Forskningsartikler

Abstarct

Objective: To evaluate and compare the predictive value of eight dementia risk scores for late-life cognitive function and cognitive decline; ANU-ADRI, CAIDE, CogDrisk, LIBRA, LIBRA2, UKBDRS(-APOE), and a Lancet commission-based risk score.

Methods: Using Norwegian Trøndelag Health Study (HUNT) data, we calculated risk scores from lifestyle and health data of 7221 dementia-free participants (mean age: 76.8 years, 54.1% female) collected in HUNT3 (2006–2008). Cognitive function was assessed using the Montreal Cognitive Assessment scale (MoCA) 11 years later in HUNT4 70+, and reassessed in 4716 participants 4 years thereafter. Associations between continuous risk scores or risk score tertiles, cognition and cognitive decline were examined using linear mixed-effects models. Logistic regression models were used to test associations between risk scores and a ≥ 3-point decline in MoCA scores.

Results: All risk scores were significantly associated with cognitive function and cognitive decline. Associations with cognitive function ranged from UKBDRS β per 1SD=-1.61(95%CI:-1.72,-1.51) to CAIDE (β=-0.74;95%CI:-0.82,-0.67), and with yearly cognitive decline from Lancet (β=-0.23;95%CI:-0.27,-0.18) to CAIDE (β=-0.04;95%CI:-0.07,-0.02). High-low risk group differences in cognitive function were largest for CogDrisk (β=-3.04;95%CI:-3.27,-2.81), LIBRA (β=-3.04;95%CI:-3.27,-2.80) and lowest for CAIDE (β=-1.65;95%CI:-1.86,-1.44). High-risk groups showed the steepest decline for UKBDRS-APOE (β=-0.43;95%CI:-0.52,-0.34), Lancet (β=-0.39;95%CI:-0.48,-0.30), and LIBRA (β=-0.38;95%CI:-0.47,-0.28). All scores predicted ≥3-point decline modestly: AUCs were highest for UKBDRS (AUC=0.61;95%CI:0.60,0.63), UKBDRS-APOE (0.61;95%CI:0.60,0.63), CogDrisk (0.60;95%CI:0.58,0.62), and Lancet (0.60;95%CI:0.58,0.61), but none outperformed a model including age and education alone (0.61;95%CI:0.60,0.63).

Conclusion: Risk scores captured meaningful gradients in cognition and decline but offered limited discriminatory accuracy beyond demographics, supporting their use for prevention-oriented risk profiling rather than prediction.

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

Abstract

Background: Cardiovascular disease (CVD) risk factors are associated with the risk of cognitive decline and dementia. Composite CVD risk scores integrate multiple risk factors and may capture the cumulative burden of CVD risk relevant to cognitive outcomes. However, the long-term association between established CVD risk scores and subsequent dementia and mild cognitive impairment (MCI), and potential differences in these associations between males and females, remains insufficiently studied. This study examined the association between NORRISK 2, a CVD risk model estimating 10-year risk of fatal- and non-fatal CVD, and the presence of dementia and mild cognitive impairment (MCI) in males and females, after 22 years of follow-up.

Methods: Participants from The Trøndelag Health Study (HUNT), a longitudinal, population-based health study, were included. NORRISK 2 scores were based on data from HUNT2 (1995-1997). Cognitive status was assessed in the sub-study HUNT4 70+ (2017–2019) and categorized as cognitively unimpaired (CU), MCI, or dementia. We used multinomial logistic regression with NORRISK 2 as the predictor and cognitive status 22 years later as the main covariate.

Results: The study sample consisted of 6,971 participants (57.6% females, mean age at HUNT2 56.1 years). At HUNT4 70+, 14.0% of the participants had developed dementia, and 34.6% had developed MCI. Per one percent increase in NORRISK 2 score, the relative risk of developing dementia increased by 14% for males (relative risk ratio (RRR) = 1.14; 95% CI 1.12–1.17) and 28% for females (RRR = 1.28; 95% CI 1.25–1.31). The relative risk of developing MCI increased by 4% for men (RRR = 1.04; 95% CI 1.02–1.05) and 10% for women (RRR = 1.10; 95% CI 1.08–1.12).

Conclusion: A higher NORRISK 2 score was associated with an increased risk of dementia and MCI in both males and females, with the strongest associations observed in females.

Silje Kleven, Linda Ernstsen, Marte Kvello-Alme, Stian Lydersen, Geir Selbæk, Rannveig Sakshaug Eldholm

Abstract

Post-diagnostic support is a critical yet underdeveloped aspect of dementia care, especially for autistic adults who present with distinct cognitive, sensory, and communication needs. Although interventions such as medication management, psychosocial support, environmental modifications, and carer training are known to improve outcomes, their relevance and accessibility for autistic individuals remain poorly understood. As part of the Second International Summit on Intellectual Disability and Dementia, an international working group examined the intersection of autism and dementia with a focus on post-diagnostic care. Drawing on interdisciplinary expertise, the group identified key barriers and opportunities in clinical practice, caregiving, and service delivery. Recommendations are organized across seven areas, including models of post-diagnostic support, caregiving contexts, pharmacological and non-pharmacological interventions, environmental adaptations, and care planning. The discussion emphasizes the complex needs of autistic adults-many of whom have co-occurring intellectual disabilities, psychiatric conditions, or chronic health issues-and the need for individualized approaches that account for sensory sensitivities and communication differences. Existing dementia care frameworks often fail to address these complexities, resulting in significant service gaps. The report calls for urgent investment in research, workforce training, and policy reform to promote equitable, autism-informed post-diagnostic support and improve quality of life for this underserved population.Lay AbstractAutistic adults who develop dementia often experience challenges that are not well addressed by current dementia care systems. After a dementia diagnosis, people may need help with memory, communication, behavior changes, and daily living. For autistic adults, these supports must be adapted to their individual sensory sensitivities, communication styles, and social differences. This article reports on the work of an international group of researchers, clinicians, and advocates who met during the Second International Summit on Intellectual Disability and Dementia. The group examined how post-diagnostic support for autistic adults with dementia could be improved. They reviewed existing evidence, identified key barriers to care, and proposed strategies to strengthen services in areas such as medication use, environmental design, caregiver training, and personalized care planning. The report emphasizes that many autistic adults also have intellectual disabilities, mental health conditions, or long-term physical health issues, which can make care more complex. Current dementia care frameworks often overlook these overlapping needs, resulting in limited or unsuitable supports. The authors call for more research, workforce training, and autism-informed policy changes to ensure that post-diagnostic care is equitable, individualized, and responsive. Enhancing understanding and adapting support can help autistic adults with dementia maintain dignity, comfort, and quality of life.

Matthew P Janicki, Philip McCallion, Nancy Jokinen, Frode Kibsgaard Larsen, Dawna T Mughal, Kathryn P Service, Tiziano Gomiero, Christina N Marsack-Topolewski, Karen Watchman, Flavia H Santos, Seth M Keller, Shahin Shooshtari, Anupam Thakur, Vikram Palanisamy

Abstract:

Purpose: To document use and impact of potentially inappropriate medications on two-year progression of dementia in individuals with cognitive declines.

Methods: A retrospective study of 397 patients with Mild Cognitive Impairment (MCI) or dementia diagnosed and followed-up in outpatient memory clinics in Norway during 2009 − 18. Beers (2019)- and STOPP-2 criteria were used to identify Potentially Inappropriate Medications (PIMcogs) in individuals with cognitive impairments at baseline and two-year-follow-up. PIMcog use in terms of dementia severity, cognitive function, and neuropsychiatric and depressive symptoms were analyzed in regression models.

Results: The prevalence of PIMcogs increased from 16% at baseline to 23% at follow-up. PIMcog users were more likely to be women (63.5%), and they used more drugs, with a median of 5 drugs at baseline and 4 drugs at follow-up, compared to non-users who had a median of 3 used drugs at both time points. PIMcog users had higher median Neuropsychiatric Inventory severity sum scores (6 [3.0–11.0] versus 4.0 [2.0–7.0]) and median Cornell Scale for Depression in Dementia scores (6.5 [3.0–11.0] versus 4.0 [1.0–7.0]) compared to non-users at follow-up (p ≤ 0.002). PIMcog users exhibited more severe dementia, with a Clinical Dementia Rate-Sum of Boxes (CDR-SB) score of 7.0 (4.0–13.0) compared to 6.0 (3.5–10.0) in non-users. The median annual increase in CDR-SB was one unit, and PIMcog use at follow-up was significantly associated with more rapid progression of dementia severity.

Conclusion: Faster dementia progression was documented among PIMcog users although, the prevalence of PIMcogs was generally low in Norwegian memory clinic patients with cognitive impairments.

Hege Kersten, Maria L. Barca, Rannveig Sakshaug Eldholm, Karin Persson, Lara Thomasgaard, Keson Jaioun, Ingvild Saltvedt, Geir Selbæk & Knut Engedal

Background: The 2024 Lancet Commission report on dementia identified 14 modifiable dementia risk factors. The Norwegian HUNT study uniquely includes data collection of all 14 risk factors in the same individuals throughout adulthood, as well as a study-specific dementia diagnosis. We aimed to evaluate the potential for dementia prevention associated with these 14 risk factors, along with three additional sociodemographic risk factors in this retrospective cohort.

Methods: This retrospective cohort study included data on participants with study-specific diagnosis from the HUNT4 70+ study (2017-19) and was linked with national administrative registries (1960-2018) and earlier HUNT surveys (1984-2008) with data on dementia risk factors at ages 35-92 years. Inverse probability weighting was applied to account for non-response. Logistic regression estimated dementia risk associated with exposure to less education in early adult life (age <45 years), hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol use in midlife (age 45-65 years), and social isolation, air pollution, and vision loss in late life (age >65 years). Midlife occupational physical activity and marital and employment status were added to the Lancet model. The potential for dementia prevention was assessed using population attributable fraction (PAF).

Findings: Between Sept 1, 2017, and Feb 28, 2019, 19 403 individuals were invited to participate and 9745 participants (1525 with dementia, 8220 without dementia) were included. 4445 (45·6%) of 9745 participants were male and 5300 (54·4%) were female. The total PAF for the 14 Lancet risk factors was 50·9% (95% CI 37·7-61·4). Including family-related and work-related risk factors increased the PAF to 54·9% (42·3-64·7; p<0·0001). When these factors were added for women, the total PAF increased from 48·0% (95% CI 29·4-61·7) to 52·2% (34·2-65·3; p=0·0090), whereas no significant change was observed in men (56·2% [95% CI 35·5-70·2] to 56·7 [95% CI 36·1-70·6]; p=0·71).

Interpretation: Addressing all 14 Lancet risk factors could prevent over half of all dementia cases. Adding factors related to marital and occupational status offers additional preventive potential, particularly among women.

Merete Ellingjord-Dale, Bjørn Heine Strand, Vegard Skirbekk, Bernt Bratsberg, Teferi Mekonnen, Ekaterina Zotcheva, Geir Selbæk, Yaakov Stern, Asta Kristine Håberg, Bo Engdahl

Background
Smoking is considered a risk factor for dementia. Nevertheless, uncertainty regarding the associations with dementia subtypes and the effects of quitting remains. In this large longitudinal population-based cohort study, we investigated smoking as an independent risk factor for all-cause dementia. Second, we investigated the associations with dementia subtypes.

Methods
We included participants from the Trøndelag Health Study (HUNT) and collected their smoking status at baseline (HUNT2, 1995-97). We assessed cognitive status at follow-up two decades later (HUNT4 70+, 2017-19, N = 8,532) and collected pack-years. We handled missing data with multiple imputations and estimated relative risks (RRs) with Poisson regression after adjustment for covariates and stratification by age and sex.

Results
Current smokers had a 31% increased dementia risk (RR 1.31, 95% confidence interval (CI) 1.12–1.52), women <85 at follow-up had a 54% increased risk (RR 1.54, 95% CI 1.20–1.98), and men <85 had a 36% increased risk (RR 1.36, 95% CI 1.01–1.82). We found no associations in persons 85+. Current smokers had an increased risk for vascular dementia but not for Alzheimer’s dementia. Pack-years were not associated with increased dementia risk, and former smoking was only associated with vascular dementia in men.

Conclusions
Current smoking was associated with an increased risk of dementia. Among those 85+ at follow-up, being a smoker 20+ years earlier was not associated with an increased risk of dementia, probably because death was a competing risk. In former smokers, there were no significant associations with dementia. Our results add to the literature an optimism about the effects of changing smoking habits and may encourage smoking cessation.

Christian Myrstad, Marie Larssen, Bo Engdahl & Geir Selbæk

Abstarct:

The prevalence of Alzheimer’s disease neuropathological changes (ADNCs), the leading cause of cognitive impairment, remains uncertain. Recent blood-based biomarkers enable scalable assessment of ADNCs¹. Here we measured phosphorylated tau at threonine 217 in 11,486 plasma samples from a Norwegian population-based cohort of individuals over 57 years of age as a surrogate marker for ADNCs. The estimated prevalence of ADNCs increased with age, from less than 8% in people 58–69.9 years of age to 65.2% in those over 90 years of age. Among participants aged 70 years or older, 10% had preclinical Alzheimer’s disease, 10.4% had prodromal Alzheimer’s disease and 9.8% had Alzheimer’s disease dementia. Furthermore, among those 70 years of age or older, ADNCs were present in 60% of people with dementia, in 32.6% of those with mild cognitive impairment and in 23.5% of the cognitively unimpaired group. Our findings suggest a higher prevalence of Alzheimer’s disease dementia in older individuals and a lower prevalence of preclinical Alzheimer’s disease in younger groups than previously estimated.

Dag Aarsland, Anita Lenora Sunde, Diego A. Tovar-Rios, Antoine Leuzy, Tormod Fladby, Henrik Zetterberg, Kaj Blennow, Kübra Tan, Giovanni De Santis, Yara Yakoub, Burak Arslan, Hanna Huber, Ilaria Pola, Lana Grötschel, Guglielmo Di Molfetta, Håvard K. Skjellegrind, Geir Selbaek & Nicholas J. Ashton

ABSTRACT

Objectives:
The study aims to conduct a systematic review of peer-reviewed articles about psychosocial interventions to reduce the caregiver burden in family caregivers of people with dementia to explore the effectiveness and the type of intervention and methodology used.

Methods:
Five databases were searched (AgeLine, CINAHL, MEDLINE, PsycINFO, PubMed) for studies reporting on experimental research of psychosocial interventions for dementia-related caregiver burden. Data quality checks were completed for included papers.

Results:
Forty-three studies were included in the analysis; about half of them (n = 24) were randomized controlled trials. The types of interventions most often used were psychoeducation (n = 21) and multi-component interventions (n = 12). The caregiver burden was after the intervention successfully reduced in about half of the studies (n = 19). Additionally, 10 studies had success in reducing caregiving burden in one of several assessment measures used. The studies using psychoeducation (57%) and multi-component (58%) intervention approaches had the highest success rates.

Conclusion:
Health professionals should be encouraged to implement psychosocial interventions for caregivers of patients with dementia.

Hande Kirisik Surer, Nilufer Korkmaz Yaylagul & Anne-Sofie Helvik

Introduction: Frontotemporal symptoms are usually associated with frontotemporal dementia (FTD), but people with all forms of dementia may develop these symptoms as the dementia disease progresses. Knowledge about psychosocial interventions that meet the needs of people with FTD symptoms, and literature on the subject, is hard to find. The aim of the study was to describe current practice as it is experienced by healthcare experts in the clinical field in Norway.

Method: Three focus groups were conducted. Healthcare personnel with clinical experience in care and treatment to people with FTD and other dementia diseases with frontotemporal symptoms were eligible for inclusion. Qualitative directed content analysis with open coding focusing on both manifest and latent content was applied.

Results: Four categories were described: (1) Dilemmas of anosognosia, (2) establishment of a diagnosis, (3) establishment of post-diagnostic support at home, and (4) establishment of care in the nursing home.

Conclusion: People with FTD and other dementias with frontotemporal symptoms need rigid, easy-to-understand, predictable surroundings and healthcare personnel that are clear, friendly, and respectful in their communication. Post-diagnostic support provided in flexible systems ensuring smooth transitions between services and levels of care is required. To ensure quality of care, frontline healthcare staff should be able to recognize FTD symptoms. To achieve this, supervision and training are needed. More research about clinical care interventions and how to derive good nursing practice should be prioritized.

Marit Mjørud, Anne-Brita Knapskog, Marit Nåvik & Janne Røsvik