Forskningsartikler

Abstract:
Background: Ongoing shifts in economic structure from automation and globalisation can affect employment and mortality, yet these relations are not well described.

Objective: We assess whether long-term employment and health outcomes relate systematically to structural change in the labour market, using the occupational Routine Task Intensity (RTI) score as indicator of exposure is to risks of outsourcing and technology-induced job loss.

Methods: Using a cohort design and administrative data with national population coverage, we categorise all Norwegian employees in 2003 by the RTI score of their occupation and examine how this score correlates with employment and health outcomes measured in 2018 and 2019. The study sample counts 416 003 men and 376 413 women aged 33-52 in 2003.

Results: The occupational RTI score at baseline is robustly associated with long-term employment, disability and mortality outcomes. Raw correlations are reduced after adjustment for potential confounders, but associations remain substantial in models controlling for individual covariates and in sibling comparisons. Working in an occupation with RTI score 1 SD above the mean in 2003 is associated with a raised probability of being deceased in 2019 of 0.24 percentage points (95% CI: 0.18 to 0.30) for men and 0.13 percentage points (95% CI: 0.02 to 0.24) for women, corresponding to raised mortality rates of 6.7% and 5.5%.

Conclusions: Individuals in occupations characterised by high routine intensity are less likely to remain employed in the long term, and have higher rates of disability and mortality.

Bernt Bratsberg, Ole Rogeberg, Vegard Skirbekk

Objective: The main objective of this study was to explore how health care professionals experience adaptation of user-involvement for people with dementia receiving health and social care.

Method: A qualitative explorative design was used with eight focus groups as the method of data collection. A total of 49 health care professionals were included representing a variety of professions, municipal and specialized health services, and all health regions of Norway. The transcribed focus group interviews were analyzed using qualitative content analysis following six steps to identify categories and the overall theme.

Results: Six main categories were identified: 1) facilitation of self-determination, 2) challenges of reduced or lack of awareness, 3) family caregivers’ concern and protection, 4) open communication, 5) establishing a trustworthy relationship, and 6) clarifying expectations. To maintain independent lives for people with dementia, health care professionals must facilitate and support shared decision-making using an open and trustworthy communication.

Conclusion: To facilitate user-involvement, health care professionals need to develop and implement strategies that consider the perspectives of people with dementia and support the relationship between people with dementia and their informal caregivers.

Anne Marie Mork Rokstad, Siren Eriksen, Guro Hanevold Bjørkløf

Background and purpose: Persons with mild cognitive impairment (MCI) and Alzheimer dementia (AD) often experience gait and balance disturbances and depressive symptoms alongside their cognitive impairment. The aim of this study was to explore the relationship between mobility and depressive symptoms in community-dwelling persons with MCI and mild to moderate AD.
Methods: Ninety-nine participants with MCI and AD from the memory clinic at Oslo University Hospital, Ullevål, Norway, were included. The Balance Evaluation Systems Test (BESTest), 10-m walk test regular (gait speed), and dual task (naming animals, dual-task cost in percent) were used to assess mobility. The Cornell Scale for Depression in Dementia, with validated cut-off 5/6 points, was used to assess presence of depressive symptoms. Multiple regression analysis was used to explore the relationship between mobility (3 separate models) and depressive symptoms, controlled for demographic factors, comorbidity, and Mini-Mental State Examination.
Results: One-third of the participants had depressive symptoms, mean (SD) gait speed was 1.09 (0.3) m/s, and median (interquartile range) BESTest percent score was 81.5 (17.6). No statistically significant associations were found between depression and BESTest, gait speed or dual-task cost, neither in the simple models (P = 0.15-0.85), nor in the 3 multivariate models (P = 0.57-0.69).

Discussion and conclusions: In this study, we found no associations between mobility and depressive symptoms in persons with MCI and AD recruited at a memory clinic. Few participants had major symptoms of depression, which may have influenced the results. Longitudinal studies are needed to explore the long-time associations between mobility and depression.

Susannah Julie Flugon, Nina Jøranson, Gro Gujord Tangen

Background: Aggregation of amyloid-β (Aβ) is an early pathological event in Alzheimer’s disease (AD). Consequently, measures of pathogenic aggregated Aβ are attractive biomarkers for AD. Here, we use a recently developed Thioflavin-T-Fluorescence Correlation Spectroscopy (ThT-FCS) assay to quantify structured ThT-responsive protein aggregates, so-called nanoplaques, in the cerebrospinal fluid (CSF).

Objective: The overall aim of this work was to assess whether ThT-FCS determined CSF nanoplaque levels could predict amyloid brain uptake as determined by 18F-Flutemetamol PET analysis. Further, we assess whether nanoplaque levels could predict clinical AD.

Methods: Nanoplaque levels in the CSF from 54 memory clinic patients were compared between sub-groups classified by 18F-Flutemetamol PET as amyloid-positive or amyloid-negative, and by clinical assessment as AD or non-AD.

Results: Nanoplaque levels did not differ between amyloid groups and could not predict brain amyloid uptake. However, nanoplaque levels were significantly increased in patients with clinical AD, and were significant predictors for AD when adjusting for age, sex, cognitive function, and apolipoprotein E (APOE) genotype.

Conclusion: The concentration of nanoplaques in the CSF differentiates patients with clinical AD from non-AD patients.

Mari Aksnes, Ebba Glersen Müller, Ann Tiiman, Trine Holt Edwin, Lars Terenius, Mona-Elisabeth Revheim, Vladana Vukojević, Nenad Bogdanović, Anne-Brita Knapskog

Bakgrunn: Alkohol og legemidler kan føre til økt funksjonssvikt, sykelighet og død, særlig hos personer med høy samsykelighet. Hensikten med studien var å undersøke bruken av alkohol, tobakk og vanedannende legemidler hos hjemmetjenestemottakere over 60 år i en middels stor kommune og se hvilke faktorer som hadde sammenheng med alkoholbruk.
Metode: Tverrsnittsundersøkelse der 210 personer over 60 år som mottok hjemmebaserte tjenester i en norsk kommune, ble intervjuet om deres bruk av alkohol, tobakk og vanedannende legemidler samt deres psykiske symptomer. Sammenhengen mellom alkoholbruk og andre variabler ble undersøkt.

Resultat: Hver femte deltaker hadde demens, 38 % hadde depressive symptomer, 16 % hadde angstsymptomer, 57 % brukte alkohol, 11 % brukte angstdempende legemidler, og 31 % brukte vanedannende legemidler mot søvnproblemer. Alkoholbruk hadde sammenheng med lavere alder, å røyke tobakk og færre depresjonssymptomer.

Konklusjon: Nesten 60 % brukte alkohol, og alkoholbruken var høyere hos yngre, blant personer som røykte tobakk, og blant deltakere med færre depresjonssymptomer. En av tre brukte vanedannende legemidler mot søvnproblemer. Denne kunnskapen er nyttig for ansatte i hjemmetjenesten og bør påvirke organiseringen tjenestene, hvilke symptomer man skal være oppmerksomme på hos brukerne, og hvilken behandling og oppfølging som skal gis.

Sverre Bergh, Elin Michaelsen, Nina Beate Andfossen, Bjørn Lichtwarck, Geir Selbæk & Øyvind Kirkevold

Abstract
Late-onset Alzheimer’s disease is a prevalent age-related polygenic disease that accounts for 50–70% of dementia cases. Currently, only a fraction of the genetic variants underlying Alzheimer’s disease have been identified. Here we show that increased sample sizes allowed identification of seven previously unidentified genetic loci contributing to Alzheimer’s disease. This study highlights microglia, immune cells and protein catabolism as relevant to late-onset Alzheimer’s disease, while identifying and prioritizing previously unidentified genes of potential interest. We anticipate that these results can be included in larger meta-analyses of Alzheimer’s disease to identify further genetic variants that contribute to Alzheimer’s pathology.

Douglas P. Wightman, Iris E. Jansen, Jeanne E. Savage, Alexey A. Shadrin, Shahram Bahrami, Dominic Holland, Arvid Rongve, Sigrid Børte, Bendik S. Winsvold, Ole Kristian Drange, Amy E. Martinsen, Anne Heidi Skogholt, Cristen Willer, Geir Bråthen, Ingunn Bosnes, Jonas Bille Nielsen, Lars G. Fritsche, Laurent F. Thomas, Linda M. Pedersen, Maiken E. Gabrielsen, Marianne Bakke Johnsen, Tore Wergeland Meisingset, Wei Zhou, Petroula Proitsi, Angela Hodges, Richard Dobson, Latha Velayudhan, 23andMe Research Team, Julia M. Sealock, Lea K. Davis, Nancy L. Pedersen, Chandra A. Reynolds, Ida K. Karlsson, Sigurdur Magnusson, Hreinn Stefansson, Steinunn Thordardottir, Palmi V. Jonsson, Jon Snaedal, Anna Zettergren, Ingmar Skoog, Silke Kern, Margda Waern, Henrik Zetterberg, Kaj Blennow, Eystein Stordal, Kristian Hveem, John-Anker Zwart, Lavinia Athanasiu, Per Selnes, Ingvild Saltvedt, Sigrid B. Sando, Ingun Ulstein, Srdjan Djurovic, Tormod Fladby, Dag Aarsland, Geir Selbæk, Stephan Ripke, Kari Stefansson, Ole A. Andreassen & Danielle Posthuma

Abstract
Objectives: Relationship quality (RQ) between a person with dementia and a family carer may influence their health and quality of life. However, evidence regarding its course and influencing factors is limited. We aimed to explore RQ trajectories in dementia, and identify predictors of change.
Methods: We analysed longitudinal data from a cohort of 350 community-dwelling people with dementia and their informal carers, participating in the Actifcare study in eight European countries. The Positive Affect Index, rated separately by both people with dementia and their carers, assessed RQ. Other measures included the Neuropsychiatric Inventory Questionnaire (regarding persons with dementia), and the Relative Stress Scale, Sense of Coherence Scale and Lubben Social Network Scale (for carers). Trajectories and influencing factors were explored applying a latent growth model (LGM).
Results: RQ in the group of carers declined over 1 year, but RQ scores for the persons with dementia did not change. Higher stress in carers negatively influenced their baseline RQ ratings. Carer sense of coherence and being a spouse were associated with more positive baseline RQ carer assessments. Higher levels of neuropsychiatric symptoms were linked to decline in carers’ RQ, whereas social support was associated with more positive RQ trajectories.
Conclusion: This study provides a valuable insight into the course of RQ. LGM proved useful to explore the factors that influence RQ trajectories and variability within- and between-persons. Our findings emphasise the importance of carer-perceived social support and sense of coherence, and of reducing neuropsychiatric symptoms, in maintaining a good RQ.

Maria J Marques, Eva Y L Tan, Bob Woods, Hannah Jelley, Liselot Kerpershoek, Louise Hopper, Kate Irving, Anja Bieber, Astrid Stephan, Anders Sköldunger, Britt-Marie Sjölund, Geir Selbæk, Janne Røsvik, Orazio Zanetti, Daniel M Portolani, João Marôco, Marjolein de Vugt, Frans Verhey, Manuel Gonçalves-Pereira, Actifcare Consortium

Abstract: We present associations between neuropsychiatric symptoms (NPS) and brain morphology in a large sample of patients with mild cognitive impairment (MCI) and Alzheimer’s disease with dementia (AD dementia).Several studies assessed NPS factor structure in MCI and AD dementia, but we know of no study that tested for associations between NPS factors and brain morphology. The use of factor scores increases parsimony and power. For transparency, we performed an additional analysis with selected Neuropsychiatric Inventory – Questionnaire (NPI-Q) items. Including regional cortical thickness, cortical and subcortical volumes, we examined associations between NPS and brain morphology across the whole brain in an unbiased fashion. We reported both statistical significance and effect sizes, using linear models adjusted for multiple comparisons by false discovery rate (FDR). Moreover, we included an interaction term for diagnosis and could thereby compare associations of NPS and brain morphology between MCI and AD dementia.We found an association between the factor elation and thicker right anterior cingulate cortex across MCI and AD dementia. Associations between the factors depression to thickness of the banks of the left superior temporal sulcus and psychosis to the left post-central volume depended on diagnosis: in MCI these associations were positive, in AD dementia negative.Our findings indicate that NPS in MCI and AD dementia are not exclusively associated with atrophy and support previous findings of associations between NPS and mainly frontotemporal brain structures.
Objectives: Neuropsychiatric symptoms (NPS) are common in mild cognitive impairment (MCI) and Alzheimer’s disease with dementia (AD dementia), but their brain structural correlates are unknown. We tested for associations between NPS and MRI-based cortical and subcortical morphometry in patients with MCI and AD dementia.
Design: Cross-sectional.

Settings: Conducted in Norway.
Participants: Patients with MCI (n = 102) and AD dementia (n = 133) from the Memory Clinic and the Geriatric Psychiatry Unit at Oslo University Hospital.
Measurements: Neuropsychiatric Inventory – Questionnaire (NPI-Q) severity indices were reduced using principal component analysis (PCA) and tested for associations with 170 MRI features using linear models and false discovery rate (FDR) adjustment. We also tested for differences between groups. For transparency, we added analyses with selected NPI-Q items.
Results: PCA revealed four factors: elation, psychosis, depression, and motor behavior.FDR adjustment revealed a significant positive association (B = 0.20, pFDR < 0.005) between elation and thickness of the right caudal anterior cingulate cortex (ACC) across groups, and significant interactions between diagnosis and psychosis (B = −0.48, pFDR < 0.0010) on the left post-central volume and between diagnosis and depression (B = −0.40, pFDR < 0.005) on the thickness of the banks of the left superior temporal sulcus. Associations of apathy, anxiety, and nighttime behavior to the left temporal lobe were replicated.
Conclusions: The positive association between elation and ACC thickness suggests that mechanisms other than atrophy underly elation. Interactions between diagnosis and NPS on MRI features suggest different mechanisms of NPS in our MCI and AD dementia samples. The results contribute to a better understanding of NPS brain mechanisms in MCI and AD dementia.

Nikias Siafarikas, Dag Alnæs, Jennifer Monereo-Sanchez, Martina J Lund, Geir Selbæk, Maria Stylianou-Korsnes, Karin Persson, Maria Lage Barca, Ina Selseth Almdahl, Tormod Fladby, Dag Aarsland, Ole A Andreassen, Lars T Westlye

Abstract:
Purpose: To explore and describe experiences of older patients with cancer throughout their radiotherapy treatment, from diagnosis until follow-up after treatment.

Methods: Individual interviews were conducted to explore different phases of radiotherapy. Interviews were recorded and transcribed verbatim. Inductive content analysis was applied. Each interview was coded separately. Then to the codes were analyzed further, and an overall theme was developed.

Results: Twelve older patients with cancer, (7 male, 5 female) aged ≥ 65 related their experiences from radiotherapy treatment. A main theme describes the essence of their experiences; Understanding “just enough”. The theme comprises five main categories: Understandable, adapted information is crucial for trusting health services; Previous experiences influence patients’ perception and understanding; Involvement of next of kin is crucial to patients’ comprehension; Professional treatment decisions and well-organized treatment determines satisfaction and Experiences of cooperation and coordination of services affects dependability.

Conclusions: Findings from this study describe how understanding “just enough” – not too much nor too little – may assist older patients with cancer in participating in treatment decisions, preventing false beliefs, feeling reassured during treatment and in navigating the complex health care system. Next of kin are important assets for older patients with cancer in understanding “just enough”. Cancer nurses may map comprehension of information, as well as reveal patients’ previous experiences.

May Ingvild Volungholen Sollid, Øyvind Kirkevold, Marit Slaaen, Bente Ervik, Line Melby, Grethe Eilertsen