Forskningsartikler

Abstract

Objective: This study presents updated regression-based norms for verbal fluency tests: «FAS,» «Animals,» and «Supermarket» in older Norwegian adults. By examining the potential modulating effects and putative interaction effects of age, education, and sex, we aim to investigate cognitive aging and the effects of education.

Method: The study includes 449 healthy participants, aged 70-92 years, from the NorFAST (n = 254) and HUNT (n = 195) studies. Regression-based norms for all three verbal fluency tasks were produced. Models were assessed for pertinent linear, curvilinear, or interaction effects of age, education, and sex. We compared our norms to previously published norms.

Results: The task «FAS» was predicted by education (b = 0.773, partial R2 = 0.117, p < .001) and sex (b = 1.110, partial R2 = 0.037, p < .001), and the task «Animals» was predicted by education (b = 0.313, partial R2 = 0.021, p < .01) and age (b = -0.123, partial R2 = 0.045, p < .001). Higher education and being female were associated with better performance, whereas older age was associated with poorer performance. Finally, for the task «Supermarket,» we found an interaction effect between age and education (b = -0.063, partial R2 = 0.034, p < .01), but the major predictor was sex (b = 1.446, partial R2 = 0.068, p < .001).

Conclusions: The norms were adjusted for the demographic variables that predicted the individual tasks. The illustrative norm comparison estimated similar mean performance but larger differences between the «exceptionally low» scores. The results also indicate that only processing speed declines with age, and that higher education has minimal effect on test-performance.

Therese Händel Waggestad, Bjørn-Eivind Kirsebom, Carsten Strobel, Linda Gjøra, Geir Selbæk, Peter Bekkhus-Wetterberg, Jens Egeland

Abstract

Aims and objectives: To explore the experiences of receiving and living with a diagnosis of prodromal Alzheimer’s disease.

Background: Alzheimer’s disease is a progressive dementia disorder, with pathology potentially developing years before clinical symptoms. Evidence concerning patients’ perspectives on living with a prodromal Alzheimer’s disease diagnosis remains scarce.

Design and methods: A qualitative, descriptive design was employed. Semi-structured interviews were conducted with 16 participants diagnosed with prodromal Alzheimer’s disease in memory clinics in Denmark, Norway and Iceland. The data were analysed using thematic analysis.

Findings: Four main themes emerged: 1) what led to the assessment, 2) receiving the diagnosis of prodromal Alzheimer’s disease, 3) everyday life after the diagnosis and 4) planning for the future. The participants experienced diverse trajectories to diagnosis, with some being alerted by others to symptoms and some recognising the symptoms themselves. The diagnostic process was often perceived as intimidating, and person-centred care was valued. After the diagnosis, the participants focused on managing daily life, experienced changes in relationships and harboured mixed emotions about the future.

Conclusion: Receiving a prodromal Alzheimer’s disease diagnosis impacts patients’ perceptions of their abilities, relationships and future. There is a need for interventions targeting both patients and their families to maintain a close bond between them and support hope. Clear communication about the distinction between prodromal Alzheimer’s disease and Alzheimer’s dementia is crucial.

Susanne Kristiansen, Siren Eriksen, Cathrine Selnes Treviño, Tarja Välimäki, Helga Atladóttir, Gudlaug Gudmundsdottir, Knut Engedal, Jón Snædal, Anne Marie Mork Rokstad, Hanne Konradsen

Abstract

High blood pressure (BP) is linked to an increased dementia risk. The role of sex and the impact of cardiorespiratory fitness (CRF) on the potential association between genetic predisposition to high blood pressure and dementia are less understood. Our aim was to investigate if there is an association between genetic predisposition to high systolic blood pressure (SBP) and occurrence of dementia in males and females and whether CRF modifies this association. This prospective cohort study utilised data from the population-based Trøndelag Health Study in Norway. We included 9145 participants ≥70 years in the HUNT4 70+ sub-study. The sex-specific association between the BP polygenic score (PGS) and dementia was estimated by logistic regression. Analyses were stratified by CRF to investigate potential effect modification by CRF. Among 5011 females (mean age 78.5 years) and 4134 males (mean age 77.4 years), 812 (16.2%) and 570 (13.8%) dementia cases were identified, respectively. Females in the highest fifth of the PGS had an increased odds of dementia [odds ratio (OR) = 1.45; 95% confidence interval (CI) 1.10 to 1.90]. This was not observed in males (OR = 1.03; 95% CI 0.77 to 1.37). The association was somewhat stronger in females with low fitness (OR = 1.53; 95% CI 1.08 to 2.17) than in females with high fitness (OR = 1.12; 95% CI 0.78 to 1.63). Genetic predisposition to high SBP was associated with higher odds of dementia in females, particularly if they had low CRF. Future studies should further examine sex-specific effects of genetic and modifiable factors on dementia risk.

Maren Lerfald, Karsten Øvretveit, Tom Ivar Lund Nilsen, Rannveig Sakshaug Eldholm, Nora Grøtting, Brooke N Wolford, Geir Selbaek, Linda Ernstsen

B Pozuelo Moyano A von Gunten, C Mueller, R Yaman-Deveci, R Howard, R Stewart 2, A Young, H Costello, S Bulteau, B Calvet, S Bonin-Guillaume, N Hoertel, G H Robert, J Roche, A Lepetit, S Louchart de la Chapelle, L Agüera-Ortiz, J Pla-Vidal, F Bouckaert, O Voshaar, L Fernandes, O Vasiliu, M Dominiak 29, J Priller, M Preisig, F Triolo, M Belvederi Murri, E Aakhus, S Ranjbar, K Swierkosz-Lenart, V Orgeta, P Vandel

Abstract

Objectives: The primary objective of healthcare personnel involved in end-of-life care is to ensure a good and dignified death. However, end-of-life care is delivered across various healthcare settings. This qualitative study aimed to identify the priorities and concerns related to end-of-life care shared by healthcare personnel working in hospitals, nursing homes, and municipal home care.

Methods: Twenty-two healthcare personnel from across Norway participated in virtual focus group interviews. Participants represented 3 distinct healthcare settings and had diverse professional backgrounds. Each interview was audio-recorded and transcribed verbatim. Qualitative content analysis was conducted and informed by theory on professional competence.

Results: The analysis demonstrated that ensuring a good death was a shared focus among participants. Across settings, they expressed aligned priorities and concerns regarding end-of-life care. They likened their role to that of a pilot boat skipper, guiding the end-of-life process with a clear focus on: 1) offering support and information, 2) providing symptom relief, and 3) ensuring a presence at the bedside. Each of these themes highlights a key priority in end-of-life care across healthcare settings, along with its associated concerns.

Significance of results: This study demonstrates that healthcare personnel across hospitals, nursing homes, and municipal home care share core priorities of what constitutes a good and dignified death. The findings challenge setting-specific assumptions in end-of-life care and support an emphasis on shared core competencies in education and practice. Overall, the study contributes to a more unified understanding of end-of-life care by highlighting foundational care values that transcend organizational boundaries and professional backgrounds, thereby supporting policies that promote continuity and coherence across care environments.

Siren Eriksen, Anne Marie Mork Rokstad, Elisabeth Wiken Telenius, Kariann Krohne

Abstract

Background and objectives: Central and general adiposity have been linked to dementia risk, but their relation to blood-based Alzheimer disease (AD) biomarkers is unclear. We examined life course adiposity, measured by waist-to-height ratio (WtHR) and body mass index (BMI), in relation to plasma p-tau217 and to AD dementia verified by biomarker status.

Methods: In this cohort study, we included data on participants from the general population aged 70 years or older from the fourth wave of the Norwegian Trøndelag Health Study (HUNT4; 2017-19). Plasma p-tau217 was collected and standardized clinical cognitive assessments were performed at HUNT4. Plasma p-tau217 concentration at ≥0.63 pg/mL defined positive p-tau217. Positive p-tau217 coupled with a clinical dementia diagnosis defined biomarker-verified AD dementia. WtHR was measured 3 times (HUNT2-4; 1995-2019), and BMI was measured 4 times (HUNT1-4; 1984-2019). We performed linear, logistic, and linear mixed-effects regression adjusting for demographics, APOE ε4, lifestyle, and mental health.

Results: The final study sample comprised 8,797 participants (53.5% women, mean age at HUNT4 77.8 [SD 6.2]). Of these, 2,649 (30.1%) were p-tau217-positive and 659 (7%) had biomarker-verified AD dementia. Midlife WtHR ≥0.60 was associated with 12.8% (95% CI 7.3-19.7) higher late-life p-tau217 concentration and higher risk of positive p-tau217 (relative risk ratios [RRRs] 1.55, 1.21-1.99) and biomarker-verified AD dementia (RRR 1.84, 1.27-2.65) compared with WtHR <0.50. In late life, WtHR ≥0.60 was associated with 15.6% (-19.0 to -12.2) lower p-tau217 concentration and lower risk of positive p-tau217 (RRR 0.49, 0.41-0.59) and biomarker-verified AD dementia (RRR 0.63, 0.46-0.86). BMI showed similar patterns: Midlife obesity was associated with higher p-tau217 concentration and elevated risk of biomarker-verified AD dementia, whereas late-life overweight/obesity was associated with lower p-tau217 and decreased risk of biomarker-verified AD dementia. Among those with positive p-tau217 or biomarker-verified AD dementia, mixed-effects regression showed higher midlife adiposity, reversing by late life.

Discussion: Our results identify midlife central and general adiposity as modifiable risk factors for AD pathology and AD dementia. WtHR may aid early risk stratification and inform interventions targeting central fat reduction.

Ekaterina Zotchev, Bjørn Heine Strand, Anita Sunde, Kay Deckers, Dag Aarsland, Nicholas J Ashton, Henrik Zetterberg, Vegard Fykse Skirbekk, Miguel G Borda, Gill Livingston, Archana Singh-Manoux, Geir Selbaek

Abstract
Background: Adults with Down syndrome (DS) have a high dementia risk, highlighting the need for robust, DS-specific assessment tools. This study evaluated the psychometric properties of the Norwegian version of the CAMDEX-DS-II by examining reliability and validity of the informant interview and the CAMCOG-DS-II cognitive assessment.

Method: In this nationwide study, 108 adults with DS were assessed across 19 hospital units during 2021-2023. Participants underwent a standardised dementia assessment including the CAMDEX-DS-II battery. Reliability was assessed using Cronbach’s alpha, weighted kappa, and intraclass correlation coefficients (ICCs), while validity was evaluated using factor analysis, receiver operating characteristic (ROC) analyses, and external cognitive and functional measures.

Results: The CAMDEX-DS-II informant interview demonstrated good to excellent psychometric properties, with high internal consistency (α ≥ 0.83) in core cognitive-functional sections and strong inter-rater reliability, with most items showing excellent weighted kappa (κ ≥ 0.80). Scores aligned closely with clinician-determined diagnostic classifications. The CAMCOG-DS-II showed very good internal consistency (α = 0.84) and excellent inter-rater reliability (ICCs ≥ 0.90). CAMCOG-DS-II total and domain scores differed significantly across diagnostic groups, with moderate-to-large effect sizes. ROC analyses indicated good overall diagnostic accuracy, with areas under the curve (AUCs) > 0.80, and particularly strong discrimination in individuals with mild ID.

Conclusions: The Norwegian CAMDEX-DS-II provides reliable indicators of dementia-related change in adults with DS. The combined informant interview and cognitive assessment provided evidence based on relations to diagnostic classification and external measures, supporting their clinical utility in the specialist services and contributing to the international evidence base.

Frode Kibsgaard Larsen, Ingrid Tøndel Medbøen, Andre Strydom, Geir Selbæk, Bjørn Heine Strand, Ellen Melbye Langballe

Abstract

Apolipoprotein E (APOE) genotype and cardiovascular risk are both associated with dementia, but their separate and joint contributions remain uncertain. We examined the independent and combined associations of APOE genotype and cardiovascular disease (CVD) risk with incident dementia in a Norwegian populationbased cohort. In this prospective cohort study, baseline data were obtained from the second Trøndelag Health Study (HUNT2, 1995–97), with follow-up through linkage to specialist health-care records and the Norwegian Cause of Death Registry through Dec 31, 2023. We included 22,108 participants aged 50 years or older who were free of CVD, diabetes, and dementia at baseline. APOE genetic risk and cardiovascular risk based on SCORE2 were each classified into three categories. Adjusted hazard ratios (HRs) for incident dementia were estimated using Cox models. During a median follow-up of 22.0 years, 3,714 incident dementia events occurred. Compared with low APOE genetic risk, adjusted HRs were 1.25(95% CI1.10–1.41) for intermediate risk and 3.09(2.73–3.49) for high risk. Compared with low-to-moderate CVD risk, adjusted HRs were 1.19(1.07–1.32) for high risk and 1.36(1.19–1.55) for very high risk. In joint analyses, the highest risk was observed in participants with high APOE genetic risk and very high cardiovascular risk (HR 3.78, 2.85–5.01). Higher cardiovascular risk was more clearly associated with dementia in participants without high APOE genetic risk, whereas dementia risk was consistently There was no clear evidence of multiplicative interaction (p=0.059). APOE genotype and cardiovascular risk were independently associated with incident dementia, with highest risk among individuals with both high genetic and cardiovascular risk.

Nora Grøtting, Brooke N. Wolford, Kirsti Kvaløy, Torbjørn Omland, Geir Selbæk & Linda Ernstsen

Abstract

Background: Capacity to consent or decision-making capacity to healthcare is a key prerequisite for a valid informed consent. A clear understanding of this concept is important to protect patients’ autonomy. Without it, clinical assessments may vary, jeopardising patients’ participation in decisions about their care and increasing the risk of delayed, denied or harmful treatment. Despite substantial international debate and reforms concerning norms on capacity assessment, there remains a paucity of scholarly literature comparing national approaches, which could enable countries to learn from one another. This study aimed to explore how the concept of capacity to consent to healthcare and the assessment is described in documents, guiding healthcare professionals, issued by health authorities in: Norway, England and Wales, Belgium, France, Sweden and Ireland.

Methods: Explorative qualitative document analysis of health laws, national guidelines and recommendations published by national health authorities in each country.

Results: There is no uniform description of the concept of capacity to consent to healthcare across all countries, although some commonalities exist, such as the functional approach and some countries are more conceptually aligned. The level of descriptive detail on the assessment varied, and in some countries the documents did not include such descriptions.

Discussion/conclusion: To protect patients’ autonomy, it is important that healthcare professionals are provided with a comprehensive guidance document to support their understanding of the concept of capacity to consent to healthcare and how to assess this capacity. The findings indicate that several countries lack such provisions. This could threaten patient safety and wellbeing and make research and clinical practice development more challenging.

Ingvild Hjorth Feiring, Reidar Pedersen, Øyvind Kirkevold, Claire Surr, Kevin De Sabbata, Jan Steyaert, Isabelle Rouch, Hanane Bada, Gunilla Nordberg, Mary Donnelly, Shaun O’Keeffe, Dianne Gove, Bjørn Lichtwarck