Forskningsartikler

Background: Odor identification (OI) ability is a suggested early biomarker of Alzheimer’s disease. In this study, we investigated brain activity within the brain’s olfactory network associated with OI in patients with amnestic mild cognitive impairment (aMCI) and mild Alzheimer’s dementia (mAD) to uncover the neuronal basis of this impairment.
Materials and Methods: Patients with aMCI (n = 11) or mAD (n = 6) and 28 healthy older adults underwent OI functional MRI (fMRI) at 3T, OI, odor discrimination, and cognitive tests and apolipoprotein-e4 (APOE4) genotyping. Eleven patients had cerebrospinal fluid (CSF) analyzed. Those with aMCI were followed for 2 years to examine conversion to dementia.
Results: The aMCI/mAD group performed significantly worse on all OI tests and the odor discrimination test compared to controls. The aMCI/mAD group had reduced activation in the right anterior piriform cortex compared to the controls during OI fMRI [Gaussian random field (GRF) corrected cluster threshold, p < 0.05]. This group difference remained after correcting for age, sex education, and brain parenchymal fraction. This difference in piriform activity was driven primarily by differences in odor discrimination ability and to a lesser extent by OI ability. There was no group by odor discrimination/identification score interaction on brain activity. Across both groups, only odor discrimination score was significantly associated with brain activity located to the right piriform cortex. Brain activity during OI was not associated with Mini Mental Status Examination scores. At the group level, the aMCI/mAD group activated only the anterior insula, while the control group had significant activation within all regions of the olfactory network during OI fMRI. There was no association between brain activity during OI fMRI and total beta-amyloid levels in the CSF in the aMCI/mAD group.
Conclusion: The OI impairment in aMCI/mAD patients is associated with significantly reduced activity in the piriform cortex compared to controls. Activation of downstream regions within the olfactory network is also significantly affected in the aMCI/mAD group, except the anterior insula, which is impinged late in the course of Alzheimer’s disease. OI tests thus reflect Alzheimer’s disease pathology in olfactory brain structures.

Grete Kjelvik, Hallvard R. Evensmoen, Thomas Hummel, Knut Engedal, Geir Selbæk, Ingvild Saltvedt and Asta K. Håberg.

Background: Depression is common among residents in long term-care facilities. Therefore, access to a valid and reliable measure of depressive symptoms among nursing home (NH) residents is highly warranted. Aim: The aim of this study was to test the psychometrical properties of the Norwegian version of the Cornell Scale for Depression in Dementia (CSDD). Methods: A sample of 309 NH residents were assessed for depressive symptoms using the CSDD in 2015-2016. Data on CSDD were missing for 64 residents, giving an effective sample of 245 (79.3%). Principal component and confirmatory factor analysis were used. Results: A five-dimensional solution yielded the best fit with the data (χ2=174.927, df=94, χ2/df=1.86, p=0.0001, RMSEA=0.058, p-value for test of close fit=0.152, CFI=0.94, TLI=0.92 and SRMR=0.056). As expected, higher depressive symptoms correlated positively with higher scores on the Minimum Data Set Depression Rating Scale (MDSDRS) and correlated negatively with Quality of life assessed with the Quality of Life in Late Stage-Dementia Scale. Limitations: The excluded residents (n=64, 20.7%) had lower cognitive function, which may limit the generalizability of the study results. Conclusion: This study suggests a five-dimensional solution of the CSDD scale. Sixteen of the 19 original items showed highly significant loadings, explaining a notable amount of the variation in the CSDD-construct. Further development and testing of a well-adapted scale assessing depression in the nursing home population with and without dementia is required.

Geir-Tore Stensvik, Anne-Sofie Helvik, Sigrid Nakrem, Gørill Haugan.

Abstract:
Responsive identity support in conversations with people with dementia: A study of interviews in a five-years narrative longitudinal study A narrative longitudinal study depends on trust and a positive relationship between the  interviewer and the  participant to encourage  the  participant’s continued participation. In reported studies, the methodological part is usually too short to present the complexities in dialogues over time. We therefore have analyzed the interview processes with younger people with dementia, relating the interactions to central  concepts associated with identity.

The aim was to explore the methodological interview approach used in a longitudinal study, focusing on supporting identity and self-esteem. We used the concept of responsive identity to illuminate our findings. In addition, we demonstrate how the interview dialogues can support identity and self-esteem of the participants. The core of this approach is that  the interviewee, living with dementia, should be seen, confirmed and supported to preserve the person`s self and dignity. Dialogue with responsive identity support is a fruitful research method in dementia research. This approach can be generalized to person-centred communication in health and caring relationships.

Kirsten Thorsen og Aud Johannessen

Abstract: The deviation between chronological age and age predicted using brain MRI is a putative marker of overall brain health. Age prediction based on structural MRI data shows high accuracy in common brain disorders. However, brain aging is complex and heterogenous, both in terms of individual differences and the underlying biological processes. Here, we implemented a multimodal model to estimate brain age using different combinations of cortical area, thickness and sub-cortical volumes, cortical and subcortical T1/T2-weighted ratios, and cerebral blood flow (CBF) based on arterial spin labeling. For each of the 11 models we assessed the age prediction accuracy in healthy controls (HC, n = 750) and compared the obtained brain age gaps (BAGs) between age-matched subsets of HC and patients with Alzheimer’s disease (AD, n = 54), mild (MCI, n = 90) and subjective (SCI, n = 56) cognitive impairment, schizophrenia spectrum (SZ, n = 159) and bipolar disorder (BD, n = 135). We found highest age prediction accuracy in HC when integrating all modalities. Furthermore, two-group case-control classifications revealed highest accuracy for AD using global T1-weighted BAG, while MCI, SCI, BD and SZ showed strongest effects in CBF-based BAGs. Combining multiple MRI modalities improves brain age prediction and reveals distinct deviations in patients with psychiatric and neurological disorders. The multimodal BAG was most accurate in predicting age in HC, while group differences between patients and HC were often larger for BAGs based on single modalities. These findings indicate that multidimensional neuroimaging of patients may provide a brain-based mapping of overlapping and distinct pathophysiology in common disorders.

Jaroslav Rokicki, Thomas Wolfers, Wibeke Nordhøy, Natalia Tesli, Daniel S Quintana, Dag Alnaes, Genevieve Richard, Ann-Marie G de Lange, Martina J Lund, Linn Norbom, Ingrid Agartz, Ingrid Melle, Terje Naerland, Geir Selbaek, Karin Persson, Jan Egil Nordvik, Emanuel Schwarz, Ole A Andreassen, Tobias Kaufmann, Lars T Westlye.

Background/Aims: The aim of this study was to examine the associations between different cognitive domains and hand function in older people diagnosed with mild cognitive impairment (MCI) or dementia.
Methods: This study is cross-sectional, including 98 communityliving older people aged ≥65 years with MCI or dementia. Assessments of hand function included grip strength, the Finger Tapping Test, and the Grooved Pegboard. Cognitive assessments were the Mini-Mental State Examination, the Clock Drawing Test, and Trail Making Tests A and B, as well as a 10-word List Learning Test. Statistical analyses were based on descriptive statistics and univariable and multivariable analyses.
Results: Sixty participants were diagnosed with MCI and 38 were diagnosed with dementia. The mean age was 78.8 years (SD 7.4). Analyses of hand function, cognitive tests, and demographic factors showed an association between cognitive tests, in particular executive function (EF), and hand function.
Conclusions: The findings indicated an association between physical and cognitive function. Among the cognitive domains, declines in EF were most related to a reduced physical function.

Karin Hesseberg, Gro Gujord Tangen, Are Hugo Pripp, Astrid Bergland

Background: The employment rate for people with intellectual disabilities is low. This study aims to increase the knowledge about the association between age, gender, diagnosis, functional level, educational level, and daily activities for adults with intellectual disabilities.
Method: A multinomial logistic analysis was applied to registry data on 12,735 adults
with intellectual disabilities from the Norwegian Information System for the Nursing and Care Sector (IPLOS) and Statistics Norway (SSB).
Results: Higher likelihood of employment and day care participation were associated with younger age but differed between genders and diagnoses. High functional level and lack of a registered functional level decreased the likelihood for employment. Educational level was not associated with employment.
Conclusions: The systematic differences in employment and day care participation among people with intellectual disabilities indicate that actions are needed to prevent inequalities. Improved individual assessment of personal resources and wishes might promote participation in employment and day care.

Jeanette Engeland, Bjørn Heine Strand, Siw Tone Innstrand, Ellen Melbye Langballe

Introduction: The progression rate of Alzheimer’s disease (AD) varies and might be affected by the triggering receptor expressed on myeloid cells (TREM2) activity. We explored if cerebrospinal fluid (CSF) soluble TREM2 (sTREM2), a proxy of microglial activity, is associated with clinical progression rate.
Methods: Patients with clinical AD (N = 231) were followed for up to 3 years after diagnosis. Cognitively healthy controls (N = 42) were followed for 5 years. CSF sTREM2 was analyzed by enzyme‐linked immunosorbent assay. Group‐based trajectory modeling revealed distinct clinical progression groups.
Results: Higher CSF sTREM2 was associated with slow clinical progression. The slow‐ and medium‐progressing groups had higher CSF sTREM2 than the cognitively healthy, who had a similar level to patients with rapid clinical progression.
Discussion: CSF sTREM2 levels were associated with clinical progression in AD, regardless of core biomarkers. This could be useful in assessing disease development in relation to patient care and clinical trial recruitment.

Trine Holt Edwin, Kristi Henjum, Lars N.G. Nilsson, Leiv Otto Watne, Karin Persson, Rannveig Sakshaug Eldholm, Ingvild Saltvedt, Nathalie Bodd Halaas, Geir Selbæk, Knut Engedal, Bjørn Heine Strand, Anne-Brita Knapskog.

Jelena Zugic Soares, Renate Pettersen, Jūratė Šaltytė Benth, Karin Persson, Carsten Strobel , Geir Selbæk, Nenad Bogdanovic.

Renato Sobral Monteiro-Junior, Lara S. F. Carneiro, Maria Lage Barca, Kari Midtbø Kristiansen, Cristina Andrade Sampaio, Desirée Sant’Ana Haikal, Lêda Antunes, Luana Lemos Leão, Andrea Camaz Deslandes.