Center for Hearing and Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Beate Øhre
- The Norwegian National Unit for Sensory Loss and Mental Health, Oslo University Hospital, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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23
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Zotcheva E, Bratsberg B, Strand BH, Jugessur A, Engdahl BL, Bowen C, Selbæk G, Kohler HP, Harris JR, Weiss J, Tom SE, Krokstad S, Mekonnen T, Edwin TH, Stern Y, Håberg AK, Skirbekk V. Trajectories of occupational physical activity and risk of later-life mild cognitive impairment and dementia: the HUNT4 70+ study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100721. [PMID: 37927437 PMCID: PMC10625024 DOI: 10.1016/j.lanepe.2023.100721] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/03/2023] [Accepted: 08/07/2023] [Indexed: 11/07/2023]
Abstract
Background High levels of occupational physical activity (PA) have been linked to an increased risk of dementia. We assessed the association of trajectories of occupational PA at ages 33-65 with risk of dementia and mild cognitive impairment (MCI) at ages 70+. Methods We included 7005 participants (49.8% were women, 3488/7005) from the HUNT4 70+ Study. Group-based trajectory modelling was used to identify four trajectories of occupational PA based on national registry data from 1960 to 2014: stable low (30.9%, 2162/7005), increasing then decreasing (8.9%, 625/7005), stable intermediate (25.1%, 1755/7005), and stable high (35.2%, 2463/7005). Dementia and MCI were clinically assessed in 2017-2019. We performed adjusted multinomial regression to estimate relative risk ratios (RRR) with 95% confidence intervals (CI) for dementia and MCI. Findings 902 participants were diagnosed with dementia and 2407 were diagnosed with MCI. Absolute unadjusted risks for dementia and MCI were 8.8% (95% CI: 7.6-10.0) and 27.4% (25.5-29.3), respectively, for those with a stable low PA trajectory, 8.2% (6.0-10.4) and 33.3% (29.6-37.0) for those with increasing, then decreasing PA; while they were 16.0% (14.3-17.7) and 35% (32.8-37.2) for those with stable intermediate, and 15.4% (14.0-16.8) and 40.2% (38.3-42.1) for those with stable high PA trajectories. In the adjusted model, participants with a stable high trajectory had a higher risk of dementia (RRR 1.34, 1.04-1.73) and MCI (1.80, 1.54-2.11), whereas participants with a stable intermediate trajectory had a higher risk of MCI (1.36, 1.15-1.61) compared to the stable low trajectory. While not statistically significant, participants with increasing then decreasing occupational PA had a 24% lower risk of dementia and 18% higher risk of MCI than the stable low PA group. Interpretation Consistently working in an occupation with intermediate or high occupational PA was linked to an increased risk of cognitive impairment, indicating the importance of developing strategies for individuals in physically demanding occupations to prevent cognitive impairment. Funding This work was supported by the National Institutes of Health (R01AG069109-01) and the Research Council of Norway (296297, 262700, 288083).
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Affiliation(s)
- Ekaterina Zotcheva
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre of Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Bernt Bratsberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Ragnar Frisch Center for Economic Research, Oslo, Norway
| | - Bjørn Heine Strand
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre of Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Astanand Jugessur
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bo Lars Engdahl
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
| | | | - Geir Selbæk
- Norwegian National Centre of Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans-Peter Kohler
- Population Aging Research Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer R. Harris
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, USA
| | - Sarah E. Tom
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, USA
- Department of Epidemiology, Columbia University, Mailman School of Public Health, USA
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Norway
| | - Teferi Mekonnen
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
| | - Trine Holt Edwin
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Yaakov Stern
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, USA
| | - Asta Kristine Håberg
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vegard Skirbekk
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre of Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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24
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Medford A, Skirbekk V, Strand BH. Trends in ages at death of Norwegian centenarians: the 1870-1904 birth cohorts. Scand J Public Health 2023:14034948231206529. [PMID: 37899540 DOI: 10.1177/14034948231206529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
BACKGROUND With rapidly rising life expectancy and ageing populations, interest has grown in the survival patterns and ages at death at the highest ages. In Scandinavia, the accumulation of very old population segments coupled with long-established, high-quality population registers permit meaningful analysis. METHODS This study is based on individual level data from extinct Norwegian birth cohorts using data obtained from the Norwegian Civil Register System. We assess trends in the ages at death of centenarians in Norway for cohorts born between 1870 and 1904 for evidence of any secular increase using quantile regression. RESULTS We observed that there is no upward trend in centenarian lifespans, in line with recent observations in Sweden, but contrary to the upward trend at the very highest percentiles as observed in Denmark. CONCLUSIONS The available evidence suggests that the stagnation in centenarian lifespans may be partly due to the failure to find ways of dealing with neurodegenerative diseases.
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Affiliation(s)
- Anthony Medford
- Center on Population Dynamics, University of Southern Denmark, Denmark
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25
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Steinsheim G, Malmedal W, Follestad T, Olsen B, Saga S. Factors associated with subjective burden among informal caregivers of home-dwelling people with dementia: a cross-sectional study. BMC Geriatr 2023; 23:644. [PMID: 37817101 PMCID: PMC10565959 DOI: 10.1186/s12877-023-04358-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/27/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND It is estimated that more than 57 million people have dementia worldwide, and it is one of the leading causes of care dependency in old age. Relatives and other informal caregivers are the most important support for individuals with dementia, but caring for a loved one with dementia may burden the caregiver. Caregiver burden may have adverse outcomes for both the informal caregiver and the care recipient, including decreased quality of life. Caregiver burden is associated with several factors concerning the informal caregiver, the care recipient, and relational and other contextual factors. The aim of this study was to explore which factors are associated with informal caregivers' subjective burden when caring for individuals living at home with dementia. METHODS This study was a cross-sectional survey among informal caregivers of home-dwelling individuals with dementia in all five geographical regions of Norway. There were 540 informal caregivers who participated, 415 of whom were included in the regression analyses. Caregivers' subjective burden was assessed with the Relatives' Stress Scale. Covariates included were classified into four levels: individual (twofold: informal caregiver and person with dementia), relational, community, and time. Linear multivariable regression analyses were used to identify associations between subjective burden and included factors. RESULTS Several covariates were statistically significantly associated with subjective burden at the four levels. These covariates included self-rated health, mental distress, age, coping through resignation and denial, emotional and instrumental support, substance use, and humor at the informal caregiver level; behavioral and psychological symptoms of dementia, dementia severity, and degree of disability at the care recipient level; the extent of care, being the primary caregiver, and previous relationship satisfaction at the relational context level; and informal caregivers spending time with friends, leisure activities, social restriction, and knowledge of available health services at the community context level. CONCLUSIONS Informal caregivers' mental distress and care recipients' neuropsychiatric symptoms were the factors with the strongest association with subjective burden.
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Affiliation(s)
- Gunn Steinsheim
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postbox 8905, Trondheim, N-7491, Norway.
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postbox 8905, Trondheim, N-7491, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olavs Hospital, Trondheim, Norway
| | - Bonnie Olsen
- Department of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Susan Saga
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Postbox 8905, Trondheim, N-7491, Norway
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Lerfald M, Lydersen S, Zotcheva E, Nilsen TIL, Eldholm RS, Martinez-Velilla N, Selbæk G, Ernstsen L. Change in physical activity and systolic blood pressure trajectories throughout mid-life and the development of dementia in older age: the HUNT study. Eur Rev Aging Phys Act 2023; 20:18. [PMID: 37784015 PMCID: PMC10544393 DOI: 10.1186/s11556-023-00328-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND There is lack of research on combinations of possible modifiable risk factors for dementia in a life-time perspective. Dementia has currently no cure, and therefore new knowledge of preventive factors is important. The purpose of this study is to investigate if changes in physical activity (PA) in combinations with systolic blood pressure (SBP) trajectories in mid to late life are related to development of dementia in older age. METHODS This prospective cohort study uses data from four consecutive surveys of the HUNT Study, Norway. Dementia was assessed in the HUNT4 70 + sub-study (2017-19). Group-based trajectory modelling identified three SBP trajectories from HUNT1 (1984-86) to HUNT3 (2006-2008): low, middle, and high. Change in PA was categorized into four groups based on high or low PA level at HUNT1 and HUNT3 and were combined with the SBP trajectories resulting in 12 distinct categories. Logistic regression was used to estimate odds ratios (ORs) of dementia. RESULTS A total of 8487 participants (55% women, mean age (SD) 44.8 (6.5) years at HUNT1) were included. At HUNT4 70 + , 15.2% had dementia. We observed an overall decrease in OR of dementia across the PA/SBP categories when ranked from low to high PA (OR, 0.96; 95% CI, 0.93 to 1.00, P = 0.04). Within PA groups, a low SBP trajectory was associated with lower OR for dementia, apart from those with decreasing PA. The strongest association was observed for people with stable high PA and low SBP trajectory (OR, 0.38; 95% confidence interval (CI), 0.13 to 1.10 and adjusted risk difference, -8.34 percentage points; 95% CI, -15.32 to -1.36). CONCLUSION Our findings illustrate the clinical importance of PA and SBP for dementia prevention and that favorable levels of both are associated with reduced occurrence of dementia.
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Affiliation(s)
- Maren Lerfald
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, PO box 8950, N-7491, Trondheim, Norway
- Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ekaterina Zotcheva
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Oslo, Norway
| | - Tom I L Nilsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, PO box 8950, N-7491, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Rannveig S Eldholm
- Department of Geriatrics, Clinic of Medicine, St.Olavs Hospital, Trondheim, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Geir Selbæk
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda Ernstsen
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, PO box 8950, N-7491, Trondheim, Norway.
- Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
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27
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Kolberg M, Paur I, Sun YQ, Gjøra L, Skjellegrind HK, Thingstad P, Strand BH, Selbæk G, Fagerhaug TN, Thoresen L. Prevalence of malnutrition among older adults in a population-based study - the HUNT Study. Clin Nutr ESPEN 2023; 57:711-717. [PMID: 37739727 DOI: 10.1016/j.clnesp.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Malnutrition is common in older adults and is associated with increased morbidity and mortality rates. AIM The aim of the study is to describe the prevalence of malnutrition based on low BMI, involuntary weight loss, and reduced food intake, in a Norwegian population of community-dwelling older adults and older adults living in nursing homes. METHODS This population-based study is part of the fourth wave of the Trøndelag Health Study (HUNT4) and includes participants ≥70 years from the HUNT4 70+ cohort. The HUNT4 70+ cohort consist of 9930 (response rate 51.2%) participants. In the current study 8127 older people had complete dataset for inclusion in the analyses. Participants completed a self-report questionnaire and standardised interviews and clinical assessments at field stations, in participants' homes or at nursing homes. Malnutrition was defined using the following criteria: low BMI, involuntary weight loss and severely reduced food intake. The standardised prevalence of malnutrition was estimated using inverse probability weighting (IPW) with weights for sex, age and education of the total population in the catchment area of HUNT. RESULTS Of the 8127 included participants, 7671 (94.4%) met at field stations, 356 (4.4%) were examined in their home, and 100 (1.2%) in nursing homes. In total, 14.3% of the population were malnourished based on either low BMI, weight loss, or reduced food intake, of which low BMI was the most frequently fulfilled criterion. The prevalence of malnutrition was less common among men than among women (10.1 vs 18.0%, p < 0.001), also after adjustment for age (OR 0.53, 95% confidence interval (CI) 0.46-0.61). The prevalence increased gradually with increasing age and the regression analysis adjusted for sex showed that for each year increase in age the prevalence of malnutrition increased with 4.0% (OR 1.04, 95% CI 1.03-1.05). The prevalence was higher both among older adults examined in their homes (26.4%) and residents in nursing home (23.6%), as compared to community-dwelling older adults who met at field stations (13.5%). CONCLUSION The prevalence of malnutrition is high in the older population. Special attention on prevention and treatment of malnutrition should be given to older women, the oldest age groups, and care-dependent community-dwelling older adults and nursing home residents.
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Affiliation(s)
- Marit Kolberg
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway.
| | - Ingvild Paur
- Norwegian Advisory Unit on Disease-related Undernutrition, Oslo, Norway; Section for Clinical Nutrition, Department of Clinical Services, Division of Cancer Medicine, Oslo University Hospital, Norway; Department of Clinical Medicine, Clinical Nutrition Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Yi-Qian Sun
- Center for Oral Health Services and Research, Mid-Norway (TkMidt), Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Håvard Kjesbu Skjellegrind
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Levanger, Norway; Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science (INB), Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Department of Health and Welfare, Trondheim Municipality, Trondheim, Norway
| | - Bjørn Heine Strand
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tone Natland Fagerhaug
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lene Thoresen
- Oncology Clinic, Trondheim University Hospital, Trondheim, Norway
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Johnsen B, Martinaityte I, Wilsgaard T, Schirmer H. Incidence of dementia over a period of 20 years in a Norwegian population. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12479. [PMID: 37780861 PMCID: PMC10540268 DOI: 10.1002/dad2.12479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION In Norway, the prevalence of dementia is higher than in demographically comparable, high income countries, but reliable incidence studies are lacking. This study calculated the incidence of age-specific dementia from 2000 to 2019. METHODS Participants from The Tromsø Study (n = 44,214) were included. Participants with a dementia diagnosis (n = 2049 cases) were identified. Poisson regression was used to calculate age-specific yearly and 5-year incidence rates from 2000 to 2019. RESULTS The incidence of dementia has decreased from 2000 to 2019. The trend was highly significant for ages of 60-99 years, and was similar for both sexes. DISCUSSION The incidence of dementia in North Norway has decreased over the past two decades similar to that in Western countries, indicating that the total prevalence is increasing due to an aging population. This decrease of incidence could introduce a reduction in future estimation of dementia prevalence.
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Affiliation(s)
- Bente Johnsen
- Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Department of Geriatric MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Ieva Martinaityte
- Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
- Department of Geriatric MedicineUniversity Hospital of North NorwayTromsøNorway
| | - Tom Wilsgaard
- Department of Community MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Henrik Schirmer
- Department of CardiologyAkershus University HospitalLørenskogNorway
- Institute of Clinical MedicineUniversity of OsloOsloNorway
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Zotcheva E, Strand BH, Bowen CE, Bratsberg B, Jugessur A, Engdahl BL, Selbæk G, Kohler HP, Harris JR, Weiss J, Grøtting MW, Tom SE, Krokstad S, Stern Y, Håberg AK, Skirbekk V. Retirement age and disability status as pathways to later-life cognitive impairment: Evidence from the Norwegian HUNT Study linked with Norwegian population registers. Int J Geriatr Psychiatry 2023; 38:e5967. [PMID: 37475192 PMCID: PMC10493399 DOI: 10.1002/gps.5967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Research shows that retirement age is associated with later-life cognition but has not sufficiently distinguished between retirement pathways. We examined how retirement age was associated with later-life dementia and mild cognitive impairment (MCI) for people who retired via the disability pathway (received a disability pension prior to old-age pension eligibility) and those who retired via the standard pathway. METHODS The study sample comprised 7210 participants from the Norwegian Trøndelag Health Study (HUNT4 70+, 2017-2019) who had worked for at least one year in 1967-2019, worked until age 55+, and retired before HUNT4. Dementia and MCI were clinically assessed in HUNT4 70+ when participants were aged 69-85 years. Historical data on participants' retirement age and pathway were retrieved from population registers. We used multinomial regression to assess the dementia/MCI risk for women and men retiring via the disability pathway, or early (<67 years), on-time (age 67, old-age pension eligibility) or late (age 68+) via the standard pathway. RESULTS In our study sample, 9.5% had dementia, 35.3% had MCI, and 28.1% retired via the disability pathway. The disability retirement group had an elevated risk of dementia compared to the on-time standard retirement group (relative risk ratio [RRR]: 1.64, 95% CI 1.14-2.37 for women, 1.70, 95% CI 1.17-2.48 for men). MCI risk was lower among men who retired late versus on-time (RRR, 0.76, 95% CI 0.61-0.95). CONCLUSION Disability retirees should be monitored more closely, and preventive policies should be considered to minimize the dementia risk observed among this group of retirees.
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Affiliation(s)
- Ekaterina Zotcheva
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre of Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Bjørn Heine Strand
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre of Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Bernt Bratsberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Ragnar Frisch Center for Economic Research, Oslo, Norway
| | - Astanand Jugessur
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bo Lars Engdahl
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
| | - Geir Selbæk
- Norwegian National Centre of Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hans-Peter Kohler
- Population Aging Research Center and Department of Sociology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer R. Harris
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, USA
| | - Maja Weemes Grøtting
- Department for Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Sarah E. Tom
- Department of Neurology, Vagelos College of Physicians and Surgeons, Department of Epidemiology, Mailman School of Public Health, Columbia University, USA
| | - Steinar Krokstad
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Norway
| | - Yaakov Stern
- Department of Neurology, Columbia University Vagelos College of Physicians and Surgeons, USA
| | - Asta Kristine Håberg
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Vegard Skirbekk
- Department for Physical Health and Aging, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre of Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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Tondo G, Aprile D, De Marchi F, Sarasso B, Serra P, Borasio G, Rojo E, Arenillas JF, Comi C. Investigating the Prognostic Role of Peripheral Inflammatory Markers in Mild Cognitive Impairment. J Clin Med 2023; 12:4298. [PMID: 37445333 DOI: 10.3390/jcm12134298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/22/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023] Open
Abstract
Growing evidence suggests that neuroinflammation plays a critical role in the pathogenesis of neurodegenerative diseases. Peripheral markers of inflammation, including blood cell counts and their ratios, such as the neutrophil-to-lymphocyte ratio (NLR), have been reported as an easily accessible and reliable proxy of central nervous system inflammation. However, the role of peripheral inflammation in dementia and Mild Cognitive Impairment (MCI) still needs to be clarified. In the current study, we aimed to assess the prognostic role of the NLR and other peripheral markers of inflammation in a sample of 130 amnestic MCI, followed up for two to five years. The Mini-Mental state examination (MMSE) score at baseline and follow-up visits was used to assess global cognitive status at each visit and the degree of cognitive decline over time. Baseline peripheral markers of inflammation included blood cell counts and ratios, specifically the NLR, the platelet-to-lymphocyte ratio (PLR), the monocyte-to-lymphocyte ratio (MLR), and the systemic immune inflammation index (SII). After classifying subjects into CONVERTERS and non-CONVERTERS (respectively, patients converting to dementia and subjects showing stability at the last available follow-up), we compared peripheral markers of inflammation among groups ed correlated them with cognitive measures, testing the ability of significant factors to predict conversion to dementia. In our cohort, CONVERTERS showed lower baseline MMSE scores (p-value = 0.004) than non-CONVERTERS. In addition, CONVERTERS had statistically elevated NLR (p-value = 0.005), PLR (p-value = 0.002), and SII levels (p-value = 0.015), besides a lower number of lymphocytes (p-value = 0.004) compared with non-CONVERTERS. In a logistic regression analysis, baseline MMSE scores and NLR predicted conversion to dementia. Tertiles analysis showed that MCI with the highest NLR values had a higher conversion risk. Our study supports the hypothesis that a dysregulation of peripheral inflammation involving both lymphocytes and neutrophils may play a role in the pathogenesis of dementia, even at the early stages of neurodegeneration, as in the MCI condition.
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Affiliation(s)
- Giacomo Tondo
- Neurology Unit, Department of Translational Medicine, Sant'Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Davide Aprile
- Neurology Unit, Department of Translational Medicine, Sant'Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Fabiola De Marchi
- Neurology Unit, Department of Translational Medicine, Maggiore della Carità Hospital, University of Piemonte Orientale, 28100 Novara, Italy
| | - Barbara Sarasso
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Paola Serra
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Giordana Borasio
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
| | - Esther Rojo
- Department of Neurology and Medicine, Hospital Clínico Universitario, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Juan Francisco Arenillas
- Department of Neurology and Medicine, Hospital Clínico Universitario, Universidad de Valladolid, 47003 Valladolid, Spain
| | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, Sant'Andrea Hospital, University of Piemonte Orientale, Corso Abbiate 21, 13100 Vercelli, Italy
- Centre for Dementia and Cognitive Disorders, Sant'Andrea Hospital, Corso Abbiate 21, 13100 Vercelli, Italy
- Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale, 28100 Novara, Italy
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Sunde AL, Aarsland D. Cognitive impairment and dementia. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:23-0407. [PMID: 37376935 DOI: 10.4045/tidsskr.23.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
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Gjøra L, Strand BH, Engedal K, Ernstsen L, Myrstad C, Skjellegrind H, Thingstad P, Selbæk G. Dementia and mild cognitive impairment in older people in Trøndelag. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:22-0815. [PMID: 37376934 DOI: 10.4045/tidsskr.22.0815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The number of people with dementia is expected to triple by 2050. We present figures showing the prevalence of dementia and mild cognitive impairment in Trondheim, and show how weighting for non-response and nursing home residency affects these figures when comparing Trondheim with Nord-Trøndelag. MATERIAL AND METHOD In the fourth data collection in the Trøndelag Health Study (HUNT4) in the Norwegian county of Trøndelag, people aged 70 and over in Trondheim were invited to participate in HUNT4 Trondheim 70+. The participants were interviewed and underwent cognitive testing. A diagnostic team diagnosed dementia and mild cognitive impairment. Weights adjusting for non-response bias were used in the comparison of Trondheim and Nord-Trøndelag. RESULTS The prevalence of dementia in Trondheim was estimated at 16.2 % for the age group 70 years and over, after weighting for non-response bias with regard to age, sex, education and proportion of nursing home residents. Unadjusted dementia prevalence was 21.0 % in Trondheim and 15.7 % in Nord-Trøndelag. After weighting, the prevalence was almost identical in the two samples. INTERPRETATION Weighting for non-response is crucial for obtaining representative figures in prevalence studies of dementia.
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Affiliation(s)
- Linda Gjøra
- Nasjonalt senter for aldring og helse, Sykehuset i Vestfold, Tønsberg, og, Helse Nord-Trøndelag, Sykehuset Levanger
| | - Bjørn Heine Strand
- Avdeling for fysisk helse og aldring, Folkehelseinstituttet, og, Nasjonalt senter for aldring og helse, Sykehuset i Vestfold, Tønsberg, og, Geriatrisk avdeling, Oslo universitetssykehus
| | - Knut Engedal
- Nasjonalt senter for aldring og helse, Sykehuset i Vestfold, Tønsberg, og, Geriatrisk avdeling, Oslo universitetssykehus
| | | | - Christian Myrstad
- Nasjonalt senter for aldring og helse, Sykehuset i Vestfold, Tønsberg, og, Helse Nord-Trøndelag, Sykehuset Levanger
| | - Håvard Skjellegrind
- HUNT forskningssenter, Institutt for samfunnsmedisin og sykepleie, NTNU, Levanger, og, Helse Nord-Trøndelag, Sykehuset Levanger
| | - Pernille Thingstad
- Institutt for nevromedisin og bevegelsesvitenskap, NTNU, og, Trondheim kommune
| | - Geir Selbæk
- Nasjonalt senter for aldring og helse, Sykehuset i Vestfold, Tønsberg, og, Geriatrisk avdeling, Oslo universitetssykehus, og, Institutt for klinisk medisin, Universitetet i Oslo
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Abbel D, Åsvold BO, Kolberg M, Selbæk G, Noordam R, Skjellegrind HK. The Association between Coffee and Tea Consumption at Midlife and Risk of Dementia Later in Life: The HUNT Study. Nutrients 2023; 15:nu15112469. [PMID: 37299431 DOI: 10.3390/nu15112469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Studies exploring the possible protective effect of coffee and tea consumption on dementia have shown inconsistent results so far. We aimed to investigate whether consumption of tea and different types of coffee at midlife are associated with dementia later in life and whether sex or ApoE4 influence such association. METHODS We included 7381 participants from the Norwegian HUNT Study. Self-reported questionnaires assessed daily consumption of coffee and tea at baseline. After 22 years, individuals 70 years or older were screened for cognitive impairment. RESULTS General coffee consumption and tea consumption was not associated with dementia risk. Compared to daily consumption of 0-1 cups of coffee, daily consumption of ≥8 cups of boiled coffee was associated with increased dementia risk in women (OR: 1.83, 95% CI: 1.10-3.04, p-value for trend = 0.03) and daily consumption of 4-5 cups of other types of coffee was associated with a decrease in dementia risk in men (OR: 0.48, 95% CI: 0.32-0.72, p-value for trend = 0.05). Furthermore, the association between boiled coffee and increased dementia risk was only found in ApoE4 non-carriers. Differences by sex or ApoE4 carrier status were not supported by strong statistical evidence for interaction. Tea consumption was not associated with dementia risk. CONCLUSION type of coffee may play a role in the direction of the association between coffee-drinking habits and dementia later in life.
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Affiliation(s)
- Denise Abbel
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7600 Levanger, Norway
- Leiden University Medical Center, Department of Internal Medicine, Section of Gerontology and Geriatrics, 2333 ZA Leiden, The Netherlands
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Bjørn Olav Åsvold
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7600 Levanger, Norway
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, 7030 Trondheim, Norway
| | - Marit Kolberg
- Center for Oral Health Services and Research Mid-Norway (TkMidt), 7030 Trondheim, Norway
| | - Geir Selbæk
- Norwegian National Centre for Aging and Health, Vestfold Hospital Trust, 3103 Tønsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Raymond Noordam
- Leiden University Medical Center, Department of Internal Medicine, Section of Gerontology and Geriatrics, 2333 ZA Leiden, The Netherlands
| | - Håvard Kjesbu Skjellegrind
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, 7600 Levanger, Norway
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, 7600 Levanger, Norway
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Engedal K, Wagle J, Benth JŠ, Gjøra L, Skjellegrind HK, Selbæk G. Normverdier for kognitive tester i demensutredningen. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:23-0180. [PMID: 37158523 DOI: 10.4045/tidsskr.23.0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
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35
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Alteren J, Johannessen A, Lyberg AM, Magnussen IL. Giving Voice to People with Dementia and Perspectives Regarding a Dementia-Friendly Society: A Synthesis of Qualitative Studies. J Multidiscip Healthc 2023; 16:851-861. [PMID: 37035259 PMCID: PMC10075266 DOI: 10.2147/jmdh.s398570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/09/2023] [Indexed: 04/03/2023] Open
Abstract
Introduction The World Health Organization [WHO] and governments worldwide envision the development of dementia-friendly societies that are based on a person-centered culture. A limited number of studies have described the features of dementia-friendly societies based on the viewpoints of people with dementia. Purpose To synthesize qualitative empirical research that expands the knowledge of what people with dementia consider to be essential for daily living in a dementia-friendly society. Methods The authors searched phrases in the databases AgeLine, CINAHL, EMBASE, MedLine, PsycINFO, PubMed, ORIA, SveMed+, and Cochrane Library. Research articles that involved people with dementia and were conducted in Western countries, written in English, published in peer-reviewed academic journals using qualitative methods, and published within the past decade were included. The research included was critically and systematically appraised using the critical appraisal skills program checklist for qualitative research, and the findings were analyzed according to Graneheim and Lundman's method of qualitative content analysis. Results Overall, 1122 records-561 from 2019 and 561 from 2021-were identified through the search, and nine studies were included in the final synthesis. The studies included were from the United Kingdom (five studies), Australia (three studies), and New Zealand (one study). Through the analysis process, the following main theme emerged: giving voice to people with dementia, which summarizes the essence of what people with dementia believe is essential for daily living in a dementia-friendly society. The main theme covered two themes: a sense of being valued and a sense of being safeguarded, each of which contained subthemes. Conclusion To meet the WHO's and the governments worldwide intention to develop dementia-friendly societies, further research should focus on the voices of people with dementia. By including those concerned, the political goals of a dementia-friendly society can be achieved.
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Affiliation(s)
- Johanne Alteren
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Correspondence: Johanne Alteren, Tel +47 71 19 58 93, Fax +47 71 21 40 00, Email
| | - Aud Johannessen
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Horten, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne Marit Lyberg
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Horten, Norway
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Chen P, Cai H, Bai W, Zhang Q, Su Z, Tang YL, Ungvari GS, Ng CH, Xiang YT. Global prevalence of mild cognitive impairment among older adults living in nursing homes: a meta-analysis and systematic review of epidemiological surveys. Transl Psychiatry 2023; 13:88. [PMID: 36906613 PMCID: PMC10008549 DOI: 10.1038/s41398-023-02361-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 03/13/2023] Open
Abstract
Mild cognitive impairment (MCI) is the early stage of cognitive impairment between the expected cognitive decline of normal aging and the more serious decline of dementia. This meta-analysis and systematic review explored the pooled global prevalence of MCI among older adults living in nursing homes and its relevant factors. The review protocol was registered in INPLASY (INPLASY202250098). PubMed, Web of Science, Embase, PsycINFO, and CINAHL databases were systematically searched from their respective inception dates to 8 January 2022. The inclusion criteria were made based on the PICOS acronym, as follows: Participants (P): Older adults living in nursing homes; Intervention (I): not applicable; Comparison (C): not applicable; Outcome (O): prevalence of MCI or the data can generate the prevalence of MCI according to study-defined criteria; Study design (S): cohort studies (only baseline data were extracted) and cross-sectional studies with accessible data published in a peer-reviewed journal. Studies involving mixed resources, reviews, systematic reviews, meta-analyses, case studies, and commentaries were excluded. Data analyses were performed using Stata Version 15.0. Random effects model was used to synthesize the overall prevalence of MCI. An 8-item instrument for epidemiological studies was used to assess the quality of included studies. A total of 53 articles were included involving 376,039 participants with a mean age ranging from 64.42 to 86.90 years from 17 countries. The pooled prevalence of MCI in older adults in nursing homes was 21.2% (95% CI: 18.7-23.6%). Subgroup and meta-regression analyses revealed that the screening tools used were significantly associated with MCI prevalence. Studies using the Montreal Cognitive Assessment (49.8%) had a higher prevalence of MCI than those using other instruments. No significant publication bias was found. Several limitations warrant attention in this study; for example, significant heterogeneity between studies remained and some factors associated with the prevalence of MCI were not examined due to insufficient data. Adequate screening measures and allocation of resources are needed to address the high global prevalence of MCI among older adults living in nursing homes.
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Affiliation(s)
- Pan Chen
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
| | - Hong Cai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China.,Institute of Advanced Studies in Humanities and Social Sciences, University of Macau, Macao, SAR, China
| | - Wei Bai
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China.,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China
| | - Qinge Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders, National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University & Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.,Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
| | - Gabor S Ungvari
- Section of Psychiatry, University of Notre Dame Australia, Fremantle, Australia.,Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao, Macao SAR, China. .,Centre for Cognitive and Brain Sciences, University of Macau, Macao, Macao SAR, China.
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Fusdahl P, Cummings J, Ballard C, Borda MG, Aarsland D. The impact of low dementia research funding on brain health for decision makers: A reflection on current health statistics. J Neurol Sci 2023; 447:120595. [PMID: 36867962 DOI: 10.1016/j.jns.2023.120595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/02/2023]
Affiliation(s)
- Peter Fusdahl
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Faculty of Medicine, University of Bergen, Stavanger, Norway.
| | - Jeffrey Cummings
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Chambers- Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences; University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Clive Ballard
- The Wolfson Centre for Age-Related Diseases, Kings College London, London, UK; College of Medicine and Health, University of Exeter, Exeter, UK
| | - Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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Engedal K, Benth JŠ, Gjøra L, Skjellegrind HK, Nåvik M, Selbæk G. Normative Scores on the Norwegian Version of the Mini-Mental State Examination. J Alzheimers Dis 2023; 92:831-842. [PMID: 36847004 DOI: 10.3233/jad-221068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND The Mini-Mental State Examination (MMSE), a simple test for measuring global cognitive function, is frequently used to evaluate cognition in older adults. To decide whether a score on the test indicates a significant deviation from the mean score, normative scores should be defined. Moreover, because the test may vary depending on its translation and cultural differences, normative scores should be established for national versions of the MMSE. OBJECTIVE We aimed to examine normative scores for the third Norwegian version of the MMSE. METHODS We used data from two sources: the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) and the Trøndelag Health Study (HUNT). After persons with dementia, mild cognitive impairment, and disorders that may cause cognitive impairment were excluded, the sample contained 1,050 cognitively healthy persons, 860 from NorCog, and 190 from HUNT, whose data we subjected to regression analyses. RESULTS The normative MMSE score varied from 25 to 29, depending on years of education and age. More years of education and younger age were associated with higher MMSE scores, and years of education was the strongest predictor. CONCLUSION Mean normative MMSE scores depend on test takers' years of education and age, with level of education being the strongest predictor.
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Affiliation(s)
- Knut Engedal
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway.,Health Service Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Linda Gjøra
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Håvard Kjesbu Skjellegrind
- HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Levanger, Norway
| | - Marit Nåvik
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Telemark Hospital Trust, Skien, Norway
| | - Geir Selbæk
- The Norwegian National Center for Aging and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Norway.,Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway
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Tangen GG, Sverdrup K, Taraldsen K, Persson K, Engedal K, Bekkhus-Wetterberg P, Knapskog AB. Mobility and associations with levels of cerebrospinal fluid amyloid β and tau in a memory clinic cohort. Front Aging Neurosci 2023; 15:1101306. [PMID: 36820757 PMCID: PMC9939466 DOI: 10.3389/fnagi.2023.1101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/19/2023] [Indexed: 02/08/2023] Open
Abstract
Background Mobility impairments, in terms of gait and balance, are common in persons with dementia. To explore this relationship further, we examined the associations between mobility and cerebrospinal fluid (CSF) core biomarkers for Alzheimer's disease (AD). Methods In this cross-sectional study, we included 64 participants [two with subjective cognitive decline (SCD), 13 with mild cognitive impairment (MCI) and 49 with dementia] from a memory clinic. Mobility was examined using gait speed, Mini-Balance Evaluation Systems test (Mini-BESTest), Timed Up and Go (TUG), and TUG dual-task cost (TUG DTC). The CSF biomarkers included were amyloid-β 42 (Aβ42), total-tau (t-tau), and phospho tau (p-tau181). Associations between mobility and biomarkers were analyzed through correlations and multiple linear regression analyses adjusted for (1) age, sex, and comorbidity, and (2) SCD/MCI vs. dementia. Results Aβ42 was significantly correlated with each of the mobility outcomes. In the adjusted multiple regression analyses, Aβ42 was significantly associated with Mini-BESTest and TUG in the fully adjusted model and with TUG DTC in step 1 of the adjusted model (adjusting for age, sex, and comorbidity). T-tau was only associated with TUG DTC in step 1 of the adjusted model. P-tau181 was not associated with any of the mobility outcomes in any of the analyses. Conclusion Better performance on mobility outcomes were associated with higher levels of CSF Aβ42. The association was strongest between Aβ42 and Mini-BESTest, suggesting that dynamic balance might be closely related with AD-specific pathology.
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Affiliation(s)
- Gro Gujord Tangen
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway,*Correspondence: Gro Gujord Tangen,
| | - Karen Sverdrup
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Karin Persson
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Engedal
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Steinsheim G, Malmedal W, Follestad T, Olsen B, Saga S. Contextual Factors Associated with Abuse of Home-Dwelling Persons with Dementia: A Cross-Sectional Exploratory Study of Informal Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2823. [PMID: 36833519 PMCID: PMC9957528 DOI: 10.3390/ijerph20042823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
One in six community-dwelling older adults experience elder abuse yearly, and persons with dementia are especially at risk. Although many risk factors for elder abuse have been identified, there are still knowledge gaps concerning risk and protective factors. This cross-sectional survey among Norwegian informal caregivers (ICGs) aimed to find individual, relational, and community factors associated with psychological and physical abuse of home-dwelling persons with dementia. This study involved 540 ICGs and was conducted from May to December 2021. Statistical analysis using penalized logistic regression with lasso was performed to find covariates associated with psychological and physical elder abuse. The most prominent risk factor for both subtypes of abuse was the caregiver being a spouse. In addition, risk factors for psychological abuse were having a higher caregiver burden, experiencing psychological aggression from the person with dementia, and the person with dementia being followed up by their general practitioner. For physical abuse, the protective factors were the ICG being female and having an assigned personal municipal health service contact, while the risk factors were the ICG attending a caregiver training program and experiencing physical aggression from the person with dementia and the person with dementia having a higher degree of disability. These findings add to the existing knowledge of risk and protective factors in elder abuse among home-dwelling persons with dementia. This study provides relevant knowledge for healthcare personnel working with persons with dementia and their caregivers and for the development of interventions to prevent elder abuse.
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Affiliation(s)
- Gunn Steinsheim
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
| | - Wenche Malmedal
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
| | - Turid Follestad
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olavs Hospital, 7030 Trondheim, Norway
| | - Bonnie Olsen
- Department of Family Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA 91803, USA
| | - Susan Saga
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
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Kolasa S, Bogen B, Nilsen RM, Nordahl SHG, Goplen FK, Engdahl B, Meldrum D, Berge JE, Wilhelmsen KT, Thingstad P, Aarhus L, Magnussen LH. Hearing threshold and physical performance in older people: a cross-sectional study from the HUNT4 cohort. Eur Geriatr Med 2023; 14:165-172. [PMID: 36396826 PMCID: PMC9902320 DOI: 10.1007/s41999-022-00713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the association between increased hearing loss and reduced physical performance in older people. METHODS Cross-sectional population-based study using data from the fourth wave of the Trøndelag Health Survey (HUNT4) in Norway. Data were obtained from the subproject HUNT4 Hearing which collected audiometric data of people > 70 years (N = 13,197). Analyses were performed on all participants who had completed audiometry and measured balance using the Short Physical Performance Battery (SPPB), which was scored from 0 (worst score) to 12. The hearing threshold was expressed as a pure tone average (PTA). Associations between the hearing threshold for the best and worst ear and physical performance were analyzed by linear regression models adjusted for age, sex, education, diabetes, and cardiovascular disease. Hearing threshold was indicated with steps of 10 dB. RESULTS Of 13,197 eligible participants, 4101 who completed audiometry and SPPB (52.3% women. mean age 76.3 years) were included. The analyses revealed an association between reduced SPPB and increased hearing threshold in the best ear (b = - 0.296; 95% CI - 0.343 to - 0. 249; P < 0.001) and the worst ear (b = - 0.229; 95% CI - 0.270 to - 0.189; P < 0.001). CONCLUSIONS In this population study, we found that the increased hearing threshold was associated to reduced physical performance as measured by SPPB. The association seemed to be strongest for the best ear. The association between hearing threshold and physical performance illustrates the importance of assessing physical performance in people with hearing loss to prevent the risk of falls and disability. The underlying causes of the associations between hearing loss and poorer physical performance are not fully understood and should be further investigated. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Sylwia Kolasa
- Department of Health and Function, Western Norway University of Applied Science, Post Box 7030, 5020, Bergen, Norway.
| | - Bård Bogen
- Department of Health and Function, Western Norway University of Applied Science, Post Box 7030, 5020, Bergen, Norway.,Department for Rehabilitation Services, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Roy Miodini Nilsen
- Department of Health and Function, Western Norway University of Applied Science, Post Box 7030, 5020, Bergen, Norway
| | - Stein Helge Glad Nordahl
- Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Frederik Kragerud Goplen
- Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Bo Engdahl
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Dara Meldrum
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
| | - Jan Erik Berge
- Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kjersti Thulin Wilhelmsen
- Department of Health and Function, Western Norway University of Applied Science, Post Box 7030, 5020, Bergen, Norway
| | - Pernille Thingstad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lisa Aarhus
- Department of Occupational Medicine and Epidemiology, National Institute of Occupational Health, Oslo, Norway
| | - Liv Heide Magnussen
- Department of Health and Function, Western Norway University of Applied Science, Post Box 7030, 5020, Bergen, Norway
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Aldridge CM. Low Glucocerebrosidase Activity Predicts Dementia in Parkinson Disease: Less Is Not More! Neurology 2023; 100:169-170. [PMID: 36257707 DOI: 10.1212/wnl.0000000000201575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 01/25/2023] Open
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Selbaek-Tungevåg S, Selbaek G, Strand BH, Myrstad C, Livingston G, Lydersen S, Bergh S, Ernstsen L. Insomnia and risk of dementia in a large population-based study with 11-year follow-up: The HUNT study. J Sleep Res 2023:e13820. [PMID: 36689779 DOI: 10.1111/jsr.13820] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 01/25/2023]
Abstract
Despite evidence suggesting that insomnia is associated with the risk of dementia and cognitive dysfunction, studies have shown mixed results. Dementia has a long prodromal phase, and studies with long follow-up are required to avoid reverse causality. In our 11-year follow-up study, we assessed whether probable insomnia disorder (PID) based on diagnostic criteria, and insomnia symptoms were associated with risk of all-cause dementia, Alzheimer's disease (AD) and cognition, measured with the Montreal Cognitive Assessment scale. We also examined if Apolipoprotein E genotype modified any associations with dementia through interaction. We analysed data from 7492 participants in the Norwegian Trøndelag Health Study. PID was not associated with all-cause dementia (odds ratio = 1.03, 95% confidence interval = 0.74-1.43), AD (odds ratio = 1.07, 95% confidence interval = 0.71-1.60) or Montreal Cognitive Assessment score (regression coefficient = 0.37, 95% confidence interval = -0.06 to 0.80). The insomnia symptom "difficulties maintaining sleep" was associated with a lower risk of all-cause dementia (odds ratio = 0.81, 95% confidence interval = 0.67-0.98), AD (odds ratio = 0.73, 95% confidence interval = 0.57-0.93), and better Montreal Cognitive Assessment score, mean 0.40 units (95% confidence interval = 0.15-0.64). No interaction with Apolipoprotein E genotype was found. PID and insomnia symptoms did not increase the risk of dementia in our study. More research with longer follow-up is needed, and future studies should explore if the associations to dementia risk vary across insomnia subtypes.
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Affiliation(s)
- Selma Selbaek-Tungevåg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.,Surgical Department, Innlandet Hospital Trust, Lillehammer, Norway
| | - Geir Selbaek
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjørn Heine Strand
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department for Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Christian Myrstad
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK.,Camden and Islington NHS Foundation Trust, London, UK
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sverre Bergh
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Research Centre for Age-Related Functional Decline, Innlandet Hospital Trust, Brumunddal, Norway
| | - Linda Ernstsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Wagle J, Selbæk G, Benth JŠ, Gjøra L, Rønqvist TK, Bekkhus-Wetterberg P, Persson K, Engedal K. The CERAD Word List Memory Test: Normative Data Based on a Norwegian Population-Based Sample of Healthy Older Adults 70 Years and Above. The HUNT Study. J Alzheimers Dis 2023; 91:321-343. [PMID: 36404547 DOI: 10.3233/jad-220672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The CERAD Word List Memory Test (WLMT) is widely used in the assessment of older adults with suspected dementia. Although normative data of the WLMT exist in many different regions of the world, normative data based on large population-based cohorts from the Scandinavian countries are lacking. OBJECTIVE To develop normative data for the WLMT based on a large population-based Norwegian sample of healthy older adults aged 70 years and above, stratified by age, gender, and education. METHODS A total of 6,356 older adults from two population-based studies in Norway, HUNT4 70 + and HUNT4 Trondheim 70+, were administered the WLMT. Only persons with normal cognitive function were included. We excluded persons with a diagnosis of mild cognitive impairment (MCI) and dementia, and persons with a history of stroke and/or depression. This resulted in 3,951 persons aged between 70 and 90 years, of whom 56.2% were females. Regression-based normative data were developed for this sample. RESULTS Age, gender, and education were significant predictors of performance on the WLMT list-learning subtests and the delayed recall subtest, i.e., participants of younger age, female sex, and higher education level attained higher scores compared to participants of older age, male sex, and lower level of education. CONCLUSION Regression-based normative data from the WMLT, stratified by age, gender, and education from a large population-based Norwegian sample of cognitively healthy older adults aged 70 to 90 years are presented. An online norm calculator is available to facilitate scoring of the subtests (in percentiles and z-scores).
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Affiliation(s)
- Jørgen Wagle
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Geir Selbæk
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Linda Gjøra
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Thale Kinne Rønqvist
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Karin Persson
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Knut Engedal
- The Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
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Thorsen K, Johannessen A. How gender matters in demanding caring for a spouse with young-onset dementia. A narrative study. J Women Aging 2023; 35:81-97. [PMID: 35722752 DOI: 10.1080/08952841.2022.2087455] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The gendered aspects of extraordinary demanding spousal caring for people with young-onset dementia have been scarcely researched. AIM To analyze spouses' experiences of the meaning, content, and effort of intensive caring for spouses/partners with young-onset frontotemporal dementia (YO-FTD), concentrating on a female perspective. METHOD A qualitative Norwegian study using narrative interviews with 10 wives and 6 husbands were conducted in 2014 and 2015. FINDINGS The analysis resulted in four gendered main themes: Different caregiving periods, Distancing: experiencing a transformed spouse and relationship, Social isolation, and Needing assistance and relief. A case analysis of wives' and men's stories was applied, especially focusing on a wife's story, to examine the detailed interrelationships between life situation, caring demands, experiences, and reactions. Spousal care is influenced by gendered caring norms and roles. The study finds marked differences between wives and husbands in the meaning, content and sustainability of care, and needs for support vary. Wives endured more stress longer than husbands, with a greater emotional impact and negative health consequences, and their needs are more easily neglected. Husbands presented their needs more efficiently and obtained public relief earlier. CONCLUSION Women may need more support earlier during different stages of caring for a spouse with YO-FTD. They need gender sensitive person-centered support to live their own lives and preserve their selves.
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Affiliation(s)
- Kirsten Thorsen
- Vestfold Hospital Trust, The Norwegian National Centre for Ageing and Health, Tønsberg, Norway.,Oslo Metropolitan University, Oslo, Norway
| | - Aud Johannessen
- Vestfold Hospital Trust, The Norwegian National Centre for Ageing and Health, Tønsberg, Norway.,Faculty of Health and Social Sciences, Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Kongsberg, Norway
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46
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Kardashyan RA, Pronin VY, Medvedev VE. [Organic mental disorders with comorbid alcoholism in the elderly]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:27-33. [PMID: 38147379 DOI: 10.17116/jnevro202312312127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Elderly people are particularly vulnerable to comorbid disorders. The age-related weakness, cognitive decline, and criticism create favorable conditions for the formation of traumatic situations and is often accompanied by an increase in alcohol consumption, which in some cases leads to the formation of mental and physical dependence. Alcohol abuse leads to exacerbation of somatic disorders, the frequency of which increases with age. Alcoholism in the elderly leads to the accelerated development of organic mental disorders of varying severity. In turn, organic mental disorders lead to aggravation and complication of alcoholism. The formed comorbid disorder makes it difficult to diagnose and provide therapeutic and preventive measures.
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Affiliation(s)
- R A Kardashyan
- Russian University of Peoples' Friendship, Moscow, Russia
| | - V Yu Pronin
- Podolsk Narcological Dispensary of the Ministry of Health of the Moscow Region, Podolsk, Russia
| | - V E Medvedev
- Russian University of Peoples' Friendship, Moscow, Russia
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47
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Asante EO, Mai XM, Eldholm RS, Skjellegrind HK, Kolberg M, Brumpton BM, Selbæk G, Chen Y, Sun YQ. Vitamin D Status Over Time and Cognitive Function in Norwegian Older Adults: A Prospective Cohort of the HUNT Study. J Nutr Health Aging 2023; 27:30-37. [PMID: 36651484 DOI: 10.1007/s12603-022-1867-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the association between vitamin D status and cognitive function in population studies. The use of one-time vitamin D measurement in cognitive health studies may not reflect long-term vitamin D status in the body. OBJECTIVE We aimed to examine the relationship of vitamin D status measured over time with the risk of neurocognitive disorders (NCDs) in Norwegian older adults. DESIGN Prospective cohort study. SETTING Regional, Trøndelag Health Study. PARTICIPANTS This study followed a random cohort of 717 participants from HUNT2 (1995-97) and HUNT3 (2006-08) to HUNT4 70+ (2017-19). The mean age at HUNT4 70+ was 77.7 years. METHODS Seasonal-standardized serum 25-hydroxyvitamin D [25(OH)D] levels in HUNT2 and HUNT3 were averaged and used as either a categorical variable (<50 and ≥50 nmol/L) or a continuous variable (per 25 nmol/L decrease). In the cohort aged 70 years or over (HUNT4 70+), NCDs consisting of mild cognitive impairment (MCI) and dementia were diagnosed by clinical experts according to the DSM-5 criteria. Logistic and linear regression models were used to estimate odds ratios (ORs) and regression coefficients (beta) with 95% confidence intervals (CIs) to assess the relationship between 25(OH)D levels and the risk of NCDs or the Montreal Cognitive Assessment (MoCA) score. RESULTS In total, 347 (48.4%) had NCDs in HUNT4, with 33.3% having MCI and 15.1% having dementia. Compared with participants with serum 25(OH)D ≥50 nmol/L, those with 25(OH)D <50 nmol/L had a similar risk of NCDs (OR 1.05, 95% CI 0.76 to 1.46). No association was observed with the risk of MCI (OR 1.01, 95% CI 0.71 to 1.44) or dementia (OR 1.16, 95% CI 0.70 to 1.92), respectively. In a subsample of participants evaluated with the MoCA (n=662), a 25 nmol/L decrease in serum 25(OH)D was not associated with a change in MoCA score (beta 0.33, 95% CI -0.17 to 0.85). CONCLUSION Vitamin D insufficiency defined by two times measurements of serum 25(OH)D with a 10-year interval was not associated with the risk of NCDs in a cohort of older Norwegian adults. Future studies utilizing multiple vitamin D measurements with a longer follow-up duration and larger sample size are warranted.
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Affiliation(s)
- E O Asante
- Ernest Obeng Asante, Norwegian University of Science and Technology, Trondheim, Sor-Trondelag, Norway,
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48
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Sandmoe A, Myhre J, Iversen MH, Eriksen S, Lichtwarck B. Vold, overgrep, utelatt helsehjelp, forsømmelser og aggresjon:Begrepsbruk i en norsk sykehjemskontekst. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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49
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Steinsheim G, Saga S, Olsen B, Broen HK, Malmedal W. Abusive episodes among home-dwelling persons with dementia and their informal caregivers: a cross-sectional Norwegian study. BMC Geriatr 2022; 22:852. [PMID: 36371161 PMCID: PMC9655791 DOI: 10.1186/s12877-022-03569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Elder abuse is a serious issue with a global prevalence of 15.7% in the community setting. Persons with dementia are at higher risk of elder abuse than the older population in general. With a high and increasing prevalence of dementia this issue cannot be neglected. Hence, the aims of this study were 1) to describe the proportion of abusive episodes among home-dwelling persons with dementia and their informal caregivers, and 2) to explore differences between informal caregivers who have reported committing and not committing abusive acts. Methods A cross-sectional survey was conducted among informal caregivers of home-dwelling persons with dementia in Norway from May to December 2021 with a total of 549 participants. Results Two-thirds of informal caregivers had committed at least one abusive episode toward the person with dementia in the past year (63.5% psychological abuse, 9.4% physical abuse, 3.9% financial abuse, 2.4% sexual abuse, 6.5% neglect). One-third of informal caregivers had experienced aggression from the person with dementia (33.9% psychological abuse, 7.8% physical abuse, 1.1% financial abuse, 1.4% sexual abuse). Tests for independence showed that the risk of abusive episodes from informal caregivers toward persons with dementia was higher when the informal caregiver was a spouse/partner of the person with dementia and if they experienced aggression from the person with dementia. Conclusions The results demonstrate that a majority of informal caregivers commit some form of abusive episodes, and episodes that fall within the scope of psychological abuse are most frequent. This study expands knowledge about elder abuse among home-dwelling persons with dementia. Increased understanding of the dynamics of abuse is essential to be able to reduce risk and prevent abuse.
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Kjelvik G, Rokstad AMM, Stuebs J, Thingstad P, Deckers K, Köhler S, Selbæk G. Public knowledge about dementia risk reduction in Norway. BMC Public Health 2022; 22:2046. [DOI: 10.1186/s12889-022-14433-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
Several modifiable lifestyle risk factors for dementia have been identified, but it is unclear how much the Norwegian public knows about the relationship between lifestyle and brain health. Therefore, this study aimed to investigate knowledge about modifiable dementia risk and protective factors and beliefs and attitudes towards dementia and dementia risk reduction in a randomly selected subsample of the Norwegian population.
Methods
The total sample (n = 1435) included individuals aged 40–70 years from four counties (Oslo, Innlandet, Nordland and Trøndelag) in Norway. Two online questionnaires were used to measure (1) awareness about dementia risk reduction and (2) an individual`s motivation to change behaviour for dementia risk reduction (MOCHAD-10).
Results
Of the participants, 70% were aware of the potential of dementia risk reduction in general. Physical inactivity (86%), cognitive inactivity (84%) and social isolation (80%) were the most frequently recognised dementia risk factors. On the other hand, diabetes (26%), coronary heart disease (19%), hearing loss (18%) and chronic kidney disease (7%) were less often recognised as dementia risk factors. Comparing men and women, the only significant difference was that women were more likely to report parents with dementia as a risk factor compared to men. Gender, age and educational differences were seen in beliefs and attitudes towards dementia prevention:women reported more negative feelings and attitudes towards dementia than men;those aged 40–49 years – more likely than older age groups – reported that ‘knowing family members with dementia’ or ‘having risk factors’ made them believe they had to change their lifestyle and behaviour.
Conclusions
The results indicate that 70% of the Norwegian public are aware of the potential for dementia risk reduction in general. However, there are major gaps in existing knowledge, particularly for cardiovascular risk factors such as hypertension, coronary heart disease, hypercholesterolemia and metabolic factors (diabetes, obesity). These findings underline the importance of further informing the Norwegian public about lifestyle-related risk and protective factors of dementia. Differences in beliefs and attitudes towards dementia risk prevention by age, gender and education require tailored public risk reduction interventions.
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