Forskningsartikler

Abstract:

Background: Cognition and frailty are sparsely studied in patients with idiopathic normal pressure hydrocephalus (iNPH). We aimed to describe the preoperative cognitive function compared with normative data and frailty profile in iNPH patients accepted for shunt surgery.

Methods: All patients were diagnosed according to international guidelines and underwent a standardized cognitive and physical examination and a geriatric assessment prior to surgery. Z-scores for the cognitive tests were calculated based on age and education adjusted population norms.

Results: The study cohort included 276 iNPH patients accepted for shunt surgery. Mean ± SD age was 73.1 ± 5.7 years, education 12.5 ± 3.8 years, and 61% were male. The median (IQR) score on the Mini-Mental State Evaluation was 27 (24–29), and the median (IQR) Clock Drawing test score was 4 (3–5). Mean (SD) z-score for immediate verbal recall was −1.74 (0.98), for delayed recall −1.66 (1.01), for figure copying −0.85 (1.35) for Trail Making Test A -1.50 (1.09), for Trail Making Test B −1.88 (1.03), for phonemic fluency −1.46 (1.10), and for semantic fluency −1.59 (1.20). Cluster analysis identified three groups, mainly differing regarding visuospatial function. The mean (SD) Frailty Index score was 0.23 (0.13), indicating mild frailty. The frailty domain most affected was physical function.

Conclusion: iNPH patients showed reduced cognitive function across all domains. The patient group is rather heterogeneous regarding cognitive symptoms, and no specific cognitive profile was identified. Cognitive assessment offers limited utility for diagnosing a typical pattern specific for iNPH but is important due to the complex needs for this patient group. Whether cognitive and frailty profile can be used to identify shunt responders, must be assessed in longitudinal studies.

Magnhild S. Dejgaard, Per Kristian Eide, Gro Gujord Tangen, Eva Skovlund, Geir Selbæk & Torgeir Bruun Wyller

Abstract:

Beyond their classical functions as redox cofactors, recent fundamental and clinical research has expanded our understanding of the diverse roles of nicotinamide adenine dinucleotide (NAD) and nicotinamide adenine dinucleotide phosphate (NADP) in signaling pathways, epigenetic regulation and energy homeostasis. Moreover, NAD and NADP influence numerous diseases as well as the processes of aging, and are emerging as targets for clinical intervention. Here, we summarize safety, bioavailability and efficacy data from NAD+-related clinical trials, focusing on aging and neurodegenerative diseases. We discuss the established NAD+ precursors nicotinic acid and nicotinamide, newer compounds such as nicotinamide riboside and nicotinamide mononucleotide, and emerging precursors. We also discuss technological advances including in industrial-scale production and real-time detection, which are facilitating NAD+ research and clinical translation. Finally, we emphasize the need for further large-scale studies to determine optimal dose, administration routes and frequency, as well as long-term safety and interindividual variability in response.

Jianying Zhang, He-Ling Wang, Sofie Lautrup, Hilde Loge Nilsen, Jonas T Treebak, Leiv Otto Watne, Geir Selbæk, Lindsay E Wu, Torbjørn Omland, Eija Pirinen, Tin Cho Cheung, Jun Wang , Mathias Ziegler, Ole-Bjørn Tysnes, Rubén Zapata-Pérez, Santina Bruzzone, Carles Canto, Michela Deleidi, Georges E Janssens, Riekelt H Houtkooper, Morten Scheibye-Knudsen, Masaya Koshizaka, Koutaro Yokote, Eric Verdin, Vilhelm A Bohr, Charalampos Tzoulis, David A Sinclair & Evandro Fei Fang

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: 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:

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: The COVID-19 pandemic increased social isolation in older adults, promoting mental and cognitive decline. The impact of social media on these effects remains unclear.

Aim: To investigate the long-term association of social isolation with mental and cognitive health in older adults and whether social media use mitigated this association.

Method: Data from the Norwegian Trøndelag Health Study before (2017-2019), during (January 2021), and after the pandemic (2021-2023) were analysed (N = 4844, 53% women, mean age 80 years). Multi-adjusted mixed-effects linear regression estimated differences in changes in mental (CONOR-MHI) and cognitive (MoCA) health related to self-reported social isolation and social media use. Beta (β) represents differences in change in z-score of CONOR-MHI or MoCA.

Results: Social isolation was associated with a steeper decline in mental health than no social isolation (β = 0.07, 95% CI 0.01, 0.13) but was not associated with change in cognitive health. Daily social media use was not related to change in mental health, whereas it was associated with a less steep cognitive decline than no social media use (< 1 h: β = 0.13, 95% CI 0.05, 0.20; ≥ 1 h: β = 0.10, 95% CI 0.01, 0.15). Stratified by social isolation, daily social media use < 1 h was related to a less steep cognitive decline than no social media use in both isolated (β = 0.15, 95% CI 0.02, 0.28) and non-isolated individuals (β = 0.13, 95% CI 0.03, 0.22).

Conclusion: Individuals experiencing social isolation during the pandemic had a steeper decline in mental, but not cognitive health, compared to those not isolated. Social media use did not buffer the decline in mental health but was associated with less steep cognitive decline. The pandemic showed limits of relying solely on digital solutions for social contact.

Tanja Louise Ibsen, Ekaterina Zotcheva, Sverre Bergh, Debby Gerritsen, Gill Livingston, Hilde Lurås, Svenn-Erik Mamelund, Anne Marie Mork Rokstad, Bjørn Heine Strand, Pernille Thingstad, Richard C Oude Voshaar & Geir Selbæk

Abstract:

Werner syndrome (WS), caused by mutations in the RecQ helicase WERNER (WRN) gene, is a classical accelerated aging disease with patients suffering from several metabolic dysfunctions without a cure. While, as we previously reported, depleted NAD+ causes accumulation of damaged mitochondria, leading to compromised metabolism, how mitochondrial NAD+ changes in WS and the impact on WS pathologies were unknown. We show that loss of WRN increases senescence in mesenchymal stem cells (MSCs) likely related to dysregulation of metabolic and aging pathways. In line with this, NAD+ augmentation, via supplementation with nicotinamide riboside, reduces senescence and improves mitochondrial metabolic profiles in MSCs with WRN knockout (WRN-/-) and in primary fibroblasts derived from WS patients compared to controls. Moreover, WRN deficiency results in decreased mitochondrial NAD+ (measured indirectly via mitochondrially-expressed PARP activity), and altered expression of key salvage pathway enzymes, including NMNAT1 and NAMPT; ChIP-seq data analysis unveils a potential co-regulatory axis between WRN and the NMNATs, likely important for chromatin stability and DNA metabolism. However, restoration of mitochondrial or cellular NAD+ is not sufficient to reinstall cellular proliferation in immortalized cells with siRNA-mediated knockdown of WRN, highlighting an indispensable role of WRN in proliferation even in an NAD+ affluent environment. Further cell and animal studies are needed to deepen our understanding of the underlying mechanisms, facilitating related drug development.

Sofie Lautrup, Shi-Qi Zhang, Shinichiro Funayama, Lisa Lirussi, Tina Visnovska, Hoi-Hung Cheung, Marc Niere, Yuyao Tian, Hilde Loge Nilsen, Geir Selbæk, Janna Saarela, Yoshiro Maezawa, Koutaro Yokote, Per Nilsson, Wai-Yee Chan, Hisaya Kato, Mathias Ziegler, Vilhelm A Bohr & Evandro F Fang

Abstract:
Aims:
The aim of this study is to explore patterns of the lived experiences of first-generation Turkish immigrants (≥ 60 years) living and ageing in Norway regarding their experiences with healthcare services and ageing.

Design:
This study used a qualitative study.

Methods:
The sample consisted of 17 individuals aged 60 and above who were of Turkish origin, and immigrated to and living in Norway. All participants resided in the same city in the middle part of Norway. Individual face-to-face interviews were conducted between February and June 2023. All transcripts were examined using reflexive thematic analysis.

Results:
Two main themes and five subthemes were identified. The first theme was ‘Utilization of the healthcare service to their best’, with the subthemes: (a) ‘Communication through a translator: Expressing health problems’ and (b) ‘From physician to physician: Seeking a second opinion in health’. The second theme was ‘Being born in Türkiye: Aging in Norway’, with the subthemes: (a) ‘Between two worlds: Efforts to establish balance’, (b) ‘Family ties and care preferences: Understanding the care preferences’ and (c) ‘Two cultures, one life: Lifestyles’.

Conclusion:
This study reveals the experiences Turkish immigrants have with the healthcare service and ageing while living in Norway and balancing between two cultures. These findings offer a valuable perspective for healthcare providers and social workers and offer insight relevant to developing a cross-cultural healthcare service programme.

Süleyman Şahin, Büşra Nur Temür, Selma Öncel, Nilgün Aksoy, Anne-Sofie Helvik

Background/Objectives: The annual incidence of falls is high in older adults with impaired cognitive function and dementia, and injuries have a detrimental effect on disability-adjusted life-years and public health spending. In this registry-based study, fall incidence and characteristics of the fallers were explored in a large population with cognitive impairment.
Methods: NorCog, “The Norwegian Registry of Persons Assessed for Cognitive Symptoms”, is a national research and quality registry with a biomaterial collection. This study included 9525 persons from the registry who had answered the question about falls. Fall incidence was studied, and the characteristics of fallers and non-fallers were compared.
Results: The annual fall incidence was 3774/9525 (39.6%). The incidence varied between types of dementia, from 22.4% in persons with the debut of Alzheimer’s disease before 65 years of age to 55.3% in persons with vascular dementia and with increasing degrees of cognitive impairment. A wide range of personal characteristics, symptoms, signs, laboratory tests, and physical, psychological, and cognitive tests differed between fallers and non-fallers, most in disfavour of the fallers. Age, reduced Personal Activities of Daily Living, reduced gait speed, delayed recall, use of a walking aid, and depression were independent predictors of falls.
Conclusions: Among cognitively impaired persons with a history of falls, frailty was an independent predictor of falls. Neither the type of dementia nor the degree of cognitive impairment were independent predictors of falls. Prevention of frailty by physical training and social activity may be important in mitigating fall risk among older adults with impaired cognition.

Per G. Farup, Knut Hestad and Knut Engedal