Forskningsartikler

Abstract

Background: Life expectancy for individuals with Down syndrome (DS) has significantly increased, primarily due to medical advances. While DS is considered a genetically determined form of Alzheimer’s disease (DS-AD), with neuropathological markers evident by age 40, the onset of clinical dementia varies. Modifiable risk factors are thought to contribute meaningfully to dementia risk in the general population. Advances in intervention studies in the general population suggest cognitive decline can be reduced through multimodal lifestyle interventions, however no large-scale multimodal studies have been conducted in the DS population.

Search strategy: A comprehensive search was conducted across five electronic databases—Medline, EMBASE, CINAHL, Web of Science, and ASSIA to identify studies that examined the relationship between lifestyle interventions and cognitive outcomes in adults with DS. The search combined database-specific controlled language with keywords related to exercise, diet, social activities, cardiovascular health, and brain stimulation. Studies included were peer-reviewed original research articles focusing on adults with DS and reported on cognitive outcomes or AD-related biomarkers.

Results: The search yielded 24,774 articles, with 16,868 remaining after duplicates were removed. A total of 44 articles met inclusion criteria across the domains of exercise, diet, cardiovascular health, social connectedness, and cognitive stimulation. Most studies focused on exercise, indicating some cognitive benefits, particularly in executive functions and working memory, though results were inconsistent, and many suggested the necessity of high adherence to intervention protocols. No studies were found that examined the direct impact of diet on cognition in DS. Findings on cognitive stimulation, cardiovascular health and social connectedness suggested potential but inconclusive benefits for cognitive function.

Conclusions: This review underscores the significant gaps in research regarding non-pharmacological interventions for DS-AD. It highlights the need for tailored, well-structured studies to better understand and leverage potential cognitive benefits of lifestyle interventions in the DS population. Implementing such interventions early in life and before significant disease progression may help maintain quality of life and independence among individuals with DS. Future research should focus on comprehensive, multi-domain interventions to ascertain their efficacy and optimal application.

Eimear McGlinchey, Sarah Pape, Shahid H. Zaman, Jessica Eustace-Cook, Anna Stockbauer, Eleni Baldimtsi, Ellen Melbye Langballe, Frode Kibsgaard Larsen, Katja Sandkühler, Phoebe Ivain, Anne-Sophie Rebillat, Pierre Ecrement, Mary McCarron, Bessy Benejam, Wan Ming Khoo, Juan Fortea, Johannes Levin, Fredrik Öhman, Ann-Charlotte Granholm-Bentley, Andre Strydom & Georg Nübling

Sammendrag
Bakgrunn: Nærmere 90 % av norske kommuner har et hukommelsesteam eller en ressursperson for demens, men det er lite kunnskap om innholdet i tjenestene og hvordan teamene ivaretar sine oppgaver.

Metode: Hensikten med studien var å undersøke og beskrive ansatte i hukommelsesteams erfaringer med organisering, rammefaktorer og ivaretagelse av oppgaver. Vi gjennomførte fire fokusgruppeintervjuer med 18 ansatte i hukommelsesteam fra ulike deler av landet. Intervjuene ble analysert i tråd med prinsipper for innholdsanalyse.

Hovedresultater: Deltagerne beskrev ingen sammenheng mellom kommunestørrelse og hukommelsesteametsstørrelse. De opplevde et stort sprik mellom behov og ressurser. Hukommelsesteamene trakk frem at samarbeidetmed fastlegen er svært viktig, men samarbeidet er sårbart, og mange kommuner mangler arenaer og systematikk for samarbeid. Mangel på kommunale planer og prioriteringer gjør at det er opp til teamene selv å prioritere de knappe ressursene de har.

Konklusjon: Resultatene fra studien indikerer et behov for at kommunene gir hukommelsesteamene en tydelig posisjon i organiseringen av tilbudet til personer med demens og deres familier. Det synes å være behov for økte ressurser, tydeligere retning for prioritering og kvalitet, samt tilrettelegging av arenaer for samarbeid internt i kommunene, spesielt med fastleger.

Siren Eriksen, Mona Michelet, Klaus Amundsen, Hege Askestad, Thea Cathrine Bredholt, Torunn Edøy, Knut Engedal, Marianne Lingner, Kjersti Løkken Aakerholm, Trude Irene Solberg & Anne Marie Mork Rokstad

Abstract

Clarissa Giebel, Rabih Chattat, Iva Holmerova, Louise Hopper, Jurate
Macijauskiene, Megan Rose Readman, Oscar Ribeiro, Anne Marie Rokstad,
Anthony Scerri, Dorota Szczesniak, Catherine Talbot, Jochen Rene Thyrian,
Lindsay Groenvynck, Marco Brigiano, Gill Windle & on behalf of the
INTERDEM Taskforce on Inequalities in Dementia

Sara E. Stinson, Alexey A. Shadrin, Zillur Rahman, Linn Rødevand, Iris J. Broce, Geir Selbæk, Hreinn Stefansson, Jan Haavik, Nadine Parker, Elise Koch, Oleksandr Frei, Kevin S. O’Connell, Olav B. Smeland, Srdjan Djurovic, Anders M. Dale, Dennis van der Meer, Ole A. Andreassen

Abstract

Objective: Accurate cognitive screening tests for culturally, linguistically, and educationally diverse populations remain scarce, contributing to diagnostic inequities. To address this, we examined the cross-cultural properties and diagnostic accuracy of the Multicultural Cognitive Examination (MCE) in classifying mild cognitive impairment (MCI), dementia, Alzheimer’s disease (AD) dementia, and non-AD dementia in participants with diverse backgrounds.

Method: In this retrospective cross-sectional study, we aggregated data from 1,449 participants across 11 countries. Multiple linear regression models were used to determine the influence of demographic variables on MCE scores, which informed the creation of regression-based normative data. Diagnostic accuracies were examined using Receiver Operating Characteristics (ROC) curves.

Results: The cohort consisted of 1001 cognitively intact participants, 140 patients with MCI, and 308 patients with dementia. 54.2% had immigrant backgrounds and originated from 63 different countries. MCE scores were significantly influenced by education and age, but not by sex or immigrant status. The MCE demonstrated high accuracy in differentiating cognitively intact participants from patients with dementia (AUC: .95) and MCI (AUC: .84). The MCE was both accurate for classifying AD dementia (AUC: .97) and non-AD dementia (AUC: .94).

Conclusions: This study supports the clinical utility of the MCE as a culturally robust and highly accurate cognitive screening test. Future studies should examine the ability of the MCE to monitor cognitive decline.

Daniel Kjaergaard, Alfonso Delgado-Álvarez, Gunhild Waldemar, Ulrike Beinhoff, Peter Bekkhus-Wetterberg, Sanne Franzen, Caitlin H Illingworth, Jerson Laks, Alvaro Lozano-Ruiz, Andreas Lueschow, Jordi A Matias-Guiu, Simone Pomati, Kurt Segers, Rozita Torkpoor, Jørgen Wagle, T Rune Nielsen

Abstract

Objectives: This study explores how healthcare professionals in Norwegian municipal memory teams experience working as case managers for people with dementia and their informal caregivers, and the approaches they employ to fulfil this role.

Method: A qualitative descriptive design was employed, using focus groups with 18 case managers from a range of municipalities. Data were analysed using thematic content analysis.

Results: Three overarching themes emerged: (1) tailoring support, (2) being committed and available, and (3) contributing to cooperation and competence development. Participants described how they adapted services to individual needs throughout the dementia trajectory, drawing on both professional expertise and personal resources. While the role was experienced as meaningful, it was also described as demanding, involving high levels of personal involvement and vulnerability due to limited resources. Case managers also played a key role in competence development and multidisciplinary collaboration.

Conclusion: The case manager role facilitates flexible, person-centred support, and continuity of care. However, its effectiveness is highly dependent on individual commitment and is vulnerable to resource constraints. Strengthening structural and professional conditions is essential to ensure the delivery of high-quality dementia care.

Mona Michelet, Siren Eriksen, Kariann Krohne, Thea C Bredholt, Knut Engedal, Hege Askestad, Trude Solberg, Anne Marie Mork Rokstad

Abstract:

Background: Neuropsychiatric symptoms (NPS) are highly prevalent in nursing home residents. The main aims of this study were to examine whether music-based care (MBC) had sustained effects on NPS in nursing home residents with dementia and chronic pain and to describe the distribution of NPS.

Methods: A secondary analysis of a cluster-randomised controlled trial with intervention and control groups was performed. The 8-week MBC intervention included daily individualised prerecorded music integration. A large sample of nursing home residents with dementia and chronic pain in 12 nursing homes in Norway were screened for pain and dementia by experts and included in the study. The Neuropsychiatric Inventory Nursing Home Edition (NPI-NH) was completed for the residents at pre-test and after the 8-week MBC intervention. Descriptive statistics were used to characterise the sample, and multilevel mixed model analysis assessed the difference in change in NPI-NH scores before and after the intervention between the groups.

Results: The sample (n = 232) had a mean age of 86 years (SD 8.8), with 71% being female. Overall, 41%, 38% and 21% had severe, moderate or mild dementia, respectively, while 77% had moderate pain and 23% severe pain. Over two-thirds (68%) of the sample had at least one clinically important (≥ 4) NPI-NH symptom at pre-test, with mean NPI-NH total score of 19 (range 0–89). The most commonly identified NPI-NH subcategories were agitation (44%), affective symptoms (34%) and psychosis (25%) at pre-test. There was no significant difference in changes either comparing the NPI-NH total score (p = 0.396) (confidence interval: CI [–2.6 to 6.6]) between the intervention group (n = 108) and the control group (n = 124) or comparing any of the three NPI subcategories: psychosis (p = 0.203) (CI [–0.5 to 2.3]), agitation (p = 0.830) (CI [–2.3 to 1.8]) or affective symptoms (p = 0.447) (CI [–0.9 to 2.1]).

Conclusions: No statistically significant sustained effect of the MBC intervention on NPI symptoms was found among residents with dementia and chronic pain. Future studies should include measurement points closer to the intervention to evaluate short-term effects of MBC.

Martin Elstad Myrenget, Reidun Sandvik, Petter Borchgrevink, Geir Selbæk, Milada Småstuen, Vegar Rangul, Odd Håpnes, Audun Myskja, Bettina Husebø, Tone Rustøen

ABSTRACT
Background Subjective memory impairment (SMI) is used as a proxy for objective memory, although their relationship remains unclear. Moreover, SMI is suggested to be a risk factor for dementia. This study investigated associations between SMI and (1) concurrent objective memory performance, (2) early‐life general cognitive abilities (GCA), and (3) if SMI and objective memory scores were associated with distinct or overlapping sociodemographic, health, and lifestyle risk factors for dementia. Material and Methods 2690 participants between 30 and 90 years from the general, geographical population study HUNT4 were included. SMI scores were from the Meta‐Memory‐Questionnaire. Verbal, spatial, and ability to differentiate between similar representations (pattern separation) were tested concurrently. GCA was from conscription at age 18. We implemented multiple imputation and inverse probability weighting from the entire population to account for selection bias. Results Higher SMI scores were associated with verbal memory and GCA, but not spatial or pattern separation memory. There was an interaction between sex and verbal memory on SMI, with men reporting higher SMI than women at similar lower verbal memory performance. Higher SMI scores were associated with higher age, blood pressure, depression, sleep, fatigue, and chronic pain, but not APOE4 or lifestyle variables. All memory tests were positively associated with each other and negatively with age. Diabetes was associated with verbal memory. Conclusion In the general population, SMI was weakly linked to concurrent verbal memory and GCA in adolescence. Health, in particular mental health, was highly associated with SMI but not objective memory performance. Thus, SMI is a complement to memory testing, not a proxy.

Simon Holmvik, Daniel Radosław Sokołowski, Ragnhild Bergene Skråstad, Olav Spigset, Bjørn Heine Strand, Asta Kristine Håberg

Abstract

Background
Dry mouth is a common and burdensome condition in older adults and its severity may increase with use of anticholinergic medications. The aims were to describe anticholinergic medication use among acutely ill older adults, examine the association between anticholinergic burden and dry mouth severity using the composite Dry Mouth Severity Points (DMSP) measure and investigate whether the association differs by sex.

Methods
Patients ≥70 years admitted to Oslo municipal inpatient acute care unit were eligible. Anticholinergic burden (ACB) was assessed using the ACB calculator and classified as 0, lower (ACB = 1–2) or high (ACB = ≥ 3). Dry mouth severity was quantified with DMSP, range 0–4, assigning one point for each indicator above cut-off: General Xerostomia Question ≥ 3, Summated Xerostomia Inventory ≥ 11, Clinical Oral Dryness Score ≥ 6 and unstimulated whole saliva secretion rate ≤ 0.1 mL/min. Associations were examined with ordinal logistic regression.

Results
Of 382 examined patients, 256 (mean age 84 ± 7 years, 70% women) had complete data. Mean [standard deviation (SD)] ACB score was 2.0 (1.7); 18% had ACB = 0, 50% had ACB = 1–2 and 32% had ACB = ≥ 3. DMSP scores of 0, 1, 2 and ≥ 3 were present in 29%, 36%, 23% and 12%, respectively.

Compared with patients with ACB = 0, those with ACB = 1–2 [odds ratio (OR) = 2.06, 95% confidence interval (CI) 1.07–3.97) and ACB = ≥ 3 (OR = 2.25, 95% CI 1.09–4.63) had higher odds of more severe dry mouth. Women had significantly higher ACB and DMSP scores than men.

Conclusions
Even lower anticholinergic burden was associated with greater dry mouth severity, highlighting the need for early recognition and proactive management in acutely ill older adults.

Ingrid Beate Ringstad, Eva Skovlund, Leonor Roa Santervas, Hege Kersten, Katrine Gahre Fjeld, Lene Hystad Hove, Torgeir Bruun Wyller, Janicke Liaaen Jensen, Rita Romskaug