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Norgren, J., Sindi, S., Sandebring-Matton, A., Kåreholt, I., Akenine, U., Nordin, K., . . . Kivipelto, M. (2020). Capillary blood tests may overestimate ketosis: triangulation between three different measures of β-hydroxybutyrate. American Journal of Physiology. Endocrinology and Metabolism, 318(2), E184-E188
Open this publication in new window or tab >>Capillary blood tests may overestimate ketosis: triangulation between three different measures of β-hydroxybutyrate
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2020 (English)In: American Journal of Physiology. Endocrinology and Metabolism, ISSN 0193-1849, E-ISSN 1522-1555, Vol. 318, no 2, p. E184-E188Article in journal (Refereed) Published
Abstract [en]

The ketone body β-hydroxybutyrate (BHB), assessed by a point-of-care meter in venous whole blood (BHBv), was used as the main outcome in a study on nutritional ketosis in healthy older adults. Two other BHB measures were also used in the study for validation and exploratory purposes, and here we report findings on correlation and agreement between those three methods. Ketosis in the range of 0-1.5 mmol/L was induced in 15 healthy volunteers by intake of medium-chain fatty acids after a 12-h fast. BHBv was assessed at 12 time points for 4 h. The same point-of-care meter was also used to test capillary blood (BHBc) at three time points, and a laboratory test determined total ketones (TK) in plasma (BHBp + acetoacetate) at four time points. A total of 180 cases included simultaneous data on BHBv, BHBc, BHBp, and TK. TK correlated with BHBp (Pearson's r = 0.99), BHBv (r = 0.91), and BHBc (r = 0.91), all P < 0.0001. BHBv and BHBp had good agreement in absolute values. However, the slope between BHBc and BHBv, measured with the same device, was in the range of 0.64-0.78 in different regression models, indicating substantially higher BHB concentrations in capillary versus venous blood. We conclude that all three methods are valid to detect relative changes in ketosis, but our results highlight the importance of method considerations and the possible need to adjust cutoffs, e.g., in the management of ketoacidosis and in the evaluation and comparison of dietary interventions.

Place, publisher, year, edition, pages
NLM (Medline), 2020
Keywords
capillary, ketosis, methods comparison, venous, β-hydroxybutyrate
National Category
Other Medical Sciences
Identifiers
urn:nbn:se:hj:diva-47724 (URN)10.1152/ajpendo.00454.2019 (DOI)31821040 (PubMedID)2-s2.0-85078513052 (Scopus ID);HOA HHJ 2020 (Local ID);HOA HHJ 2020 (Archive number);HOA HHJ 2020 (OAI)
Available from: 2020-02-04 Created: 2020-02-04 Last updated: 2020-02-05Bibliographically approved
Hoang, M. T., Kåreholt, I., von Euler, M., Jönsson, L., von Koch, L., Eriksdotter, M. & Garcia-Ptacek, S. (2020). Costs of Inpatient Rehabilitation for Ischemic Stroke in Patients with Dementia: A Cohort Swedish Register-Based Study. Journal of Alzheimer's Disease, 73(3), 967-979
Open this publication in new window or tab >>Costs of Inpatient Rehabilitation for Ischemic Stroke in Patients with Dementia: A Cohort Swedish Register-Based Study
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2020 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 73, no 3, p. 967-979Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Stroke and dementia are frequent comorbidities. Dementia possibly increases total costs of stroke care, especially cost of institutionalization and informal medical care. However, stroke rehabilitation costs in dementia patients are understudied.

OBJECTIVE:

To estimate inpatient stroke rehabilitation costs for Swedish dementia patients in comparison with non-dementia patients.

METHODS:

A longitudinal cohort study with linked data from the Swedish Dementia Register and the Swedish Stroke Register was conducted. Patients diagnosed with dementia who suffered a first ischemic stroke between 2010 and 2014 (n = 138) were compared with non-dementia patients (n = 935). Cost analyses were conducted from a Swedish health care perspective. The difference of rehabilitation costs between the two groups was examined via simple linear regression (before and after matching by propensity scores of dementia) and multiple linear regression.

RESULTS:

Mean inpatient rehabilitation costs for dementia and non-dementia patients were SEK 103,693/$11,932 and SEK 130,057/$14,966, respectively (median SEK 92,183/$10,607 and SEK 106,365/$12,239) (p = 0.001). Dementia patients suffered from more comorbidities and experienced lower functioning, compared to non-dementia patients. The inpatient rehabilitation cost for patients with known dementia was 0.84 times the cost in non-dementia individuals.

CONCLUSION:

Dementia diagnosis was significantly associated with lower inpatient stroke rehabilitation costs. This might be explained by physicians' beliefs on the limited effectiveness of rehabilitation in dementia patients. Further research on cost-effectiveness of stroke rehabilitation and patients' satisfaction with stroke rehabilitation is necessary.

Place, publisher, year, edition, pages
NLM (Medline), 2020
Keywords
Cost analysis, dementia, register studies, rehabilitation, stroke, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-47844 (URN)10.3233/JAD-190749 (DOI)31884465 (PubMedID)2-s2.0-85079202120 (Scopus ID);GOA HHJ 2020 (Local ID);GOA HHJ 2020 (Archive number);GOA HHJ 2020 (OAI)
Available from: 2020-02-19 Created: 2020-02-19 Last updated: 2020-02-19Bibliographically approved
Kåreholt, I., Dahl Aslan, A. K., Siverskog, A. & Torgé, C. J. (2019). ARN-J: A beautiful kaleidoscope of gerontologists and gerontological research: Three examples of our research. In: : . Paper presented at International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden.
Open this publication in new window or tab >>ARN-J: A beautiful kaleidoscope of gerontologists and gerontological research: Three examples of our research
2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-43753 (URN)
Conference
International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-05-22Bibliographically approved
Hooshmand, B., Refsum, H., Smith, A. D., Kalpouzos, G., Mangialasche, F., von Arnim, C. A. F., . . . Fratiglioni, L. (2019). Association of methionine to homocysteine status with brain magnetic resonance imaging measures and risk of dementia. JAMA psychiatry, 76(11), 1198-1205
Open this publication in new window or tab >>Association of methionine to homocysteine status with brain magnetic resonance imaging measures and risk of dementia
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2019 (English)In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 76, no 11, p. 1198-1205Article in journal (Refereed) Published
Abstract [en]

Importance  Impairment of methylation status (ie, methionine to homocysteine ratio) may be a modifiable risk factor for structural brain changes and incident dementia.

Objective  To investigate the association of serum markers of methylation status and sulfur amino acids with risk of incident dementia, Alzheimer disease (AD), and the rate of total brain tissue volume loss during 6 years.

Design, Setting, and Participants  This population-based longitudinal study was performed from March 21, 2001, to October 10, 2010, in a sample of 2570 individuals aged 60 to 102 years from the Swedish Study on Aging and Care in Kungsholmen who were dementia free at baseline and underwent comprehensive examinations and structural brain magnetic resonance imaging (MRI) on 2 to 3 occasions during 6 years. Data analysis was performed from March 1, 2018, to October 1, 2018.

Main Outcomes and Measures  Incident dementia, AD, and the rate of total brain volume loss.

Results  This study included 2570 individuals (mean [SD] age, 73.1 [10.4] years; 1331 [56.5%] female). The methionine to homocysteine ratio was higher in individuals who consumed vitamin supplements (median, 1.9; interquartile range [IQR], 1.5–2.6) compared with those who did not (median, 1.8; IQR, 1.3–2.3; P < .001) and increased per each quartile increase of vitamin B12 or folate. In the multiadjusted model, an elevated baseline serum total homocysteine level was associated with an increased risk of dementia and AD during 6 years: for the highest homocysteine quartile compared with the lowest, the hazard ratios (HRs) were 1.60 (95% CI, 1.01-2.55) for dementia and 2.33 (95% CI, 1.26-4.30) for AD. In contrast, elevated concentrations of methionine were associated with a decreased risk of dementia (HR, 0.54; 95% CI, 0.36-0.81) for the highest quartile compared with the lowest. Higher values of the methionine to homocysteine ratio were significantly associated with lower risk of dementia and AD: for the fourth methionine-homocysteine quartile compared with the first quartile, the HR was 0.44 (95% CI, 0.27-0.71) for incident dementia and 0.43 (95% CI, 0.23-0.80) for AD. In the multiadjusted linear mixed models, a higher methionine to homocysteine ratio was associated with a decreased rate of total brain tissue volume loss during the study period (β [SE] per 1-SD increase, 0.038 [0.014]; P = .007).

Conclusions and Relevance  The methionine to homocysteine status was associated with dementia development and structural brain changes during the 6-year study period, suggesting that a higher methionine to homocysteine ratio may be important in reducing the rate of brain atrophy and decreasing the risk of dementia in older adults.

Place, publisher, year, edition, pages
American Medical Association, 2019
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-47295 (URN)10.1001/jamapsychiatry.2019.1694 (DOI)000503200800016 ()31339527 (PubMedID)2-s2.0-85069846674 (Scopus ID)KOA HHJ 2019;HHJARNIS (Local ID)KOA HHJ 2019;HHJARNIS (Archive number)KOA HHJ 2019;HHJARNIS (OAI)
Funder
Swedish Research CouncilForte, Swedish Research Council for Health, Working Life and WelfareKnut and Alice Wallenberg FoundationFredrik och Ingrid Thurings Stiftelse
Available from: 2020-01-08 Created: 2020-01-08 Last updated: 2020-01-10Bibliographically approved
Chang, M., Geirsdottir, O. G., Sigurdarsdottir, S. H., Kåreholt, I. & Ramel, A. (2019). Associations between education and need for care among community dwelling older adults in Iceland. Scandinavian Journal of Caring Sciences, 33(4), 885-891
Open this publication in new window or tab >>Associations between education and need for care among community dwelling older adults in Iceland
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2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 4, p. 885-891Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Older adults in Iceland have good access to social services that support them in maintaining an independent life, although receiving informal care is common for community living older adults in Iceland. The aim of this study was to examine whether the need for care as well as receiving formal and informal care is associated with education among older adults in Iceland.

METHODS: Among a national sample of 782 Icelandic community dwelling old adults (mean age 76.9 ± 7.4 years, 55% women), a telephone survey was conducted. The survey included questions on: socioeconomic status, social network, health status, activities of daily living and formal/informal care.

RESULTS: A full data set was available for 720 subjects and among these, 349 (48.5%) had no need for care, 197 (27.4%) received informal care only, 31 (4.3%) received formal care only, and 143 (19.9%) received both type of care. Participants with higher education were significantly less likely to need care (OR 0.67, 95% CI, 0.47-0.97, p = 0.031) when compared with those who had primary education. Categorisation by age showed that this difference was only significant in participants younger than 80 years. Education was not related to formal care, but adults with higher education were less likely to receive informal care compared with older adults who had primary education (OR: 0.65, 95%CI: 0.46, 0.93, p = 0.018).

CONCLUSIONS: People with higher education were significantly less likely to need care and this association was mainly present among those aged below 80 years. Further, in participants that needed care, the likelihood of receiving informal care was lower in highly educated participants, but no differences in formal care were observed between educational levels.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
community dwelling, education, formal care, informal care, need for care
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-44112 (URN)10.1111/scs.12685 (DOI)000505266700014 ()31058338 (PubMedID)2-s2.0-85065392080 (Scopus ID);HHJARNIS (Local ID);HHJARNIS (Archive number);HHJARNIS (OAI)
Available from: 2019-06-05 Created: 2019-06-05 Last updated: 2020-01-16Bibliographically approved
Mangialasche, F., Rydström, A., Kåreholt, I., Rosenberg, A. & Kivipelto, M. (2019). Mental stimulation and multimodal trials to build resilience against cognitive impairment and Alzheimer´s disease. In: : . Paper presented at International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden.
Open this publication in new window or tab >>Mental stimulation and multimodal trials to build resilience against cognitive impairment and Alzheimer´s disease
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-43743 (URN)
Conference
International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-05-22Bibliographically approved
Sindi, S., Darin-Mattsson, A., Kåreholt, I., Kulmala, J., Ngandu, T., Laatikainen, T., . . . Kivipelto, M. (2019). Midlife improvements in financial situation are associated with a reduced dementia risk later in life: The CAIDE 30-Year Study. International psychogeriatrics
Open this publication in new window or tab >>Midlife improvements in financial situation are associated with a reduced dementia risk later in life: The CAIDE 30-Year Study
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2019 (English)In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Objectives:

Perceived financial strain is associated with various health conditions, but it is unknown whether it is associated with an increased risk for dementia. The goal is to examine the associations between midlife perceptions of financial situation and dementia risk later in life.

Methods:

Participants were derived from the Cardiovascular Risk Factors, Aging, and Dementia population-based cohort study (n = 2000) (between 1972 and 1987, baseline mean age 50 years) in Finland. Participants returned for two re-examinations in late life (in 1998 and 2005–2008, mean age 71 and 78 years). In this study, 1442 subjects that participated in at least one re-examination (mean total follow-up 25 years) were included in analyses. Financial strain was measured using two questions in midlife on perceptions of financial situation and perceptions of changes in financial situation. For each question, participants were categorized into three groups reporting improvement, worsening, or stability, with the latter set as the reference group. Analyses were adjusted for potential confounding factors.

Results:

The group reporting better financial situation had a reduced risk for dementia (fully adjusted model: odds ratio (OR): 0.53, 95% confidence interval (CI): 0.33–0.86). In contrast, the group reporting worse financial situation did not have an increased risk for dementia (OR: 1.04, 95% CI: 0.53–2.02). Analyses on perceptions of current financial situation showed that the groups reporting satisfaction or dissatisfaction with financial situation did not differ in risk for dementia.

Conclusion:

This study is the first to show that midlife improvements in financial situation are associated with a reduced dementia risk later in life. Potential pathways related to stress reduction, improved lifestyle, and potential biological mechanisms are discussed.

Place, publisher, year, edition, pages
Cambridge University Press, 2019
Keywords
financial strain, stress, cognitive impairment, midlife risk factors, midlife protective factors
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-47294 (URN)10.1017/S104161021900173X (DOI)31762430 (PubMedID)
Available from: 2020-01-08 Created: 2020-01-08 Last updated: 2020-01-10
Nilsen, C., Andel, R., Darin-Mattsson, A. & Kåreholt, I. (2019). Psychosocial working conditions across working life may predict late-life physical function: a follow-up cohort study. BMC Public Health, 19(1), Article ID 1125.
Open this publication in new window or tab >>Psychosocial working conditions across working life may predict late-life physical function: a follow-up cohort study
2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1125Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Increasing life expectancy has made understanding the mechanisms underlying late-life health and function more important. We set out to investigate whether trajectories of change in psychosocial working conditions are associated with late-life physical function.

METHODS: Two Swedish surveys, linked at the individual level, were used (n = 803). A psychosocial job exposure matrix was used to measure psychosocial working conditions during people's first occupation, as well as their occupation every five years thereafter until baseline in 1991. Physical function was measured in 2014. Random effects growth curve models were used to calculate intraindividual trajectories of working conditions. Predictors of physical function were assessed with ordered logistic regression.

RESULTS: A more active job at baseline was associated with increased odds of late-life physical function (OR 1.15, CI 1.01-1.32). Higher baseline job strain was associated with decreased odds of late-life physical function (OR 0.75, CI 0.59-0.96). A high initial level followed by an upward trajectory of job strain throughout working life was associated with decreased odds of late-life physical function (OR 0.32, CI 0.17-0.58).

CONCLUSIONS: Promoting a healthier workplace by reducing chronic stress and inducing intellectual stimulation, control, and personal growth may contribute to better late-life physical function.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Cohort, Job control, Life course, Mobility limitations, Sweden, Work-related stress
National Category
Gerontology, specialising in Medical and Health Sciences Work Sciences
Identifiers
urn:nbn:se:hj:diva-46361 (URN)10.1186/s12889-019-7473-y (DOI)000481797300003 ()31419956 (PubMedID)2-s2.0-85070911774 (Scopus ID)GOA HHJ 2019;HHJARNIS (Local ID)GOA HHJ 2019;HHJARNIS (Archive number)GOA HHJ 2019;HHJARNIS (OAI)
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2019-10-01Bibliographically approved
Sindi, S., Kåreholt, I., Ngandu, T., Rosenberg, A., Kulmala, J., Johansson, L., . . . Kivipelto, M. (2019). Sex differences in dementia: Evidence from population-based studies and a lifestyle intervention. In: : . Paper presented at International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden.
Open this publication in new window or tab >>Sex differences in dementia: Evidence from population-based studies and a lifestyle intervention
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2019 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-43757 (URN)
Conference
International Association of Gerontology and Geriatrics European Region Congress 2019, 23rd – 25th May 2019, Gothenburg, Sweden
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-05-22Bibliographically approved
Lundgren, D., Ernsth-Bravell, M., Börjesson, U. & Kåreholt, I. (2019). The impact of leadership and psychosocial work environment on recipient satisfaction in nursing homes and home care. Gerontology and geriatric medicine
Open this publication in new window or tab >>The impact of leadership and psychosocial work environment on recipient satisfaction in nursing homes and home care
2019 (English)In: Gerontology and geriatric medicine, E-ISSN 2333-7214Article in journal (Refereed) Published
Abstract [en]

This study examines the association between nursing assistants’ assessment of leadership, their psychosocial work environment, and satisfaction among older people receiving care in nursing homes and home care. Cross-sectional surveys were conducted with nursing assistants (n = 1,132) and people receiving care (n = 1,535) in 45 nursing homes and 21 home care units. Direct leadership was associated with the psychosocial work environment in nursing homes and home care. Furthermore, better leadership was related to higher satisfaction among nursing assistants and older people in nursing homes. Thus, indirect leadership had no effect on recipients’ satisfaction in either nursing homes or home care. The path analysis showed an indirect effect between leadership factors and recipient satisfaction. The findings suggest that the psychosocial work environment of nursing assistants and recipient satisfaction in nursing homes can be increased by improving leadership.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
satisfaction with care, nursing assistants, nursing homes, home care
National Category
Gerontology, specialising in Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-41998 (URN)10.1177/2333721419841245 (DOI)000475377000001 ()31037251 (PubMedID)GOA HHJ 2019 (Local ID)GOA HHJ 2019 (Archive number)GOA HHJ 2019 (OAI)
Note

Included in thesis in manuscript form.

Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2019-09-02Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8617-0355

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