Dementia and Geriatric Cognitive Disorders Extra, 2020

Associations between Cognition and Hand Function in Older People Diagnosed with Mild Cognitive Impairment or Dementia.

Abstract

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.

Forfattere

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

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J Appl Res Intellect Disabil, 2020

Participation in employment and day care for adults with intellectual disabilities: Equal access for all?

Abstract

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.

 

Forfattere

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

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Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring, 2020

A high cerebrospinal fluid soluble TREM2 level i s associated with slow clinical progression of Alzheimer’s disease.

Abstract

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.

Forfattere

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.

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Journal of Alzheimer's Disease, 2020

Vitamin D Levels, APOE Allele, and MRI Volumetry Assessed by NeuroQuant in Norwegian Adults with Cognitive Symptoms.

Abstract

Background: Allele ɛ4 of the apolipoprotein (APOE∈4) gene is the strongest known genetic risk factor for late-onset sporadic Alzheimer’s disease. A possible relationship between vitamin D and APOE is not yet clear.
Objective: In this exploratory, cross-sectional study, we examined the association between serum levels of 25-hydroxyvitamin D [25(OH)D] and brain volumes and the associations of both serum levels of 25(OH)D and APOE polymorphism to brain volumes in 127 persons (mean age 66 years) with cognitive symptoms.
Methods: All subjects were examined with fully automated software for MRI volumetry, NeuroQuant.
Results: After adjustment for relevant covariates, higher serum 25(OH)D levels were associated with greater volumes of cortical gray matter on both left (p = 0.02) and right (p = 0.04) sides. When both 25(OH)D levels and APOE genotype were used as the main covariates, no significant associations were found between vitamin D level and brain volume in any of the 11 brain regions. In adjusted models, only homozygous but not heterozygous APOE∈4 allele carriers had significantly larger inferior lateral ventricles (p = 0.003) and smaller hippocampal volume (p = 0.035) than those without ɛ4. Homozygous APOE∈4 carriers also had significantly higher vitamin D levels (p = 0.009) compared to persons without the APOE∈4 allele.
Conclusion: Higher vitamin D levels might have a preserving effect on cortical grey matter volume.

Forfattere

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

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International Psychogeriatrics, 2020

COVID-19 pandemic: a multinational report providing professional experiences in the management of mental health of elderly.

Abstract

Introduction

There is a huge amount of information on SARS-CoV-2 (COVID-19), but its influence on mental health is still lacking. Although all age groups are at risk of contracting COVID-19, older people face significant risk of developing severe illness (Kluge, Reference Kluge2020). The old age is an independent factor for the COVID-19-related death (RR = 9.45) (Zhao et al., Reference Zhao2020). This pandemic might affect this population’s mental health. Retrospective studies of the Severe Acute Respiratory Syndrome epidemic demonstrated that suicide rates raised among elderly during this period (Kluge, Reference Kluge2020). This data emphasize the urgency of studying COVID-19 mental health impact in real time, since it has brought consequences such as psychological suffering, fear, depression and anxiety (Courtin and Knapp, Reference Courtin and Knapp2017; Fiorillo and Gorwood, Reference Fiorillo and Gorwood2020).

Researchers and health professionals from Brazil, Norway and Portugal documented their health professional experiences facing this novel pandemic to advise health services. These countries were selected due to their position in the worldwide ranking on the 2019 Human Development (HD) Report (http://www.hdr.undp.org/en/2019-report). HD classifies countries according to indices such as economic and gender inequality, health, education, dignity and respect for human rights. Among the 100 countries in that report, Norway (1st), Portugal (40th) and Brazil (75th) are top, middle and bottom listed, respectively. Could the differences between these countries counteract the assistance to elderly in the COVID-19 pandemic age? This report aims to provide an overview of each country’s response from the authors’ perspective based on their informal interviews with a multidisciplinary health professional range.

Forfattere

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.

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PLoS One, 2020

Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis

Abstract

Objectives: To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times.
Design: Markov multistate survival analysis and flexible parametric models.
Setting: Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data.
Participants: 2,938 home-dwelling persons with dementia, ages 40-97 years at time of diagnosis (mean 76.1, SD 8.5).
Results: During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group.
Conclusion: Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.

Forfattere

Marit Mjørud, Geir Selbæk, Espen Bjertness, Trine Holt Edwin, Knut Engedal, Anne-Brita Knapskog, Bjørn Heine Strand.

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Geriatrics, 2020

Protein Intake, Protein Mealtime Distribution and Seafood Consumption in Elderly Norwegians: Associations with Physical Function and Strength

Abstract

Abstract: Protein intake is considered important in the maintenance of muscle health in ageing. However, both the source and mealtime distribution of protein might affect the intake of protein and its effect on muscle protein synthesis. In this study, protein intake, mealtime distribution of protein, and seafood consumption were assessed in 92 older adults (aged 65+), and associations with physical performance (Short Physical Performance Battery (SPPB)), grip strength and gait speed were assessed in a multiple linear regression analysis. The participants had a mean age of 73 ± 8.9 years. Mean protein intake was 1.1 g/kg body weight. Protein intake was well distributed, with coefficient of variance between meals (CV meals) 0.6 ± 0.3. However, dinner had the highest protein intake. No associations were found between the nutrition factors and physical performance or strength; however, this result might have been caused by a ceiling effect in the chosen test batteries, as the mean score on SPPB was 10.3 ± 2.7, and 48.9% of the participants reached the top score of 12 points. Mean grip strength was 44.4 ± 9.4 kg (men) and 26.2 ± 6.8 kg (women). Mean gait speed was 1.0 ± 0.3 m/s. The interaction analysis suggests that there might be gender differences in the effect of seafood consumption on gait speed.

Forfattere

Linda Kornstad Nygård, Lisbeth Dahl, Ingunn Mundal, Jūratė Šaltytė Benth, Anne Marie Mork Rokstad.

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Nordic Studies on Alcohol and Drugs, 2020

Health professionals’ experience of nursing home residents’ consumption of alcohol and use of psychotropic drugs

Abstract

Background: Nursing home (NH) residents are in most cases in older ages and use prescription drugs. As alcohol interacts with many commonly prescribed drugs, NH residents may be more vulnerable to the effects of alcohol.
Aim: To investigate the experiences of health professionals in
Norwegian NHs when it comes to residents’ alcohol consumption and use of psychotropic drugs, and the facilitation of such use in the NH.
Method: Focus-groups and individual interviews with NH health professionals were performed in 2017 and 2018. The data were analysed using content analysis.
Findings: Two main themes emerged: (1) the balancing of alcohol consumption, and (2) the use of psychotropic drugs. Each of these themes involved reasoning, which revealed that the informants in general had little attention regarding alcohol consumption among residents, and few institutions had policies regarding serving and consumption of alcohol. The informants reported an increased attention regarding use of psychotropic drugs and a tendency towards less use of psychotropic drugs among the residents than before, but few informants reported use of standardised observations tools of symptoms related to prescribing and discontinuation of drugs.
Conclusion: Alcohol policies or procedures related to alcohol consumption were uncommon at the NH that the interviewees of this study represented, and the professionals regarded infrequent serving and consumption of alcohol among the residents as a part of everyday life. In cases when residents frequently consumed alcohol, the professionals used dialogue to underpin the adherent risks and they also tried to control the consumption of the resident in different ways. The interviewees were aware of various side-effects of psychotropic drugs; they were also aware of their effects in combination with alcohol.

Forfattere

Aud Johannessen, Kjerstin Tevik, Knut Engedal, Anne-Sofie Helvik

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International Psychogeriatric, 2020

Trajectories and risk factors of dementia progression: a memory clinic cohort followed up to 3 years from diagnosis

Abstract

Objectives: Patients with dementia follow different trajectories of progression. We aimed to investigate which factors at the time of diagnosis could predict trajectory group membership.
Design: Longitudinal observational study.
Setting: Specialized memory clinic, Oslo University Hospital in Norway.
Participants: Patients assessed at the memory clinic, between 12 January 2009 and 31 July 2016, who were registered in the Norwegian Registry of persons assessed for cognitive symptoms (NorCog) and diagnosed with dementia after the baseline examination period (n = 442). The patients were followed up to 3 years, with an average of 3.5 examinations.
Measurements: Clinical Dementia Rating Scale Sum of Boxes (CDR-SB), Mini-Mental State Examination (MMSE), the Consortium to Establish a Registry of Alzheimer’s disease (CERAD) 10-item word list delayed recall, the Clock Drawing Test, (CDT) Trail Making Test A (TMT-A), and Neuropsychiatric Inventory Questionnaire (NPI-Q). Based on changes in scores on the CDR-SB, we used group-based trajectory modeling (GBTM) to explore the presence of trajectory groups. Multinomial logistic regression was used to explore whether a set of baseline variables could predict trajectory group membership.
Results: Three trajectory groups were identified, one with a slow progression rate and two with more-rapid progression. Rapid progression was associated with older age, lower cognitive function (MMSE and TMT-A), and more-pronounced neuropsychiatric symptoms (NPI-Q) at the time of diagnosis.
Conclusions: Our findings demonstrate the heterogeneity of dementia progression and describe risk factors for rapid progression, emphasizing the need for individual follow-up regimes. For future intervention studies, our results may guide the selection of patients.

Forfattere

Trine Holt Edwin, Bjørn Heine Strand, Karin Persson, Knut Engedal, Geir Selbæk and Anne-Brita Knapskog.

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