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Gustavsson, A.-M., van Westen, D., Stomrud, E., Engström, G., Nägga, K. & Hansson, O. (2020). Midlife Atherosclerosis and Development of Alzheimer or Vascular Dementia. Annals of Neurology, 87(1), 52-62
Open this publication in new window or tab >>Midlife Atherosclerosis and Development of Alzheimer or Vascular Dementia
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2020 (English)In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 87, no 1, p. 52-62Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate whether midlife atherosclerosis is associated with different dementia subtypes and related underlying pathologies.

METHODS: Participants comprised the cardiovascular cohort of the Swedish prospective population-based Malmö Diet and Cancer Study (N = 6,103). Carotid plaques and intima media thickness (IMT) were measured at baseline (1991-1994). Dementia incidence until 2014 was obtained from national registers. Diagnoses were reviewed and validated in medical records. In a cognitively unimpaired subcohort (n = 330), β-amyloid42 and tau were quantified in cerebrospinal fluid (CSF), and white matter hyperintensity volume, lacunar infarcts, and cerebral microbleeds were estimated on magnetic resonance imaging (2009-2015).

RESULTS: During 20 years of follow-up, 462 individuals developed dementia (mean age at baseline = 57.5 ± 5.9 years, 58% women). Higher IMT in midlife was associated with an increased hazard ratio (HR) of all-cause dementia (adjusted HR = 1.14 [95% confidence interval (CI) = 1.03-1.26]) and vascular dementia (adjusted HR = 1.32 [95% CI = 1.10-1.57]) but not Alzheimer disease (AD) dementia (adjusted HR = 0.95 [95% CI = 0.77-1.17]). Carotid plaques were associated with vascular dementia when assessed as a 3-graded score (adjusted HR = 1.90 [95% CI = 1.07-3.38]). In the cognitively unimpaired subcohort (53.8 ± 4.6 years at baseline, 60% women), higher IMT in midlife was associated with development of small vessel disease (adjusted odds ratio [OR] = 1.47 [95% CI = 1.05-2.06]) but not significantly with abnormal CSF AD biomarkers (adjusted OR = 1.28 [95% CI = 0.87-1.90] for Aβ42 and 1.35 [95% CI = 0.86-2.13] for Aβ42 /p-tau). Carotid plaques revealed no significant association with any of the underlying brain pathologies.

INTERPRETATION: Our findings support an association between midlife atherosclerosis and development of vascular dementia and cerebral small vessel disease but not between atherosclerosis and subsequent AD dementia or AD pathology. ANN NEUROL 2019.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-162409 (URN)10.1002/ana.25645 (DOI)000499175300001 ()31721283 (PubMedID)2-s2.0-85075725346 (Scopus ID)
Note

Funding agencies: European Research CouncilEuropean Research Council (ERC); Swedish Research CouncilSwedish Research Council; Knut and Alice Wallenberg FoundationKnut & Alice Wallenberg Foundation; Marianne and Marcus Wallenberg Foundation; Strategic Research Area MultiPar

Available from: 2019-12-10 Created: 2019-12-10 Last updated: 2020-01-22Bibliographically approved
Bransvik, V., Granvik, E., Minthon, L., Nordstrom, P. & Nägga, K. (2020). Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study. Aging & Mental Health
Open this publication in new window or tab >>Mortality in patients with behavioural and psychological symptoms of dementia: a registry-based study
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2020 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives: Behavioural and psychological symptoms of dementia (BPSD) are common in patients with dementia. In the elderly population, comorbidities frequently coexist with dementia and mortality in dementia is high. The aim of this study was to investigate the impact of BPSD on mortality in severe dementia. Methods: This study of 11,448 individuals was based on linked information from the Swedish BPSD registry, the National Patient Register and the Cause of Death register. BPSD was assessed with the Neuropsychiatric Inventory (NPI). Cox proportional hazards regressions were performed for survival analysis. To study different degrees of BPSD, data was categorized into groups: no (NPI, 0 points), mild (NPI, 1-3 points on amp;gt;= 1 item), moderate (NPI, 4-8 points on amp;gt;= 1 item) and severe (NPI, 9-12 points on amp;gt;= 1 item) BPSD based on the highest score on any of the BPSD assessed (NPI items). Results: The presence of moderate or severe BPSD was associated with a stepwise increased risk of mortality (hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.08-1.60 and HR 1.74; 95% CI 1.44-2.12, respectively) compared with individuals with no BPSD. In addition, there was an association between total NPI score and mortality (HR 1.01; 95% CI 1.007-1.010). The results remained significant after multivariable adjustment for age, sex, dementia diagnosis, medication, previous myocardial infarction, hip fracture and stroke. Conclusions: The results show a stepwise increase in mortality risk with increased BPSD, highlighting the importance of adequate management of BPSD to reduce mortality in dementia.

Place, publisher, year, edition, pages
Routledge, 2020
Keywords
Behavioural and psychological symptoms of dementia; mortality; BPSD; Neuropsychiatric Inventory; nursing homes; registry-based study
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-164259 (URN)10.1080/13607863.2020.1727848 (DOI)000514739900001 ()32067466 (PubMedID)2-s2.0-85079717496 (Scopus ID)
Available from: 2020-03-12 Created: 2020-03-12 Last updated: 2020-04-02Bibliographically approved
Nakanishi, M., Endo, K., Hirooka, K., Nakashima, T., Morimoto, Y., Granvik, E., . . . Nishida, A. (2018). Dementia behaviour management programme at home: impact of a palliative care approach on care managers and professional caregivers of home care services. Aging & Mental Health, 22(8), 1063-1068
Open this publication in new window or tab >>Dementia behaviour management programme at home: impact of a palliative care approach on care managers and professional caregivers of home care services
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2018 (English)In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915, Vol. 22, no 8, p. 1063-1068Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Care managers and professional caregivers of home care services are sometimes unaware of the psychosocial approaches to the challenging behaviour of dementia. Therefore, we developed a Behaviour Analytics & Support Enhancement (BASE) programme. We investigated the effects of the programme on the attitudes towards dementia care among professionals.

METHOD: Forty-six participants in Japan received training in August 2016. The ongoing monitoring and assessment system was introduced to the participants for repeated measures of challenging behaviour. A 1-day follow-up meeting for debriefing was also performed after two months. A baseline and follow-up questionnaire survey was administered to the participating caregivers using a Japanese version of the Approaches to Dementia Questionnaire (ADQ) and the Zarit Burden Interview (ZBI).

RESULTS: A significant improvement was observed in the total ADQ score among the participating caregivers from baseline to follow-up assessment. There was no significant difference between the baseline and follow-up assessment in the ZBI scores. In the follow-up meeting, several participants reported challenges and suggested solutions in facilitating a discussion on an action plan among professionals from various organizations.

CONCLUSION: The implementation of the programme resulted in enhanced attitudes towards dementia care among the participants without an increased burden of care. Future studies should examine the programme's effectiveness on the challenging behaviour of persons with dementia.

Place, publisher, year, edition, pages
Routledge, 2018
Keywords
Care managers, challenging behaviour, dementia, home care workers, palliative care
National Category
Geriatrics
Identifiers
urn:nbn:se:liu:diva-162700 (URN)10.1080/13607863.2017.1332160 (DOI)000448734100018 ()28553880 (PubMedID)2-s2.0-85019712326 (Scopus ID)
Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2020-01-09Bibliographically approved
Nilsson, E. D., Elmståhl, S., Minthon, L., Nilsson, P. M., Pihlsgård, M. & Nägga, K. (2016). Associations of central and brachial blood pressure with cognitive function: a population-based study. Journal of Human Hypertension, 30(2), 95-99
Open this publication in new window or tab >>Associations of central and brachial blood pressure with cognitive function: a population-based study
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2016 (English)In: Journal of Human Hypertension, ISSN 0950-9240, E-ISSN 1476-5527, Vol. 30, no 2, p. 95-99Article in journal (Refereed) Published
Abstract [en]

Previous observational studies on the association between brachial blood pressure (BP) and cognition have reported conflicting results. Central BP has been hypothesized to be more strongly related to cognition than brachial BP. The aim of this study was to assess the association between brachial as well as central BP and cognitive function, both cross-sectionally and with brachial BP measured 17 years before cognitive testing. The study population comprised 2548 individuals aged 61-85 years at follow-up (61.4% women). The cognitive tests administered were A Quick Test of cognitive speed and the Mini Mental State Examination. In fully adjusted linear regressions, small but significant cross-sectional associations were found between higher BP (systolic, diastolic and pulse pressure) and worse results on both of the cognitive tests (P-values <0.05). No significant prospective associations were found. Central BP did not show a stronger association than brachial BP did. After stratification, significant results were mainly found in the group taking BP-lowering drugs at follow-up. In summary, these findings add to existing evidence on the relationship between BP and cognition, but they do not support a superior role of central compared with brachial BP in the elderly.

Place, publisher, year, edition, pages
Nature Publishing Group, 2016
National Category
Neurology Geriatrics
Identifiers
urn:nbn:se:liu:diva-162691 (URN)10.1038/jhh.2015.33 (DOI)000370448900004 ()25880593 (PubMedID)2-s2.0-84953363263 (Scopus ID)
Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2020-01-08Bibliographically approved
Nägga, K., Mayer, S., Marcusson, J. & Wressle, E. (2015). Evaluation of short cognitive screening tests in 85-year-old men and women. European Geriatric Medicine, 6(6), 545-550
Open this publication in new window or tab >>Evaluation of short cognitive screening tests in 85-year-old men and women
2015 (English)In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 6, no 6, p. 545-550Article in journal (Refereed) Published
Abstract [en]

Introduction: The study aimed to investigate different aspects of cognition using the Cognitive Assessment Battery (CAB) in community-dwelling older adults aged 85 years. We also investigated the eventual influence of sex on the results and aimed to identify predictors for further cognitive decline after 1 year. Methods: CAB consists of 10 subtests covering the cognitive domains of speed and attention, learning and episodic memory, visuospatial abilities, language, and executive functions. Cognitive tests were performed at baseline (n = 335) and follow-up after 1 year (n = 270). Results: Univariate statistics revealed that men performed better than women on episodic memory (P < 0.05) and on the naming test (P < 0.001). However, floor effects in the paragraph memory test were revealed. There was a high rate of abnormal results on Token Test (67%), PaSMO (50%), Clox (48%), and the cube copying (40%) tests in participants with normal cognition. Logistic regression showed that impaired results on the Stroop III test (odds ratio, 2.38; P < 0.05) was independently associated with an increased risk of cognitive decline. Conclusion: Men performed better than women on the memory and on the naming test. However, due to floor effects in the paragraph memory test in 85 year olds, these results can be disputed. The high rate of abnormal results on the Token Test, PaSMO, Clox, and the cube copying tests in cases with normal cognition indicate that these tests are less suitable for screening in the age group. Impaired result on the Stroop test increased the risk more than two-fold for cognitive decline after 1 year.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
populations study, oldest old, MMSE
National Category
Geriatrics Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-123648 (URN)10.1016/j.eurger.2015.10.002 (DOI)000368322100006 ()
Note

Funding agencies: Skane County Council; Lund University; Health Research Council in south east Sweden [FORSS-8888, FORSS-11636, FORSS-31811]; County of Ostergotland [LIO-11877, LIO-31321, LIO-79951]; Family Janne Elgqvist Foundation

Available from: 2016-01-04 Created: 2016-01-04 Last updated: 2019-06-27
Hertze, J., Nägga, K., Minthon, L. & Hansson, O. (2014). Changes in cerebrospinal fluid and blood plasma levels of IGF-II and its binding proteins in Alzheimer's disease: an observational study. BMC Neurology, 14, Article ID 64.
Open this publication in new window or tab >>Changes in cerebrospinal fluid and blood plasma levels of IGF-II and its binding proteins in Alzheimer's disease: an observational study
2014 (English)In: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 14, article id 64Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Insulin-like Growth Factor (IGF)-related system is implicated in neuroregeneration and cell repair, as well as regulating lifespan. IGF-II, one component of this system, has also been found to affect memory functions in a rat model. In this study we explored changes in the IGF-related system in patients with Alzheimer's disease (AD), including changes in IGF-II levels.

METHODS: We measured blood plasma and cerebrospinal fluid (CSF) levels of IGF-I, IGF-II, IGFBP-2 and IGFBP-3 in 72 healthy controls and 92 patients with AD.

RESULTS: We found significantly lower blood plasma levels of IGF-II and IGFBP-3 in patients with AD, compared with controls. The levels of IGF-II and IGFBP-2 were significantly elevated in the CSF from patients with AD. We also found correlations between established CSF biomarkers for AD (tau and P-tau) and components of the IGF system.

CONCLUSIONS: CSF and blood plasma levels of IGF-II and some of its binding proteins are changed in patients with AD. Further investigation into this area may unravel important clues to the nature of this disease.

Place, publisher, year, edition, pages
BioMed Central, 2014
National Category
Geriatrics Neurology
Identifiers
urn:nbn:se:liu:diva-162685 (URN)10.1186/1471-2377-14-64 (DOI)000333689900002 ()24685003 (PubMedID)2-s2.0-84897370805 (Scopus ID)
Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2020-01-22Bibliographically approved
Nägga, K., Hansson, O., van Westen, D., Minthon, L. & Wennström, M. (2014). Increased levels of hyaluronic acid in cerebrospinal fluid in patients with vascular dementia. Journal of Alzheimer's Disease, 42(4), 1435-1441
Open this publication in new window or tab >>Increased levels of hyaluronic acid in cerebrospinal fluid in patients with vascular dementia
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2014 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 42, no 4, p. 1435-1441Article in journal (Refereed) Published
Abstract [en]

Hyaluronic acid (HA) has been shown to affect angiogenesis and the function of the blood-brain barrier, and a crucial role for HA in atherosclerosis has been described. We have recently demonstrated changes in the levels of HA in cerebrospinal fluid (CSF) in patients with Alzheimer's disease (AD) with documented vascular alterations. To further investigate if the level of HA in CSF can be used as a clinical diagnostic biomarker to identify vascular pathology in dementia, we analyzed the levels of HA in the CSF of patients with vascular dementia (VaD) (n = 46), AD (n = 45), and controls without dementia (n = 26). In line with our previous data, we found significantly increased levels of HA in CSF from patients with VaD compared with controls, whereas the levels of HA in patients with AD were found to be unaltered compared with controls and patients with VaD. We also detected increased levels of HA in individuals with vascular changes determined as significant white matter changes or previous infarction on cranial computed tomography or magnetic resonance imaging, compared with individuals without these findings. Furthermore, we found a significant positive correlation between the levels of HA and the CSF/serum albumin ratio, an indicator of blood-brain barrier integrity, in patients with VaD and AD, supporting the role of HA in vascular changes in the brain. Our results indicate a potential diagnostic value for the detection of vascular brain changes in dementia using CSF levels of HA, but emphasize the importance of further development of more sensitive HA assays.

Place, publisher, year, edition, pages
IOS Press, 2014
Keywords
Biomarker, cerebrospinal fluid, glycocalyx, hyaluronic acid, vascular dementia
National Category
Neurology Geriatrics
Identifiers
urn:nbn:se:liu:diva-162687 (URN)10.3233/JAD-141200 (DOI)000343763000028 ()25024336 (PubMedID)2-s2.0-84907972736 (Scopus ID)
Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2020-01-07Bibliographically approved
Hansson, O., Hall, S., Ohrfelt, A., Zetterberg, H., Blennow, K., Minthon, L., . . . El-Agnaf, O. M. (2014). Levels of cerebrospinal fluid α-synuclein oligomers are increased in Parkinson's disease with dementia and dementia with Lewy bodies compared to Alzheimer's disease. Alzheimer's Research & Therapy, 6(3), Article ID 25.
Open this publication in new window or tab >>Levels of cerebrospinal fluid α-synuclein oligomers are increased in Parkinson's disease with dementia and dementia with Lewy bodies compared to Alzheimer's disease
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2014 (English)In: Alzheimer's Research & Therapy, E-ISSN 1758-9193, Alzheimer's research & therapy, ISSN 1758-9193, Vol. 6, no 3, article id 25Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: The objective was to study whether α-synuclein oligomers are altered in the cerebrospinal fluid (CSF) of patients with dementia, including Parkinson disease with dementia (PDD), dementia with Lewy bodies (DLB), and Alzheimer disease (AD), compared with age-matched controls.

METHODS: In total, 247 CSF samples were assessed in this study, including 71 patients with DLB, 30 patients with PDD, 48 patients with AD, and 98 healthy age-matched controls. Both total and oligomeric α-synuclein levels were evaluated by using well-established immunoassays.

RESULTS: The levels of α-synuclein oligomers in the CSF were increased in patients with PDD compared with the controls (P < 0.05), but not in patients with DLB compared with controls. Interestingly, the levels of α-synuclein oligomers in the CSF were also significantly higher in patients with PDD (P < 0.01) and DLB (P < 0.05) compared with patients with AD. The levels of CSF α-synuclein oligomers and the ratio of oligomeric/total-α-synuclein could distinguish DLB or PDD patients from AD patients, with areas under the curves (AUCs) of 0.64 and 0.75, respectively. In addition, total-α-synuclein alone could distinguish DLB or PDD patients from AD patients, with an AUC of 0.80.

CONCLUSIONS: The levels of α-synuclein oligomers were increased in the CSF from α-synucleinopathy patients with dementia compared with AD cases.

Place, publisher, year, edition, pages
BioMed Central, 2014
National Category
Neurology Geriatrics
Identifiers
urn:nbn:se:liu:diva-162686 (URN)10.1186/alzrt255 (DOI)000343200100002 ()24987465 (PubMedID)2-s2.0-84989182833 (Scopus ID)
Available from: 2019-12-16 Created: 2019-12-16 Last updated: 2020-01-22Bibliographically approved
Nägga, K., Dong, H.-J., Marcusson, J., Olin Skoglund, S. & Wressle, E. (2012). Health-related factors associated with hospitalization for old people: Comparisons of elderly aged 85 in a population cohort study. Archives of gerontology and geriatrics (Print), 54(2), 391-397
Open this publication in new window or tab >>Health-related factors associated with hospitalization for old people: Comparisons of elderly aged 85 in a population cohort study
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2012 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 54, no 2, p. 391-397Article in journal (Refereed) Published
Abstract [en]

The aim of this population-based study was to (1) describe living conditions and actual health care utilization among 85 year olds; (2) determine factors that affect hospital admissions in this age. The study was conducted on 85-year-old residents in Linkoping municipality, Sweden. The data collected included medical records, health care utilization during the preceding 12 months and a postal questionnaire on assistance, assistive technology, functional impairment, feelings of loneliness, worries and health-related quality of life measured by the EQ-5D. Out of 650 eligible individuals, 496 (78% of those alive) participated. Despite the prevalence of multi-morbidity (68%) and mental discomfort, the majority managed self-care (85%), usual activities (74%) and had high (andgt;60/100) self-rated health evaluated by a visual analog scale (VAS). The non-hospitalized group reported a better health status than the hospitalized group in terms of medical aspects, living conditions and subjective estimation. Factors associated with in-patient care were an increased number of general practitioner visits, more assistive technology, community assistance, multimorbidity and/or diagnosed congestive heart failure and arrhythmia.

Place, publisher, year, edition, pages
Elsevier, 2012
Keywords
Population study, Hospitalization, Health care service, postal questionnaire
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-76812 (URN)10.1016/j.archger.2011.04.023 (DOI)000301647400064 ()
Note

Funding Agencies|Health Research Council of the South-East of Sweden|FORSS-8888FORSS-11636FORSS-31811|County of Ostergotland|LIO-11877LIO-31321LIO-79951|Janne Elgqvist Family Foundation||

Available from: 2012-04-20 Created: 2012-04-20 Last updated: 2019-06-27
Öberg, M., Marcusson, J., Nägga, K. & Wressle, E. (2012). Hearing difficulties, uptake and outcomes of hearing aids in people 85 years of age. International Journal of Audiology, 51(2), 108-115
Open this publication in new window or tab >>Hearing difficulties, uptake and outcomes of hearing aids in people 85 years of age
2012 (English)In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 51, no 2, p. 108-115Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to investigate self-reported hearing difficulties, uptake, and hearing-aid outcomes and their relationships to demographic, cognitive, psychosocial, and health variables in 85 year olds. Design and study sample: Three hundred and forty-six elderly adults participated in a survey that included questionnaires and home visits. Fifty-five percent of participants admitted to having hearing difficulties, and 59% of these owned hearing aids. The participants most frequently cited reason for not acquiring hearing aids was that they did not think their hearing problem was perceived as severe enough. Participants with hearing difficulties who did not own hearing aids showed worse general and mental health. Many of the elderly participants were successful in their rehabilitation, and their hearing-aid outcomes were similar to those of a younger group, with the exception of a greater proportion of non-users among the elderly. Conclusion: Many older people with self-reported hearing difficulties do not acquire hearing aids, despite this studys findings that older people are likely to have success with hearing rehabilitation. It is important to make greater efforts to try to increase elderly adults awareness of hearing loss and the benefits of hearing rehabilitation.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keywords
self-reported hearing difficulties, hearing aids, elderly, general health
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-74754 (URN)10.3109/14992027.2011.622301 (DOI)000299291800006 ()
Note
funding agencies|Gunnar Arnbrinks Foundation||County of Ostergotland||Swedish Institute of Assistive Technology||Available from: 2012-02-07 Created: 2012-02-07 Last updated: 2019-06-27
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0194-8402

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