Forskningsartikler

Abstract

Background/Objective: Dementia is a major global health concern, necessitating effective risk assessment tools early intervention. This study compared the performance of five modifiable dementia risk indices – ANU-ADRI, CAIDE, CogDrisk, LIBRA, and LIBRA2 and a “demographics-only” (age, education) model.

Methods: We analyzed data from 5247 Norwegian participants in the Trøndelag Health Study (HUNT4 70+, 2017–2019) and dementia risk indices from baseline data in HUNT3 (2006–2008). Logistic regression models assessed associations between standardized index scores and all-cause dementia and Alzheimer’s disease (AD) across age group (<65 vs. ≥65 years), sex, and APOE4 status.

Results: During the mean follow-up of 10.6 (9.3–12.3) years (SD=0.74), all indices significantly predicted dementia and AD, though none outperformed the demographics-only model. CogDrisk showed significantly better discriminative ability than all other indices (0.76, 95 % CI:0.74–0.78; DeLong p < 0.05), followed by LIBRA (0.75, 95 % CI:0.72–0.77) and ANU-ADRI (0.74, 95 % CI:0.72–0.76). LIBRA2 (0.69, 95 % CI:0.66–0.71) and CAIDE (0.59, 95 % CI:0.56–0.61) had significantly lower accuracy (DeLong p < 0.001). Removing demographics maintained rank order but reduced accuracy across all indices. Stratified analyses showed stronger performance in those ≥65 years and females at HUNT3, while APOE4 status did not affect performance.

Conclusion: All indices were associated with dementia risk, with CogDrisk performing best across all conditions, and LIBRA2 and CAIDE performing weakest. No index outperformed a model including age and education only. Future research should refine risk indices for age- and sex-specific applications and assess whether simpler demographic models may suffice in some contexts.

Josephine Stubs, Ellen Melbye Langballe, Gill Livingston, Kaarin J. Anstey, Kay Deckers, Fiona E. Mathews, Mika Kivimäki, Bjørn Heine Strand, Anne-Marie Rokstad, Steinar Krokstad & Geir Selbæk

Abstarct:

Background/Objectives: Multifactorial prevention of falls in persons with dementia has minimal or non-significant effects. Personalised prevention is recommended. We have previously shown that gait speed, basic activities of daily living (ADL), and depression (high Cornell scores) were independent predictors of falls in persons with mild and moderate cognitive impairment. This study explored person-specific risks of falls related to physical, mental, and cognitive functions and types of dementia: Alzheimer’s disease (AD), vascular dementia (VD), mixed Alzheimer’s disease/vascular dementia (MixADVD), frontotemporal dementia (FTD), and dementia with Lewy bodies (DLB).

Methods: The study used data from “The Norwegian Registry of Persons Assessed for Cognitive Symptoms” (NorCog). Differences between the dementia groups and predictors of falls, gait speed, ADL, and Cornell scores were analysed.

Results: Among study participants, 537/1321 (40.7%) reported a fall in the past year, with significant variations between dementia diagnoses. Fall incidence increased with age, comorbidity/polypharmacy, depression, and MAYO fluctuation score and with reduced physical activity, gait speed, and ADL. Persons with VD and MixADVD had high fall incidences and impaired gait speed and ADL. Training of physical fitness, endurance, muscular strength, coordination, and balance and optimising treatment of comorbidities and medication enhance gait speed. Improving ADL necessitates, in addition, relief of cognitive impairment and fluctuations. Relief of depression and fluctuations by psychological and pharmacological interventions is necessary to reduce the high fall risk in persons with DLB.

Conclusions: The fall incidence and fall predictors varied significantly. Personalised interventions presuppose knowledge of each individual’s fall risk factors.

Per G. Farup, Knut Hestad and Knut Engedal

Abstract:

Objectives: To investigate patterns and correlates of depression among Norwegian older adults (age 70+), 1995-2019, and estimate the number of older adults with depression by 2050.

Design: Population-based cross-sectional study.

Setting and participants: Three surveys of the Trøndelag Health Study (Norway): HUNT2 (1995-96), HUNT3 (2007-08), and HUNT4 (2017-19). 22,822 home dwellers aged 70 + who participated in at least one of the three surveys.

Methods: Depression was defined as scores ≥8 on the depression subscale of the Hospital Anxiety and Depression Scale. Covariates included sex, age, education, marital status, and reported loneliness. Depression prevalence (%) was standardized to the Norwegian population by age, sex, and education for years close to the initial HUNT survey year (1995, 2006, and 2016). Projection of the total number of individuals with depression in the coming decades were estimated. Predictors of depression were analyzed with logistic regression and the potential reduction in depression prevalence by reducing the prevalence of loneliness was estimated.

Results: Standardized depression prevalence decreased from 16.7% (HUNT2) to 14.9% (HUNT3), and 11.5% (HUNT4), and was highest among men, the oldest (85+), the lower-educated, and in earlier surveys (all p < 0.001). Living alone was also associated with higher depression prevalence, but only if loneliness was present. While depression rates are falling, we expect the number of depressed individuals to double by 2050 as the population ages.

Conclusion and implications: Depression rates among adults aged 70 + decreased by 50% from 1995 to 2019, but less so among the oldest old. The rates were highest among single older men. Despite decreasing prevalence, the number of depressed older adults will increase significantly in the future. Given the major individual and societal costs of depression, this trend is alarming for societies preparing for the challenges posed by population aging. This can, however, be addressed by addressing predictors of depression.

Maria Lage Barca, Eivind Aakhus, Ellen Melbye Langballe, Thomas Hansen, Ragnhild Holmberg Aunsmo, Geir Selbæk, Steinar Krokstad, Bjørn Heine Strand

Abstract

Introduction: Loneliness is postulated to be a risk factor for dementia. However, the findings are inconsistent, and long-term studies on this association remain scarce.

Methods: In all, 9389 participants self-reported loneliness in the Trøndelag Health Study (HUNT) in HUNT1 (1984-1986), HUNT2 (1995-1997), and/or HUNT3 (2006-2008) and underwent cognitive assessment in HUNT4 (2017-2019) at age 70 years or older. Logistic regression was employed to analyze the association between the course of loneliness and dementia, with those never lonely as a reference.

Results: In the fully adjusted model, the odds ratio (OR) for persistent loneliness was 1.47 (95% confidence interval [CI] 1.10, 1.95). This attenuated when adjusting for depression (OR 1.28, 95% CI 0.95, 1.72).

Discussion: Persistent loneliness from midlife into older age, as well as becoming lonely, were associated with increased odds of dementia, whereas transient loneliness in midlife was not. These findings underscore the importance of reducing loneliness.

Clinical trial registration: The study was registered with ClinicalTrials.gov (NCT04786561) and is available online .

Highlights: Persistent and incident loneliness was associated with a higher risk of dementia.Transient loneliness was not associated with a higher risk of dementia.Loneliness 11 years before to the cognitive assessment was associated with dementia.Reducing the sense of loneliness might reduce or delay the onset of dementia.

Ragnhild Holmberg Aunsmo, Bjørn Heine Strand, Sverre Bergh, Thomas Hansen, Mika Kivimäki, Sebastian Köhler, Steinar Krokstad, Ellen M Langballe, Gill Livingston, Fiona E Matthews, Geir Selbæk

Abstract:

Background: Mental and neurological conditions have been linked to structural brain variations. However, aside from dementia, the value of brain structural characteristics derived from brain scans for prediction is relatively low. One reason for this limitation is the clinical and biological heterogeneity inherent to such conditions. Recent studies have implicated aberrations in the cerebellum, a relatively understudied brain region, in these clinical conditions.

Methods: Here, we used machine learning to test the value of individual deviations from normative cerebellar development across the lifespan (based on trained data from >27,000 participants) for prediction of autism spectrum disorder (ASD) (n = 317), bipolar disorder (n = 238), schizophrenia (SZ) (n = 195), mild cognitive impairment (n = 122), and Alzheimer’s disease (n = 116); individuals without diagnoses were matched to the clinical cohorts. We applied several atlases and derived median, variance, and percentages of extreme deviations within each region of interest.

Results: The results show that lobular and voxelwise cerebellar data can be used to discriminate reference samples from individuals with ASD and SZ with moderate accuracy (the area under the receiver operating characteristic curves ranged from 0.56 to 0.65). Contributions to these predictive models originated from both anterior and posterior regions of the cerebellum.

Conclusions: Our study highlights the utility of cerebellar normative modeling in predicting ASD and SZ, aided by 4 cerebellar atlases that enhanced the interpretability of the findings.

Milin Kim, Nitin Sharma, Esten H Leonardsen, Saige Rutherford, Geir Selbæk, Karin Persson, Nils Eiel Steen, Olav B Smeland, Torill Ueland, Geneviève Richard, Aikaterina Manoli, Sofie L Valk, Dag Alnæs, Christian F Beckman, Andre F Marquand, Ole A Andreassen, Lars T Westlye, Thomas Wolfers, Torgeir Moberget

Abstract:

Introduction: Development of accessible group exercise sessions is warranted for home-dwelling older people with cognitive impairment or dementia. This study aims to explore the experiences of participants in a group exercise session organized with volunteers both as instructors and as those providing support for the participants.

Methods: This qualitative descriptive study reports on a primary analysis of qualitative data collected through semistructured focus group interviews with 12 people with cognitive impairment or dementia at three group exercise sessions in three municipalities. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Results: Participants expressed an overall satisfaction with the new group exercise sessions. We found four meaning units forming a chain of support. The participants highlighted support to be motivated enough to engage in the sessions, support by offering transportation, the exercise content, and the role of instructors. Overall, the participants expressed that these exercise sessions had become a social arena for them, and all wanted to continue.

Discussion and conclusions: Exercise groups can be a meaningful and social arena for people with cognitive impairment or dementia, through careful organization with volunteers and minimal involvement from informal caregivers. This study underlines the need for properly organized activities, outside the home, to overcome the challenges associated with participation for this population.

Kristin Taraldsen, Arnhild J. Nygård, Elisabeth Boulton, Guro Grønningsæter, Marit H. Erland, Nina Waldenstrøm, Linda Johnsen, Gro G. Tangen and Randi Granbo

Abstract

Objectives: The second International Summit on Intellectual Disability and Dementia, held in 2023, highlighted the unique challenges of diagnosing dementia in older autistic adults, particularly those with intellectual disabilities, due to the complex interplay of cognitive, communicative, and behavioral factors. This article addresses key diagnostic issues and post-diagnostic considerations for this population.

Method:
A consensus report was developed by the Summit’s Autism/Dementia Working Group through background reviews, expert discussions at the Summit, and iterative draft revisions, incorporating feedback from internal and external stakeholders. Key issues were extracted from the report and abridged for this manuscript.

Results:
Diagnostic challenges stem from overlapping symptoms of co-occurring neurodevelopmental and psychiatric conditions, rendering standard dementia tools insufficient. Comprehensive evaluations tailored to autism-related traits, sensory sensitivities, and alternative communication methods are essential. Building diagnostic capacity among clinicians and fostering multidisciplinary collaboration are critical. Longitudinal assessments, initiated before dementia symptoms appear, facilitate early detection of subtle changes. Emerging biomarkers and neuroimaging techniques show promise and should be incorporated where feasible. Accommodations, such as virtual assessments in familiar settings, can enhance diagnostic accuracy by reducing anxiety. Creating transition processes from diagnostics to post-diagnostic supports will aid in mitigating challenges and enhance life quality when dementia is a factor.

Conclusions:
Research and clinician education are urgently needed to improve diagnostic approaches and streamline the transition from diagnosis to tailored post-diagnostic support. An integrated framework of comprehensive efforts is vital for our better understanding of age-associated neuropathological diagnostics and enabling long-term well-being of older autistic adults with dementia.

Matthew P Janicki, Philip McCallion, Nancy Jokinen, Frode Kibsgaard Larsen, Kathyrn P Service, Dawna T Mughal, Karen Watchman, Tiziano Gomiero, Seth M Keller

Abstract:

Aims:
Independent living among older adults is a global political goal aimed at reducing government spending on health and care services. This study investigates the prevalence of having someone to rely on for help when needed among community-dwelling adults aged 70 and older.

Methods:
The study sample comprised population-based data from 24,289 adults aged 70 or older participating in the Trøndelag Health Study (HUNT4). Standardized prevalence of having someone to rely on for help if needed in total, and from family, friends, or neighbors was estimated using Trøndelag county as the standard population. Prevalences were additionally stratified by gender, age, living situation, activities of daily living (ADL), and utilization of home-based services.

Results:
Standardized results showed that overall, 97.3% reported having someone to ask for help if needed, of whom 92.5% relied on family, 31.7% on friends, 23.1% on neighbors. The youngest men living alone had fewer to rely on compared to those living with others. Moreover, living alone was associated with relying less on family and more on friends and neighbors. Factors associated with relying on family members were female gender, younger age, cohabitation, no ADL problems, and no home-based services. Along with education, these factors also correlated with relying on friends for help.

Conclusions:
Nearly all those aged 70 and older in Norway have someone to ask for help, which is positive for aging in place policies. However, those living alone, especially men, are at a higher risk of not having anyone to rely on for help when needed.

Bjørn Heine Strand  & Ellen Melbye Langballe

Abstract:
Background/Objectives:
Old age and cognitive impairment/dementia are risk factors for falling and fall-related injuries. We have, in a previous study in persons with cognitive impairment, shown that falls were associated with frailty, reduced physical fitness, and cognitive reduction. Falls were independent of the disorders causing the impaired functions. Because most falls are innocent, knowledge of predictors of fall-related injuries seems more clinically relevant than the predictors of falls. Predictors of falls and fall-related injuries are not necessarily identical. The aim of this follow-up study to our previous one in the same population was to explore predictors of fall-related injuries in fallers and compare these predictors with those of falls.
Methods:
This study and our previous study used data from the “The Norwegian Registry of Persons Assessed for Cognitive Symptoms” (NorCog), a Norwegian research and quality registry with a biobank. The registry included consecutive home-dwelling persons referred to Norwegian specialist healthcare units for assessment of cognitive decline. This study included 3774 persons from our previous study who experienced falls last year and compared persons with and without a fall-related injury. A fall-related injury was defined as admittance to a hospital for the injury.
Results:
The annual incidence of fall-related injuries in the fallers was 884/3774 (23.4%). Female sex, older age, lower BMI, in need of public health service and walking assistance, and low Hb and Ca were independent predictors of fall-related injuries, indicating reduced physical fitness and state of health and a high burden of comorbidity. Injuries were not associated with the degree of cognitive impairment or the dementia diagnosis.

Conclusions:
In home dwelling persons with impaired cognitive functions and falls, fall-related injuries were associated with reduced physical fitness and state of health. In contrast to predictors of falls, neither the degree of cognitive impairment nor the dementia diagnosis was associated with fall-related injuries. The difference is comprehensible. Persons with cognitive impairment or dementia might have reduced power of judgment and be inattentive, unconcerned and careless, which increases the fall incidence but not the risk of injury once falling. Prevention of fall-related injuries should focus on relieving comorbidities, improving physical fitness and general health rather than on cognitive improvement.

Per G. Farup, Knut Hestad and Knut Engedal