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Overton M, Skoog J, Laukka EJ, Bodin TH, Mattsson AD, Sjöberg L, Hofer SM, Johansson L, Kulmala J, Kivipelto M, Solomon A, Skoog I, Kåreholt I, Sindi S. Sleep disturbances and change in multiple cognitive domains among older adults: a multicenter study of five Nordic cohorts. Sleep 2024; 47:zsad244. [PMID: 37708350 PMCID: PMC10925948 DOI: 10.1093/sleep/zsad244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/31/2023] [Indexed: 09/16/2023] Open
Abstract
STUDY OBJECTIVES We examined and compared cross-sectional and longitudinal associations between self-reported sleep disturbances and various cognitive domains in five separate Nordic European longitudinal aging studies (baseline N = 5631, mean age = 77.7, mean follow-up = 4.16 years). METHODS Comparable sleep parameters across studies included reduced sleep duration/quality, insomnia symptoms (sleep latency, waking up at night, and early awakenings), short and long sleep duration, and daytime napping. The cognitive domains were episodic memory, verbal fluency, perceptual speed, executive functioning, and global cognition (aggregated measure). A series of mixed linear models were run separately in each study and then compared to assess the level and rate of change in cognitive functioning across each sleep disturbance parameter. Models were adjusted for age, sex, education, hypnotic usage, depressive symptoms, lifestyle factors, cardiovascular, and metabolic conditions. By using a coordinated analytic approach, comparable construct-level measurements were generated, and results from identical statistical models were qualitatively compared across studies. RESULTS While the pattern of statistically significant results varied across studies, subjective sleep disturbances were consistently associated with worse cognition and steeper cognitive decline. Insomnia symptoms were associated with poorer episodic memory and participants sleeping less or more than 7-8 hours had a steeper decline in perceptual speed. In addition, daytime napping (>2 hours) was cross-sectionally and longitudinally associated with all examined cognitive domains. Most observed associations were study-specific (except for daytime napping), and a majority of association estimates remained significant after adjusting for covariates. CONCLUSION This rigorous multicenter investigation further supports the importance of sleep disturbance, including insomnia, long and short sleep duration, and daytime napping on baseline cognitive functioning and rate of change among older adults. These sleep factors may be targeted in future lifestyle interventions to reduce cognitive decline.
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Affiliation(s)
- Marieclaire Overton
- Division of Geriatric Medicine, Department of Clinical Sciences in Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Johan Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Erika J Laukka
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Timothy Hadarsson Bodin
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Alexander Darin Mattsson
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Scott M Hofer
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA
| | - Lena Johansson
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Jenni Kulmala
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
- Theme Inflammation and Aging. Karolinska University Hospital, Stockholm, Sweden
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ingmar Skoog
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Institute of Gerontology, School of Health and Welfare, Aging Research Network – Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
| | - Shireen Sindi
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College London, London, UK
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Etholén A, Kouvonen A, Hänninen M, Kulmala J, Rahkonen O, Mänty M, Lallukka T. Individual and dual trajectories of insomnia symptoms and body mass index before and after retirement and their associations with changes in subjective cognitive functioning. Prev Med 2024; 179:107830. [PMID: 38142966 DOI: 10.1016/j.ypmed.2023.107830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND We examined individual and dual trajectories of insomnia symptoms and body mass index (BMI) before and after retirement, and their associations with changes in subjective cognitive functioning after retirement. METHODS We used the Helsinki Health Study's (n = 2360, 79% women, aged 40-60 at baseline, Finland) repeated surveys to identify the developmental patterns of insomnia symptoms and BMI (2000-2017) and changes in subjective cognitive functioning (2017-2022). We analysed the data using latent group-based dual trajectory modelling and logistic regression analysis. RESULTS Three latent groups were identified for insomnia symptoms (stable low, decreasing and increasing symptoms) and BMI (stable healthy weight, stable overweight and stable obesity). Insomnia symptoms were associated with declining subjective cognitive functioning and largely explained the effects in the dual models. CONCLUSION The association between dual trajectories of insomnia symptoms and BMI with subjective cognitive decline is dominated by insomnia symptoms.
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Affiliation(s)
- Antti Etholén
- Department of Public Health, PO BOX 20 (Tukholmankatu 8 B), 00014 University of Helsinki, Finland.
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, POB 54, 00014 University of Helsinki, Finland; Centre for Public Health, Queen's University Belfast, Royal Victoria Hospital, Belfast BT12 6BA, UK.
| | - Mirja Hänninen
- Department of Public Health, PO BOX 20 (Tukholmankatu 8 B), 00014 University of Helsinki, Finland; Western Uusimaa Wellbeing Services County, Social and Health Care Services, P.O. BOX 33, 02033 Espoo, Finland.
| | - Jenni Kulmala
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland; Population Health Unit, Finnish Institute for Health and Welfare, POB 30, 00271 Helsinki, Finland; Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solnavägen 1, 171 77 Solna, Sweden.
| | - Ossi Rahkonen
- Department of Public Health, PO BOX 20 (Tukholmankatu 8 B), 00014 University of Helsinki, Finland.
| | - Minna Mänty
- Department of Public Health, PO BOX 20 (Tukholmankatu 8 B), 00014 University of Helsinki, Finland.
| | - Tea Lallukka
- Department of Public Health, PO BOX 20 (Tukholmankatu 8 B), 00014 University of Helsinki, Finland.
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Wimo A, Handels R, Antikainen R, Eriksdotter M, Jönsson L, Knapp M, Kulmala J, Laatikainen T, Lehtisalo J, Peltonen M, Sköldunger A, Soininen H, Solomon A, Strandberg T T, Tuomilehto J, Ngandu T, Kivipelto M. Response to "Comment on 'Dementia prevention: The potential long-term cost-effectiveness of the FINGER prevention program'". Alzheimers Dement 2023; 19:4760-4763. [PMID: 37130291 DOI: 10.1002/alz.13044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 05/04/2023]
Affiliation(s)
- Anders Wimo
- Department of NVS, Centre of Alzheimer research, division of neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Ron Handels
- Department of NVS, Centre of Alzheimer research, division of neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
- Deperatment of Psychiatry and Neuropsychology, Maastricht University
- Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht, The Netherlands
| | - Riitta Antikainen
- Center for Life Course Health Research/Geriatrics, University of Oulu, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Maria Eriksdotter
- Department of NVS, Centre of Alzheimer research, division of clinical geriatrics Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska university hospital, Stockholm, Sweden
| | - Linus Jönsson
- Department of NVS, Centre of Alzheimer research, division of neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Knapp
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jenni Kulmala
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health and Welfate, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jenni Lehtisalo
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Markku Peltonen
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden
| | - Anders Sköldunger
- Department of NVS, Centre of Alzheimer research, division of neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Hilkka Soininen
- Institute of Clinical Medicine, neurology, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Institute of Clinical Medicine, neurology, University of Eastern Finland, Kuopio, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Timo Strandberg T
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
- National School of Public Health, Madrid, Spain
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Population Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- South Ostrobothnia Central Hospital, Seinäjoki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tiia Ngandu
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Theme Inflammation and Aging, Karolinska university hospital, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
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Tirkkonen A, Törmäkangas T, Kulmala J, Hänninen T, Neely AS, Sipilä S. Participant characteristics associated with the effects of a physical and cognitive training program on executive functions. Front Aging Neurosci 2022; 14:1038673. [PMID: 36389079 PMCID: PMC9640753 DOI: 10.3389/fnagi.2022.1038673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background Physical and cognitive interventions have been shown to induce positive effects on older adults’ executive functioning. However, since participants with different background characteristics may respond differently to such interventions, we investigated whether training effects on executive functions were associated with sex, training compliance, and age. We also investigated if change in global cognition was associated with physical and cognitive training intervention-induced changes in executive functions. Methods Exploratory data from a randomized controlled trial were analyzed. Participants were 70–85-year-old men and women who received a 12-month physical (PT) or physical and cognitive training (PTCT) intervention. Measurements of executive functions related to inhibition (Stroop), set shifting (Trail Making Test B) and updating (Verbal Fluency) were performed at baseline and 12 months. Data were analyzed using a longitudinal linear path model for the two measurements occasion. Results Stroop improved significantly more in women and participants in the low compliance subgroup who received PTCT than in counterparts in the PT subgroup (difference –8.758, p = 0.001 and difference –8.405, p = 0.010, respectively). In addition, TMT B improved after the intervention in the low compliance PTCT subgroup and worsened in the corresponding PT subgroup (difference –15.034, p = 0.032). No other significant associations were observed. Conclusion Executive functions in women and in the participants, who only occasionally engaged in training showed greater improvement after the PTCT than PT intervention. However, the additional extra benefit gained from the PTCT intervention was uniquely expressed in each executive function measured in this study.
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Affiliation(s)
- Anna Tirkkonen
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- *Correspondence: Anna Tirkkonen,
| | - Timo Törmäkangas
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jenni Kulmala
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre, Tampere University, Tampere, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tuomo Hänninen
- NeuroCenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden
- Engineering Psychology, Luleå University of Technology, Luleå, Sweden
| | - Sarianna Sipilä
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Wimo A, Handels R, Antikainen R, Eriksdotter M, Jönsson L, Knapp M, Kulmala J, Laatikainen T, Lehtisalo J, Peltonen M, Sköldunger A, Soininen H, Solomon A, Strandberg T, Tuomilehto J, Ngandu T, Kivipelto M. Dementia prevention: The potential long-term cost-effectiveness of the FINGER prevention program. Alzheimers Dement 2022; 19:999-1008. [PMID: 35841619 DOI: 10.1002/alz.12698] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/15/2022] [Accepted: 04/27/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The aim of this study was to estimate the potential cost-effectiveness of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) program. METHODS A life-time Markov model with societal perspective, simulating a cohort of people at risk of dementia reflecting usual care and the FINGER program. RESULTS Costs were 1,653,275 and 1,635,346 SEK and quality-adjusted life years (QALYs) were 8.636 and 8.679 for usual care and the FINGER program, respectively, resulting in savings of 16,928 SEK (2023 US$) and 0.043 QALY gains per person, supporting extended dominance for the FINGER program. A total of 1623 dementia cases were avoided with 0.17 fewer person-years living with dementia. The sensitivity analysis confirmed the conclusions in most scenarios. DISCUSSION The model provides support that programs like FINGER have the potential to be cost-effective in preventing dementia. Results at the individual level are rather modest, but the societal benefits can be substantial because of the large potential target population.
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Affiliation(s)
- Anders Wimo
- Department of NVS, Centre of Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Ron Handels
- Department of NVS, Centre of Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
- Deperatment of Psychiatry and Neuropsychology, Maastricht University, Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht, the Netherlands
| | - Riitta Antikainen
- Center for Life Course Health Research/Geriatrics, University of Oulu, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Maria Eriksdotter
- Department of NVS, Centre of Alzheimer Research, Division of Clinical Geriatrics Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Linus Jönsson
- Department of NVS, Centre of Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Martin Knapp
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Jenni Kulmala
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jenni Lehtisalo
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Markku Peltonen
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anders Sköldunger
- Department of NVS, Centre of Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
- Population Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Timo Strandberg
- Department of Public Health, University of Helsinki, Helsinki, Finland
- National School of Public Health, Madrid, Spain
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
- South Ostrobothnia Central Hospital, Seinäjoki, Finland
- Diabetes Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tiia Ngandu
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
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Chowdhary N, Barbui C, Anstey KJ, Kivipelto M, Barbera M, Peters R, Zheng L, Kulmala J, Stephen R, Ferri CP, Joanette Y, Wang H, Comas-Herrera A, Alessi C, Suharya Dy K, Mwangi KJ, Petersen RC, Motala AA, Mendis S, Prabhakaran D, Bibi Mia Sorefan A, Dias A, Gouider R, Shahar S, Ashby-Mitchell K, Prince M, Dua T. Reducing the Risk of Cognitive Decline and Dementia: WHO Recommendations. Front Neurol 2022; 12:765584. [PMID: 35082745 PMCID: PMC8784726 DOI: 10.3389/fneur.2021.765584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
With population ageing worldwide, dementia poses one of the greatest global challenges for health and social care in the 21st century. In 2019, around 55 million people were affected by dementia, with the majority living in low- and middle-income countries. Dementia leads to increased costs for governments, communities, families and individuals. Dementia is overwhelming for the family and caregivers of the person with dementia, who are the cornerstone of care and support systems throughout the world. To assist countries in addressing the global burden of dementia, the World Health Organisation (WHO) developed the Global Action Plan on the Public Health Response to Dementia 2017–2025. It proposes actions to be taken by governments, civil society, and other global and regional partners across seven action areas, one of which is dementia risk reduction. This paper is based on WHO Guidelines on risk reduction of cognitive decline and dementia and presents recommendations on evidence-based, multisectoral interventions for reducing dementia risks, considerations for their implementation and policy actions. These global evidence-informed recommendations were developed by WHO, following a rigorous guideline development methodology and involved a panel of academicians and clinicians with multidisciplinary expertise and representing geographical diversity. The recommendations are considered under three broad headings: lifestyle and behaviour interventions, interventions for physical health conditions and specific interventions. By supporting health and social care professionals, particularly by improving their capacity to provide gender and culturally appropriate interventions to the general population, the risk of developing dementia can be potentially reduced, or its progression delayed.
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Affiliation(s)
- Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Department of Neuroscience, Biomedicine and Movement Sciences, WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | | | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,The Ageing Epidemiology Research Unit, Imperial College London, School of Public Health, London, United Kingdom.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Mariagnese Barbera
- The Ageing Epidemiology Research Unit, Imperial College London, School of Public Health, London, United Kingdom.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ruth Peters
- University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - Lidan Zheng
- University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Sydney, NSW, Australia
| | - Jenni Kulmala
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
| | - Ruth Stephen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Cleusa P Ferri
- Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Yves Joanette
- Canadian Institutes of Health Research, Government of Canada, Ottawa, ON, Canada
| | - Huali Wang
- Dementia Care and Research Center, Peking University Institute of Mental Health, Beijing, China.,Beijing Dementia Key Laboratory, Beijing, China
| | - Adelina Comas-Herrera
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
| | | | | | - Kibachio J Mwangi
- Division of Non-communicable Diseases, Ministry of Health, Nairobi, Kenya
| | | | | | | | | | | | - Amit Dias
- Department of Preventive and Social Medicine, Goa Medical College, Goa, India
| | - Riadh Gouider
- Faculty of Medicine, Clinical Investigation Centre Neurosciences and Mental Health Razi University Hospital, Tunis, Tunisia.,Faculty of Medicine, University Tunis El Manar, Tunis, Tunisia
| | - Suzana Shahar
- Centre for Healthy Aging and Wellness, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | | | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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7
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Kulmala J, Tiilikainen E, Lisko I, Ngandu T, Kivipelto M, Solomon A. Personal Social Networks of Community-Dwelling Oldest Old During the Covid-19 Pandemic-A Qualitative Study. Front Public Health 2022; 9:770965. [PMID: 35004583 PMCID: PMC8739883 DOI: 10.3389/fpubh.2021.770965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic and its related restrictions have affected the everyday life of older people. Advanced age is a significant predisposing factor for a more severe COVID-19 infection, increasing the risk for hospitalization and mortality. Even though restrictions have been, thus, well-grounded, they may also have had detrimental effects on the social well-being of older people. Personal networks and social activity are known protective factors against the premature decline in health and functioning, and it is widely acknowledged that social isolation increases feelings of loneliness, poor quality of life, and even the risk for diseases and disabilities among older adults. This qualitative study investigated changes in personal networks among community-dwelling oldest-old individuals (persons aged 80 and over) during the first and second waves of the COVID-19 pandemic in Finland. The data is part of the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE85+) study, which is an ongoing large longitudinal population-based study in Finland. In this qualitative sub-study, we analyzed fifteen in-depth telephone interviews using directed content analyses and identified five types of changes in personal social networks during the pandemic. In type 1, all social contacts were significantly reduced due to official recommendations and fear of the virus. Type 2 included modified ways of being socially active i.e., by deploying new technology, and in type 3, social contacts increased during the lockdown. In type 4, personal social networks were changed unexpectedly or dramatically due to a death of a spouse, for example. In type 5, we observed stable social networks, which had not been affected by the pandemic. At an individual level, one person could have had different types of changes during the pandemic. These results highlight the heterogeneity of the oldest olds' personal social networks and changes related to them during the exceptional times of the COVID-19 pandemic. Social activity and personal networks play an important role in the well-being of the oldest old, but individual situations, needs, and preferences toward personal social networks should be taken into account when planning social activities, policies, and interventions.
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Affiliation(s)
- Jenni Kulmala
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland.,Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Elisa Tiilikainen
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Inna Lisko
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Faculty of Sport and Health Sciences and Gerontology Research Center (GEREC), University of Jyväskylä, Jyväskylä, Finland
| | - Tiia Ngandu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom.,Clinical Trials Unit, Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Helsinki, Finland.,Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
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8
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Kekkonen E, Hall A, Kulmala J, Lisko I, Ngandu T, Barbera M, Hallikainen M, Soininen H, Kivipelto M, Solomon A. Association between sleep, depressive symptoms, and pain with physical activity and physical functioning in the oldest old: CAIDE 85+ study. Alzheimers Dement 2021. [DOI: 10.1002/alz.051092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Anette Hall
- University of Eastern Finland Kuopio Finland
| | - Jenni Kulmala
- Gerontology Research Center Tampere Finland
- Karolinska Institutet Stockholm Sweden
- Finnish Institute for Health and Welfare Helsinki Finland
| | - Inna Lisko
- Gerontology Research Center Jyväskylä Finland
| | - Tiia Ngandu
- Finnish Institute for Health and Welfare Helsinki Finland
| | | | | | | | - Miia Kivipelto
- University of Eastern Finland Kuopio Finland
- Karolinska Institutet Stockholm Sweden
- Imperial College London London United Kingdom
| | - Alina Solomon
- University of Eastern Finland Kuopio Finland
- Karolinska Institutet Stockholm Sweden
- Imperial College London London United Kingdom
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9
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Lisko I, Ngandu T, Solomon A, Kivipelto M, Kulmala J. Social functioning and cognitive impairment among the oldest old. Alzheimers Dement 2021. [DOI: 10.1002/alz.053490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Inna Lisko
- University of Jyväskylä Jyväskylä Finland
- Karolinska Institutet Stockholm Sweden
- Gerontology Research Center Jyväskylä Finland
| | - Tiia Ngandu
- Karolinska Institutet Stockholm Sweden
- Finnish Institute for Health and Welfare Helsinki Finland
| | - Alina Solomon
- Karolinska Institutet Stockholm Sweden
- University of Eastern Finland Kuopio Finland
- Imperial College London London United Kingdom
| | - Miia Kivipelto
- Karolinska Institutet Stockholm Sweden
- University of Eastern Finland Kuopio Finland
- Imperial College London London United Kingdom
- Medical Unit Aging, Karolinska University Hospital Stockholm Sweden
| | - Jenni Kulmala
- Karolinska Institutet Stockholm Sweden
- Finnish Institute for Health and Welfare Helsinki Finland
- Tampere University Tampere Finland
- Gerontology Research Center Tampere Finland
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10
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Stephen R, Barbera M, Peters R, Ee N, Zheng L, Lehtisalo J, Kulmala J, Håkansson K, Chowdhary N, Dua T, Solomon A, Anstey KJ, Kivipelto M. Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions. Front Neurol 2021; 12:763573. [PMID: 34764935 PMCID: PMC8577650 DOI: 10.3389/fneur.2021.763573] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 11/13/2022] Open
Abstract
The first WHO guidelines for risk reduction of cognitive decline and dementia marked an important milestone in the field of dementia prevention. In this paper, we discuss the evidence reviewed as part of the guidelines development and present the main themes emerged from its synthesis, to inform future research and policies on dementia risk reduction. The role of intervention effect-size; the mismatch between observational and intervention-based evidence; the heterogeneity of evidence among intervention trials; the importance of intervention duration; the role of timing of exposure to a certain risk factor and interventions; the relationship between intervention intensity and response; the link between individual risk factors and specific dementia pathologies; and the need for tailored interventions emerged as the main themes. The interaction and clustering of individual risk factors, including genetics, was identified as the overarching theme. The evidence collected indicates that multidomain approaches targeting simultaneously multiple risk factors and tailored at both individual and population level, are likely to be most effective and feasible in dementia risk reduction. The current status of multidomain intervention trials aimed to cognitive impairment/dementia prevention was also briefly reviewed. Primary results were presented focusing on methodological differences and the potential of design harmonization for improving evidence quality. Since multidomain intervention trials address a condition with slow clinical manifestation—like dementia—in a relatively short time frame, the need for surrogate outcomes was also discussed, with a specific focus on the potential utility of dementia risk scores. Finally, we considered how multidomain intervention could be most effectively implemented in a public health context and the implications world-wide for other non-communicable diseases targeting common risk factors, taking into account the limited evidence in low-middle income countries. In conclusion, the evidence from the first WHO guidelines for risk reduction of cognitive decline and dementia indicated that “one size does not fit all,” and multidomain approaches adaptable to different populations and individuals are likely to be the most effective. Harmonization in trial design, the use of appropriate outcome measures, and sustainability in large at-risk populations in the context of other chronic disorders also emerged as key elements.
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Affiliation(s)
- Ruth Stephen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mariagnese Barbera
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,The Ageing Epidemiology Research Unit, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Ruth Peters
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Nicole Ee
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Lidan Zheng
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Jenni Lehtisalo
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jenni Kulmala
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Krister Håkansson
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Neerja Chowdhary
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Tarun Dua
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Alina Solomon
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,The Ageing Epidemiology Research Unit, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.,Neuroscience Research Australia, Randwick, NSW, Australia
| | - Miia Kivipelto
- The Ageing Epidemiology Research Unit, Faculty of Medicine, School of Public Health, Imperial College London, London, United Kingdom.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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11
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Kulmala J, Rosenberg A, Ngandu T, Hemiö K, Tenkula T, Hyytiä A, Vienola M, Huhtamäki-Kuoppala M, Saarinen A, Korkki S, Laatikainen T, Solomon A, Kivipelto M. Facilitators and barriers to implementing lifestyle intervention programme to prevent cognitive decline. Eur J Public Health 2021; 31:816-822. [PMID: 34448856 PMCID: PMC8505000 DOI: 10.1093/eurpub/ckab087] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Finnish Intervention Study to Prevent Cognitive Impairment and Disability is a randomized controlled trial that has tested the efficacy of a multidomain intervention targeting modifiable risk factors to prevent cognitive impairment/dementia. A combination of healthy diet, physical, social and cognitive activity, and management of cardiovascular risks was shown to be an effective model to promote brain health among older people. The aim of this qualitative study was to explore healthcare professionals' perceptions of facilitators and barriers to implementing this lifestyle programme into health care. METHODS Four semi-structured focus group interviews were conducted among healthcare professionals working in primary care and in non-governmental organizations (N=27). Participants were asked to discuss their perceptions of facilitators and barriers for implementing the multidomain intervention into clinical practice. Interviews were analyzed using content analysis. RESULTS Barriers and facilitators described by the healthcare professionals were related to infrastructure and resources, client's personal characteristics and the lifestyle intervention itself. These main categories included several sub-categories related to knowledge, motivation, resources, individualization and collaboration. The interviewees pointed out that more education on dementia prevention is needed, the work should be coordinated efficiently, resources to provide preventive health care should be adequate and multiprofessional collaboration is needed. CONCLUSIONS Transferring a lifestyle intervention from a trial-setting to real life requires knowledge about the factors that influence effective implementation. Identifying drivers and constraints of successful implementation helps to design and tailor future prevention programmes, increases motivation and adherence and supports system change.
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Affiliation(s)
- Jenni Kulmala
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland.,Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Anna Rosenberg
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tiia Ngandu
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Katri Hemiö
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tarja Tenkula
- Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
| | - Arja Hyytiä
- Southern Ostrobothnia Central Hospital, Seinäjoki, Finland
| | | | | | | | - Saana Korkki
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | - Alina Solomon
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Miia Kivipelto
- Department of Public Health and Welfare, Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden.,Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
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12
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Solomon A, Stephen R, Altomare D, Carrera E, Frisoni GB, Kulmala J, Molinuevo JL, Nilsson P, Ngandu T, Ribaldi F, Vellas B, Scheltens P, Kivipelto M. Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services-part 4 of 6. Alzheimers Res Ther 2021; 13:171. [PMID: 34635167 PMCID: PMC8507202 DOI: 10.1186/s13195-021-00875-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/06/2021] [Indexed: 11/28/2022]
Abstract
Although prevention of dementia and late-life cognitive decline is a major public health priority, there are currently no generally established prevention strategies or operational models for implementing such strategies into practice. This article is a narrative review of available evidence from multidomain dementia prevention trials targeting several risk factors and disease mechanisms simultaneously, in individuals without dementia at baseline. Based on the findings, we formulate recommendations for implementing precision risk reduction strategies into new services called Brain Health Services. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: non-pharmacological multidomain interventions (i.e., combining two or more intervention domains), target population including individuals without dementia, and primary outcomes including cognitive/functional performance changes and/or incident cognitive impairment or dementia. Further literature searches covered the following topics: sub-group analyses assessing potential modifiers for the intervention effect on cognition in the multidomain prevention trials, dementia risk scores used as surrogate outcomes in multidomain prevention trials, dementia risk scores in relation to brain pathology markers, and cardiovascular risk scores in relation to dementia. Multidomain intervention studies conducted so far appear to have mixed results and substantial variability in target populations, format and intensity of interventions, choice of control conditions, and outcome measures. Most trials were conducted in high-income countries. The differences in design between the larger, longer-term trials that met vs. did not meet their primary outcomes suggest that multidomain intervention effectiveness may be dependent on a precision prevention approach, i.e., successfully identifying the at-risk groups who are most likely to benefit. One such successful trial has already developed an operational model for implementing the intervention into practice. Evidence on the efficacy of risk reduction interventions is promising, but not yet conclusive. More long-term multidomain randomized controlled trials are needed to fill the current evidence gaps, especially concerning low- and middle-income countries and integration of dementia prevention with existing cerebrovascular prevention programs. A precision risk reduction approach may be most effective for dementia prevention. Such an approach could be implemented in Brain Health Services.
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Affiliation(s)
- Alina Solomon
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK.
| | - Ruth Stephen
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Daniele Altomare
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | - Emmanuel Carrera
- Stroke Center, Department of Neurology, University Hospitals and University of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
| | - Jenni Kulmala
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Solutions, Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain
| | - Peter Nilsson
- Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Tiia Ngandu
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Solutions, Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Federica Ribaldi
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, Geneva, Switzerland
- Memory Clinic, Geneva University Hospitals, Geneva, Switzerland
- Laboratory of Alzheimer's Neuroimaging and Epidemiology (LANE), Saint John of God Clinical Research Centre, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Bruno Vellas
- Gérontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), Toulouse, France
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Miia Kivipelto
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
- Department of Public Health Solutions, Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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13
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Tiilikainen E, Lisko I, Kekkonen E, Solomon A, Ngandu T, Kivipelto M, Kulmala J. Everyday Life Meaningfulness for the Community-Dwelling Oldest Old During the COVID-19 Pandemic. Front Psychol 2021; 12:716428. [PMID: 34566798 PMCID: PMC8459014 DOI: 10.3389/fpsyg.2021.716428] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
In many countries, the COVID-19 pandemic has led to strong restrictions and changed the everyday lives of older people. In Finland, people aged 70 and over were instructed to stay at home under quarantine-like conditions. Existing studies from other countries have reported increases in negative experiences and symptoms as a result of such restrictions, including psychosocial stress. However, little focus has been given to older people's experiences of meaningfulness during the pandemic. Using survey and interview data, we ask to what extent have community-dwelling oldest old (80+) experienced meaningfulness during the pandemic, what background factors are associated with meaningfulness and what factors have contributed to everyday life meaningfulness during the pandemic. The data was collected as part of the COVID-19 sub-study of the third follow-up of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE85+) study, a Finnish population-based cohort study carried out in the eastern part of the country. In the quantitative analyses, meaningfulness was assessed as part of the Experiences of Social Inclusion Scale. The association of meaningfulness with different background factors (gender, age, living alone, self-chosen quarantine or physical isolation, self-rated health, physical functioning, and cognitive capacity) was explored with the Chi-square test. The quantitative findings indicate that the majority of the participants experienced meaningfulness during the pandemic. Participants who did not practice any physical isolation measures and participants with higher self-rated health experienced more meaningfulness. There was no evidence for difference in the prevalence of meaningfulness and other background factors. The qualitative data was analyzed using thematic analysis. The findings indicated that factors contributing to meaningfulness in everyday life were social contacts, daily chores and activities, familiar places and seasonal changes. The small sample size does not provide possibilities for generalizing the results into the wider population of older adults. However, the results provide new understanding of the oldest old's experiences of meaningfulness in everyday life during the global pandemic. The findings may help find ways to support older people's meaningfulness in challenging times.
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Affiliation(s)
- Elisa Tiilikainen
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
| | - Inna Lisko
- Faculty of Sport and Health Sciences and Gerontology Research Center (GEREC), University of Jyväskylä, Jyväskylä, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Eija Kekkonen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Tiia Ngandu
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Helsinki, Finland
| | - Jenni Kulmala
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Center (GEREC), Tampere University, Tampere, Finland
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14
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Sindi S, Kåreholt I, Ngandu T, Rosenberg A, Kulmala J, Johansson L, Wetterberg H, Skoog J, Sjöberg L, Wang H, Fratiglioni L, Skoog I, Kivipelto M. Sex differences in dementia and response to a lifestyle intervention: Evidence from Nordic population-based studies and a prevention trial. Alzheimers Dement 2021; 17:1166-1178. [PMID: 34255432 PMCID: PMC8361986 DOI: 10.1002/alz.12279] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Evidence on sex differences in the risk for dementia has been mixed. The goal was to assess sex differences in the development of dementia, and in the effects of a lifestyle intervention. METHODS Two strategies were adopted, one using combined data from three large Nordic population-based cohort studies (n = 2289), adopting dementia as outcome, and 2-year multidomain lifestyle intervention (n = 1260), adopting cognitive change as outcome. RESULTS There was higher risk for dementia after age 80 years in women. The positive effects of the lifestyle intervention on cognition did not significantly differ between men and women. Sex-specific analyses suggested that different vascular, lifestyle, and psychosocial risk factors are important for women and men in mid- and late-life. CONCLUSION Women had higher risk for dementia among the oldest individuals. Lifestyle interventions may be effectively implemented among older men and women.
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Affiliation(s)
- Shireen Sindi
- Division of Clinical GeriatricsCenter for Alzheimer ResearchKarolinska Institutet and Karolinska University HospitalStockholmSweden
- Ageing Epidemiology (AGE) Research UnitSchool of Public HealthImperial College LondonLondonUK
| | - Ingemar Kåreholt
- Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
- Institute of GerontologySchool of Health and WelfareAging Research Network – Jönköping (ARN‐J)Jönköping UniversityJönköpingSweden
| | - Tiia Ngandu
- Public Health Promotion UnitNational Institute for Health and WelfareHelsinkiFinland
| | - Anna Rosenberg
- Institute of Public Health and Clinical Nutrition and Institute of Clinical MedicineNeurologyUniversity of Eastern FinlandKuopioFinland
| | - Jenni Kulmala
- Division of Clinical GeriatricsCenter for Alzheimer ResearchKarolinska Institutet and Karolinska University HospitalStockholmSweden
- Public Health Promotion UnitNational Institute for Health and WelfareHelsinkiFinland
| | - Lena Johansson
- Institute of Neuroscience and PhysiologyCenter for Health and Ageing AGECAPSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Hanna Wetterberg
- Institute of Neuroscience and PhysiologyCenter for Health and Ageing AGECAPSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Johan Skoog
- Department of PsychologyCenter for Health and Ageing (AGECAP)University of GothenburgGothenburgSweden
| | - Linnea Sjöberg
- Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
| | - Hui‐Xin Wang
- Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
- Stress Research InstituteStockholom UniversityStockholmSweden
| | - Laura Fratiglioni
- Aging Research CenterKarolinska Institutet and Stockholm UniversityStockholmSweden
- Stockholm Gerontology Research CenterStockholmSweden
| | - Ingmar Skoog
- Institute of Neuroscience and PhysiologyCenter for Health and Ageing AGECAPSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Miia Kivipelto
- Division of Clinical GeriatricsCenter for Alzheimer ResearchKarolinska Institutet and Karolinska University HospitalStockholmSweden
- Ageing Epidemiology (AGE) Research UnitSchool of Public HealthImperial College LondonLondonUK
- Institute of Public Health and Clinical Nutrition and Institute of Clinical MedicineNeurologyUniversity of Eastern FinlandKuopioFinland
- Theme AgingKarolinska University HospitalStockholmSweden
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15
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Abstract
Ageing of the population, together with population growth, has brought along an ample increase in the number of older individuals living with dementia and disabilities. Dementia is the main cause of disability in old age, and promoting healthy brain ageing is considered as a key element in diminishing the burden of age-related disabilities. The World Health Organization recently launched the first risk reduction guidelines for cognitive impairment and dementia. According to recent estimates, approximately 40% of dementia cases worldwide could be attributable to 12 modifiable risk factors: low education; midlife hypertension and obesity; diabetes, smoking, excessive alcohol use, physical inactivity, depression, low social contact, hearing loss, traumatic brain injury and air pollution indicating clear prevention potential. Dementia and physical disability are closely linked with shared risk factors and possible shared underlying mechanisms supporting the possibility of integrated preventive interventions. FINGER trial was the first large randomized controlled trial indicating that multidomain lifestyle-based intervention can prevent cognitive and functional decline amongst at-risk older adults from the general population. Within the World-Wide FINGERS network, the multidomain FINGER concept is now tested and adapted worldwide proving evidence and tools for effective and easily implementable preventive strategies. Close collaboration between researchers, policymakers and healthcare practitioners, involvement of older adults and utilization of new technologies to support self-management is needed to facilitate the implementation of the research findings. In this scoping review, we present the current scientific evidence in the field of dementia and disability prevention and discuss future directions in the field.
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Affiliation(s)
- I. Lisko
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Faculty of Sport and Health Sciences and Gerontology Research CenterUniversity of JyväskyläJyväskyläFinland
| | - J. Kulmala
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Public Health Promotion UnitFinnish Institute for Health and WelfareHelsinkiFinland
- School of Health Care and Social WorkSeinäjoki University of Applied SciencesSeinäjokiFinland
| | - M. Annetorp
- Karolinska University Hospital, Theme AgingStockholmSweden
| | - T. Ngandu
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Public Health Promotion UnitFinnish Institute for Health and WelfareHelsinkiFinland
| | - F. Mangialasche
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Aging Research CenterDepartment of Neurobiology, Care Sciences and SocietyKarolinska Institutet and Stockholm UniversityStockholmSweden
| | - M. Kivipelto
- From theDivision of Clinical GeriatricsCenter for Alzheimer ResearchDepartment of Neurobiology, Care Sciences and SocietyKarolinska InstitutetStockholmSweden
- Karolinska University Hospital, Theme AgingStockholmSweden
- Institute of Public Health and Clinical NutritionUniversity of Eastern FinlandHelsinkiFinland
- Ageing and Epidemiology (AGE) Research UnitSchool of Public HealthImperial College LondonLondonUK
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16
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Sipilä S, Tirkkonen A, Savikangas T, Hänninen T, Laukkanen P, Alen M, Fielding RA, Kivipelto M, Kulmala J, Rantanen T, Sihvonen SE, Sillanpää E, Stigsdotter Neely A, Törmäkangas T. Effects of physical and cognitive training on gait speed and cognition in older adults: A randomized controlled trial. Scand J Med Sci Sports 2021; 31:1518-1533. [PMID: 33772877 DOI: 10.1111/sms.13960] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/12/2021] [Accepted: 03/23/2021] [Indexed: 01/14/2023]
Abstract
Gait speed is a measure of health and functioning. Physical and cognitive determinants of gait are amenable to interventions, but best practices remain unclear. We investigated the effects of a 12-month physical and cognitive training (PTCT) on gait speed, dual-task cost in gait speed, and executive functions (EFs) compared with physical training (PT) (ISRCTN52388040). Community-dwelling older adults, who did not meet physical activity recommendations, were recruited (n = 314). PT included supervised walking/balance (once weekly) and resistance/balance training (once weekly), home exercises (2-3 times weekly), and moderate aerobic activity 150 min/week in bouts of >10 min. PTCT included the PT and computer training (CT) on EFs 15-20 min, 3-4 times weekly. The primary outcome was gait speed. Secondary outcomes were 6-min walking distance, dual-task cost in gait speed, and EF (Stroop and Trail Making B-A). The trial was completed by 93% of the participants (age 74.5 [SD3.8] years; 60% women). Mean adherence to supervised sessions was 59%-72% in PT and 62%-77% in PTCT. Home exercises and CT were performed on average 1.9 times/week. Weekly minutes spent in aerobic activities were 188 (median 169) in PT and 207 (median 180) in PTCT. No significant interactions were observed for gait speed (PTCT-PT, 0.02; 95%CI -0.03, 0.08), walking distance (-3.8; -16.9, 9.3) or dual-task cost (-0.22; -1.74, 1.30). Stroop improvement was greater after PTCT than PT (-6.9; -13.0, -0.8). Complementing physical training with EFs training is not essential for promotion of gait speed. For EF's, complementing physical training with targeted cognitive training provides additional benefit.
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Affiliation(s)
- Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anna Tirkkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tiina Savikangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tuomo Hänninen
- NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Pia Laukkanen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Alen
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Miia Kivipelto
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
| | - Jenni Kulmala
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
| | - Taina Rantanen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sanna E Sihvonen
- School of Health and Social Studies, Jyväskylä University of Applied Sciences, Jyväskylä, Finland
| | - Elina Sillanpää
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.,Engineering Psychology, Luleå University of Technology, Luleå, Sweden
| | - Timo Törmäkangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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17
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Kolehmainen L, Havulinna S, Ngandu T, Strandberg T, Levälahti E, Lehtisalo J, Antikainen R, Hietikko E, Peltonen M, Pölönen A, Soininen H, Tuomilehto J, Laatikainen T, Rauramaa R, Kivipelto M, Kulmala J. Earlier life leisure-time physical activity in relation to age-related frailty syndrome. Age Ageing 2021; 50:161-168. [PMID: 32808971 DOI: 10.1093/ageing/afaa132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND frailty syndrome is common amongst older people. Low physical activity is part of frailty, but long-term prospective studies investigating leisure-time physical activity (LTPA) during the life course as a predictor of frailty are still warranted. The aim of this study is to investigate whether earlier life LTPA predicts frailty in older age. METHODS the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) included older adults (aged 60-77 years) from the general population who were at increased risk of cognitive decline. Frailty was assessed for 1,137 participants at a baseline visit using a modified version of Fried's phenotype, including five criteria: weight loss, exhaustion, weakness, slowness and low physical activity. Self-reported data on earlier life LTPA were available from previous population-based studies (average follow-up time 13.6 years). A binomial logistic regression analysis was used to investigate the association between earlier life LTPA and pre-frailty/frailty in older age. RESULTS the prevalence of frailty and pre-frailty was 0.8% and 27.3%, respectively. In the analyses, pre-frail and frail groups were combined. People who had been physically very active (OR 0.37, 95% CI 0.23-0.60) or moderately active (OR 0.45, 95% CI 0.32-0.65) earlier in life had lower odds of becoming pre-frail/frail than individuals who had been sedentary. CONCLUSIONS frailty was rare in this relatively healthy study population, but almost a third of the participants were pre-frail. Earlier life LTPA was associated with lower levels of pre-frailty/frailty. The results highlight the importance of physical activity when aiming to promote healthy old age.
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Affiliation(s)
- Laura Kolehmainen
- Ageing, Disability and Functioning Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Satu Havulinna
- Ageing, Disability and Functioning Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiia Ngandu
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Timo Strandberg
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Esko Levälahti
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jenni Lehtisalo
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Riitta Antikainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
- Oulu City Hospital, Oulu, Finland
| | - Elina Hietikko
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
- Oulu City Hospital, Oulu, Finland
| | - Markku Peltonen
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
- Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Jaakko Tuomilehto
- Department of Public Health, University of Helsinki, Helsinki, Finland
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- National School of Public Health, Madrid, Spain
- South Ostrobothnia Central Hospital, Seinäjoki, Finland
| | - Tiina Laatikainen
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | - Rainer Rauramaa
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Miia Kivipelto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
| | - Jenni Kulmala
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
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18
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Lisko I, Hall A, Håkansson K, Neuvonen E, Kulmala J, Ngandu T, Solomon A, Kivipelto M. Does suppressing one’s emotions increase the risk of all‐cause dementia among older adults? Alzheimers Dement 2020. [DOI: 10.1002/alz.043899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Anette Hall
- University of Eastern Finland Kuopio Finland
| | | | | | - Jenni Kulmala
- Seinäjoki University of Applied Sciences Seinäjoki Finland
| | - Tiia Ngandu
- Finnish Institute for Health and Welfare Helsinki Finland
| | | | - Miia Kivipelto
- University of Eastern Finland Kuopio Finland
- Karolinska Institute Stockholm Sweden
- Aging Research Center Karolinska Institutet and Stockholm University Stockholm Sweden
- Division of Clinical Geriatrics Centre for Alzheimer Research Department of Neurobiology Care Sciences, and Society Karolisnka Institutet Stockholm Sweden
- Imperial College London London United Kingdom
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19
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Pietilä EK, Hall A, Ngandu T, Kivipelto M, Antikainen R, Havulinna S, Kulmala J, Laatikainen T, Levälahti E, Paajanen T, Soininen H, Strandberg T, Solomon A. Impact of baseline impaired sleep, depressive symptoms and pain on physical activity in the FINGER multidomain lifestyle trial. Alzheimers Dement 2020. [DOI: 10.1002/alz.041462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Anette Hall
- University of Eastern Finland Kuopio Finland
| | - Tiia Ngandu
- Finnish Institute for Health and Welfare Helsinki Finland
| | | | | | - Satu Havulinna
- National Institute for Health and Welfare Helsinki Finland
| | - Jenni Kulmala
- National Institute for Health and Welfare Helsinki Finland
| | | | - Esko Levälahti
- Finnish Institute for Health and Welfare Helsinki Finland
| | - Teemu Paajanen
- Finnish Institute of Occupational Health Helsinki Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine University of Eastern Finland Kuopio Finland
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20
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Barbera M, Kulmala J, Lisko I, Pietilä E, Rosenberg A, Hallikainen I, Hallikainen M, Laatikainen T, Lehtisalo J, Neuvonen E, Rusanen M, Soininen H, Tuomilehto J, Ngandu T, Solomon A, Kivipelto M. Third follow-up of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) cohort investigating determinants of cognitive, physical, and psychosocial wellbeing among the oldest old: the CAIDE85+ study protocol. BMC Geriatr 2020; 20:238. [PMID: 32650731 PMCID: PMC7350760 DOI: 10.1186/s12877-020-01617-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/15/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The oldest old is the fastest growing age group worldwide and the most prone to severe disability, especially in relation to loss of cognitive function. Improving our understanding of the predictors of cognitive, physical and psychosocial wellbeing among the oldest old can result in substantial benefits for the individuals and for the society as a whole. The Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study investigated risk factors and determinants of cognitive impairment in a population-based longitudinal cohort, which was first examined between 1972 and 1992, when individuals were in their midlife, and re-assessed in 1998 and 2005-2009. Most of the study participants are currently aged 85 years or older. We aim to re-examine the cohort's survivors and gain further insights on the mechanisms underlying both cognitive and overall healthy ageing at old age. METHODS CAIDE85+ is the third follow-up of the CAIDE study participants. All individuals still alive and living in the Kuopio and Joensuu areas of Eastern Finland, from the original CAIDE cohort (two random samples, N = 2000 + ~ 900), will be invited to a re-examination. The assessment includes self-reported data related to basic demographics and lifestyle, as well as psychosocial and physical health status. Cognitive and physical evaluations are also conducted. Blood biomarkers relevant for dementia and ageing are assessed. Primary outcomes are the measurements related to cognition and daily life functioning (CERAD, Trail Making Test-A, Letter-Digit Substitution Test, Clinical Dementia Rating and Activities of Daily Living). Secondary endpoints of the study are outcomes related to physical health status, psychosocial wellbeing, as well as age-related health indicators. DISCUSSION Through a follow-up of more than 40 years, CAIDE85+ will provide invaluable information on the risk and protective factors that contribute to cognitive and physical health, as well as ageing and longevity. STUDY REGISTRATION The present study protocol has been registered at https://clinicaltrials.gov/ (registration nr NCT03938727 , date 03.05.2019).
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Affiliation(s)
- Mariagnese Barbera
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Jenni Kulmala
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden
| | - Inna Lisko
- Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden
| | - Eija Pietilä
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Anna Rosenberg
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Ilona Hallikainen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Merja Hallikainen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Tiina Laatikainen
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Central Hospital, Tikkamäentie 16, 80210, Joensuu, Finland
| | - Jenni Lehtisalo
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Elisa Neuvonen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland
| | - Minna Rusanen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Neurocenter Finland, Department of Neurology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Neurocenter Finland, Department of Neurology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Department of Public Health, University of Helsinki, PO BOX 20, 00014, Helsinki, Finland.,Diabetes Research Group, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Tiia Ngandu
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden
| | - Alina Solomon
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden
| | - Miia Kivipelto
- Institute of Clinical Medicine, Department of Neurology, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Karolinska Universitetssjukhuset, Karolinska Vägen 37 A, QA32, Stockholm, Sweden.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, P.O. Box 1627, 70211, Kuopio, Finland.,Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, Charing Cross Hospital, St Dunstan's Road, London, W6 8RP, UK
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21
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Rosenberg A, Coley N, Soulier A, Kulmala J, Soininen H, Andrieu S, Kivipelto M, Barbera M. Experiences of dementia and attitude towards prevention: a qualitative study among older adults participating in a prevention trial. BMC Geriatr 2020; 20:99. [PMID: 32164544 PMCID: PMC7068959 DOI: 10.1186/s12877-020-1493-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/26/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND A better insight into older adults' understanding of and attitude towards cognitive disorders and their prevention, as well as expectations and reasons for participation in prevention trials, would help design, conduct, and implement effective preventive interventions. This qualitative study aimed at exploring the knowledge and perceptions of cognitive disorders and their prevention among participants in a prevention trial. METHODS Semi-structured interviews were conducted among the participants of a multinational randomised controlled trial testing the efficacy of a lifestyle-based eHealth intervention in preventing cardiovascular disease or cognitive decline in community dwellers aged 65+. Participants were probed on their reasons for participation in the trial and their views on general health, cardiovascular disease, ageing, and prevention. The subset of data focusing on cognitive disorders (15 interviewees; all in Finland) was considered for this study. Data were analysed using content analysis. RESULTS Participants' knowledge of the cause and risk factors of cognitive disorders and prevention was limited and superficial, and a need for up-to-date, reliable, and practical information and advice was expressed. Cognitive disorders evoked fear and concern, and feelings of hopelessness and misery were frequently expressed, indicating a stigma. Strong heredity of cognitive disorders was a commonly held belief, and opinions on the possibility of prevention were doubtful, particularly in relation to primary prevention. Family history and/or indirect experiences of cognitive disorders was a recurrent theme and it showed to be linked to both the knowledge of and feelings associated with cognitive disorders, as well as attitude towards prevention. Indirect experiences were linked to increased awareness and knowledge, but also uncertainty about risk factors and possibility of prevention. Distinct fear and concerns, particularly over one's own cognition/risk, and high motivation towards engaging in prevention and participating in a prevention trial were also identified in connection to this theme. CONCLUSIONS Family history and/or indirect experiences of cognitive disorders were linked to sensitivity and receptiveness to brain health and prevention potential. Our findings may be helpful in addressing older adults' expectations in future prevention trials to improve recruitment, maximise adherence, and facilitate the successful implementation of interventions.
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Affiliation(s)
- Anna Rosenberg
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Nicola Coley
- LEASP, UMR 1027, INSERM/Université Toulouse III Paul Sabatier, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Alexandra Soulier
- LEASP, UMR 1027, INSERM/Université Toulouse III Paul Sabatier, University of Toulouse, Toulouse, France
| | - Jenni Kulmala
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
| | - Hilkka Soininen
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurocenter Finland, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Sandrine Andrieu
- LEASP, UMR 1027, INSERM/Université Toulouse III Paul Sabatier, University of Toulouse, Toulouse, France
- Department of Epidemiology and Public Health, Toulouse University Hospital, Toulouse, France
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Stockholms Sjukhem, Research & Development Unit, Stockholm, Sweden
| | - Mariagnese Barbera
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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22
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Sindi S, Kåreholt I, Ngandu T, Rosenberg A, Kulmala J, Johansson L, Wetterberg H, Skoog J, Fratiglioni L, Skoog I, Kivipelto M. O5‐09‐03: SEX DIFFERENCES IN DEMENTIA: EVIDENCE FROM POPULATION‐BASED STUDIES AND THE FINGER LIFESTYLE INTERVENTION. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Tiia Ngandu
- National Institute for Health and Welfare Helsinki Finland
| | | | - Jenni Kulmala
- National Institute for Health and Welfare Helsinki Finland
| | | | - Hanna Wetterberg
- Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | | | | | - Ingmar Skoog
- Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics Karolinska Institutet Stockholm Sweden
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23
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Kulmala J, Ngandu T, Havulinna S, Levälahti E, Lehtisalo J, Solomon A, Antikainen R, Laatikainen T, Pippola P, Peltonen M, Rauramaa R, Soininen H, Strandberg T, Tuomilehto J, Kivipelto M. The Effect of Multidomain Lifestyle Intervention on Daily Functioning in Older People. J Am Geriatr Soc 2019; 67:1138-1144. [PMID: 30809801 DOI: 10.1111/jgs.15837] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the effect of a 2-year multidomain lifestyle intervention on daily functioning of older people. DESIGN A 2-year randomized controlled trial (ClinicalTrials.gov, NCT01041989). SETTING Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability. PARTICIPANTS A total of 1260 older adults, with a mean age of 69 years at the baseline, who were at risk of cognitive decline. INTERVENTION A multidomain intervention, including simultaneous physical activity intervention, nutritional counseling, vascular risk monitoring and management, and cognitive training and social activity. MEASUREMENTS The ability to perform daily activities (activities of daily living [ADLs] and instrumental ADLs) and physical performance (Short Physical Performance Battery). RESULTS The mean baseline ADL score was 18.1 (SD = 2.6) points; the scale ranges from 17 (no difficulties) to 85 (total ADL dependence). During the 2-year intervention, the ADL disability score slightly increased in the control group, while in the intervention group, it remained relatively stable. Based on the latent growth curve model, the difference in the change between the intervention and control groups was -0.95 (95% confidence interval [CI] = -1.61 to -0.28) after 1 year and -1.20 (95% CI = -2.02 to -0.38) after 2 years. In terms of physical performance, the intervention group had a slightly higher probability of improvement (from score 3 to score 4; P = .041) and a lower probability of decline (from score 3 to scores 0-2; P = .043) for chair rise compared to the control group. CONCLUSION A 2-year lifestyle intervention was able to maintain the daily functioning of the at-risk older population. The clinical significance of these results in this fairly well-functioning population remains uncertain, but the study results hold promise that healthy eating, exercise, and cognitive and social activity may have favorable effects on functional independence in older people.
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Affiliation(s)
- Jenni Kulmala
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.,School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland
| | - Tiia Ngandu
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Satu Havulinna
- Ageing, Disability and Functioning Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Esko Levälahti
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Jenni Lehtisalo
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland
| | - Riitta Antikainen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland.,Oulu City Hospital, Oulu, Finland
| | - Tiina Laatikainen
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Joint Municipal Authority for North Karelia Social and Health Services (Siun Sote), Joensuu, Finland
| | | | - Markku Peltonen
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Rainer Rauramaa
- Kuopio Research Institute of Exercise Medicine, Kuopio, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neurocenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Strandberg
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland.,National School of Public Health, Madrid, Spain
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom
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Sipilä S, Tirkkonen A, Hänninen T, Laukkanen P, Alen M, Fielding RA, Kivipelto M, Kokko K, Kulmala J, Rantanen T, Sihvonen SE, Sillanpää E, Stigsdotter-Neely A, Törmäkangas T. Promoting safe walking among older people: the effects of a physical and cognitive training intervention vs. physical training alone on mobility and falls among older community-dwelling men and women (the PASSWORD study): design and methods of a randomized controlled trial. BMC Geriatr 2018; 18:215. [PMID: 30219032 PMCID: PMC6139154 DOI: 10.1186/s12877-018-0906-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 08/30/2018] [Indexed: 01/05/2023] Open
Abstract
Background Safe and stable walking is a complex process involving the interaction of neuromuscular, sensory and cognitive functions. As physical and cognitive functions deteriorate with ageing, training of both functions may have more beneficial effects on walking and falls prevention than either alone. This article describes the study design, recruitment strategies and interventions of the PASSWORD study investigating whether a combination of physical and cognitive training (PTCT) has greater effects on walking speed, dual-task cost in walking speed, fall incidence and executive functions compared to physical training (PT) alone among 70–85-year-old community-dwelling sedentary or at most moderately physically active men and women. Methods Community-dwelling sedentary or at most moderately physically active, men and women living in the city of Jyväskylä will be recruited and randomized into physical training (PT) and physical and cognitive training (PTCT). The 12-month interventions include supervised training sessions and home exercises. Both groups attend physical training intervention, which follows the current physical activity guidelines. The PTCT group performes also a web-based computer program targeting executive functions. Outcomes will be assessed at baseline and at 6 and 12 months thereafter. Falls data are collected during the interventions and the subsequent one-year follow-up. The primary outcome is 10-m walking speed. Secondary outcomes include 6-min walking distance, dual-task cost in walking speed, fall incidence and executive function assessed with color Stroop and Trail Making A and B tests. Explanatory outcomes include e.g. body composition and bone characteristics, physical performance, physical activity, life-space mobility, fall-related self-efficacy, emotional well-being and personality characteristics. Discussion The study is designed to capture the additive and possible synergistic effects of physical and cognitive training. When completed, the study will provide new knowledge on the effects of physical and cognitive training on the prevention of walking limitations and rate of falls in older people. The expected results will be of value in informing strategies designed to promote safe walking among older people and may have a significant health and socio-economic impact. Trial registration ISRCTN52388040.
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Affiliation(s)
- Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
| | - Anna Tirkkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tuomo Hänninen
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Pia Laukkanen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Alen
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Miia Kivipelto
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
| | - Katja Kokko
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jenni Kulmala
- Department of Public Health Solutions, Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Taina Rantanen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sanna E Sihvonen
- School of Health and Social Studies, Jyväskylä University of Applied Sciences, Jyväskylä, Finland
| | - Elina Sillanpää
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anna Stigsdotter-Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.,Department of Psychology, Umeå University, Umeå, Sweden
| | - Timo Törmäkangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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25
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Ngandu T, Kulmala J, Antikainen R, Laatikainen T, Soininen H, Strandberg T, Tuomilehto J, Kivipelto M. P3‐610: USE OF HEALTH CARE SERVICES AMONG OLDER ADULTS PARTICIPATING IN A MULTIDOMAIN LIFESTYLE INTERVENTION TO PREVENT COGNITIVE IMPAIRMENT (FINGER). Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Tiia Ngandu
- National Institute for Health and WelfareHelsinkiFinland
| | - Jenni Kulmala
- National Institute for Health and WelfareHelsinkiFinland
| | | | | | | | | | | | - Miia Kivipelto
- National Institute for Health and WelfareHelsinkiFinland
- University of Eastern FinlandKuopioFinland
- Karolinska InstitutetStockholmSweden
- Karolinska University HospitalStockholmSweden
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26
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Affiliation(s)
- Jenni Kulmala
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Tiia Ngandu
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
- Department of Geriatrics, Karolinska University Hospital, Stockholm, Sweden
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
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27
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Sindi S, Johansson L, Skoog J, Mattsson AD, Sjöberg L, Wang HX, Fratiglioni L, Kulmala J, Soininen H, Solomon A, Johansson B, Skoog I, Kivipelto M, Kåreholt I. Sleep disturbances and later cognitive status: a multi-centre study. Sleep Med 2018; 52:26-33. [PMID: 30216820 DOI: 10.1016/j.sleep.2017.11.1149] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 10/13/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the associations between sleep disturbances in mid-life and late-life and late-life cognitive status. METHODS In four population-based studies (three Swedish studies: H70 study, Kungsholmen Project (KP) and The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD); and one Finnish study: Cardiovascular Risk Factors, Aging and Dementia (CAIDE)), participants provided self-reports on insomnia, nightmares and general sleep problems. Late-life cognitive status was measured by the Mini Mental State Exam (MMSE). The associations between late-life sleep disturbances and cognition 3-11 years later were investigated across all studies (n = 3210). Mean baseline ages were 70 (CAIDE, H70 and SWEOLD), and 84 years (KP). Additional analyses examined the association between midlife sleep and late-life cognition using CAIDE (21 and 31 years follow-up, n = 1306, mean age 50 years), and SWEOLD (20-24 years follow-up, n = 2068, mean age 58 years). Ordered logistic regressions, adjusted for potential baseline confounders, were used in the analyses. RESULTS Late-life sleep disturbances were associated with poorer cognition after 3-11 years (fully adjusted β = -0.12, 95% CI = -0.24 to -0.01). Midlife nightmares and insomnia were also associated with lower MMSE scores (fully adjusted β = -0.28, 95% CI = -0.49 to -0.07 and β = -0.20, 95% CI = -0.39 to -0.01), although the latter association was attenuated after adjusting for lifestyle/health-related confounders. Midlife general sleep problems were not associated with late-life MMSE performance. CONCLUSIONS Sleep disturbances and midlife nightmares were associated with lower MMSE scores, which suggests that sleep disturbances in earlier life stages can be associated with worse late-life cognition.
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Affiliation(s)
- Shireen Sindi
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom.
| | - Lena Johansson
- Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Johan Skoog
- Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, Center for Health and Ageing AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Alexander Darin Mattsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden
| | - Hui-Xin Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Jenni Kulmala
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Hilkka Soininen
- Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland; Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Alina Solomon
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Boo Johansson
- Department of Psychology, Center for Health and Ageing AGECAP, University of Gothenburg, Gothenburg, Sweden
| | - Ingmar Skoog
- Institute of Neuroscience and Physiology, Center for Health and Ageing AGECAP, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden; Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, United Kingdom; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
| | - Ingemar Kåreholt
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute of Gerontology, School of Health and Welfare, Aging Research Network - Jönköping (ARN-J), Jönköping University, Jönköping, Sweden
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28
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Sindi S, Hagman G, Håkansson K, Kulmala J, Nilsen C, Kåreholt I, Soininen H, Solomon A, Kivipelto M. Midlife Work-Related Stress Increases Dementia Risk in Later Life: The CAIDE 30-Year Study. J Gerontol B Psychol Sci Soc Sci 2017; 72:1044-1053. [PMID: 27059705 DOI: 10.1093/geronb/gbw043] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 03/18/2016] [Indexed: 01/05/2023] Open
Abstract
Objective To investigate the associations between midlife work-related stress and mild cognitive impairment (MCI), dementia, and Alzheimer's disease later in life, in a large representative population. Method Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study participants were randomly selected from independent population-based surveys (mean age 50 years). A random sample of 2,000 individuals was invited for two reexaminations including cognitive tests (at mean age 71 and mean age 78), and 1,511 subjects participated in at least one reexamination (mean follow-up 28.5 years). Work-related stress was measured using two questions on work demands that were administered in midlife. Analyses adjusted for important confounders. Results Higher levels of midlife work-related stress were associated with higher risk of MCI (odds ratio [OR], 1.38; 95% confidence interval [CI], 1.08-1.76), dementia (OR, 1.53; CI, 1.13-2.07), and Alzheimer's disease (OR, 1.55; CI, 1.19-2.36) at the first follow-up among the CAIDE participants. Results remained significant after adjusting for several possible confounders. Work-related stress was not associated with MCI and dementia during the extended follow-up. Discussion Midlife work-related stress increases the risk for MCI, dementia, and Alzheimer's disease in later life. The association was not seen after the extended follow-up possibly reflecting selective survival/participation, heterogeneity in dementia among the oldest old, and a critical time window for the effects of midlife stress.
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Affiliation(s)
- Shireen Sindi
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden
| | - Göran Hagman
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden
| | - Krister Håkansson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden
| | - Jenni Kulmala
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Charlotta Nilsen
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Ingemar Kåreholt
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden.,Institute of Gerontology, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Hilkka Soininen
- NeuroCenter, Department of Neurology, Kuopio University Hospital, Kuopio, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Alina Solomon
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Miia Kivipelto
- Aging Research Center, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet Center for Alzheimer Research, Stockholm, Sweden.,Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.,Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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29
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Kulmala J, Göös K, Sorsamäki S, Hemiö K, Ngandu T, Kivipelto M. [P3–575]: PARTICIPANTS’ EXPERIENCES OF MULTIDOMAIN LIFESTYLE‐BASED INTERVENTION (FINGER) TO PREVENT COGNITIVE DECLINE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.1795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jenni Kulmala
- National Institute for Health and WelfareHelsinkiFinland
| | - Kati Göös
- Seinäjoki University of Applied SciencesSeinäjokiFinland
| | | | - Katri Hemiö
- National Institute for Health and WelfareHelsinkiFinland
| | - Tiia Ngandu
- National Institute for Health and WelfareHelsinkiFinland
- Karolinska Institutet Center for Alzheimer ResearchStockholmSweden
| | - Miia Kivipelto
- National Institute for Health and WelfareHelsinkiFinland
- Karolinska InstitutetStockholmSweden
- Karolinska Institutet‐Stockholm UniversityStockholmSweden
- University of Eastern FinlandKuopioFinland
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30
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Solomon A, Borodulin K, Ngandu T, Kivipelto M, Laatikainen T, Kulmala J. Self-rated physical fitness and estimated maximal oxygen uptake in relation to all-cause and cause-specific mortality. Scand J Med Sci Sports 2017; 28:532-540. [PMID: 28543703 DOI: 10.1111/sms.12924] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2017] [Indexed: 01/31/2023]
Abstract
This study investigated the longitudinal associations of self-rated physical fitness and estimated maximal oxygen uptake (VO2max) with all-cause and cause-specific mortality. A total of 59 741 participants in the Finnish National FINRISK Study Cohort had data on self-rated physical fitness and covariates. A subsample of 4823 participants had estimated VO2max data. Follow-up ranged from 3 to 38 years. Associations of self-rated physical fitness and VO2max with mortality were analyzed using multivariate Cox proportional hazard models. The study showed that poor self-rated physical fitness was related to all-cause mortality (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.8-2.0) and mortality due to cardiovascular (HR 2.0, 95% CI 1.9-2.2), cerebrovascular (HR 1.9, 95% CI 1.6-2.2) and respiratory diseases (HR 2.1, 95% CI 1.9-2.4), trauma (HR 1.7, 95% CI 1.3-2.0), infections (HR 1.8, 95% CI 1.3-2.7), dementia (HR 1.9, 95% CI 1.6-2.3), and cancer (HR 1.7, 95% CI 1.5-1.9). Coexisting higher age, physical inactivity, male gender, and severe chronic conditions further increased the risk. In men, higher VO2max was associated with a lower risk of lung cancer mortality (HR 0.8, 95% CI 0.7-0.96). Based on the results, self-rated physical fitness reflects a combination of unfavorable biological and lifestyle-related factors, which increase mortality risk. A simple question about perceived physical fitness may reveal at-risk individuals who would benefit from more intensive treatment of chronic conditions and other interventions aiming to promote better fitness and well-being.
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Affiliation(s)
- A Solomon
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Aging Research Center, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden
| | - K Borodulin
- Health Monitoring Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - T Ngandu
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - M Kivipelto
- Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Aging Research Center, Karolinska Institutet, Stockholm, Sweden.,Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - T Laatikainen
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland.,Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Joensuu, Finland.,Hospital District of North Karelia, Joensuu, Finland
| | - J Kulmala
- Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.,Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
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31
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Borodulin K, Kulmala J, Solomon A, Ngandu T, Kivipelto M, Laatikainen T. Self-rated Physical Fitness And Estimated Maximal Oxygen Uptake In Relation To All-cause And Cause-specific Mortality. Med Sci Sports Exerc 2016. [DOI: 10.1249/01.mss.0000486668.20385.dc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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32
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Kuosmanen K, Rovio S, Kivipelto M, Tuomilehto J, Nissinen A, Kulmala J. Determinants of Self-Rated Health and Self-Rated Physical Fitness in Middle and Old Age. EJMH 2016. [DOI: 10.5708/ejmh.11.2016.1-2.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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von Bonsdorff ME, Rantanen T, Törmäkangas T, Kulmala J, Hinrichs T, Seitsamo J, Nygård CH, Ilmarinen J, von Bonsdorff MB. Midlife work ability and mobility limitation in old age among non-disability and disability retirees--a prospective study. BMC Public Health 2016; 16:154. [PMID: 26880684 PMCID: PMC4754857 DOI: 10.1186/s12889-016-2846-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022] Open
Abstract
Background Little is known about the wellbeing and mobility limitation of older disability retirees. Personal and environmental factors, such as time spent in working life, may either exacerbate or mitigate the onset of mobility limitation in general population. We aimed to study perceived midlife work ability as a determinant of self-reported mobility limitation in old age among municipal employees who transitioned into non-disability and disability retirement. Methods 4329 participants of the Finnish Longitudinal Study of Municipal Employees (FLAME) had retired during January 1985 and July 2000. They had data on retirement, perceived work ability in 1985, and self-reported mobility limitation (non-disability retirement n = 2870, men 39 %; and diagnose-specific disability retirement n = 1459, men 48 %). Self-reported mobility was measured in 1985, 1992, 1997 and 2009. The latest score available was used to assess the number of mobility limitation. Work ability was measured by asking the respondents to evaluate their current work ability against their lifetime best in 1985. Incidence rate ratios (IRRs) and 95 % confidence intervals (CIs) for work ability predicting mobility limitation in non-disability and diagnose-specific disability retirement groups were calculated using Poisson regression models. Results The prevalence of mobility limitation for those who transitioned into non-disability retirement (Incidence Rate, IR = 0.45, 95 % CI = 0.44–0.46) was lower compared to those who retired due to disability (IR = 0.65, CI = 0.63–0.66). A one-point increase in the work ability score decreased the risk for having one more mobility limitation among non-disability and all diagnose-specific retirement groups (musculoskeletal disease, cardiovascular disease, mental disorder, and other diseases). Conclusions Better midlife work ability may protect from old age mobility limitation among those who retire due to non-disability and disability. Promoting work ability in midlife may lead to more independent, active aging, regardless of type of retirement.
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Affiliation(s)
- Monika E von Bonsdorff
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, PO Box 35, Jyväskylä, Finland. .,Folkhälsan Research Center, Helsinki, Finland.
| | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, PO Box 35, Jyväskylä, Finland.
| | - Timo Törmäkangas
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, PO Box 35, Jyväskylä, Finland.
| | - Jenni Kulmala
- Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland. .,School of Health Care and Social Work, Seinäjoki University of Applied Sciences, Seinäjoki, Finland.
| | - Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland.
| | - Jorma Seitsamo
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Clas-Håkan Nygård
- Gerontology Research Center and School of Health Sciences, University of Tampere, Tampere, Finland.
| | | | - Mikaela B von Bonsdorff
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, PO Box 35, Jyväskylä, Finland. .,Folkhälsan Research Center, Helsinki, Finland.
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von Bonsdorff ME, Rantanen T, Törmäkangas T, Kulmala J, Seitsamo J, Nygård CH, Ilmarinen J, von Bonsdorff MB. Type of retirement as a determinant of pre- and post-retirement hospital in-patient care use: a prospective study. J Public Health (Oxf) 2014; 37:707-15. [PMID: 25515822 DOI: 10.1093/pubmed/fdu100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined prospectively the use of all-cause hospital in-patient care among public sector employees by using a 3-year pre- and post-retirement study window. METHODS A total of 5269 participants of the Finnish Longitudinal Study of Municipal Employees had retired during January 1984 and July 2000. They had register-based data on retirement (non-disability retirement n = 3411, men 40%, and diagnose-specific disability retirement n = 1858, men 50%) and all-cause hospital in-patient admissions and discharges. Analyses were conducted using Generalized Estimating Equation model. RESULTS The prevalence of hospital care use for non-disability retirees remained stable during the 6-year study window. The rate ratio (RR) for hospital care use increased in the year prior to retirement for men and women who transitioned into disability retirement due to cardiovascular disease and for women with disability due to mental disease. The RRs for hospital care use in the post-retirement year decreased for men who retired due to cardiovascular disease or mental disorders and for women who retired due to cardiovascular or musculoskeletal diseases. CONCLUSIONS An increase in hospital care preceding retirement in major diagnosis-specific disability retirement groups was followed by various patterns of decrease in the need of care indicated a beneficial health effect of retirement.
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Affiliation(s)
- Monika E von Bonsdorff
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Timo Törmäkangas
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jenni Kulmala
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jorma Seitsamo
- Finnish Institute of Occupational Health, Helsinki, Finland
| | - Clas-Håkan Nygård
- Gerontology Research Center and School of Health Sciences, University of Tampere, Tampere, Finland
| | | | - Mikaela B von Bonsdorff
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Kulmala J, Hinrichs T, Törmäkangas T, von Bonsdorff MB, von Bonsdorff ME, Nygård CH, Klockars M, Seitsamo J, Ilmarinen J, Rantanen T. Work-related stress in midlife is associated with higher number of mobility limitation in older age-results from the FLAME study. Age (Dordr) 2014; 36:9722. [PMID: 25378119 PMCID: PMC4223109 DOI: 10.1007/s11357-014-9722-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 10/22/2014] [Indexed: 05/30/2023]
Abstract
The aim of this study is to investigate whether work-related stress symptoms in midlife are associated with a number of mobility limitations during three decades from midlife to late life. Data for the study come from the Finnish Longitudinal Study of Municipal Employees (FLAME). The study includes a total of 5429 public sector employees aged 44-58 years at baseline who had information available on work-related stress symptoms in 1981 and 1985 and mobility limitation score during the subsequent 28-year follow-up. Four midlife work-related stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. People with a high number of stress symptoms in 1981 and 1985 were categorized as having constant stress. The number of self-reported mobility limitations was computed based on an eight-item list of mobility tasks presented to the participants in 1992, 1997, and 2009. Data were analyzed using joint Poisson regression models. The study showed that depending on the stress profile, persons suffering from constant stress in midlife had a higher risk of 30-70 % for having one more mobility limitation during the following 28 years compared to persons without stress after adjusting for mortality, several lifestyle factors, and chronic conditions. A less pronounced risk increase (20-40 %) was observed for persons with occasional symptoms. The study suggests that effective interventions aiming to reduce work-related stress should focus on both primary and secondary prevention.
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Affiliation(s)
- Jenni Kulmala
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. Box 35, 40014, Jyväskylä, Finland,
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Kulmala J, Solomon A, Kåreholt I, Ngandu T, Rantanen T, Laatikainen T, Soininen H, Tuomilehto J, Kivipelto M. Association between mid- to late life physical fitness and dementia: evidence from the CAIDE study. J Intern Med 2014; 276:296-307. [PMID: 24444031 DOI: 10.1111/joim.12202] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This study investigated the association between perceived physical fitness at midlife, changes in perceived fitness during the three decades from mid- to late life and dementia risk. DESIGN Prospective cohort study. SETTING Cardiovascular risk factors, ageing and incidence of dementia (CAIDE) study. SUBJECTS Subjects were selected from four independent, random samples of population-based cardiovascular surveys and were first examined in 1972, 1977, 1982 or 1987, when they were on average 50 years old. The CAIDE target population included 3559 individuals. A random sample of 2000 individuals still alive in 1997 was drawn for re-examinations (performed in 1998 and 2005-2008) that consisted of cognitive assessments, with 1511 subjects participating in at least one re-examination. Dementia diagnoses were also confirmed from national registers for the entire target population. MAIN OUTCOME MEASURE All-cause dementia. RESULTS Poor physical fitness at midlife was associated with increased dementia risk in the entire target population [hazard ratio (HR), 1.5; 95% confidence interval (CI), 1.1-2.0]. In participants, odds ratio (OR) was 2.0 (95% CI, 0.9-4.0). This association was significant in apolipoprotein E ε4 allele (APOEε4) noncarriers (OR, 4.3; 95% CI, 1.4-13.3), men (HR, 1.8; 95% CI, 1.1-3.0) and people with chronic conditions (HR, 2.9; 95% CI, 1.3-6.6). A decline in fitness after midlife was also associated with dementia (OR, 3.0; 95% CI, 1.7-5.1), which was significant amongst both men and women and more pronounced in APOEε4 carriers (OR, 4.4; 95% CI, 2.1-9.1). CONCLUSIONS Perceived poor physical fitness reflects a combination of biological and lifestyle-related factors that can increase dementia risk. A simple question about perceived physical fitness may reveal at-risk individuals who could benefit from preventive interventions.
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Affiliation(s)
- J Kulmala
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Kulmala J, Vuorinen M, Solomon A, Spulber G, Kareholt I, Waller K, Ngandu T, Soininen H, Kivipelto M. P2‐310: MIDLIFE SELF‐RATED HEALTH AND FITNESS IN RELATION TO WHITE MATTER LESIONS AND GREY MATTER VOLUME 20 YEARS LATER. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | | | - Tiia Ngandu
- National Institute for Health and WelfareHelsinkiFinland
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Sindi S, Hakansson K, Hagman G, Kulmala J, Soininen H, Kareholt I, Solomon A, Kivipelto M. P3‐315: MID‐LIFE WORK‐RELATED STRESS INCREASES DEMENTIA RISK IN LATE‐LIFE: THE CAIDE 30‐YEAR STUDY. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.1408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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von Bonsdorff MB, von Bonsdorff M, Kulmala J, Törmäkangas T, Seitsamo J, Leino-Arjas P, Nygård CH, Ilmarinen J, Rantanen T. Job strain in the public sector and hospital in-patient care use in old age: a 28-year prospective follow-up. Age Ageing 2014; 43:393-9. [PMID: 24321842 PMCID: PMC4001173 DOI: 10.1093/ageing/aft192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND high job strain increases the risk of health decline, but little is known about the specific consequences and long-term effects of job strain on old age health. OBJECTIVES purpose was to investigate whether physical and mental job strain in midlife was associated with hospital care use in old age. METHODS study population included 5,625 Finnish public sector employees aged 44-58 years who worked in blue- and white-collar professions in 1981. The number of in-patient hospital care days was collected from the Finnish Hospital Discharge Register for the 28-year follow-up period. RESULTS rates of hospital care days per 1,000 person-years for men were 7.78 (95% confidence interval [CI] 7.71-7.84) for low, 9.68 (95% CI 9.50-9.74) for intermediate and 12.56 (95% CI 12.47-12.66) for high physical job strain in midlife. The corresponding rates for women were 6.63 (95% CI 6.57-6.68), 7.91 (95% CI 7.87-7.95) and 10.35 (95% CI 10.25-10.42), respectively. Rates were parallel but lower for mental job strain. Reporting high physical job strain in midlife increased the risk of hospital care in old age compared with those who reported low job strain, fully adjusted incidence rate ratio 1.17 (95% CI 1.00-1.38) for men and 1.42 (95% CI 1.25-1.61) for women. These associations were robust in analyses confined to hospital care that took place after the employees had turned 65 years. CONCLUSION exposure to high mental and, particularly, high physical job strain in midlife may set employees on a higher healthcare use trajectory which persists into old age.
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Affiliation(s)
- Mikaela Birgitta von Bonsdorff
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
- Address correspondence to: M. B. von Bonsdorff. Tel: +358 400 342 692; Fax: +358 14 617 422.
| | - Monika von Bonsdorff
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Jenni Kulmala
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Timo Törmäkangas
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
| | - Jorma Seitsamo
- Finnish Institute of Occupational Health, Helsinki, Finland
| | | | - Clas-Håkan Nygård
- Gerontology Research Center and School of Health Sciences, University of Tampere, Finland
| | | | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Finland
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Hinrichs T, von Bonsdorff MB, Törmäkangas T, von Bonsdorff ME, Kulmala J, Seitsamo J, Nygård CH, Ilmarinen J, Rantanen T. Inverse effects of midlife occupational and leisure time physical activity on mobility limitation in old age--a 28-year prospective follow-up study. J Am Geriatr Soc 2014; 62:812-20. [PMID: 24731135 DOI: 10.1111/jgs.12793] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate in a sample of initially middle-aged municipal employees whether leisure time (LPA) or occupational physical activity (OPA) was associated with mobility limitation (ML) in old age. DESIGN Prospective population-based follow-up. SETTING Municipalities in Finland. PARTICIPANTS Public sector employees from the Finnish Longitudinal Study on Municipal Employees (FLAME) initially aged 44 to 58 (N = 5,200). MEASUREMENTS Baseline data were collected in 1981, including LPA (average exercise within previous year: inactive (no exercise), moderate (some form of exercise ≤ 1 time per week), vigorous (brisk exercise ≥ 1 time per week)) and OPA (usual activities at work within previous year: light (light work sitting, standing, or moving around), moderate (moderate work moving around), vigorous (heavy physical work)). Number of MLs was assessed using a questionnaire (8 items) in 1985, 1992, 1997, and 2009; the latest mobility score available for each subject was used for analyses. Incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for LPA and OPA predicting ML were estimated in a joint Poisson regression model adjusted for survival data; the other type of PA; and sociodemographic, socioeconomic, and health-related factors. RESULTS Mean age at baseline was 50.3 ± 3.6; 56.9% of participants were female. Participants with vigorous OPA in midlife had greater risk of a unit increase in ML in old age than those with light OPA (fully adjusted IRR = 1.09, 95% CI = 1.03-1.16). Participants with vigorous LPA had lower risk of ML than inactive participants (fully adjusted IRR = 0.81, 95% CI = 0.76-0.86). CONCLUSION Findings suggest that LPA and OPA in midlife have independent, inverse effects on mobility in old age in terms of a harmful effect of vigorous OPA and a protective effect of vigorous LPA.
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Affiliation(s)
- Timo Hinrichs
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Sports Medicine and Sports Nutrition, University of Bochum, Bochum, Germany
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Tolppanen AM, Solomon A, Kulmala J, Kåreholt I, Ngandu T, Rusanen M, Laatikainen T, Soininen H, Kivipelto M. Leisure-time physical activity from mid- to late life, body mass index, and risk of dementia. Alzheimers Dement 2014; 11:434-443.e6. [PMID: 24721528 DOI: 10.1016/j.jalz.2014.01.008] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/02/2014] [Accepted: 01/21/2014] [Indexed: 01/27/2023]
Abstract
BACKGROUND Physical activity may be beneficial for cognition, but the effect may vary depending on personal characteristics. METHODS We investigated the associations between leisure-time physical activity (LTPA) from mid- to late life, the risk of dementia, and the role of body mass index, sex, and APOE in the CAIDE study during 28-year follow-up. Cognitive function of a random subsample was assessed at a mean age of 78.8 years (n = 1511), and dementia/Alzheimer's disease (AD) diagnoses were identified from national registers for the entire target population (n = 3559). RESULTS Moderate (hazard ratio [HR], 1.46; 95% confidence interval [CI], 1.08-1.99) and low levels of midlife LTPA (HR, 1.39; 95% CI, 0.99-1.95) were associated with higher risk of dementia in comparison with the most active category. The benefits were more pronounced among men, overweight individuals, and APOE ε4 noncarriers. Maintaining high LTPA (HR, 0.16; 95% CI, 0.06-0.41) or increasing LTPA (HR, 0.19; 95% CI, 0.09-0.40) after midlife was associated with lower dementia risk. Similar results were observed for AD. CONCLUSIONS The window of opportunity for preventive physical activity interventions may extend from midlife to older ages.
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Affiliation(s)
| | - Alina Solomon
- Department of Neurology, University of Eastern Finland, Kuopio, Finland; Alzheimer Disease Research Center, Karolinska Institutet, Stockholm, Sweden; Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Jenni Kulmala
- Gerontology Research Center, Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Ingemar Kåreholt
- Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Institute for Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Tiia Ngandu
- Alzheimer Disease Research Center, Karolinska Institutet, Stockholm, Sweden; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Minna Rusanen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland
| | - Tiina Laatikainen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Hospital District of North Karelia, Joensuu, Finland
| | - Hilkka Soininen
- Department of Neurology, University of Eastern Finland, Kuopio, Finland; Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Miia Kivipelto
- Department of Neurology, University of Eastern Finland, Kuopio, Finland; Alzheimer Disease Research Center, Karolinska Institutet, Stockholm, Sweden; Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden; Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
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Kulmala J, Nykänen I, Hartikainen S. Frailty as a predictor of all-cause mortality in older men and women. Geriatr Gerontol Int 2014; 14:899-905. [DOI: 10.1111/ggi.12190] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Jenni Kulmala
- Gerontology Research Center and Department of Health Sciences; University of Jyväskylä; Jyväskylä Finland
| | - Irma Nykänen
- Kuopio Research Center of Geriatric Care; University of Eastern Finland; Kuopio Finland
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
| | - Sirpa Hartikainen
- Kuopio Research Center of Geriatric Care; University of Eastern Finland; Kuopio Finland
- School of Pharmacy; University of Eastern Finland; Kuopio Finland
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Kulmala J, Nykänen I, Mänty M, Hartikainen S. Association between Frailty and Dementia: A Population-Based Study. Gerontology 2014; 60:16-21. [DOI: 10.1159/000353859] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/19/2013] [Indexed: 11/19/2022] Open
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Viljanen A, Kulmala J, Rantakokko M, Koskenvuo M, Kaprio J, Rantanen T. Accumulation of sensory difficulties predicts fear of falling in older women. J Aging Health 2013; 25:776-91. [PMID: 23832841 DOI: 10.1177/0898264313494412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore whether the accumulation of sensory difficulties predicts fear of falling (FOF), and whether the traits correlate with each other regardless of familial factors. METHODS Self-reported hearing, vision and balance difficulties, and FOF were assessed using structured questionnaires at the baseline and after a 3-year follow-up in 63- to 76-year-old women (n = 434). RESULTS Among the women without FOF at baseline (n = 245), 41% reported FOF at follow-up. Increasing numbers of sensory difficulties at baseline predicted higher incidence of FOF. The relationship between accumulated sensory difficulties and FOF was not mediated by familial factors. DISCUSSION The accumulation of multiple sensory difficulties may hinder older people from receiving compensatory information about body position and environment, thus jeopardizing a person's confidence in maintaining a balanced position. Regular screening of sensory functions followed by appropriate actions may prevent the development of FOF, and thus contribute to prevention of falls and promotion of healthy aging.
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Affiliation(s)
- Anne Viljanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
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Kulmala J, von Bonsdorff MB, Stenholm S, Törmäkangas T, von Bonsdorff ME, Nygård CH, Klockars M, Seitsamo J, Ilmarinen J, Rantanen T. Perceived stress symptoms in midlife predict disability in old age: a 28-year prospective cohort study. J Gerontol A Biol Sci Med Sci 2013; 68:984-91. [PMID: 23371968 DOI: 10.1093/gerona/gls339] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Stress has damaging effects on individual's health. However, information about the long-term consequences of mental stress is scarce. METHODS This 28-year prospective cohort study examined on the associations between midlife stress and old age disability among 2,994 Finnish municipal professionals aged 44-58 years at baseline. Self-reported stress symptoms were assessed at baseline in 1981 and 4 years later in 1985 and perceived disability in 2009. For the baseline data, principal component analysis was used for differentiation into stress symptom profiles. The regression coefficient estimates for self-care disability (activities of daily living) and instrumental activities of daily living disability were estimated using left-censored regression. The odds ratios for mobility limitation were estimated using logistic regression. RESULTS Four midlife stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. We saw a clear gradient of increasing disability severity in old age for increasing intensity of midlife stress symptoms. In comparison with the participants with no stress symptoms, the extensively adjusted left-censored and logistic regression models showed that in old age, disability scores were almost 2-4 units higher and risk for mobility limitation was 2-3 times higher for those with constant stress symptoms in midlife. CONCLUSIONS Among occupationally active 44- to 58-year-old men and women, perceived stress symptoms in midlife correlated with disability 28 years later. Stress symptoms may be the first signs of decompensation of individual functioning relative to environmental demands, which may later manifest in disabilities.
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Affiliation(s)
- Jenni Kulmala
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, P.O. Box 35, FIN - 40014, Jyväskylä, Finland.
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Salminen E, Niiniviita H, Kulmala J, Määttänen H, Järvinen H. Radiation dose estimation in computed tomography examinations using NRPB-SR250 software in aretrospective analysis of a patient population. Radiat Prot Dosimetry 2012; 152:328-333. [PMID: 22668757 DOI: 10.1093/rpd/ncs065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Computed tomography (CT) imaging contributes to a major part of medical radiation exposure. With regard to patients safety, frequent CT examinations (CTEs) performed on the same patient are of particular concern. Tools for tracking the individual patient radiation exposure history and cumulative dose assessment may become important. Here, the applicability of the NRPB-SR250 software was assessed in a retrospective analysis of radiation doses from CTE made consecutively in male patients. Most of the examinations focused on the abdomen or the whole body. The mean number of CTs per patient was 6.8. Significant cumulative effective doses were observed: 76 (66 %) patients received an effective dose higher than 50 mSv, while the maximum was ∼280 mSv. A more than 3-fold effective dose difference was observed between scanners, depending on the scanning protocols. The NRPB-SR250 software proved to be a robust tool for the assessment of organ doses and the effective radiation dose from CT, while challenges were encountered in finding the precise imaging data in retrospective protocols.
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Affiliation(s)
- E Salminen
- STUK-Radiation and Nuclear Safety Authority, PO Box 14, FI-00881 Helsinki, Finland.
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Salminen E, Niiniviita H, Kulmala J, Määttänen H, Järvinen H. Re: diagnostic radiation exposure risk in a contemporary cohort of male patients with germ cell tumor. J Urol 2012; 189:1602-4. [PMID: 23123545 DOI: 10.1016/j.juro.2012.10.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 11/19/2022]
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Viljanen A, Kulmala J, Rantakokko M, Koskenvuo M, Kaprio J, Rantanen T. Fear of Falling and Coexisting Sensory Difficulties As Predictors of Mobility Decline in Older Women. J Gerontol A Biol Sci Med Sci 2012; 67:1230-7. [DOI: 10.1093/gerona/gls134] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kulmala J, Sipilä S, Tiainen K, Pärssinen O, Koskenvuo M, Kaprio J, Rantanen T. Vision in relation to lower extremity deficit in older women: cross-sectional and longitudinal study. Aging Clin Exp Res 2011; 24:461-7. [PMID: 22183242 DOI: 10.3275/8185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS Vision problems are common experiences within the older population. This study aimed to examine the association between vision and lower extremity impairment. METHODS 434 women aged 63-75 participated in visual acuity (VA) measurements at baseline and 313 persons at three-year follow-up. Measurements of lower extremity function included maximal isometric knee extension strength, leg extension power, maximal walking speed and standing balance. RESULTS At baseline, knee extension strength was lower among participants with visual impairment (VI) (273.2±6.4 N) compared to those with good vision (306.5±5.9 N, p<0.001) as well as leg extension power (95.2±2.7 W vs 104.2±2.6 W, p=0.009) and maximal walking speed (1.6±0.02 m/s vs 1.8±0.03 m/s, p<0.001). Higher velocity moment among persons with VI (53.5±2.7 mm²/s vs 42.7±1.4 mm²/s, p<0.001) indicated that persons with VI had poorer balance compared to persons with good vision. Decreased isometric knee extension strength (OR 1.26, 95% CI 1.09-1.45), poorer standing balance (OR 1.16, 95% CI 1.00-1.35) as well as lower maximal walking speed (OR 1.34, 95% CI 1.13-1.59) were associated with VI in the logistic regression models. Additionally, the association between poorer leg extension power and VI (OR 1.14, 95% CI 0.99-1.31) was of borderline statistical significance. In longitudinal analyses, VI did not predict decline in lower extremity function. CONCLUSIONS Lower extremity impairment was associated with VI among relatively healthy older women. However, change in lower extremity function was quite similar between the vision groups. It is possible that decreased VA may be a marker of underlying systemic factors or the aging process, which lead to poorer functional capacity, or there may be shared background factors, which lead to decreased vision and lower extremity impairment.
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Affiliation(s)
- Jenni Kulmala
- University of Jyväskylä, Department of Health Sciences, Gerontology Research Centre, Jyväskylä, Finland.
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Seppala J, Kulmala J. DOSIMETRIC CHARACTERISTICS OF DIFFERENT CARBON FIBER TABLETOPS. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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