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  • 1.
    Dahl, Anna
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Response letter to Dr. Hazzard2009In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 57, no 7, p. 1316-1317Article in journal (Other (popular science, discussion, etc.))
  • 2.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health. Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Fauth, Elizabeth
    Department of Family, Consumer, and Human Development, Utah State University, Logan, Utah.
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Hassing, Linda
    University of Gothenburg.
    Ram, Nilam
    Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennysylvania.
    Gerstorf, Denis
    Department of Psychology, Humboldt University, Berlin, Germany.
    Body Mass Index, Change in Body Mass Index, and Survival in Old and Very Old Persons2013In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 61, no 4, p. 512-518Article in journal (Refereed)
    Abstract [en]

    Background: Current recommendations from the World Health Organization (WHO) are that individuals should seek to maintain a body mass index (BMI) between 18.5-25 kg/m2, independent of age. However, there is an ongoing discussion whether the WHO recommendations apply to old (70 ≥ 80 years) and very old persons (80+ years). In the present study we examine how BMI status and change in BMI are associated with mortality among old and very old individuals.

    Design: Pooled data from three multidisciplinary prospective population-based studies OCTO-twin, GENDER, and NONA.

    Setting: Sweden.

    Participants: 882 individuals aged 70 to 95 years.

    Measurements: Body Mass Index was calculated from measured height and weight as kg/m2. Information about survival status and time of death was obtained from Swedish Civil Registration System

    Results: Mortality hazard was 20% lower for the overweight group relative to the normal/underweight group (RR = 0.80, p < .05), and the mortality hazard for the obese group did not differ significantly from the normal/underweight group (RR = 0.93, > .10), independent of age, education, and multimorbidity. Furthermore, mortality hazard was 141% higher for the BMI loss group relative to the BMI stable group (RR = 1.65, p < .05); and 178% higher for the BMI gain group relative to BMI stable group (RR = 1.53, p < .05).  However, the BMI change differences were moderated by age, i.e. the higher mortality risks associated with both loss in BMI and BMI gain were less severe in very old age.

    Conclusion: Old persons who were overweight had a decreased mortality risk compared to old persons having a BMI below 25, even after controlling for weight change and multimorbidity. Compared to persons who had a stable BMI those who increased or decreased in BMI had a higher mortality risk, particularly among people aged 70 to 80. This study lends further support for the opinion that the WHO guidelines are overly restrictive in old age.

  • 3.
    Dahl, Anna
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Löppönen, Minna
    Åbo University.
    Isoaho, Raimo
    Åbo University.
    Berg, Stig
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Kivelä, Sirkka-Lisa
    Åbo University.
    Overweight and obesity in old age are not associated with greater dementia risk2008In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 56, no 12, p. 2261-2266Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe the association between body mass index (BMI) and dementia risk in older persons.

    DESIGN: Prospective population‐based study, with 8 years of follow‐up.

    SETTING: The municipality of Lieto, Finland, 1990/91 and 1998/99.

    PARTICIPANTS: Six hundred five men and women without dementia aged 65 to 92 at baseline (mean age 70.8).

    MEASUREMENTS: Weight and height were measured at baseline and at the 8‐year follow‐up. Dementia was clinically assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.

    RESULTS: Eighty‐six persons were diagnosed with dementia. Cox regression analyses, adjusted for age, sex, education, cardiovascular diseases, smoking, and alcohol use, indicated that, for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio (HR)=0.92, 95% confidence interval (CI)=0.87–0.97). This association remained significant when individuals who developed dementia early during the first 4 years of follow‐up were excluded from the analyses (HR=0.93, 95% CI=0.86–0.99). Women with high BMI scores had a lower dementia risk (HR=0.90, 95% CI=0.84–0.96). Men with high BMI scores also tended to have a lower dementia risk, although the association did not reach significance (HR=0.95, 95% CI=0.84–1.07).

    CONCLUSION: Older persons with higher BMI scores have less dementia risk than their counterparts with lower BMI scores. High BMI scores in late life should not necessarily be considered to be a risk factor for dementia.

  • 4.
    Eide, Leslie S. P.
    et al.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Ranhoff, Anette H.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Fridlund, Bengt
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Haaverstad, Rune
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Hufthammer, Karl Ove
    Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway.
    Kuiper, Karel K. J.
    Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
    Nordrehaug, Jan E.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Norekvål, Tone M.
    Department of Clinical Science, University of Bergen, Bergen, Norway.
    Delirium as a predictor of physical and cognitive function in individuals aged 80 and older after transcatheter aortic valve implantation or surgical aortic valve replacement2016In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 64, no 6, p. 1178-1186Article in journal (Refereed)
    Abstract [en]

    Objectives: To determine how development of delirium after surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) could predict activity of daily living (ADL) and instrumental ADLs (IADL) disability, cognitive function, and self-reported health in individuals aged 80 and older.

    Design: Prospective cohort study. Setting: Tertiary university hospital.

    Participants: Individuals aged 80 and older undergoing elective SAVR or TAVI (N = 136).

    Measurements: Delirium was assessed for 5 days using the Confusion Assessment Method. The Barthel Index, Nottingham Extended ADL Scale, and SF-12 were used to determine ADL and IADL ability and self-reported health at baseline and 1- and 6-month follow-up. Cognition was assessed using the Mini-Mental State Examination at baseline and 6-month follow-up.

    Results: Participants had lower IADL scores 1 month after SAVR than at baseline (baseline 58, 1 month: delirium 42, no delirium 50, P ≤.02), but scores had returned to baseline levels at 6 months. The Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) Physical Component Summary (PCS) score was higher at 6-month follow-up (48) than at baseline (39), especially in participants who did not develop delirium (P <.001). No differences in other outcomes were found. Regression models suggest that delirium may help predict IADL disability 1 month after baseline (P ≤.07) but does not predict large differences in ADL disability, cognitive function, or SF-12-scores. Individuals who underwent TAVI and developed delirium had lower ADL (baseline 19, 1-month 16, P <.001) and IADL (baseline 49, 1-month 40, P =.003) scores at 1-month follow-up. SF-12 PCS score (baseline 30) increased from baseline to 1- (35, P =.04) and 6- (35, P =.02) month follow-up in individuals who underwent TAVI and did not develop delirium. Delirium after TAVI predicted greater ADL and IADL disability at 1-month but not at 6-month follow-up.

    Conclusion: Individuals who develop delirium after SAVR and TAVI have poorer short-term IADL function but do not seem to have long-term reductions in physical, mental, or self-reported health.

  • 5.
    Garcia-Ptacek, Sara
    et al.
    Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Cermakova, Pavla
    Division of Neurogeriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Rizzuto, Debora
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Religa, Dorota
    Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Eriksdotter, Maria
    Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Causes of Death According to Death Certificates in Individuals with Dementia: A Cohort from the Swedish Dementia Registry.2016In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 64, no 11, p. e137-e142Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The causes of death in dementia are not established, particularly in rarer dementias. The aim of this study is to calculate risk of death from specific causes for a broader spectrum of dementia diagnoses.

    DESIGN: Cohort study.

    SETTING: Swedish Dementia Registry (SveDem), 2007-2012.

    PARTICIPANTS: Individuals with incident dementia registered in SveDem (N = 28,609); median follow-up 741 days. Observed deaths were 5,368 (19%).

    MEASUREMENTS: Information on number of deaths and causes of mortality was obtained from death certificates. Odds ratios for the presence of dementia on death certificates were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox hazards regression for cause-specific mortality, using Alzheimer's dementia (AD) as reference. Hazard ratios for death for each specific cause of death were compared with hazard ratios of death from all causes (P-values from t-tests).

    RESULTS: The most frequent underlying cause of death in this cohort was cardiovascular (37%), followed by dementia (30%). Dementia and cardiovascular causes appeared as main or contributory causes on 63% of certificates, followed by respiratory (26%). Dementia was mentioned less in vascular dementia (VaD; 57%). Compared to AD, cardiovascular mortality was higher in individuals with VaD than in those with AD (HR = 1.82, 95% CI = 1.64-2.02). Respiratory death was higher in individuals with Lewy body dementia (LBD, including Parkinson's disease dementia and dementia with Lewy bodies, HR = 2.16, 95% CI = 1.71-2.71), and the risk of respiratory death was higher than expected from the risk for all-cause mortality. Participants with frontotemporal dementia were more likely to die from external causes of death than those with AD (HR = 2.86, 95% CI = 1.53-5.32).

    CONCLUSION: Dementia is underreported on death certificates as main and contributory causes. Individuals with LBD had a higher risk of respiratory death than those with AD.

  • 6. Reynolds, Chandra A.
    et al.
    Gatz, Margaret
    Prince, Jonathan A.
    Berg, Stig
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Pedersen, Nancy L.
    Serum Lipid Levels and Cognitive Change in Late Life2010In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 58, no 3, p. 501-509Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To assess the effect of lipids and lipoproteins on longitudinal cognitive performance and cognitive health in late life and to consider moderating factors such as age and sex that may clarify conflicting prior evidence.

    DESIGN: Prospective cohort study.

    SETTING: A 16-year longitudinal study of health and cognitive aging.

    PARTICIPANTS: Eight hundred nineteen adults from the Swedish Adoption Twin Study of Aging aged 50 and older at first cognitive testing, including 21 twin pairs discordant for dementia.

    MEASUREMENTS: Up to five occasions of cognitive measurements encompassing verbal, spatial, memory, and perceptual speed domains across a 16-year span; baseline serum lipids and lipoproteins including high-density lipoprotein cholesterol (HDL-C), apolipoprotein (apo)A1, apoB, total serum cholesterol, and triglycerides.

    RESULTS: The effect of lipids on cognitive change was most evident before age 65. In women, higher HDL-C and lower apoB and triglycerides predicted better maintenance of cognitive abilities, particularly verbal ability and perceptual speed, than age. Lipid values were less predictive of cognitive trajectories in men and, where observed, were in the contrary direction (i.e., higher total cholesterol and apoB values predicted better perceptual speed performance though faster rates of decline). In twin pairs discordant for dementia, higher total cholesterol and apoB levels were observed in the twin who subsequently developed dementia.

    CONCLUSION: High lipid levels may constitute a more important risk factor for cognitive health before age 65 than after. Findings for women are consistent with clinical recommendations, whereas for men, the findings correspond with earlier age-associated shifts in lipid profiles and the importance of lipid homeostasis to cognitive health.

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