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  • 51. Rosel, P.
    et al.
    Marcusson, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, MC - Medicincentrum, Geriatrik-LAH.
    Differential regional distribution of the 5-HT reuptake complex, the 5-HTa receptors and their second message IP3 in human brain.1999In: Neuroscience research communications, ISSN 0893-6609, E-ISSN 1520-6769, Vol. 24, p. 107-115Article in journal (Refereed)
  • 52.
    Sandberg, Jonas
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Placing a spouse in a care home for older people: (re)-constructing roles and relationships2001Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis explores the process of placing a spouse in a care home for older people from the perspectives of the key actors involved. Due to the lack of previous studies in this area in Sweden and the desire to generate new insights that have the potential to inform practice developments a grounded theory methodology was adopted.

    Data were collected using semi-structured interviews (70 in total) with spouses, adult children, community based staff and staff in care homes. Analyses of these data suggested that placement is best interpreted as a temporal experience comprising four stages: making the decision, making the move, adjusting to the move and reorientation. Each of the key actors offered differing insights into the way that the process as a whole was experienced with it emerging that in the initial two phases the primacy focus was on the practical and instrumental aspects of the move, with the emotional consequences being largely overlooked. This is a key issue as spouses were usually unprepared for the sense of separation and loss that the placement caused. Subsequently, spouses placed particular importance on maintaining their sense of involvement with their partner by a variety of 'keeping' activities. However, children and staff in care homes shared varying degrees of 'awareness' which influenced the way that relationships were forged.

    Based on a synthesis of the data the core category and basic social process that emerged was termed '(re)-constructing roles and relationships'. This highlights the subtle and dynamic way that placement unfolds and reinforces the importance of understanding the process from multiple perspectives. In addition to providing new theoretical insights the thesis identifies a number of ways in which the placement process could be improved and suggests the need for more open and explicit discussion of a number of aspects, particularly the ways in which expectations of roles and relationships change over time. Thls is essential if spouses are to be better prepared and supported both for the sense of separation from their partner and for the need to integrate into the care home setting.

    List of papers
    1. 'I don't have any other choice': spouses' experiences of placing a partner in a care home for older people in Sweden
    Open this publication in new window or tab >>'I don't have any other choice': spouses' experiences of placing a partner in a care home for older people in Sweden
    2000 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 32, no 5, p. 1178-1186Article in journal (Refereed) Published
    Abstract [en]

    The main aim of this paper is to consider the experiences of Swedish spouses who have placed a partner in a care home for older people. Data were gathered from semi-structural interviews with 14 spouses (11 wives and 3 husbands) who had been involved in a care home placement within the previous 6 months. The results reported here are from the first component of a larger grounded theory study, the aim of which is to explore, describe and understand the experience of care home placement from a variety of perspectives and to identify the implications for policy and practice in Sweden. The focus here is on the experience of spouses, relating to the decision-making process, the move into care and subsequent contact with the care home. Four themes emerged from the data – making the decision, making the move, adjusting to the move and reorientation. The results show a lack of planning for the elder person’s entry to a care home, and professional dominance of this stage of the process. The largely ambivalent emotional responses to the move that spouses experience and the difficulties in initiating and sustaining relationships with staff in the home are discussed in the light of previous research.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-27024 (URN)10.1046/j.1365-2648.2000.01588.x (DOI)11668 (Local ID)11668 (Archive number)11668 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    2. Placing a spouse in a care home: the importance of keeping
    Open this publication in new window or tab >>Placing a spouse in a care home: the importance of keeping
    2001 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 3, p. 406-416Article in journal (Refereed) Published
    Abstract [en]

    • Despite a universal policy of community care, the number of frail older people entering care homes is likely to increase in the future.

    • There have been relatively few studies exploring the experience of spouses who have placed a partner in care.

    • Due to a lack of preparation, the placement process is often ad hoc, with little attention being given to spouses’ emotional reactions or their efforts to maintain their relationship with their partner.

    • The relationship between care home staff and families is often superficial and strained.

    • There is a need for more proactive efforts to facilitate a partnership between care home staff and families.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-27028 (URN)10.1046/j.1365-2702.2001.00497.x (DOI)11672 (Local ID)11672 (Archive number)11672 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    3. Moving into a care home: the role of adult children in the placement process
    Open this publication in new window or tab >>Moving into a care home: the role of adult children in the placement process
    2002 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 39, no 3, p. 353-362Article in journal (Refereed) Published
    Abstract [en]

    Admission of an older person to a care home is widely recognised as a very stressful period for the family and one which, despite community care policy, is likely to be an increasingly common experience. Although there is a growing research base in this area, there have been few studies on the role of adult children in supporting their parents during this difficult transition. This paper reports on the third stage of a grounded theory study conducted in Sweden which explored the part played by adult children in the placement process. Data were collected from 13 adult children using in-depth semi-structured interviews and the results are compared with themes previously derived from interviews with 26 spouse carers. The analysis reveals important overlaps and differences and suggests the need for further research exploring the dynamics of the placement process.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-27025 (URN)10.1016/S0020-7489(01)00033-5 (DOI)11669 (Local ID)11669 (Archive number)11669 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    4. The role of community staff in care home placement in Sweden
    Open this publication in new window or tab >>The role of community staff in care home placement in Sweden
    2002 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 4, p. 488-497Article in journal (Refereed) Published
    Abstract [en]

    • The role of community staff in placing a relative in a care home is a relatively unexplored area of practice.

    •  Interviews with a variety of community staff in Sweden suggest that they play a significant role in helping family carers, particularly spouses, research the decision about the need for placement.

    •  This role can include recognition that placement is required (seeing the need), initiating and sustaining discussions about placement (sowing the seed and nurturing the seed) and legitimating the decision.

    •  However, once the decision has been made relatively little attention is given to the emotional consequences of the move and attention is focused largely on instrumental aspects.

    •  Despite showing sensitivity in the decision-making phase, community staff could do more to help carers deal with the guilt they experience and to initiate contact with the care home.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-27933 (URN)10.1046/j.1365-2702.2002.00619.x (DOI)12694 (Local ID)12694 (Archive number)12694 (OAI)
    Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
    5. 'Entering a New World': empathic awareness as the key to positive family/staff relationships in care homes
    Open this publication in new window or tab >>'Entering a New World': empathic awareness as the key to positive family/staff relationships in care homes
    2002 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 39, no 5, p. 507-515Article in journal (Refereed) Published
    Abstract [en]

    Despite an almost universal policy of community care, placing a relative in a care home will be an increasingly common event as population ageing continues. Studies suggest that most families wish to remain involved in care following placement but that they often experience difficulties in establishing relationships with staff. This paper reports on the fifth phase of a Swedish study exploring the experience of placement from a temporal perspective and including the views of all the key actors (relatives, staff in the community, staff in care homes). The focus here is placed on the perceptions of care home staff and their perceived role in relation to spouses who have recently placed a partner. The study adopted a grounded theory approach and data were collected from in-depth interviews with 16 staff members of varying grades and positions. Analysis of the data suggested 3 levels of awareness amongst staff: empathic awareness, guarded awareness and limited awareness. The characteristics of empathic awareness are outlined and its implications briefly considered.

    Keywords
    Care home placement, Family carers, Grounded theory, Partnership, Staff perceptions
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-46840 (URN)10.1016/S0020-7489(01)00056-6 (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
  • 53.
    Sandberg, Jonas
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Lundh, Ulla
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nolan, Mike
    School of Nursing and Midwifery, University of Sheffield, Samuel Fox House, Northern General Hospital, Herries Road, Sheffield, UK.
    Moving into a care home: the role of adult children in the placement process2002In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 39, no 3, p. 353-362Article in journal (Refereed)
    Abstract [en]

    Admission of an older person to a care home is widely recognised as a very stressful period for the family and one which, despite community care policy, is likely to be an increasingly common experience. Although there is a growing research base in this area, there have been few studies on the role of adult children in supporting their parents during this difficult transition. This paper reports on the third stage of a grounded theory study conducted in Sweden which explored the part played by adult children in the placement process. Data were collected from 13 adult children using in-depth semi-structured interviews and the results are compared with themes previously derived from interviews with 26 spouse carers. The analysis reveals important overlaps and differences and suggests the need for further research exploring the dynamics of the placement process.

  • 54.
    Sandberg, Jonas
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Lundh, Ulla
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    Nolan, Mike
    Gerontological Nursing, University of Sheffield, UK.
    Placing a spouse in a care home: the importance of keeping2001In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 3, p. 406-416Article in journal (Refereed)
    Abstract [en]

    • Despite a universal policy of community care, the number of frail older people entering care homes is likely to increase in the future.

    • There have been relatively few studies exploring the experience of spouses who have placed a partner in care.

    • Due to a lack of preparation, the placement process is often ad hoc, with little attention being given to spouses’ emotional reactions or their efforts to maintain their relationship with their partner.

    • The relationship between care home staff and families is often superficial and strained.

    • There is a need for more proactive efforts to facilitate a partnership between care home staff and families.

  • 55.
    Sandberg, Jonas
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Nolan, Mike
    Gerontological Nursing, University of Sheffield, UK.
    Lundh, Ulla
    Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
    The role of community staff in care home placement in Sweden2002In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 11, no 4, p. 488-497Article in journal (Refereed)
    Abstract [en]

    • The role of community staff in placing a relative in a care home is a relatively unexplored area of practice.

    •  Interviews with a variety of community staff in Sweden suggest that they play a significant role in helping family carers, particularly spouses, research the decision about the need for placement.

    •  This role can include recognition that placement is required (seeing the need), initiating and sustaining discussions about placement (sowing the seed and nurturing the seed) and legitimating the decision.

    •  However, once the decision has been made relatively little attention is given to the emotional consequences of the move and attention is focused largely on instrumental aspects.

    •  Despite showing sensitivity in the decision-making phase, community staff could do more to help carers deal with the guilt they experience and to initiate contact with the care home.

  • 56. Sjögren, M
    et al.
    Davidsson, P
    Tullberg, M
    Minthon, L
    Wallin, A
    Wikkelso, C
    Granérus, Ann-Kathrine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, MC - Medicincentrum, Geriatrik-LAH.
    Vanderstichele, H
    Vanmechelen, E
    Blennow, K
    Both total and phosphorylated tau are increased in Alzheimer's disease2001In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 70, no 5, p. 624-630Article in journal (Refereed)
    Abstract [en]

    Background - Pathological tau protein concentrations in CSF are found in both Alzheimer's disease (AD) and frontotemporal dementia (FTD), but studies on brain tissue have suggested that the tau pathology in AD differs from that in FTD and that the difference may be related to the degree of phosphorylation. As CSF tau protein is increased after stroke, tau may also be implicated in the pathophysiology of vascular dementia, of which subcortical arteriosclerotic encephalopathy (SAE) is a putative subtype. Objectives - To investigate the nature of tau protein in CSF and the involvement of total CSF tau and phosphorylated CSF tau (phosphotau) in various types of dementia. Methods - Using ELISAs for total tau and tau phosphorylated at Thr181 (phosphotau), the CSF concentrations of total tau and phosphotau were determined in patients with probable and possible AD (n=41 and 19, respectively), FTD (n=18), SAE (n=17), and Parkinson's disease (PD, n= 15) and in age matched controls (n=17). All the antibodies stained the lower molecular weight bands, whereas only the antibodies that recognise phosphorylated tau stained the higher molecular bands. Results - Both CSF tau and CSF phosphotau were increased in probable AD compared with FTD (p<0.001), SAE (p<0.001), PD (p<0.001), and controls (p<0.001). CSF phosphotau was increased in possible AD compared with FTD (p<0.001) and SAE (p<0.001). CSF tau and CSF phosphotau were positively correlated in all the groups. Molecular weight forms of tau ranging from 25 kDa to 80 kDa were found in the CSF Conclusion - Both phosphorylated and unphosphorylated tau isoforms were present in the CSF, and tau protein appeared in both truncated and full length forms. The results suggest that the CSF concentrations of tau and phosphotau are increased in about two thirds of patients with probable AD and in half of those with possible AD but are normal in FTD, SAE, and PD compared with normal aging. Values in the normal range do not exclude AD.

  • 57. Sjögren, M
    et al.
    Minthon, L
    Davidsson, P
    Granérus, Ann-Kathrine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, MC - Medicincentrum, Geriatrik-LAH.
    CSF levels of tau, beta-amyloid and GAP-43 in frontotemporal 1-42 dementia, other types of dementia and normal aging2000In: Journal of neural transmission, ISSN 0300-9564, E-ISSN 1435-1463, Vol. 107, no 5, p. 563-579Article in journal (Refereed)
    Abstract [en]

    Cerebrospinal fluid (CSF) levels of tau, ▀-amyloid1-42 and growth-associated protein 43 (GAP-43) were studied in patients with frontotemporal dementia (FTD, n = 17), Alzheimer's disease (AD, n = 60), subcortical white-matter dementia (SWD, n = 24), Parkinson's disease (PD, n = 23) and dysthymia (n = 19) and in age-matched controls (n = 32). CSF-tau was significantly increased only in AD, and CSF-▀-amyloid1-42 was significantly decreased in AD and SWD as compared to controls, and in AD compared to FTD. CSF-GAP-43 was significantly decreased only in PD. The GAP-43/tau ratio was decreased in all the patient groups except the dysthymia group compared to controls. A positive correlation was found between CSF-GAP-43 and CSF-tau in all groups. The results suggest normal levels of CSF-tau and CSF-▀-amyloid1-42 in FTD, which will aid in the clinical separation of FTD from AD. In SWD, decreased levels of CSF-▀-amyloid1-42 suggest concomitant involvement of vascular and amyloid protein mechanisms.

  • 58. Sjögren, M
    et al.
    Vanderstichele, H
    Ågren, H
    Zachrisson, O
    Edbagge, M
    Wikkelso, C
    Skoog, I
    Wallin, A
    Wahlund, LO
    Marcusson, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, MC - Medicincentrum, Geriatrik-LAH.
    Nägga, Katarina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, MC - Medicincentrum, Geriatrik-LAH.
    Andreasen, N
    Davidsson, P
    Vanmechelen, E
    Blennow, K
    Tau and Abeta42 in cerebrospinal fluid from healthy adults 21-93 years of age: establishment of reference values2001In: Clinical Chemistry, ISSN 0009-9147, E-ISSN 1530-8561, Vol. 47, p. 1776-1781Article in journal (Refereed)
  • 59.
    Skogh, Elisabeth
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Reis, Margareta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Psychiatry.
    Dahl, Marja-Liisa
    Lundmark, Jöns
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, MC - Medicincentrum, Geriatrik-LAH.
    Bengtsson, Finn
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Therapeutic drug monitoring data on olanzapine and its N-demethyl metabolite in the naturalistic clinical setting2002In: Therapeutic Drug Monitoring, ISSN 0163-4356, E-ISSN 1536-3694, Vol. 24, no 4, p. 518-526Article in journal (Refereed)
    Abstract [en]

    Olanzapine (Zyprexa«) was approved for general prescription in Sweden in November 1996, and an HPLC-based therapeutic drug monitoring (TDM) routine for serum olanzapine (OLA) and its major metabolite, N-demethylolanzapine (DMO) was established in February 1997. During 1997 to 1999, a total of 753 TDM requests for a total of 545 Swedish patients was analyzed. Additional patient information on certain clinical variables was collected on specifically designed TDM request forms. After the exclusion process, samples from 194 patients were found to be eligible for further scrutiny. The concentration-to-dose (C/D) ratio for OLA varied 25-fold and that of DMO 22-fold. Women had a higher (P < 0.01) median C/D ratio for OLA than men (median, 7.2 nmol/L/mg vs 5.2 nmol/L/mg). Nonsmokers had a higher (P < 0.001) C/D ratio for OLA than smokers (median, 9,2 nmol/L/mg vs 4.0 nmol/L/mg). Smokers got higher prescribed (P < 0.05) doses of OLA than nonsmokers did. In the group with reported side effects, the median serum OLA concentration was 22% higher (P < 0.05) than in the group without side effects. Patients co-medicated with carbamazepine had a 71% lower median C/D ratio for OLA than patients on OLA monotherapy. The present TDM-based follow-up suggests that the influence of gender, smoking habits, and certain drug interactions may need to be considered for optimal dosage of OLA. TDM may be used for this purpose more readily in the future.

  • 60. Sundman, I
    et al.
    Blennow, K
    Marcusson, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, MC - Medicincentrum, Geriatrik-LAH.
    Increased [3H]tiagabine binding to GAT-1 in the cingulate cortex in schizophrenia2002In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 45, no 1Article in journal (Refereed)
    Abstract [en]

    Postmortem samples from individuals with schizophrenia (n = 13) and control subjects (n = 10) were investigated for binding of [3H]tiagabine to GABA transporter-1 GAT-1. The binding was analyzed in the cingulate cortex and the caudate nucleus. There were no differences in binding affinity between the groups in any of the investigated areas. The maximum number of binding sites (Bmax) was elevated in the schizophrenic cingulate cortex compared to controls (1,264 ▒ 96 vs. 860 ▒ 123 fmol/mg of protein). The Bmax in the caudate nucleus for schizophrenics (426 ▒ 40 fmol/mg of protein) was the same as for controls (495 ▒ 69 fmol/mg of protein). The increase in GAT-1 in schizophrenia could be explained by a modulatory upregulation in the cingulate cortex. Copyright ⌐ 2002 S. Karger AG, Basel.

  • 61.
    Terman, Alexei
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics.
    Gustafsson, Bertil
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Brunk, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Pharmacology.
    Mitochondrial damage and intralysosomal degradation in cellular aging2006In: Molecular Aspects of Medicine, ISSN 0098-2997, E-ISSN 1872-9452, Vol. 27, no 5-6, p. 471-482Article in journal (Refereed)
    Abstract [en]

    Normal mitochondrial respiration is associated with a continuous production of superoxide and hydrogen peroxide, inevitably resulting in minor macromolecular damage. Damaged cellular components are not completely turned over by autophagy and other cellular repair systems, leading to a progressive age-related accumulation of biological "garbage" material, such as defective mitochondria, cytoplasmic protein aggregates and an intralysosomal undegradable material, lipofuscin. These changes primarily affect neurons, cardiac myocytes and other long-lived postmitotic cells that neither dilute this "garbage" by mitotic activity, nor are replaced by newly differentiated cells. Defective mitochondria are insufficient in ATP production and often generate increased amounts of reactive oxygen species, further enhancing oxidative stress. Lipofuscin-loaded lysosomes, in turn, poorly turn over mitochondria that gradually leads to the overload of long-lived postmitotic cells with "garbage" material, decreased adaptability and eventual cell death. © 2006 Elsevier Ltd. All rights reserved.

  • 62.
    Terman, Alexei
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics.
    Gustafsson, Bertil
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pathology and Clinical Genetics.
    Brunk, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Pharmacology.
    The lysosomal-mitochondrial axis theory of postmitotic aging and cell death2006In: Chemico-Biological Interactions, ISSN 0009-2797, E-ISSN 1872-7786, Vol. 163, no 1-2, p. 29-37Article in journal (Refereed)
    Abstract [en]

    Aging (senescence) is characterized by a progressive accumulation of macromolecular damage, supposedly due to a continuous minor oxidative stress associated with mitochondrial respiration. Aging mainly affects long-lived postmitotic cells, such as neurons and cardiac myocytes, which neither divide and dilute damaged structures, nor are replaced by newly differentiated cells. Because of inherent imperfect lysosomal degradation (autophagy) and other self-repair mechanisms, damaged structures (biological "garbage") progressively accumulate within such cells, both extra- and intralysosomally. Defective mitochondria and aggregated proteins are the most typical forms of extralysosomal "garbage", while lipofuscin that forms due to iron-catalyzed oxidation of autophagocytosed or heterophagocytosed material, represents intralysosomal "garbage". Based on findings that autophagy is diminished in lipofuscin-loaded cells and that cellular lipofuscin content positively correlates with oxidative stress and mitochondrial damage, we have proposed the mitochondrial-lysosomal axis theory of aging, according to which mitochondrial turnover progressively declines with age, resulting in decreased ATP production and increased oxidative damage. Due to autophagy of ferruginous material, lysosomes contain a pool of redox-active iron, which makes these organelles particularly susceptible to oxidative damage. Oxidant-mediated destabilization of lysosomal membranes releases hydrolytic enzymes to the cytosol, eventuating in cell death (either apoptotic or necrotic depending on the magnitude of the insult), while chelation of the intralysosomal pool of redox-active iron prevents these effects. In relation to the onset of oxidant-induced apoptosis, but after the initiating lysosomal rupture, cytochrome c is released from mitochondria and caspases are activated. Mitochondrial damage follows the release of lysosomal hydrolases, which may act either directly or indirectly, through activation of phospholipases or pro-apoptotic proteins such as Bid. Additional lysosomal rupture seems to be a consequence of a transient oxidative stress of mitochondrial origin that follows the attack by lysosomal hydrolases and/or phospholipases, creating an amplifying loop system. © 2006 Elsevier Ireland Ltd. All rights reserved.

  • 63. Wallin, Anders
    et al.
    Jennersjö, Cecilia
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Internal Medicine. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Granérus, Ann-Kathrine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, MC - Medicincentrum, Geriatrik-LAH.
    Prevalence of dementia and regional brain syndromes in long-standing Parkinson´s disease.1999In: Parkinsonism & Related Disorders, ISSN 1353-8020, E-ISSN 1873-5126, Vol. 5, p. 103-110Article in journal (Refereed)
  • 64.
    Wressle, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Occupational Therapy. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Bringer, Birgitta
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Granerus, Ann-Kathrine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Quality of life in Parkinson´s disease at a geriatric outpatient department in Sweden2006In: International journal of therapy and rehabilitation, ISSN 1741-1645, Vol. 13, p. 365-369Article in journal (Refereed)
    Abstract [en]

        

  • 65.
    Wressle, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Occupational Therapy. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Engstrand, Christina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion. Östergötlands Läns Landsting, Reconstruction Centre, Department of Plastic Surgery, Hand surgery UHL.
    Granerus, Ann-Kathrine
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Living with Parkinson´s disease: Elderly patients´ and relatives´ perspective on daily living2007In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 54, p. 131-139Article in journal (Refereed)
    Abstract [en]

    Background/aim: Parkinson's disease is a progressive neurodegenerative disorder resulting in significant disability. We examined how Parkinson's disease affects daily living from the perspective of both patients and relatives. Methods: Qualitative interviews were performed with seven patients with Parkinson's disease and nine relatives from families other than those of the interviewed patients. Patients and relatives were recruited from an outpatient geriatric unit at a university hospital in Sweden. The interviews were transcribed and analysed qualitatively. Results: A conceptual framework encompassing aggravating factors, consequences in daily living and facilitating factors is presented. Patients perceived activity restrictions, changed habits, decreased socialisation and anxiety. Relatives reported changed roles and habits, decreased socialisation, strain and anxiety about the future. Facilitating factors included accessibility, strategies and psychological support for both patients and relatives. Conclusions: The results show that Parkinson's disease affects daily living not only for patients but also for relatives. They need to be seen, heard and supported in this burden. Services must be adapted to the needs of both patients and relatives with accessibility to health-care facilities with deep knowledge about the disease and its consequences. The identified factors are areas of concern in occupational therapy.

  • 66.
    Wressle, Ewa
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Occupational Therapy. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Filipsson, Viveka
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Andersson, Lena
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Jacobsson, Beatrice
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Martinsson, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Engel, Kristina
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Evaluation of occupational therapy interventions for elderly patients in Swedish acute care: A pilot study2006In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 13, no 4, p. 203-210Article in journal (Refereed)
    Abstract [en]

    The aim was to evaluate whether occupational therapy interventions in acute care could improve the elderly patient's perception of ability to manage at home after discharge. A pilot study was performed, including 22 patients in the experimental group and 19 in the control group. Occupational therapy interventions were conducted in the experimental group concerning personal care, information, prescription of assistive devices, planning of discharge, and reporting to primary care or community care. The control group was given no occupational therapy interventions. Structured interviews were performed on discharge and at a follow-up in about 14 weeks after discharge. The two groups were comparable concerning gender, age, days of care, and diagnoses. Patients in the experimental group scored lower on mental health and were more anxious on discharge. However, there was no difference between the groups in managing at home after discharge. Patients in the control group had greater need of further contacts with healthcare after discharge. Due to the small sample interpretations must be made with caution. The findings indicate that occupational therapy interventions in acute care might have a positive effect from the perspective of the elderly patient. These results need to be confirmed in a larger study.

  • 67.
    Zheng, Lin
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Roberg, Karin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Östergötlands Läns Landsting, Reconstruction Centre, Department of ENT - Head and Neck Surgery UHL.
    Jerhammar, Fredrik
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology.
    Marcusson, Jan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine.
    Terman, Alexei
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Pathology.
    Autophagy of amyloid beta-protein in differentiated neuroblastoma cells exposed to oxidative stress2006In: Neuroscience Letters, ISSN 0304-3940, E-ISSN 1872-7972, Vol. 394, no 3, p. 184-189Article in journal (Refereed)
    Abstract [en]

    Oxidative stress is considered important for the pathogenesis of Alzheimer disease (AD), which is characterized by the formation of senile plaques rich in amyloid beta-protein (Aβ). Aβ cytotoxicity has been found dependent on lysosomes, which are abundant in AD neurons and are shown to partially co-localize with Aβ. To determine whether oxidative stress has any influence on the relationship between lysosomes and Aβ1-42 (the most toxic form of Aβ), we studied the effect of hyperoxia (40% versus 8% ambient oxygen) on the intracellular localization of Aβ1-42 (assessed by immunocytochemistry) in retinoic acid differentiated SH-SY5Y neuroblastoma cells maintained in serum-free OptiMEM medium. In control cells, Aβ1-42 was mainly localized to small non-lysosomal cytoplasmic granules. Only occasionally Aβ1-42 was found in large (over 1 μm) lysosomal-associated membrane protein 2 positive vacuoles, devoid of the early endosomal marker rab5. These large Aβ1-42-containing lysosomes were not detectable in the presence of serum (known to suppress autophagy), while their number increased dramatically (up to 24-fold) after exposure of cells to hyperoxia during 5 days. Activation of autophagy by hyperoxia was confirmed by transmission electron microscopy. Furthermore, an inhibitor of autophagic sequestration 3-methyladenine prevented the accumulation of Aβ1-42-positive lysosomes due to hyperoxia. In parallel experiments, intralysosomal accumulation of Aβ1-40 following oxidative stress has been found as well. The results suggest that Aβ can be autophagocytosed and its accumulation within neuronal lysosomes is enhanced by oxidative stress. © 2005 Elsevier Ireland Ltd. All rights reserved.

  • 68.
    Zheng, Lin
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Roberg, Karin
    Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
    Jerhammar, Fredrik
    Linköping University, Department of Clinical and Experimental Medicine, Experimental Pathology. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Terman, Alexei
    Linköping University, Department of Neuroscience and Locomotion, Pathology. Linköping University, Faculty of Health Sciences.
    Oxidative Stress Induces Intralysosomal Accumulation of Alzheimer Amyloid β-Protein in Cultured Neuroblastoma Cells2006In: Annals of the New York Academy of Sciences, ISSN 0077-8923, E-ISSN 1749-6632, Vol. 1067, p. 248-251Article in journal (Refereed)
    Abstract [en]

    Oxidative stress is considered important for the pathogenesis of Alzheimer's disease (AD), which is characterized by the formation of extracellular senile plaques, mainly composed of amyloid β-protein (Aβ). Aβ also accumulates within AD neurons and is believed to exert cellular toxicity through lysosomal labilization. We report that the exposure of human neuroblastoma cells to hyperoxia (40% vs. 8% ambient oxygen) induced the accumulation of large (over 1 μM) Aβ-containing lysosomes, which were not typical of control cells, showing a distinct localization of Aβ and lysosomal markers. An inhibitor of autophagy, 3-methyladenine, suppressed the effect of hyperoxia. The results suggest a link between the involvement of oxidative stress and lysosomes in AD.

  • 69.
    Ólafsdóttir, María
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Dementia in Primary Care: Why the Low Detection Rate?2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 3, p. 194-198Article in journal (Refereed)
    Abstract [en]

    Objective - The aim of the present study was to find reasons for the low detection rate of dementia in primary care. Another aim was to investigate the attitudes and knowledge on dementia among Swedish general practitioners (GPs).

    Design - Two-hundred-and-twenty-eight postal questionnaires were distributed to GPs in the county of Östergötland. Setting - Primary care in Sweden.

    Main outcome measures - The opinions of GPs on dementia management in primary care.

    Results - The response rate was 67%. GPs showed a good knowledge of dementia diseases but underestimated the occurrence of dementia. They presented a positive attitude towards managing patients with dementia and considered that existing drug therapy justified an active search for patients with dementia in primary care, but they believed the efficacy of the drugs to be limited. Assessing the social environment of patients and organising social support were regarded as the most difficult tasks in the management of demented patients.

    Conclusion - The study indicates that the main obstacles are a lack of resources and a sceptical attitude to the benefits of drug treatment. Co-operation between the community services, specialist clinics and the primary care team should be improved.

  • 70.
    Ólafsdóttir, María
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Skoog, Ingemar
    Institute of Clinical Neuroscience, Department of Psychiatry, Sahlgrenska University Hospital, Göteborg University, Sweden.
    Mental Disorders Among Elderly People in Primary Care: The Linköping Study2001In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 104, no 1, p. 12-18Article in journal (Refereed)
    Abstract [en]

    Objective: The aims of this study were to describe the prevalence of mental disorders among elderly patients in primary care and to compare diagnoses from psychiatric interview with diagnoses in medical records.

    Method: Patients aged 70 years and above attending a primary care centre (N=350) were studied using a psychiatric and medical record examination.

    Results: The prevalence of mental disorder according to the psychiatric interview was 33% (16% dementia, 17% other mental disorders). Only 49% of these had any psychiatric diagnosis in case records and 17–38% received specific treatments. The frequency of psychiatric symptoms among those with no mental disorder was between 1% and 66%. Patients with mental disorders were more often females, had more visits to a doctor, more diagnoses in medical records, and were prescribed more drugs.

    Conclusion: Mental disorders and symptoms are common among the elderly in primary care. More effort should be made to increase the recognition rate.

  • 71.
    Ólafsdóttir, María
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Ragnardóttir, Bertha
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Skoog, Ingemar
    Institute of Clinical Neuroscience, Department of Psychiatry, Sahlgrenska University Hospital, Göteborg University.
    Mini-Mental State Examination: A Tool for Detecting Dementia in Primary Care?Manuscript (preprint) (Other academic)
    Abstract [en]

    The Mini-mental State Examination (MMSE) is the most widely used test for cognitive function, but its usefulness as a screening tool for dementia has been debated. We investigated the ciiterion validity of the MMSE in patients, aged 70 years and above, attending a piimary care centre (PPC). The MMSE was administered (N=1225) and compared with further diagnosing of dementia according to DSM-III-R in a subgroup (N=350). The major finding was that the use of the traditional cut-off score of 23/24 points on MMSE, left more than 70% of mild cases and 30% of moderate cases undetected. When using a cut-off score of 26/27 a good criterion validity was found and an excellent agreement between the testing by the social worker at the PCC and the general practitioner in the patient's home. As the major problem in the dementia management has been under-detection, we recommend MMSE as an opportunistic screening test in PCC population.

  • 72.
    Ólafsdóttir, María
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Skoog, Ingemar
    Department of Psychiatry, Institute of Clinical Neuroscience, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Detection of Dementia in Primary Care: The Linköping Study2000In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 11, no 4, p. 223-229Article in journal (Refereed)
    Abstract [en]

    We examined to what extent dementia and cognitive impairment are detected in a primary health care centre. A systematic sample of patients aged 70 years and above, who attended a primary health care centre for a doctor’s consultation (n = 350) were examined with a neuropsychiatric examination and an interview with a close informant. Dementia was diagnosed according to DSM-III-R. Medical records from the health centre were examined for entries on cognitive decline or dementia, other diagnoses and prescribed drugs. The prevalence of dementia was 16.3% and a further 3.1% had questionable dementia. Cognitive disturbances or dementia were noted in case records in 15 out of 57 (26%) demented cases, and in 1 out of 11 (9%) questionable dementias. Compared to non-demented patients, the demented had more diagnoses and a higher number of prescribed drugs. Severity and duration of dementia were associated with an increased detection.

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