Forskningsartikler

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

Abstract:

Background: Mental and neurological conditions have been linked to structural brain variations. However, aside from dementia, the value of brain structural characteristics derived from brain scans for prediction is relatively low. One reason for this limitation is the clinical and biological heterogeneity inherent to such conditions. Recent studies have implicated aberrations in the cerebellum, a relatively understudied brain region, in these clinical conditions.

Methods: Here, we used machine learning to test the value of individual deviations from normative cerebellar development across the lifespan (based on trained data from >27,000 participants) for prediction of autism spectrum disorder (ASD) (n = 317), bipolar disorder (n = 238), schizophrenia (SZ) (n = 195), mild cognitive impairment (n = 122), and Alzheimer’s disease (n = 116); individuals without diagnoses were matched to the clinical cohorts. We applied several atlases and derived median, variance, and percentages of extreme deviations within each region of interest.

Results: The results show that lobular and voxelwise cerebellar data can be used to discriminate reference samples from individuals with ASD and SZ with moderate accuracy (the area under the receiver operating characteristic curves ranged from 0.56 to 0.65). Contributions to these predictive models originated from both anterior and posterior regions of the cerebellum.

Conclusions: Our study highlights the utility of cerebellar normative modeling in predicting ASD and SZ, aided by 4 cerebellar atlases that enhanced the interpretability of the findings.

Milin Kim, Nitin Sharma, Esten H Leonardsen, Saige Rutherford, Geir Selbæk, Karin Persson, Nils Eiel Steen, Olav B Smeland, Torill Ueland, Geneviève Richard, Aikaterina Manoli, Sofie L Valk, Dag Alnæs, Christian F Beckman, Andre F Marquand, Ole A Andreassen, Lars T Westlye, Thomas Wolfers, Torgeir Moberget

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

Objectives: The second International Summit on Intellectual Disability and Dementia, held in 2023, highlighted the unique challenges of diagnosing dementia in older autistic adults, particularly those with intellectual disabilities, due to the complex interplay of cognitive, communicative, and behavioral factors. This article addresses key diagnostic issues and post-diagnostic considerations for this population.

Method:
A consensus report was developed by the Summit’s Autism/Dementia Working Group through background reviews, expert discussions at the Summit, and iterative draft revisions, incorporating feedback from internal and external stakeholders. Key issues were extracted from the report and abridged for this manuscript.

Results:
Diagnostic challenges stem from overlapping symptoms of co-occurring neurodevelopmental and psychiatric conditions, rendering standard dementia tools insufficient. Comprehensive evaluations tailored to autism-related traits, sensory sensitivities, and alternative communication methods are essential. Building diagnostic capacity among clinicians and fostering multidisciplinary collaboration are critical. Longitudinal assessments, initiated before dementia symptoms appear, facilitate early detection of subtle changes. Emerging biomarkers and neuroimaging techniques show promise and should be incorporated where feasible. Accommodations, such as virtual assessments in familiar settings, can enhance diagnostic accuracy by reducing anxiety. Creating transition processes from diagnostics to post-diagnostic supports will aid in mitigating challenges and enhance life quality when dementia is a factor.

Conclusions:
Research and clinician education are urgently needed to improve diagnostic approaches and streamline the transition from diagnosis to tailored post-diagnostic support. An integrated framework of comprehensive efforts is vital for our better understanding of age-associated neuropathological diagnostics and enabling long-term well-being of older autistic adults with dementia.

Matthew P Janicki, Philip McCallion, Nancy Jokinen, Frode Kibsgaard Larsen, Kathyrn P Service, Dawna T Mughal, Karen Watchman, Tiziano Gomiero, Seth M Keller

Abstract:

Introduction: People with dementia are eligible for rehabilitation for functional difficulties resulting from cognitive symptoms, but no method for this is used in Norwegian municipalities. GREAT cognitive rehabilitation (CR) is an approach which has shown significant positive effects. The study aimed to explore the experiences of dementia case managers using the GREAT CR approach to address the rehabilitation goals of people with dementia.

Method: Six dementia case managers, from four Norwegian municipalities, participated. The pilot study had two phases: phase 1: the participants learnt the approach, and each used it with two clients, to become CR practitioners; phase 2: the participants could use CR in their normal practice. Their experiences were explored in two focus groups. The focus groups were audiotaped, transcribed, and analysed in line with directed content analysis.

Results: Three categories were described: (1) the training and written material, (2) professional development, and (3) proposals for solutions on how to use CR in clinical practice. The case managers found it both engaging and challenging to use CR. They observed that the experience had changed their usual practice: they asked people with dementia more questions about their everyday functioning and resources. The most important barrier to implementing CR was lack of time, although funds were provided to allow municipalities to provide cover for participants’ time, participants still found they lacked the time to use the approach as planned.

Conclusion: This study has demonstrated that it is feasible to implement CR in a Norwegian municipality if enough time is available and sufficient resources are provided. There is an urgent need to identify how healthcare services can be enabled to make rehabilitation methods like CR a regular part of post-diagnostic support.

Marit Mjørud, Mona Michelet, Kariann Krohne, Thea Catherine Bredholt, Suzannah Evans, Linda Clare

Abstract

This article synthesizes findings, from the Autism/Dementia Work Group of the 2nd International Summit on Intellectual Disabilities and Dementia, on the nature of autism/autism spectrum disorder and later-age neuropathologies, particularly dementia. The convened group of experts explored genetic, neurobiological, and environmental risk factors that may affect the lifespan and lived experiences of older adults with autism. A review of current literature indicates a lack of comprehensive information on the demographics and factors associated with aging in autistic adults. However, our understanding of autism is evolving, challenging traditional views of it as a static, inherited neurodevelopmental disorder. The relationship between autism and other neurodevelopmental conditions-such as Down syndrome, fragile X syndrome, and tuberous sclerosis complex-reflects the complex genetic landscape of neurodevelopmental disorders. These genetic and familial factors may contribute to progressive health challenges and cognitive decline in later life. Key findings reveal a complex link between autism and dementia, despite limited research on this relationship, particularly among older adults. The overall prevalence of dementia in this population appears to be influenced by co-occurring intellectual disabilities, particularly Down syndrome. While the association between autism and specific types of dementia is still not well understood, the reviewed evidence suggests a notable connection with frontotemporal dementia, although causality has not been established. Exploration of biomarkers may offer further insights. Currently, the relationship between autism, cognitive health, and cognitive decline in older adults remains a complex and underexplored area of research.

M P Janicki, P McCallion, N Jokinen, F K Larsen, D Mughal, V Palanisamy, F Santos, K Service, A Shih, S Shooshtari, A Thakur, G Tiziano & K Watchman

Abstract:

Background: Studies have shown that quantitative EEG is useful in predicting conversion from mild cognitive impairment (MCI) to Alzheimer’s disease dementia (ADD) and dementia with Lewy bodies (DLB). As subcortical pathology is present and executive impairment is common in DLB, we hypothesized that EEG could predict conversion in patients with impaired executive function and any subcortical pathology.
Methods: We included 113 patients with MCI from five Nordic memory clinics, 80 (71%) with amnestic MCI, 17 (15%) with dysexecutive MCI (deMCI), 3 (3%) with aphasic, 2 (2%) with visuospatial and 11 (10%) with unspecific MCI. Patients were examined with EEG in a resting state applying the statistical pattern recognition (SPR) method and followed up for five years. Eleven drop-outs were assessed after baseline. Receiver operating characteristic (ROC) analyses were used to examine the ability of EEG to predict conversion.

Results: Sixty patients converted to dementia, 47 to ADD, eight to vascular dementia, two to DLB, one to frontotemporal dementia and two to unspecific dementia. Eight (11%) recovered and 45 (40%) remained MCI stable. ROC analyses revealed that EEG predicted conversion from dysexecutive MCI to dementia with area under the curve (AUC) of 0.92 (95% CI 0.76-100), sensitivity of 89% and specificity of 100%. Subcortical pathology was present in 89% of the dysexecutive MCI converters. EEG did not predict conversion from amnestic MCI to dementia.
Conclusion: This study demonstrates that quantitative EEG using the SPR method predicts conversion from deMCI to dementia disorders with subcortical pathology with high sensitivity and specificity.

Knut Engedal, Lars-Olof Wahlund, Christian Sandøe Musaeu,  Peter Hoegh, Maria Lage Barca, Thorkell Eli Gudmundsson, Birgitte Bo Andersen, Daniel Ferreira, Mala Naik, Anne Rita Oeksengaard, Jon Snaedal