Forskningsartikler

Abstract

Introduction: Efficient and cost-effective diagnostic tools for supporting dementia assessment are increasingly important. We aimed to evaluate whether providing neuroradiologists with volumetric data from an automatic MRI software, NeuroQuant, enhanced the diagnostic accuracy of their visual MRI assessment.

Methods: Two neuroradiologists assessed brain MRIs from 366 patients (mean age 67.5 years, SD 9.2, and 52% females) with subjective cognitive decline (SCD, n 79), mild cognitive impairment (MCI, n 86), or dementia (n 201). The MCI and dementia patients were further diagnosed according to an etiology of Alzheimer’s disease (AD, n 217) versus non-AD (n 70). In random order the neuroradiologists visually evaluated medial temporal lobe atrophy (MTA, scale 0-4) with and without having access to the NeuroQuant report of age and sex adjusted volumetric percentiles of the hippocampus. Receiver operating characteristics (ROCs) analyses were conducted to calculate the area under the curves (AUCs) for the visual MTA, the automated NeuroQuant percentile, and the combined NeuroQuant-assisted MTA in discriminating dementia from SCD and AD from non-AD.

Results: The AUC of the visual MTA for dementia versus SCD discrimination increased slightly but not significantly when the neuroradiologists were provided with NeuroQuant results (AUC 0.76-0.79, p 0.28). Yet, the isolated NeuroQuant evaluation reached the highest accuracy (AUC 0.85, p < 0.001), significantly better than the MTA assessment (p 0.002) and the NeuroQuant-assisted MTA (p 0.04). Only the isolated NeuroQuant assessment discriminated AD from non-AD (AUC 0.60, p 0.006).

Conclusion: On the basis of our findings, we suggest an increased use of clinically approved automatic volumetry methods in radiological departments.

Karin Persson, Hanneke F M Rhodius-Meester, Trine Holt Edwin, Anne-Brita Knapskog, Peter Bekkhus-Wetterberg, Geir Selbæk, Knut Engedal, Till Schellhorn

Abstract

Bernt Bratsberg, Jennifer R Harris, Vegard Skirbekk, Yaakov Stern, Asta Kristine Håberg, Geir Selbæk, Bjørn Heine Strand, Trine Holt Edwin

Abstract
Introduction: It is unclear how dementia affects loss in life expectancy (LE). In this registry-based study, we aimed to study sex differences in LE and loss in LE in dementia, mild cognitive impairment (MCI), and subjective cognitive decline (SCD).

Methods: A total of 16,358 patients diagnosed with dementia, MCI, or SCD from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) during 2009-2022 were included and followed up for mortality. Sex differences in LE and loss in LE were predicted using flexible parametric survival models and sex-specific mortality in the general population as reference.

Results: Among dementia patients, women with dementia had the largest loss in LE: 17 years loss at 60 years; correspondingly, men lost 13.5 years. Similar patterns were observed for MCI and dementia subtypes.

Discussion: Women with dementia or MCI had a larger loss in LE compared to men with these diagnoses.

Highlights: Women with dementia had the largest loss in life expectancy compared to the general population.The excess female loss in life expectancy was also evident for all the dementia subtypes and for mild cognitive impairment.The loss in life expectancy was more pronounced in younger patients with dementia, with a loss of 17 years in women at 60 years of age. Men, in comparison, lost 13.5 years at the same age.Subjective cognitive decline was associated with a minor loss in life expectancy in both sexes.

Rachel Amland, Geir Selbæk, Anne Brækhus, Hanneke F M Rhodius-Meester, Bjørn H Strand

Abstract:
Background:
With increasing population longevity, Alzheimer’s disease and dementia have become a health priority, and high-quality incidence estimates are needed.

Objective:
To provide reliable and precise incidence estimates of dementia applying a population-based sample of individuals aged 70+.

Methods:
A longitudinal cohort design was used, with baseline assessment in the Norwegian HUNT4 70+ study (2017–19) and at follow-up four years later (2021–23). Age-specific dementia incidence rates, standardized for the Norwegian population, were calculated as the number of new dementia cases per 1000 person-years assuming onset midway between study waves with inverse probability weights based on baseline factors associated with non-participation or death.

Results:
Among 5229 dementia-free individuals at baseline, 749 developed dementia over a 4.2-year period, resulting in a cumulative incidence proportion of 14.3%. At follow-up, 33.8% of new dementia cases showed no baseline cognitive impairment, while the rest had mild cognitive impairment (MCI). Of those with baseline MCI, 25.5% reverted to normal cognition, 48.2% remained MCI, and 26.2% developed dementia. The dementia incidence per 1000 person-years, was 43.9 (95% confidence interval (CI) 40.8, 47.1) (weighted for non-response and standardized to the dementia-free Norwegian population).

Conclusions:
Our study found higher dementia incidence rates in the 70+ population than hospital records indicate. Most individuals had preceding MCI, with similar numbers reverting to normal cognition as developing dementia. The projected incident dementia cases suggest a near doubling between 2023 and 2050, significantly impacting families and healthcare planning, including early detection and interventions.

Inger Molvik, Bjørn Heine Strand, Anne Marie Mork Rokstad, Eivind Aakhus, Stina Aam, Sverre Bergh, Anne Brækhus, Knut Engedal, Linda Gjøra, Grete Kjelvik, Marte Kvello-Alme, Gill Livingston, Fiona E Matthews, Karin Persson, Håvard Kjesbu Skjellegrind, Geir Selbæk

Abstract

Objectives:
The study aimed to investigate the psychometric properties of the Norwegian version of the Threadgold Communication Tool, a proxy-rated instrument assessing communication abilities in people with dementia.

Design:
The study employed a prospective design, with two measurement points within 10 days. The Threadgold Communication Tool was translated into Norwegian following the World Health Organization’s protocol for translation and back-translation.

Setting and participants:
The study included 126 residents from ten different nursing homes and one assisted living facility in Norway. The participants consisted of 99 women (78.57 %) and 27 men (21.43 %), aged between 61 and 100 years, with a mean age of 85.67 (SD 7.59).

Outcome measures:
The outcome measures were the internal consistency, test-retest reliability, and construct validity of the Threadgold Communication Tool.

Results:
The Norwegian version of the Threadgold Communication Tool demonstrated satisfactory psychometric properties, with a high level of internal consistency (Cronbach’s α coefficient = 0.95) and robust test-retest reliability (r = 0.8, p < 0.001). Principal Component Analysis revealed a two-component structure, explaining 62.9 % of the variance. However, the item ‘vocalization’ scored lower than other items and was identified as difficult to interpret by the Sonas Licensed Practitioners.

Conclusions:
The Norwegian version of the Threadgold Communication Tool is a reliable and valid tool for assessing communication abilities in people with dementia. However, further research is needed to refine the instrument based on these findings, particularly regarding the interpretation of the ‘vocalization’ item.

Anne-Martha Utne Øygarden, Ellen Karine Grov, Anne Marie Mork Rokstad, Orla Brady, Knut Engedal, Benedicte Sørensen Strøm

Abstract

Meaning in life is a key aspect of our well-being and is a central issue within the field of existential health. Knowledge is scarce on the experience of meaning in life of people living with dementia. Dementia is defined as loss of memory and other cognitive abilities, reducing the person’s ability to perform activities of daily living. This poses challenges to interviewing and including persons with dementia in qualitative research. In this study we explore how nursing home residents with dementia experience meaning in life, and how they can reflect on this existential question. We used an exploratory qualitative design with semi-structured interviews of ten people with mild to severe dementia living in one nursing home and found that conversations about meaning in life with persons with dementia were feasible. Some memories of the past were told as if they were happening here and now, and some topics were repeated several times throughout the interview. This study highlights the importance of awareness of existential themes and interventions facilitating meaning in life for this population, despite certain challenges to be overcome. The past and present merge, giving their stories a unique character. This holds significance for the moment by providing insight into how cognitive impairment might affect the perception of time. It is important to acknowledge this perspective and understand that meaning in life may be connected to memories and experiences from the past, and that this might be more prominent for this group than others.

Silje M Nylund, Lars Danbolt, Ingvild Hjorth Feiring, Sverre Bergh, Bjørn Lichtwarck, Øyvind Kirkevold & Knut A. Hestad

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 Stuebs, 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

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