Forskningsartikler

Background: The declining incidence of stroke, ischemic heart disease (IHD) and dementia (the triple threat) in Norway encourages further investigation. We analysed the risks and trends of the three conditions using data from the Global Burden of Disease study (GBD).

Methods: We used GBD 2019 estimations for age-, sex-, and risk factor-specific incidence and prevalence of «the triple threat» and their risk factor-attributed deaths and disability combined and their age-standardised rates per 100,000 population in 2019 and their changes during 1990-2019. Data are presented in means and 95% uncertainty intervals (UI).

Results: In 2019, 71.1 thousand Norwegian were living with dementia, 157.2 thousand with IHD, and 95.2 thousand with strokes. In 2019, there were 9.9 thousand (8.5 to 11.3) new cases of dementia (35.0% increase since 1990), 17.0 thousand (14.6 to 19.6) with IHD (3.6% decrease), and 8.0 thousand (7.0 to 9.1) with strokes (12.9% decrease) in Norway. During 1990-2019, their age-standardised incidence rates decreased significantly; dementia by -5.4% (-8.4 to -3.2), IHD by -30.0% (-31.4 to -28.6), and stroke by -35.3% (-38.3 to -32.2), respectively. There were significant declines in the attributable risks to both ENVIRONMENTAL and behavioural factors in Norway, but contradictory trends for metabolic risk factors during 1990-2019.

Conclusions: The risk of «the triple threat» conditions is declining in Norway, despite the increased prevalence. This offers the opportunity to find out why and how and to accelerate their joint prevention through new approaches and the promotion of the National Brain Health Strategy.

Abolfazl Avan, Anne Hege Aamodt, Geir Selbaek, Gunnar Bovim, Claudio L A Bassetti, Paul Boon, Wolfgang Grisold, Vladimir Hachinski

Sammendrag

Hensikt: Studien belyser hvilke erfaringer fysioterapeuter har med å gi fysioterapibehandling til beboere med langtidsopphold i norske sykehjem, og hvordan fysioterapeutene er involvert i behandlingen av beboere i livets sluttfase.

Design, materiale og metode: Artikkelen er basert på eksplorerende kvalitative intervjuer med seks fysioterapeuter som jobber i sykehjem. Intervjuene var semistrukturerte og datamaterialet ble analysert med systematisk tekstkondensering.

Funn: Deltakerne inntar i stor grad en tradisjonell fysioterapeutrolle med fokus på trening. De anerkjenner at fysioterapeuter har kunnskap og ferdigheter som er relevante for beboerne i livets sluttfase, men er i liten grad involvert i det tverrfaglige teamet rundt den døende.

Konklusjon: Fysioterapeutene som jobber i langtidsavdelinger i sykehjem bruker mesteparten av arbeidstiden sin på tradisjonell fysioterapi. De er ikke er involvert i lindrende behandling og omsorg i livets sluttfase, men mener at de har relevant kunnskap – og således er en ubrukt ressurs. Mangelen på fysioterapeuter i det tverrfaglige palliative teamet er et resultat av at fysioterapeutene selv ikke gir uttrykk for at de ønsker å bidra, samtidig som leger og sykepleiere ikke etterspør deres kunnskap på dette området. Organiseringen av fysioterapitjenesten i sykehjem ser også ut til å kunne påvirke det tverrfaglige samarbeidet.

Kristine Bjorheim Bøe, Tone Dahl-Michelsen & Elisabeth Wiken Telenius

Background:Behavioural and psychological symptoms of dementia (BPSD) profiles vary depending on aetiology in patients with mild-to-moderate BPSD. It is not known if similar differences exist in patients with severe BPSD.

Methods:We analysed data collected at baseline in 398 patients with severe BPSD (NPI ≥ 32) and defined diagnosis of dementia (Alzheimer’s disease (AD) 297; frontotemporal dementia (FTD) 39; Lewy body disease/Parkinsonian dementia (LBD/PD) 31; and vascular dementia (VD) 31) included in the European multicentre cohort RECAGE.

Results:Mean total NPI was 52.11 (18.55). LBD/PD patients demonstrated more hallucinations, more anxiety and more delusions than patients with other dementia. FTD patients had less delusions and more disinhibition than patients with other neurodegenerative disorders. These profiles overlapped partially with those reported in the literature in patients with less severe symptoms.

Conclusion: Patients with severe BPSD display different and specific profiles of neuropsychiatric symptoms depending on dementia aetiology.

Cognat, S. Sabia, A. Fayel, M. Lilamand, R. Handels, S. Fascendini, S. Bergh, G.B. Frisoni, A. Fabbo, M. Tsolaki, L. Frölich, O. Peters, P. Merlo, A. Ciccone, P. Mecocci, J. Dumurgier, C.A. Defanti, J. Hugon, C. Paquet

Background: Malnutrition – comprising both undernutrition and overweight – has to be addressed in the medical follow-up of older adults due to the negative consequences for the functional state and general health. Still, little is known about the nutritional state of nursing home (NH) residents, especially with respect to weight gain or weight loss after NH admission. Therefore, this study aims to evaluate changes in the body mass index (BMI) during the first year following NH admission, and to explore demographic and clinical characteristics related to BMI changes.

Methods: Data from two prospective studies that recruited participants at NH admission were combined. Demographic and clinical characteristics including the BMI were assessed at baseline and after one year. A linear regression model was estimated to explore the impact of demographic and clinical characteristics on the change in BMI.

Results: The study cohort consisted of 1,044 participants with a mean age of 84.3 years (SD7.6) at baseline; 64.2% were female. At baseline, 33% of the NH residents had severe to moderate undernutrition, while 10% were obese. During the first year of their NH stay, residents with severe to moderate undernutrition had an average increase in BMI of 1.3 kg/m2 (SD 2.2; p < 0.001), while weight changes were either very small or not significant in the other BMI groups. Characteristics related to weight gain were younger age and less agitation.

Conclusion: Malnutrition is a common health challenge at NH admission, with one third of NH residents being moderately to severely underweight and 10% being obese. However, during the first year of NH stay, there was a favourable development for underweight NH residents, as they increased their BMI, and 43.6% changed to a higher weight classification, while we observed no changes in the BMI in residents with obesity. As NH residents are in the last phase of their lives, interventions to prevent malnutrition or overweight should be initiated while still home-dwelling, and then continued in the nursing homes.

Corinna Vossius, Miguel G Borda, Bjørn Lichtwarck, Janne Myhre, May Ingvild Volungholen Sollid, Tom Borza, Ingvild Hjorth Feiring, Jūratė Šaltytė Benth, Sverre Bergh

Introduction: There is a pressing need for non-invasive, cost-effective tools for early detection of Alzheimer’s disease (AD).

Methods: Using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), Cox proportional models were conducted to develop a multimodal hazard score (MHS) combining age, a polygenic hazard score (PHS), brain atrophy, and memory to predict conversion from mild cognitive impairment (MCI) to dementia. Power calculations estimated required clinical trial sample sizes after hypothetical enrichment using the MHS. Cox regression determined predicted age of onset for AD pathology from the PHS.

Results: The MHS predicted conversion from MCI to dementia (hazard ratio for 80th versus 20th percentile: 27.03). Models suggest that application of the MHS could reduce clinical trial sample sizes by 67%. The PHS alone predicted age of onset of amyloid and tau.

Discussion: The MHS may improve early detection of AD for use in memory clinics or for clinical trial enrichment.

Highlights: A multimodal hazard score (MHS) combined age, genetics, brain atrophy, and memory. The MHS predicted time to conversion from mild cognitive impairment to dementia. MHS reduced hypothetical Alzheimer’s disease (AD) clinical trial sample sizes by 67%. A polygenic hazard score predicted age of onset of AD neuropathology.

Emilie T Reas, Alexey Shadrin, Oleksandr Frei, Ehsan Motazedi, Linda McEvoy, Shahram Bahrami, Dennis van der Meer, Carolina Makowski, Robert Loughnan, Xin Wang, Iris Broce, Sarah J Banks, Vera Fominykh, Weiqiu Cheng, Dominic Holland, Olav B Smeland, Tyler Seibert, Geir Selbaek, James B Brewer, Chun C Fan, Ole A Andreassen, Anders M Dale; Alzheimer’s Disease Neuroimaging Initiative