Forskningsartikler

Abstract:

Objectives: The prevalence of clinically significant depressive symptoms (CSDS) in community-living older adults ≥70 years living at home in Norway has not been investigated for years. This study aimed to examine the prevalence and variables related to CSDS in older adults 70+, with a sub-analysis among the oldest (80+).

Methods: In the Trøndelag Health Study (HUNT), Norway, 8911 inhabitants comprising 47.1 % men (mean age in women 77, SD 5.6 and men 76.5, SD 5.3, range 70-102.7) completed the Depression subscale in the Hospital Anxiety and Depression Scale (HADS-D). Chi-square and multivariable logistic regression were used to test variables associated with CSDS.

Results: The prevalence of CSDS (HADS-D ≥ 8) was in the total sample 8.4 % among women and 11.5 % among men, while among the oldest (80+), the prevalence was 14.4 % and 16.6 %, respectively. Feeling lonely or perceiving health as poor was associated with CSDS. Reported impaired functioning was associated with CSDS than in those without such limitations in men, but not in women.

Conclusions: Men had a higher prevalence of CSDS than women in the total sample and among the oldest (80+). Loneliness and poor health are important variables associated with CSDS.

Heidi Emly Sivertsen, Gørill Haugan & Anne-Sofie Helvik

Abstract

Background
Infections may contribute to Alzheimer’s disease (AD) pathogenesis. Prior studies on the relationship between Helicobacter pylori (H. pylori) infection and AD or dementia have shown differing results.ObjectiveWe investigated whether H. pylori serology is associated with the risk of AD and dementia in the Trøndelag Health Study (HUNT).
Methods
The HUNT cohort study measured serum H. pylori antibody titers using the Pyloriset EIA-IgG test. 22 years after baseline serum sampling, cognitive assessments were conducted using standardized tests and proxy interviews. We performed logistic regression (n = 1364) adjusted for sex and age to estimate odds ratios for cognitive outcomes. Subgroup analyses were stratified by sex, age, Apolipoprotein E4 (APOE ε4) carrier status and high sensitivity serum C-reactive protein levels and sensitivity analyses further adjusted for lifestyle and co-morbidity risk factors. Cox regression models (n = 4689) were used to estimate hazard ratios for all-cause mortality.
Results
H. pylori titers were not associated with AD (OR 0.99 per 1 SD higher titer, 95% CI 0.82-1.20) or dementia (OR 0.98, 95% CI 0.84-1.15). There were no associations between H. pylori seropositivity (≥ 300 titers) and AD (OR 1.10, CI 0.75-1.63) or dementia (OR 0.96, CI 0.68-1.32). Stratifications by sex, age, CRP, or APOE ε4 genotype and adjusting for additional covariates showed no associations. All-cause mortality was higher with H. pylori positivity (HR 1.07, CI 1.03-1.11).
Conclusions
H. pylori was not associated with later AD or dementia in this study. The relationship between specific versus multi-pathogenic infection burden and neurodegenerative diseases warrants further clarification.

Pieta T Kelsey, Geir Selbæk, Hugo Lövheim, Bjørn Olav Åsvold, Kristian Hveem, Brooke N Wolford & Håvard K Skjellegrind

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

Background: It is of interest to local authorities to better understand cultural adaptation among immigrant groups who came to a new culture and country at a young age. There is a gap in the literature on the cultural adaptation of Turkish immigrants from arrival until and during old age. This study aimed to explore the experiences of cultural adaptation among long-term older Turkish immigrants in Norway.

Methods: This study had a qualitative, explorative design and employed reflexive thematic analysis and face-to-face semi-structured individual interviews to improve the understanding of cultural adaptation. A total of 15 Turkish immigrants aged 60 years and over were interviewed once between March and June 2023.

Results: The following two main themes and five subthemes about cultural adaptation were generated: (a) encouraging cultural adaptation (experiencing social equality, tolerance, and economic prosperity; meeting supportive people and functioning welfare systems; learning and liking the culture and people); (b) restricting cultural adaptation (a continuing language barrier: struggling to communicate; preserving one’s own culture and heritage).

Conclusion: To enhance cultural adaptation, researchers should conduct interventional studies that consider encouragement and restriction. For long-term older migrants, nursing is an essential tool for enhancing cultural adaption and promoting healthy aging in the host country. This study recommends further education and research for nurses to be more effective in overcoming cultural barriers and supporting older immigrants.

Ayşegül Ilgaz, Büşra Nur Temür, Süleyman Şahin, Sebahat Gözüm, Anne-Sofie Helvik

Abstract:

COVID-19 containment measures reduced older adults’ healthcare access, with uncertain long-term effects on cognitive, physical, and mental health. To investigate whether reductions in primary and specialist healthcare service use during the pandemic were associated with changes in cognitive, physical, and mental health in community-dwelling older adults, with attention to sex differences. Data from the Norwegian Trøndelag Health Study collected before (HUNT4 70 + , 2017-2019) and after the pandemic (HUNT AiT, 2021-2023) included 5387 participants (53% women) aged 70 + . Propensity score matching, accounting for baseline confounders, was used to examine associations between reduced healthcare service use and cognitive, physical, and mental health changes from pre- to post-pandemic. Reduced contact with general practitioners was associated with greater cognitive decline among women (MoCa-change – 0.32 [95% CI – 0.62, – 0.32]). No differences were observed in physical or mental health. Reductions in other primary care services (e.g., in-home nursing, practical assistance) were associated with greater decline in cognitive function (MoCa-change – 0.94 [- 1.53, – 0.36]), particularly among men (MoCa-change – 2.12 [- 3.13, – 1.11]). Men also had a decline in physical function (SPPB-change – 1.06 [- 1.79, – 0.33]). No differences in mental health were observed. Reductions in specialist healthcare services were unrelated to health changes in the overall sample but linked to improved physical function in women (SPPB-change 0.32 [0.11, 0.53]). Although associations between reduced healthcare service use during the pandemic and cognitive, physical, and mental health were limited, findings highlight the importance of sustaining access to primary care for older adults during public health crises.Trial registration The study is pre-registered at ClinicalTrials.gov 02.02.2021, with the identification number NCT04792086.

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

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: 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