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  • 1.
    Agahi, Neda
    et al.
    Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden.
    Kelfve, Susanne
    Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden; Department of Sociology, Stockholm University, Stockholm, Sweden.
    Lennartsson, Carin
    Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Karolinska Institutet/Stockholm University, Stockholm, Sweden.
    Alcohol consumption in very old age and its association with survival: a matter of health and physical function2016In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 159, 240-245 p.Article in journal (Refereed)
    Abstract [en]

    Background

    Alcohol consumption in very old age is increasing; yet, little is known about the personal and health-related characteristics associated with different levels of alcohol consumption and the association between alcohol consumption and survival among the oldest old.

    Methods

    Nationally representative data from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD, ages 76-101; n = 863) collected in 2010/2011 were used. Mortality was analyzed until 2014. Alcohol consumption was measured with questions about frequency and amount. Drinks per month were calculated and categorized as abstainer, light-to-moderate drinker (0.5–30 drinks/month) and heavy drinker (>30 drinks/month). Multinomial logistic regressions and Laplace regressions were performed.

    Results

    Compared to light-to-moderate drinkers, abstainers had lower levels of education and more functional health problems, while heavy drinkers were more often men, had higher levels of education, and no serious health or functional problems. In models adjusted only for age and sex, abstainers died earlier than drinkers. Among light-to-moderate drinkers, each additional drink/month was associated with longer survival, while among heavy drinkers, each additional drink/month was associated with shorter survival. However, after adjusting for personal and health-related factors, estimates were lower and no longer statistically significant.

    Conclusions

    The association between alcohol consumption and survival in very old age seems to have an inverse J-shape; abstention and heavy use is associated with shorter survival compared to light-to-moderate drinking. To a large extent, differences in survival are due to differences in baseline health and physical function.

    Graphical abstract

  • 2.
    Agahi, Neda
    et al.
    Karolinska Institutet.
    Lennartsson, Carin
    Karolinska Institutet.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Karolinska Institutet.
    Shaw, Benjamin A.
    School of Public Health, University at Albany, Rensselaer, NY, USA.
    Trajectories of social activities from middle age to old age and late-life disability: a 36-year follow-up2013In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 42, no 6, 790-793 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: to examine the association between 34-year trajectories of social activity, from middle age to old age and late-life disability.

    METHODS: data from the Swedish Level of Living Survey (LNU) and the Swedish Panel Study of the Oldest Old (SWEOLD) were used. LNU data from 1968, 1981, 1991 and 2000 were merged with SWEOLD data from 1992, 2002 and 2004 to create a longitudinal data set with five observation periods. Trajectories of social activities covered 1968-2002, and late-life disability was measured in 2004. The sample consisted of 729 individuals aged 33-61 at baseline (1968), who participated in at least four observation periods and who were free from mobility limitations at baseline. Four trajectories of social activity were identified and used as predictors of late-life disability.

    RESULTS: reporting low/medium levels of social activity from mid-life to old age was the most common trajectory group. Persons reporting continuously low/medium or decreasing levels of social activity had higher odds ratios for late-life disability (OR = 2.33 and OR = 2.15, respectively) compared with those having continuously high levels of activity, even when adjusting for age, sex and mobility limitations, and excluding persons with baseline mobility limitations.

    CONCLUSIONS: results suggest that the disability risk associated with social activities is related to recent levels of activity, but also that risk may accumulate over time, as indicated by the higher disability risk associated with the continuously low/medium level social activity trajectory.

  • 3. Agahi, Neda
    et al.
    Shaw, Ben
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Lennartsson, Carin
    Trajectories of social activities and mobility problems from middle to old age2012In: The 21st Nordic Congress of Gerontology, Dilemmas in Ageing Societies, Abstracts and Program, Copenhagen, Denmark, June 10th - 13th, 2012, 2012, 207- p.Conference paper (Refereed)
    Abstract [en]

    Objectives: To investigate how trajectories of social activities, suchas spending time with family and friends, observed during a34-year period (from middle age to old age) were associated withtrajectories of mobility problems during the same time periodamong men and women.Methods: Nationally representative data from the Swedish Levelof Living Survey (LNU) and the Swedish Panel Study of the OldestOld (SWEOLD) were used. LNU data from 1968, 1981, 1991 and2000 were merged with SWEOLD data from 1992 and 2002 tocreate a longitudinal dataset with four observation periodscovering the period 1968-2002. The sample consisted of thoseaged 40-60 years at baseline who survived through the period,and participated in at least three observation periods (n=698).Trajectories of social activity were identified through clusteranalysis, and then used as predictors of mobility trajectories inmultilevel regression models.Results: Most people had a socially active life as they moved frommiddle age into old age. Five trajectories of social activity wereidentified: continuously very active, continuously active,increasing social activity, decreasing social activity, and continuouslyinactive. Upholding a very active social life was morecommon among women than men.Mobility problems increased significantly over time for bothwomen and men. Among men, decreasing activity levels overtime were associated with a faster increase in mobility problems.Among women, those who were continuously inactive or whodecreased their activity levels had higher levels of mobilityproblems, but the increase in mobility problems with age wassimilar across trajectories of social activity.Conclusions: Most men and women had high levels of socialactivity in midlife, and continued their high activity levels into latelife. Decreasing social activity was related to worse mobility inboth men and women. The nature and direction of theseassociations need to be explored further.

  • 4.
    Ahacic, Kozma
    et al.
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Kennison, Robert F.
    Department of Psychology, California State University, Los Angeles, California.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Alcohol abstinence, non-hazardous use and hazardous use a decade after alcohol-related hospitalization: registry data linked to population-based representative postal surveys2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, no 874, 1-13 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Although there is evident association between alcohol-related hospitalization and alcohol use, the relationship has not been well examined. This study analyzed the extent of alcohol abstinence, non-hazardous use and hazardous use among people who had experienced alcohol-related hospitalization during the preceding decade.

    METHOD:

    Registry data concerning alcohol-related hospitalizations between 1996 and 2007 were linked to two representative surveys, in 2006 and 2007, of residents of Stockholm County. Relevant contrasts were modeled, using logistic regression, in the pooled sample (n = 54 955). Ages were 23-84 years at follow-up.

    RESULTS:

    Among persons previously hospitalized (n = 576), half reported non-hazardous use. Non-hazardous use was less prevalent than in the general population--and the extent of non-hazardous use did not change over time following hospitalization. There were no significant age differences, but non-hazardous use was less frequent among people with repeated episodes of care. One in six was abstinent. Abstinence was more common among the old, while hazardous use (exceeding 14 drinks per week for men, and 9 drinks per week for women) decreased with age. Abstinence also increased over time; among persons hospitalized ten years ago, the abstinence rate was twice that of the general population. Associations with hazardous use over time were less conclusive. Hazardous use among those previously hospitalized decreased over time in one sample but not in the other. After pooling the data, there were indications of a decrease over time following hospitalization, but more prevalent hazardous use than in the general population.

    CONCLUSIONS:

    Following alcohol-related hospitalization, abstinence increased, and there was no evidence of regression towards the mean, i.e., towards non-hazardous use. Abstinence was also more widespread among previously hospitalized persons of older ages. With advancing age, changing hazardous alcohol habits among previously hospitalized appears to yield a trend towards promotion of abstinence.

  • 5. Ahacic, Kozma
    et al.
    Kennison, Robert F.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Changes in sobriety in the Swedish population over three decades: age, period or cohort effects?2012In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 107, no 4, 748-755 p.Article in journal (Refereed)
    Abstract [en]

    Aims: This study aimed to examine age, cohort and period trends in alcohol abstinence.

    Design: Two surveys, the Level of Living Survey collected in 1968, 1974, 1981, 1990 and 2000, and the Swedish Panel Study of the Oldest Old (SWEOLD) collected in 1992 and 2002, were studied with graphical depictions of cross-sectional and longitudinal data presented over time and over age. Cross-sectional 10-year age group differences, time-lag differences between waves and within-cohort differences between waves for 10-year birth cohorts were examined. Logistic regression models were applied to confirm the observed patterns.

    Setting: The samples were representative of the Swedish population.

    Participants: Participants ranged in age from 18 to 75 (n = 5000 per wave), and 77+ at later waves (n = 500).

    Measurements: Alcohol abstinence was determined by asking 'Do you ever drink wine, beer, or spirits?', where a 'no' response indicated abstinence.

    Findings: Decreases in abstinence rates were observed from 1968 to 2000/02. While cross-sectional analysis indicated increased abstinence with advancing age, the longitudinal analysis suggested otherwise. Inspection of cohort differences revealed little change within cohorts and large differences between cohorts; abstinence rates declined in later-born cohorts up to the 1940s birth cohorts; stability was observed in cohorts born since the 1940s. Logistic regression models indicated that neither age nor period were significant (P > 0.05) predictors of abstinence when cohort (P < 0.001) was included.

    Conclusion: Decreasing proportions of total alcohol abstainers in Sweden from 1968 to 2000 appear to be attributable primarily to decreases in successive cohorts rather than drinkers becoming abstainers.

  • 6.
    Ahacic, Kozma
    et al.
    Karolinska Institutet.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Helgason, Asgeir R
    Karolinska Institutet.
    Allebeck, Peter
    Karolinska Institutet.
    Non-response bias and hazardous alcohol use in relation to previous alcohol-related hospitalization: comparing survey responses with population data2013In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, Vol. 8, no 10Article in journal (Refereed)
    Abstract [en]

    Background: This study examines whether alcohol-related hospitalization predicts survey non-response, and evaluates whether this missing data result in biased estimates of the prevalence of hazardous alcohol use and abstinence.

    Methods: Registry data on alcohol-related hospitalizations during the preceding ten years were linked to two representative surveys. Population data corresponding to the surveys were derived from the Stockholm County registry. The alcohol-related hospitalization rates for survey responders were compared with the population data, and corresponding rates for non-responders were based on the differences between the two estimates. The proportions with hazardous alcohol use and abstinence were calculated separately for previously hospitalized and non-hospitalized responders, and non-responders were assumed to be similar to responders in this respect.

    Results: Persons with previous alcohol-related admissions were more likely currently to abstain from alcohol (RR=1.58, p<.001) or to have hazardous alcohol use (RR=2.06, p<.001). Alternatively, they were more than twice as likely to have become non-responders. Adjusting for this skewed non-response, i.e., the underrepresentation of hazardous users and abstainers among the hospitalized, made little difference to the estimated rates of hazardous use and abstinence in total. During the ten-year period 1.7% of the population were hospitalized.

    Conclusions: Few people receive alcohol-related hospital care and it remains unclear whether this group’s underrepresentation in surveys is generalizable to other groups, such as hazardous users. While people with severe alcohol problems – i.e. a history of alcohol-related hospitalizations – are less likely to respond to population surveys, this particular bias is not likely to alter prevalence estimates of hazardous use.

  • 7. Ahacic, Kozma
    et al.
    Trygged, Sven
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Income and education as predictors of stroke mortality after the survival of a first stroke2012In: Stroke Research and Treatment, ISSN 2042-0056Article in journal (Refereed)
    Abstract [en]

    Background: It is well known that socioeconomic indicators, such as income and education, predict both stroke incidence and stroke mortality. This means that persons in lower socioeconomic positions are less likely to survive their stroke, and there will be a selective survival in the group discharged from hospital after their first stroke.

    Question: Does socioeconomic position continue to predict mortality, stroke specific, or from other causes, among patients surviving their first stroke in spite of this selective survival?

    Methods: All persons in Sweden aged 40–59 years who were discharged after a first hospitalization for stroke in 1996–2000 were included (n = 10,487), then followed up until the end of the fourth calendar year after discharge. Data were analysed with Cox regressions controlling for age, sex, and stroke type.

    Results: Persons with high socioeconomic position, measured by education and income, have lower mortality than those of low position. Education was not significant when adjusted for income, however. The risk of dying was similar for stroke-specific mortality and all-cause mortality, for those with cerebral infarction as well as for all patients.

    Conclusions: Socioeconomic position predicted stroke-specific mortality also in the selective group of persons who survived their first stroke.

  • 8. Andel, Ross
    et al.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    The role of midlife ocupational complexity and leisure time activity in cognitive performance later in life.2013Conference paper (Other academic)
  • 9. Andel, Ross
    et al.
    Silverstein, Merril
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Occupational and Leisure Time Engagement at Midlife and Cognitive Functioning in Advanced Old Age2012In: The 21st Nordic Congress of Gerontology, Dilemmas in Ageing Societies, Abstracts and Program, Copenhagen, Denmark, June 10th - 13th, 2012, 2012Conference paper (Refereed)
  • 10.
    Andel, Ross
    et al.
    School of Aging Studies, University of South Florida, Tampa, Florida.
    Silverstein, Merril
    Sociology Department and School of Social Work, Aging Studies Institute, Syracuse University, New York.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    The role of midlife occupational complexity and leisure activity in late-life cognition2015In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 70, no 2, 314-321 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To examine whether occupational complexity of working with data or people, and cognitive or social leisure activity at midlife predicted cognition in advanced old age.

    METHODS:

    We used 810 eligible participants from Longitudinal Study of Living Conditions of the Oldest Old, a Swedish nationally representative study of individuals aged 77+ with cognitive assessments (an abridged version of the Mini-Mental State Exam) administered in 1992 and 2002 and linked to information about their midlife occupation and leisure activities collected in 1968 and 1981. A bootstrapping technique was applied to examine the direct and interactive associations of occupational complexity and leisure activity with late-life cognition.

    RESULTS:

    Controlling for demographic and health-related factors from childhood, midlife, and late life, we found that greater work complexity, both with people and with data, and greater participation in cognitive or social leisure activities independently related to better late-life cognitive scores. The complexity-cognition link was moderated by leisure activity such that the cognitive benefit related to the complexity of work-especially complexity of working with people-was rendered insignificant when participation in leisure activities-especially social activities-was above average.

    DISCUSSION:

    Results are discussed in terms of using work complexity to compensate for lack of leisure activity as well as in terms of promoting leisure engagement to compensate for long-term cognitive disadvantage imposed by working in less challenging occupations.

  • 11. Besga, Ariadna
    et al.
    Cedazo-Minguez, Angel
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Solomon, Alina
    Björkhem, Ingemar
    Winblad, Bengt
    Leoni, Valerio
    Hooshmand, Babak
    Spulber, Gabriela
    Gonzalez-Pinto, Ana
    Kivipelto, Miia
    Wahlund, Lars-Olof
    Differences in brain cholesterol metabolism and insulin in two subgroups of patients with different CSF biomarkers but similar white matter lesions suggest different pathogenic mechanisms2012In: Neuroscience Letters, ISSN 0304-3940, E-ISSN 1872-7972, Vol. 510, no 2, 121-126 p.Article in journal (Refereed)
    Abstract [en]

    Investigate possible associations of white matter hyperintensities (WMHs) with the metabolism of cholesterol and insulin in two subgroups of patients with memory complaints and different CSF Aβ42 and CSF tau levels. 59 patients from the memory clinic at Karolinska Hospital were included. Degree of WMHs was rated using the ARWMC scale and the following biomarkers were measured in CSF and plasma: insulin, cholesterol, lanosterol, lathosterol, and oxidized cholesterol metabolites. The WMHs in CSF control-like group correlated with increased brain cholesterol synthesis and reduced efflux of oxysterols and insulin in CSF. In the CSF AD-like group, the WMHs correlated with increased peripheral cholesterol metabolism. Despite having similar appearance on FLAIR images, the pathogenic mechanisms of WMHS are likely to be different in the two groups investigated.

  • 12. Darin Mattsson, A
    et al.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Is work complexity associated with psychological distress after retirement age?2013Conference paper (Other academic)
  • 13. Darin Mattsson, Alexander
    et al.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Fors, Stefan
    Social stratification, work complexity, and psychological distress in old age: Exploring the associations2013Conference paper (Refereed)
  • 14.
    Darin-Mattsson, Alexander
    et al.
    Karolinska Institutet, Solna, Sweden; Stockholm University, Sweden .
    Andel, Ross
    School af Aging Studies, University of South Florida, Tampa, USA; International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic .
    Fors, Stefan
    Karolinska Institutet, Solna, Sweden; Stockholm University, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Karolinska Institutet, Solna, Sweden; Stockholm University, Sweden.
    Are Occupational Complexity and Socioeconomic Position Related to Psychological Distress 20 Years Later?2015In: Journal of Aging and Health, ISSN 0898-2643, E-ISSN 1552-6887, Vol. 27, no 7, 1266-1285 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To assess occupational complexity in midlife in relation to psychological distress in older adulthood (69+ years) and explore the role of socioeconomic position.

    Method: Baseline data from the Swedish Level of Living Survey and follow-up data from the Swedish Longitudinal Study ofLiving Conditions of the Oldest Old were combined, resulting in 20+ years of follow-up. Data were analyzed using ordered logistic regressions.

    Results: Higher occupational complexity was associated with less psychological distress 20 years later adjusted for age, sex, follow-up year, hours worked the year before baseline, and psychological distress at baseline. Higher socioeconomic position yielded the same pattern of results. Socioeconomic position partially accounted for the association between occupational complexity and psychological distress.

    Discussion: With social gradient not easily amenable to modification, efforts to increase engagement at work may offer a viable option to attenuate the influence of work environment on psychological distress later in life.

  • 15.
    Darin-Mattsson, Alexander
    et al.
    Aging Research Centre (ARC), Karolinska Institutet, Stockholm University, Sweden.
    Fors, Stefan
    Aging Research Centre (ARC), Karolinska Institutet, Stockholm University, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Centre (ARC), Karolinska Institutet, Stockholm University, Sweden.
    Different indicators of socioeconomic status and their relative importance as determinants of health in old age2017In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, no 1, 173Article in journal (Refereed)
    Abstract [en]

    Background: Socioeconomic status has been operationalised in a variety of ways, most commonly as education, social class, or income. In this study, we also use occupational complexity and a SES-index as alternative measures of socioeconomic status. Studies show that in analyses of health inequalities in the general population, the choice of indicators influence the magnitude of the observed inequalities. Less is known about the influence of indicator choice in studies of older adults. The aim of this study is twofold: i) to analyse the impact of the choice of socioeconomic status indicator on the observed health inequalities among older adults, ii) to explore whether different indicators of socioeconomic status are independently associated with health in old age.

    Methods: We combined data from two nationally representative Swedish surveys, providing more than 20 years of follow-up. Average marginal effects were estimated to compare the association between the five indicators of SES, and three late-life health outcomes: mobility limitations, limitations in activities of daily living (ADL), and psychological distress.

    Results: All socioeconomic status indicators were associated with late-life health; there were only minor differences in the effect sizes. Income was most strongly associated to all indicators of late-life health, the associations remained statistically significant when adjusting for the other indicators. In the fully adjusted models, education contributed to the model fits with 0-3% (depending on the outcome), social class with 0-1%, occupational complexity with 1-8%, and income with 3-18%.

    Conclusions: Our results indicate overlapping properties between socioeconomic status indicators in relation to late-life health. However, income is associated to late-life health independently of all other variables. Moreover, income did not perform substantially worse than the composite SES-index in capturing health variation. Thus, if the primary objective of including an indicator of socioeconomic status is to adjust the model for socioeconomic differences in late-life health rather than to analyse these inequalities per se, income may be the preferable indicator. If, on the other hand, the primary objective of a study is to analyse specific aspects of health inequalities, or the mechanisms that drive health inequalities, then the choice of indicator should be theoretically guided. 

  • 16.
    Darin-Mattsson, Alexander
    et al.
    Karolinska Institutet, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Karolinska Institutet, Sweden.
    Andel, Ross
    University of South Florida, Tampa, USA.
    Economic hardship and income before retirement in relation to anxiety and depression in older adulthood. (2015) Work-related stress in midlife and all-cause mortality: the role of sense of coherence.2015In: Life Courses in Cross-­National Comparison: Similarities and Differences: Abstract book, 2015, 69- p.Conference paper (Refereed)
  • 17.
    Enache, D.
    et al.
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Fereshtehnejad, S.-M.
    Division of Clinical Geriatrics, 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, Stockholm, Sweden.
    Cermakova, P.
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Garcia-Ptacek, S.
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Johnell, K.
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Religa, D.
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Jelic, V.
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Winblad, B.
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Ballard, C.
    Wolfson Centre for Age-Related Diseases, King's College London, London, United Kingdom.
    Aarsland, D.
    Division of Neurogeriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Fastbom, J.
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Eriksdotter, M.
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Antidepressants and mortality risk in a dementia cohort: data from SveDem, the Swedish Dementia Registry2016In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 134, no 5, 430-440 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The association between mortality risk and use of antidepressants in people with dementia is unknown.

    OBJECTIVE: To describe the use of antidepressants in people with different dementia diagnoses and to explore mortality risk associated with use of antidepressants 3 years before a dementia diagnosis.

    METHODS: Study population included 20 050 memory clinic patients from the Swedish Dementia Registry (SveDem) diagnosed with incident dementia. Data on antidepressants dispensed at the time of dementia diagnosis and during 3-year period before dementia diagnosis were obtained from the Swedish Prescribed Drug Register. Cox regression models were used.

    RESULTS: During a median follow-up of 2 years from dementia diagnosis, 25.8% of dementia patients died. A quarter (25.0%) of patients were on antidepressants at the time of dementia diagnosis, while 21.6% used antidepressants at some point during a 3-year period before a dementia diagnosis. Use of antidepressant treatment for 3 consecutive years before a dementia diagnosis was associated with a lower mortality risk for all dementia disorders and in Alzheimer's disease.

    CONCLUSION: Antidepressant treatment is common among patients with dementia. Use of antidepressants during prodromal stages may reduce mortality in dementia and specifically in Alzheimer's disease.

  • 18.
    Enache, Daniela
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.
    Solomon, Alina
    Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden, and Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.
    Cavallin, Lena
    Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Department of Neurobiology, Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Kramberger, Milica Gregoric
    Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden, and Department of Neurology, University Medical Centre, Ljubljana, Slovenia.
    Aarsland, Dag
    Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden, and Center for Age-Related Diseases, Psychiatric Clinic, Stavanger University Hospital, Stavanger, Norway.
    Kivipelto, Miia
    Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden, and Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.
    Eriksdotter, Maria
    Department of Geriatric Medicine, Memory Clinic, Karolinska University Hospital-Huddinge, Stockholm, Sweden.
    Winblad, Bengt
    Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.
    Jelic, Vesna
    Department of Geriatric Medicine, Memory Clinic, Karolinska University Hospital-Huddinge, Stockholm, Sweden.
    CAIDE Dementia Risk Score and biomarkers of neurodegeneration in memory clinic patients without dementia2016In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 42, 124-131 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore cross-sectional associations between Cardiovascular Risk Factors, Aging and Dementia Study (CAIDE) Dementia Risk Score and dementia-related cerebrospinal fluid and neuroimaging biomarkers in 724 patients without dementia from the Memory Clinic at Karolinska University Hospital, Huddinge, Sweden. We additionally evaluated the score's capacity to predict dementia. Two risk score versions were calculated: one including age, gender, obesity, hyperlipidemia, and hypertension; and one additionally including apolipoprotein E (APOE) ε4 carrier status. Cerebrospinal fluid was analyzed for amyloid β (Aβ), total tau, and phosphorylated tau. Visual assessments of medial temporal lobe atrophy (MTA), global cortical atrophy-frontal subscale, and Fazekas scale for white matter changes (WMC) were performed. Higher CAIDE Dementia Risk Score (version without APOE) was significantly associated with higher total tau, more severe MTA, WMC, and global cortical atrophy-frontal subscale. Higher CAIDE Dementia Risk Score (version with APOE) was associated with reduced Aβ, more severe MTA, and WMC. CAIDE Dementia Risk Score version with APOE seemed to predict dementia better in this memory clinic population with short follow-up than the version without APOE.

  • 19.
    Ericsson, Malin Christina
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Psychology, University of Southern California, Los Angeles, United States.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
    Parker, Marti G.
    Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
    Fors, Stefan
    Aging Research Center, Karolinska Institutet & Stockholm University, Stockholm, Sweden.
    Validation of abridged mini-mental state examination scales using population-based data from Sweden and USA2017In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 14, no 2, 199-205 p.Article in journal (Refereed)
    Abstract [en]

    The objective of this study is to validate two abridged versions of the mini-mental state examination (MMSE): one intended for use in face-to-face interviews, and the other developed for telephonic interviews, using data from Sweden and the US to validate the abridged scales against dementia diagnoses as well as to compare their performance to that of the full MMSE scale. The abridged versions were based on eight domains from the original MMSE scale. The domains included in the MMSE-SF were registration, orientation, delayed recall, attention, and visual spatial ability. In the MMSE-SF-C, the visual spatial ability item was excluded, and instead, one additional orientation item was added. There were 794 participants from the Swedish HARMONY study [mean age 81.8 (4.8); the proportion of cognitively impaired was 51 %] and 576 participants from the US ADAMS study [mean age 83.2 (5.7); the proportion of cognitively impaired was 65 %] where it was possible to compare abridged MMSE scales to dementia diagnoses and to the full MMSE scale. We estimated the sensitivity and specificity levels of the abridged tests, using clinical diagnoses as reference. Analyses with both the HARMONY and the ADAMS data indicated comparable levels of sensitivity and specificity in detecting cognitive impairment for the two abridged scales relative to the full MMSE. Receiver operating characteristic curves indicated that the two abridged scales corresponded well to those of the full MMSE. The two abridged tests have adequate validity and correspond well with the full MMSE. The abridged versions could therefore be alternatives to consider in larger population studies where interview length is restricted, and the respondent burden is high.

  • 20.
    Garcia-Ptacek, S
    et al.
    Hospital Clínico San Carlos.
    Eriksdotter-Jönhagen, M.
    Karolinska Institutet.
    Jelic, V.
    Karolinska Institutet.
    Porta-Etessam, J
    Hospital Clínico San Carlos.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Manzano Palmo, S.
    Hospital Infanta Cristina.
    Quejas cognitivas subjetivas: hacia una identificación precoz de la enfermedad de Alzheimer [Subjective cognitive impairment: Towards early identification of Alzheimer disease]2016In: Neurología, ISSN 0213-4853, E-ISSN 1578-1968, Vol. 8, no 31, 562-571 p.Article in journal (Refereed)
    Abstract [en]

    Introduction: Neurodegeneration in Alzheimer disease (AD) begins decades before dementia and patients with mild cognitive impairment (MCI) already demonstrate significant lesion loads. Lack of information about the early pathophysiology in AD complicates the search for therapeutic strategies.

    Subjective cognitive impairment is the description given to subjects who have memory-related complaints without pathological results on neuropsychological tests. There is no consensus regarding this heterogeneous syndrome, but at least some of these patients may represent the earliest stage in AD.

    Method: We reviewed available literature in order to summarise current knowledge on subjective cognitive impairment.

    Results: Although they may not present detectable signs of disease, SCI patients as a group score lower on neuropsychological tests than the general population does, and they also have a higher incidence of future cognitive decline. Depression and psychiatric co-morbidity play a role but cannot account for all cognitive complaints. Magnetic resonance imaging studies in these patients reveal a pattern of hippocampal atrophy similar to that of amnestic mild cognitive impairment and functional MRI shows increased activation during cognitive tasks which might indicate compensation for loss of function. Prevalence of an AD-like pattern of beta-amyloid (Aβ42) and tau proteins in cerebrospinal fluid is higher in SCI patients than in the general population.

    Conclusions: Memory complaints are relevant symptoms and may predict AD. Interpatient variability and methodological differences between clinical studies make it difficult to assign a definition to this syndrome. In the future, having a standard definition and longitudinal studies with sufficient follow-up times and an emphasis on quantifiable variables may clarify aspects of early AD.

  • 21.
    Garcia-Ptacek, Sara
    et al.
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Sweden.
    Cavallin, Lena
    Department of Clinical Science, Intervention and Technology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Kramberger, Milica Gregoric
    Karolinska Institutet Alzheimer Disease Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Sweden.
    Winblad, Bengt
    Department of Neurology, University Medical Centre, Ljubljana, Slovenia.
    Jelic, Vesna
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Sweden.
    Eriksdotter, Maria
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Sweden.
    Subjective cognitive impairment subjects in our clinical practice2014In: Dementia and geriatric cognitive disorders extra, E-ISSN 1664-5464, Vol. 4, no 3, 419-430 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The clinical challenge in subjective cognitive impairment (SCI) is to identify which individuals will present cognitive decline. We created a statistical model to determine which variables contribute to SCI and mild cognitive impairment (MCI) versus Alzheimer's disease (AD) diagnoses.

    METHODS:

    A total of 993 subjects diagnosed at a memory clinic (2007-2009) were included retrospectively: 433 with SCI, 373 with MCI and 187 with AD. Descriptive statistics were provided. A logistic regression model analyzed the likelihood of SCI and MCI patients being diagnosed with AD, using age, gender, Mini-Mental State Examination score, the ratio of β-amyloid 42 divided by total tau, and phosphorylated tau as independent variables.

    RESULTS:

    The SCI subjects were younger (57.8 ± 8 years) than the MCI (64.2 ± 10.6 years) and AD subjects (70.1 ± 9.7 years). They were more educated, had less medial temporal lobe atrophy (MTA) and frequently normal cerebrospinal fluid biomarkers. Apolipoprotein E4/E4 homozygotes and apolipoprotein E3/E4 heterozygotes were significantly less frequent in the SCI group (6 and 36%) than in the AD group (28 and 51%). Within the regression model, cardiovascular risk factors, confluent white matter lesions, MTA and central atrophy increased the AD likelihood for SCI subjects.

    CONCLUSIONS:

    SCI patients form a distinct group. In our model, factors suggesting cardiovascular risk, MTA and central atrophy increased the AD likelihood for SCI subjects.

  • 22.
    Garcia-Ptacek, Sara
    et al.
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Farahmand, Bahman
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Religa, Dorota
    Department of Geriatric Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Cuadrado, Maria Luz
    Department of Medicine, Universidad Complutense, Madrid, Spain.
    Eriksdotter, Maria
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Mortality risk after dementia diagnosis by dementia type and underlying factors: a cohort of 15,209 patients based on the Swedish Dementia Registry2014In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 41, no 2, 467-477 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Knowledge on survival in dementia is crucial for patients and public health planning. Most studies comparing mortality risk included few different dementia diagnoses.

    OBJECTIVES:

    To compare mortality risk in the most frequent dementia disorders in a large cohort of patients with an incident diagnosis, adjusting for potential confounding factors.

    METHODS:

    15,209 patients with dementia from the national quality database, Swedish Dementia Registry (SveDem), diagnosed in memory clinics from 2008 to 2011, were included in this study. The impact of age, gender, dementia diagnosis, baseline Mini-Mental State Examination (MMSE), institutionalization, coresidency, and medication on survival after diagnosis were examined using adjusted hazard ratios (HR) with 95% confidence intervals (CI).

    RESULTS:

    During a mean follow-up of 2.5 years, 4,287 deaths occurred, with 114 (95% CI 111-117) deaths/1,000 person-years. Adjusted HR of death for men was 1.56 (95% CI 1.46-1.66) compared to women. Low MMSE, institutionalization, and higher number of medications were associated with higher HR of death. All dementia diagnoses demonstrated higher HR compared to Alzheimer's disease, with vascular dementia presenting the highest crude HR. After adjusting, frontotemporal dementia had the highest risk with a HR of 1.91 (95% CI 1.52-2.39), followed by Lewy body dementia (HR 1.64; 95% CI 1.39-1.95), vascular dementia (HR 1.55; 95% CI 1.42-1.69), Parkinson's disease dementia (HR 1.47; 95% CI 1.17-1.84), and mixed Alzheimer's disease and vascular dementia (HR 1.32; 95% CI 1.22-1.44).

    CONCLUSION:

    Worse cognition, male gender, higher number of medications, institutionalization, and age were associated with increased death risk after dementia diagnosis. Adjusted risk was lowest in Alzheimer's disease patients and highest in frontotemporal dementia subjects.

  • 23.
    Garcia-Ptacek, Sara
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Farahmand, Bahman
    Karolinska institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Karolinska institutet, Stockholm, Sweden.
    Religa, Dorota
    Karolinska institutet, Stockholm, Sweden.
    Luz Cuadrado, Maria
    Universidad Complutense, Madrid, Spain.
    Eriksdotter, Maria
    Karolinska institutet, Stockholm, Sweden.
    Mortality in dementia: Data from SveDem, Swedish dementia registry2014In: Alzheimer's & Dementia: the journal of the alzheimer's association, Elsevier, 2014, Vol. 10, 4, supplement-152 p.Conference paper (Refereed)
  • 24.
    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, e137-e142 p.Article 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.

  • 25.
    Garcia-Ptacek, Sara
    et al.
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Modéer, Ingrid Nilsson
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, 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, Center for Alzheimer Research, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Fereshtehnejad, Seyed-Mohammad
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Farahmand, Bahman
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Religa, Dorota
    Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Eriksdotter, Maria
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
    Differences in diagnostic process, treatment and social support for Alzheimer's dementia between primary and specialist care: results from the Swedish Dementia Registry2017In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 46, no 2, 314-319 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: the increasing prevalence of Alzheimer's dementia (AD) has shifted the burden of management towards primary care (PC). Our aim is to compare diagnostic process and management of AD in PC and specialist care (SC).

    DESIGN: cross-sectional study.

    SUBJECTS: a total of, 9,625 patients diagnosed with AD registered 2011-14 in SveDem, the Swedish Dementia Registry.

    METHODS: descriptive statistics are shown. Odds ratios are presented for test performance and treatment in PC compared to SC, adjusted for age, sex, Mini-Mental State Examination (MMSE) and number of medication.

    RESULTS: a total of, 5,734 (60%) AD patients from SC and 3,891 (40%) from PC. In both, 64% of patients were women. PC patients were older (mean age 81 vs. 76; P < 0.001), had lower MMSE (median 21 vs. 22; P < 0.001) and more likely to receive home care (31% vs. 20%; P < 0.001) or day care (5% vs. 3%; P < 0.001). Fewer diagnostic tests were performed in PC and diagnostic time was shorter. Basic testing was less likely to be complete in PC. The greatest differences were found for neuroimaging (82% in PC vs. 98% in SC) and clock tests (84% vs. 93%). These differences remained statistically significant after adjusting for MMSE and demographic characteristics. PC patients received less antipsychotic medication and more anxiolytics and hypnotics, but there were no significant differences in use of cholinesterase inhibitors between PC and SC.

    CONCLUSION: primary and specialist AD patients differ in background characteristics, and this can influence diagnostic work-up and treatment. PC excels in restriction of antipsychotic use. Use of head CT and clock test in PC are areas for improvement in Sweden.

  • 26.
    García-Ptacek, Sara
    et al.
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Farahmand, Bahman
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Cuadrado, Maria Luz
    Department of Medicine, Universidad Complutense, Madrid, Spain.
    Religa, Dorota Religa
    Department of Geriatric Medicine, Karolinska University Hospital, Stockholm, Sweden.
    Eriksdotter, Maria
    Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Body-mass index and mortality in incident dementia: a cohort study on 11,398 patients from SveDem, the Swedish Dementia Registry2014In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 15, no 6, 447.e1-447.e7 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Body mass index (BMI) is used worldwide as an indirect measure of nutritional status and has been shown to be associated with mortality. Controversy exists over the cut points associated with lowest mortality, particularly in older populations. In patients suffering from dementia, information on BMI and mortality could improve decisions about patient care.

    OBJECTIVES:

    The objective was to explore the association between BMI and mortality risk in an incident dementia cohort.

    DESIGN:

    Cohort study based on SveDem, the Swedish Quality Dementia Registry; 2008-2011.

    SETTING:

    Specialist memory clinics, Sweden.

    PARTICIPANTS:

    A total of 11,398 patients with incident dementia with data on BMI (28,190 person-years at risk for death).

    MAIN OUTCOME MEASURES:

    Hazard ratios and 95% confidence intervals for mortality associated with BMI were calculated, controlling for age, sex, dementia type, results from Mini-Mental State Examination, and number of medications. BMI categories and linear splines were used.

    RESULTS:

    Higher BMI was associated with decreased mortality risk, with all higher BMI categories showing reduced risk relative to patients with BMI of 18.5 to 22.9 kg/m(2), whereas underweight patients (BMI <18.5 kg/m(2)) displayed excess risk. When explored as splines, increasing BMI was associated with decreased mortality risk up to BMI of 30.0 kg/m(2). Each point increase in BMI resulted in an 11% mortality risk reduction in patients with BMI less than 22.0 kg/m(2), 5% reduction when BMI was 22.0 to 24.9 kg/m(2), and 3% risk reduction among overweight patients. Results were not significant in the obese weight range. Separate examination by sex revealed a reduction in mortality with increased BMI up to BMI 29.9 kg/m(2) for men and 24.9 kg/m(2) for women.

    CONCLUSION:

    Higher BMI at the time of dementia diagnosis was associated with a reduction in mortality risk up to and including the overweight category for the whole cohort and for men, and up to the normal weight category for women.

  • 27.
    Hallgren, Jenny
    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.
    Fransson, Eleonor I.
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Reynolds, Chandra A.
    Department of Psychology, University of Southern California, Riverside, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Factors associated with hospitalization risk among community living middle aged and older persons: results from the Swedish Adoption/TwinStudy of Aging (SATSA)2016In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 66, 102-108 p.Article in journal (Refereed)
    Abstract [en]

    The aims of the present study were to: (1) describe and compare individual characteristics of hospitalized and not hospitalized community living persons, and (2) to determine factors that are associated with hospitalization risk over time. We conducted a prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). A total of 772 Swedes (mean age at baseline 69.7 years, range 46–103, 59.8% females) answered a postal questionnaire about physical and psychological health, personality and socioeconomic factors. During nine years of follow-up, information on hospitalizations and associated diagnoses were obtained from national registers. Results show that 484 persons (63%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases (25%) and tumors (22%). Cox proportional hazard regression models controlling for age, sex and dependency within twin pairs, showed that higher age (HR = 1.02, p < 0.001) and more support from relatives (HR = 1.09, p = 0.028) were associated with increased risk of hospitalization, while marital status (unmarried (HR = 0.75, p = 0.033) and widow/widower (HR = 0.69, p < 0.001)) and support from friends (HR = 0.93, p = 0.029) were associated with lower risk of hospitalization. Social factors were important for hospitalization risk even when medical factors were controlled for in the analyses. Number of diseases was not a risk in the final regression model. Hospitalization risk was also different for women and men and within different age groups. We believe that these results might be used in future interventions targeting health care utilization.

  • 28.
    Hooshmand, Babak
    et al.
    Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Mangialasche, Francesca
    Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden, and Department of Neurology, Klinikum Augsburg, Augsburg, Germany.
    Kalpouzos, Grégoria
    Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Solomon, Alina
    Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Smith, David
    Department of Pharmacology, University of Oxford, Oxford, UK.
    Refsum, Helga
    Department of Pharmacology, University of Oxford, Oxford, UK, and Institute of Nutrition, University of Oslo, Oslo, Norway.
    Wang, Rui
    Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Mühlmann, Marc
    Institute for Clinical Radiology, Ludwig-Maximillian University Hospital, Munich, Germany.
    Ertl-Wagner, Birgit
    Institute for Clinical Radiology, Ludwig-Maximillian University Hospital, Munich, Germany.
    Jonsson, Erika
    Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Bäckman, Lars
    Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Fratiglioni, Laura
    Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Kivipelto, Miia
    Center for Alzheimer Research–Aging Research Center, Karolinska Institutet, Stockholm University, Stockholm, Sweden.
    Association of vitamin B12, folate, and sulfur amino acids with brain magnetic resonance imaging measures in older adults: A longitudinal population-based study2016In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 73, no 6, 606-613 p.Article in journal (Refereed)
    Abstract [en]

    Importance 

    Vitamin B12, folate, and sulfur amino acids may be modifiable risk factors for structural brain changes that precede clinical dementia.

    Objective 

    To investigate the association of circulating levels of vitamin B12, red blood cell folate, and sulfur amino acids with the rate of total brain volume loss and the change in white matter hyperintensity volume as measured by fluid-attenuated inversion recovery in older adults.

    Design, Setting, and Participants 

    The magnetic resonance imaging subsample of the Swedish National Study on Aging and Care in Kungsholmen, a population-based longitudinal study in Stockholm, Sweden, was conducted in 501 participants aged 60 years or older who were free of dementia at baseline. A total of 299 participants underwent repeated structural brain magnetic resonance imaging scans from September 17, 2001, to December 17, 2009.

    Main Outcomes and Measures 

    The rate of brain tissue volume loss and the progression of total white matter hyperintensity volume.

    Results 

    In the multi-adjusted linear mixed models, among 501 participants (300 women [59.9%]; mean [SD] age, 70.9 [9.1] years), higher baseline vitamin B12 and holotranscobalamin levels were associated with a decreased rate of total brain volume loss during the study period: for each increase of 1 SD, β (SE) was 0.048 (0.013) for vitamin B12 (P < .001) and 0.040 (0.013) for holotranscobalamin (P  = .002). Increased total homocysteine levels were associated with faster rates of total brain volume loss in the whole sample (β [SE] per 1-SD increase, –0.035 [0.015]; P = .02) and with the progression of white matter hyperintensity among participants with systolic blood pressure greater than 140 mm Hg (β [SE] per 1-SD increase, 0.000019 [0.00001]; P = .047). No longitudinal associations were found for red blood cell folate and other sulfur amino acids.

    Conclusions and Relevance 

    This study suggests that both vitamin B12 and total homocysteine concentrations may be related to accelerated aging of the brain. Randomized clinical trials are needed to determine the importance of vitamin B12 supplementation on slowing brain aging in older adults.

  • 29. Hooshmand, Babak
    et al.
    Solomon, Alina
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Rusanen, Minna
    Hänninen, Tuomo
    Leiviskä, Jaana
    Winblad, Bengt
    Laatikainen, Tiina
    Soininen, Hilkka
    Kivipelto, Miia
    Associations between serum homocysteine, holotranscobalamin, folate and cognition in the elderly: a longitudinal study2012In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 271, no 2, 204-212 p.Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine the associations between serum homocysteine (tHcy), holotranscobalamin (holoTC, the biologically active fraction of vitamin B12) and folate and cognitive functioning in a longitudinal population-based study of Finnish elderly subjects.

    Subjects and design: tHcy, holoTC and folate were measured at baseline in 274 dementia-free subjects aged 65-79years from the Cardiovascular Risk Factors, Aging and Dementia study. Subjects were re-examined 7years later, and global cognition, episodic memory, executive functioning, verbal expression and psychomotor speed were assessed.

    Results: Higher baseline tHcy levels were associated with poorer performance in global cognition, relative difference: 0.90 [95% confidence interval (CI) 0.81-0.99]; episodic memory: 0.87 (95% CI 0.77-0.99); executive functions: 0.86 (95% CI 0.75-0.98); and verbal expression: 0.89 (95% CI 0.81-0.97) at follow-up. Increased holoTC levels were related to better performance on global cognition: 1.09 (95% CI 1.00-1.19); executive functions: 1.11 (95% CI 1.01-1.21); and psychomotor speed: 1.13 (95% CI 1.01-1.26). After excluding 20 cases of incident dementia, increased tHcy remained associated with poorer performance in episodic memory, execution functions and verbal expression. Higher holoTC levels tended to be related to better performance in executive functions and psychomotor speed, while elevated serum folate concentrations were significantly related to higher scores in global cognition and verbal expression tests.

    Conclusions: tHcy, holoTC and folate levels are related to cognitive performance 7years later even in nondemented elderly subjects. Randomized trials are needed to determine the impact of vitamin B12 and folate supplementation on preventing cognitive decline in the elderly.

  • 30.
    Kramberger, MG
    et al.
    University Medical Centre Ljubljana.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Andersson, T
    Karolinska University Hospital Huddinge.
    Winblad, B
    Karolinska Institutet.
    Eriksdotter, M
    Karolinska Institutet.
    Jelic, V
    Karolinska Institutet.
    Association between EEG Abnormalities and CSF Biomarkers in a Memory Clinic Cohort2013In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 36, no 5-6, 319-328 p.Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the study was to describe distinct electroencephalogram (EEG) phenotypes defined after routine visual EEG analysis in a large memory clinic cohort and to investigate their relationship to cerebrospinal fluid (CSF) biomarkers. Methods: Patients with Alzheimer's disease (n = 131), mild cognitive impairment (n = 285), subjective cognitive impairment (n = 310), and mixed dementia (n = 29) were assessed clinically with neuroimaging, EEG and CSF investigations. EEG phenotypes were based on frequency of background activity (BA) and presence and degree of episodic abnormalities (EA). Results: BA and EA differed significantly (p < 0.001) between diagnostic groups. A lower CSF amyloid β42/phospho-tau ratio and higher total tau were associated with slower BA (p < 0.01) and a higher degree of EA (p < 0.04). Conclusions: Slowing of BA in combination with EA seems to be related to biological markers of neurodegeneration.

  • 31.
    Kramberger, Milica G.
    et al.
    Department of Neurology, University Medical Centre, Ljubljana, Slovenia.
    Giske, Katarina
    Department of Neurophysiology, Karolinska University Hospital, Stockholm, Sweden.
    Cavallin, Lena
    Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping). Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Andersson, Thomas
    Department of Neurophysiology, Karolinska University Hospital, Stockholm, Sweden.
    Winblad, Bengt
    Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden.
    Jelic, Vesna
    Department of Geriatric Medicine, Memory Clinic, Karolinska University Hospital-Huddinge, Stockholm, Sweden.
    Subclinical white matter lesions and medial temporal lobe atrophy are associated with EEG slowing in a memory clinic cohort.2017In: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 128, no 9, 1575-1582 p., S1388-2457(17)30214-6Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of the study was to describe the relationship between electroencephalographic (EEG) findings obtained by standardized visual analysis, subclinical white matter lesions (WML) and brain atrophy in a large memory clinic population.

    METHODS: Patients with Alzheimer's disease (AD, n=58), mild cognitive impairment (MCI, n=141), subjective cognitive impairment (SCI, n=194) had clinical, MRI based WML severity and regional atrophy assessments, and routine resting EEG recording. Background activity (BA) and episodic and continuous abnormalities were assessed visually in EEG.

    RESULTS: WML (p=0.006) and atrophy in medial temporal regions (MTA) (p=<0.001) were associated with slower BA in all diagnoses. WML were associated in SCI with total episodic EEG abnormalities (p=0.03).

    CONCLUSIONS: EEG is associated with subclinical WML burden and cortical brain atrophy in a memory clinic population.

    SIGNIFICANCE: Even the standard visually assessed EEG can complement a memory clinic diagnostic workup.

  • 32. Kramberger, Milica Gregoric
    et al.
    Jelic, Vesna
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Enache, Daniela
    Eriksdotter Jönhagen, Maria
    Winblad, Bengt
    Aarsland, Dag
    Cerebrospinal fluid alzheimer markers in depressed elderly dubjects with and without alzheimer's disease2012In: Dementia and Geriatric Cognitive Disorders. Extra., ISSN 1664-5464, Vol. 2, no 1, 48-56 p.Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore the relationship between cerebrospinal fluid Alzheimer's disease (AD) markers and depression in elderly people.

    Method: We included subjects with AD as well as persons with subjective cognitive impairment and normal cognition. Depression was assessed with the Cornell Scale for Depression in Dementia, and a cut-off score of >6 was used to define depression. Cerebrospinal fluid was analyzed using commercially available assays for β-amyloid 1-42, total tau, and phosphorylated tau 181.

    Result: A total of 183 participants (66.7% female) were included (92 with AD and 91 with subjective cognitive impairment), with a mean age (±SD) of 67.6 ± 7.4 years, a Mini-Mental State Examination score of 26.0 ± 4.0, and a median Cornell Scale for Depression in Dementia score of 5 (range 0-19). Depression scores were not associated with higher phosphorylated tau 181 and total tau or reduced β-amyloid 1-42 in AD or non-demented subjects.

    Conclusions: These results suggest that AD pathology does not contribute to depression, indicating that other factors may be more important. Further studies of the aetiology of depression in elderly people with and without AD are warranted.

  • 33.
    Kulmala, Jenni
    et al.
    Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Solomon, Alina
    Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. Ageing - living conditions and health.
    Ngandu, Tiia
    Karolinska Institute Alzheimer Disease Research Center, Stockholm, Sweden.
    Rantanen, Taina
    Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
    Laatikainen, Tiina
    Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
    Soininen, Hilkka
    Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
    Tuomilehto, Jaakko
    Center for Vascular Prevention, Danube-University Krems, Krems, Austria.
    Kivipelto, Miia
    Department of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
    Association between mid- to late life physical fitness and dementia: evidence from the CAIDE study2014In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 276, no 3, 296-307 p.Article in journal (Refereed)
    Abstract [en]

    Objectives

    This study investigated the association between perceived physical fitness at midlife, changes in perceived fitness during the three decades from mid- to late life, and dementia risk.

    Design

    Prospective cohort study.

    Setting

    Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) study.

    Subjects

    Subjects were selected from four independent, random samples of population-based cardiovascular surveys and were first examined in 1972, 1977, 1982, or 1987, when they were on average 50 years old. The CAIDE target population included 3,559 individuals. A random sample of 2,000 individuals still alive in 1997 was drawn for re-examinations (performed in 1998 and 2005–2008) that consisted of cognitive assessments, with 1,511 subjects participating in at least one re-examination. Dementia diagnoses were also confirmed from national registers for the entire target population.

    Main outcome measure

    All-cause dementia.

    Results

    Poor physical fitness at midlife was associated with increased dementia risk in the entire target population [hazard ratio (HR), 1.5; 95% confidence interval (CI), 1.1–2.0]. In participants, odds ratio (OR) was 2.0 (95% CI, 0.9–4.0). This association was significant in apolipoprotein E ε4 allele (APOEε4) non-carriers (OR, 4.3; 95% CI, 1.4–13.3), men (HR, 1.8; 95% CI, 1.1–3.0), and people with chronic conditions (HR, 2.9; 95% CI, 1.3–6.6). A decline in fitness after midlife was also associated with dementia (OR, 3.0; 95% CI, 1.7–5.1), which was significant among both men and women and more pronounced in APOEε4 carriers (OR, 4.4; 95% CI, 2.1–9.1).

    Conclusions

    Perceived poor physical fitness reflects a combination of biological and lifestyle-related factors that can increase dementia risk. A simple question about perceived physical fitness may reveal at-risk individuals who could benefit from preventive interventions.

  • 34.
    Kulmala, Jenni
    et al.
    University of Jyväskylä , Jyväskylä, Finland.
    Vuorinen, Miika
    University of Eastern Finland , Kuopio, Finland.
    Solomon, Alina
    University of Eastern Finland , Kuopio, Finland.
    Spulber, Gabriela
    Karolinska institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Karolinska institutet, Stockholm, Sweden.
    Waller, Katja
    University of Jyväskylä , Jyväskylä, Finland.
    Ngandu, Tiia
    National Institute for Health and Welfare , Helsinki, Finland.
    Soininen, Hilkka
    Kuopio University and University Hospital , Kuopio, Finland.
    Kivipelto, Miia
    Karolinska institutet, Stockholm, Sweden.
    Midlife self-rated health and fitness in relation to white matter lesions and grey matter volume 20 years later2014In: Alzheimer's & Dementia: the journal of the alzheimer's association, Elsevier, 2014, Vol. 10, 592- p.Conference paper (Refereed)
  • 35.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    A life-course with financial hardship and psychological distress in old age: A cohort study with Swedish data.2015Conference paper (Other academic)
  • 36.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Karolinska Institutet, Stockholm.
    Age and Sex Differences in the Relation between Education and Physical and Cognitive Functioning among Men and Women Aged 76 Years and Older2012In: International Journal of behavioral medicine, 19, Issue S1: Abstracts from the ICBM 2012 Meeting, New York: Springer, 2012, 224- p.Conference paper (Refereed)
    Abstract [en]

    Introduction: The socioeconomic position (SEP) and health association is well studied; less is known about how the association varies with age. We study how the relation between education and physical and cognitive functioning vary by age.

    Methods: A nationally representative random sample of Swedes aged 76+ years was interviewed in 2010/2011 (n=890) (non-response 14%). Men aged 80+ years and women 85+ were over sampled. (Sampling weights was used to control for this.)

    Physical functioning was measured by tests of lung function (peak flow), performance (9 tests of strength, range of motion, etc), and vision, and self-reported mobility (walking 500m, 100m, stairs, running 100m).

    Cognition was measured by the MMSE and a test of everyday competence.

    Global self-rated health (GSRH) was included as a comparison.

    Education was measured as number of years of education.

    Results: Significant associations were found between higher education and better function (and better global self-rated health) for all indicators. All associations to education decreased with age except vision that only decreased for men. The associations between education and performance, mobility, everyday competence, and GSRH decreased more with age among women. The associations between education and lung functioning and MMSE decreased more with age among men.

    Conclusions: Age patterns in the associations between education and functioning differ by indicator. In general education’s relation to both physical functioning and cognitive functioning and global self-rated health seems to decrease with age.

  • 37.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Midlife work-related stress increases dementia risk in late-life: The CAIDE 30-year study.2015Conference paper (Other academic)
  • 38.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health.
    Socieconomic position and political participation in terms of voting among elderly 77+ in Sweden2012Conference paper (Other academic)
    Abstract [en]

    Introduction: Political participation e.g. voting is important for the possibility to influence national and regional politics. From an egalitarian perspective it is desirable that all persons independent of age, sex, and socioeconomic position have the possibility to vote.

    The association between socioeconomic position and health, and between socioeconomic position and life situation among elderly is well studied; less is known about the association between socioeconomic position and political participation. We study the relation between three measures of socioeconomic position (social class based on occupation, years of education, and income) and voting.

    Methods: Two nationally representative sample of Swedes aged 53 to 75 where interviewed in 1968 and 1981 respectively. Survivors from 1968 where again interviewed in 1992 (n = 461), survivors from 1981 in 2002 (n = 614).

    Both 1992 and 2002 were election years in Sweden. A single item question regarding voting was posed – did you vote in the election.

    Logistic regressions controlling for sex, age, age-square, walking ability (walking 100 meters and walking stairs) and walking aids (no aids/cane(s), quadruped(s), crutch(es), and walker/wheelchair/ never go out) was used.

    Results: Significant differences in voting was found for both men and women for all three measures of socioeconomic position – persons with a high socioeconomic position was more likely to have voted. The associations were stronger for education and income and less strong for social class. The relation to social class was only significant on the 10-percent level among men. The associations were stronger among men than among women for all three measures of socioeconomic position. A significantly lower proportion of women voted.  

    Conclusions: There are systematic differences in political participation measured as voting. This might indicate that there are systematic injustices in the possibility to vote.

  • 39.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Socieconomic position, mobility, and political participation among men and women 77+ in Sweden2012Conference paper (Other academic)
    Abstract [en]

    Introduction: Political participation, e.g. voting, is important as itallows people to influence national/regional politics. From an egalitarianperspective it is desirable that everyone, irrespective of age, sex,socioeconomic position, and health, has the possibility to vote. We studythe relationship between voting and a combination of mobility and threemeasures of socioeconomic position (social class based on occupation,years of education, and income). Methods: Two nationally representativeSwedish samples aged 53-75 were interviewed in 1968 and 1981respectively. Survivors from 1968 where re-interviewed in 1992 (n=461),survivors from 1981 in 2002 (n=614). Both 1992 and 2002 were electionyears in Sweden. The question posed was: did you vote in the election?Logistic regressions were controlled for sex, age, and cognition.Mobility, measured as walking aids outdoors was coded: 1)no aids;2)some aids (cane(s), quadruped(s), crutch(es), walker); 3)wheelchair/never go out. Results: Significant differences in voting were foundfor both sexes, for all measures of socioeconomic position – people witha high socioeconomic position being more likely to have voted. Theassociation between voting and socioeconomic position varied overmobility, but not systematically: social class had the strongest associationamong men without walking aids; education among men using someaids; and income for men using a wheelchair/not going out. Social classand income had the strongest associations among women with someaids, education among women without aids. Conclusions: There are systematicsocioeconomic differences in political participation measuredby voting, but no systematic pattern in how the associations vary overmobility.

  • 40.
    Kåreholt, Ingemar
    et al.
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology. Karolinska institutet, Stockholm, Sweden.
    Darin Mattsson, Alexander
    Nilsen, Charlotta
    Are socioeconomic position, work stress, and work complexity associated to mobility after retirement?2014In: International Journal of behavioral medicine: Abstracts from the ICBM 2014 Meeting, Springer, 2014, Vol. 21, 154-154 p.Conference paper (Refereed)
  • 41.
    Kåreholt, Ingemar
    et al.
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Meinow, B
    Darin Mattsson, A
    Are work conditions more than 20 year earlier associated to complex and severe health problems after retirement age?2013Conference paper (Other academic)
  • 42.
    Kåreholt, Ingemar
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Nilsen, Charlotta
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Darin-Mattsson, Alexander
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Andel, Ross
    School of Aging Studies, University of South Florida, Tampa, Florida, USA ; International Clinical Research Center, St. Anne’s University Hospital, Brno, Czech Republic.
    Are socioeconomic position and working conditions before retirement age related to physical function 20 years later after retirement?2015In: Differences, Inequalities and Sociological Imagination: ESA 2015 12th conference of the European Sociological Association: Abstract book, European Sociological Association (ESA). I nstitute of Sociology of the Czech Academy of Scienc es (IS CAS) , 2015, 107-107 p.Conference paper (Refereed)
    Abstract [en]

    INTRODUCTION: Socioeconomic position and working situation are two factors associated to health inequalities and to each other.AIM: To study how socioeconomic position and working conditions 20+ years earlier associates to physical functioning after retirement age.DATA: Swedish nationally representative samples, from 1968, 1981, and 1991 were re-interviewed 1992, 2002, and 2011 (76+) with 20-24 years follow-up time (women, n=431; men, n=450).METHOD: Ordered logistic regressions, censored normal regression, and ordinary OLS regressions will be used.VARIABLES: Physical function: Self-reported mobility, objective tests of lung function and general physical function.Socioeconomic position: Education, income, cash margin, social class based on occupation, and an index based on all measures.Psychosocial working conditions: job control, psychological demands, high strain (low control+high demands) and work complexity regarding data (information), people, and substantive (general) complexity.Controls: age, sex, follow-up year, mobility at baseline, and hours worked.RESULTS: Job control, work complexity with data and people and all measures of SEP, were significantly associated to the three measures of physical function. Controlling for working conditions, the only significant associations was between general physical function and cash margin and the socioeconomic index respectively. When controlling for socioeconomic position, job control was significantly associated to less limitations in mobility and general physical functioning, substantive complexity and complexity with data were associated to less mobility limitations.CONCLUSIONS: Both socioeconomic position, work related stress, and work complexity were associated to physical function in old age, but only partly independent of each other. The strongest single factor is job control.

  • 43.
    Larsson, Kristina
    et al.
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Thorslund, Mats
    Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Care utilisation in the last years of life in Sweden: the effects of gender and marital status differ by type of care2014In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 11, no 4, 349-359 p.Article in journal (Refereed)
    Abstract [en]

    The effects of gender and marital status on care utilisation in the last years of life are highly correlated. This study analysed whether gender differences in use of eldercare (home help services or institutional care) or hospital care in the last 5 years of life, and the place of death, could be attributed to differences in marital status and thereby to potential access to informal care. A longitudinal Swedish study provided register data on 567 participants (aged 83 +) who died between 1995 and 2004. A higher proportion of unmarried than married people used home help services; this was true of both men and women. The likelihood of receiving home help was lower for those living with their spouse (OR = 0.38) and for those with children (OR = 0.60). In the 2 years preceding death, the proportion receiving home help services decreased and the proportion in institutional care increased. Women were significantly more likely to die in institutional care (OR = 1.88) than men. Although men were less likely to live in institutional care than women and more likely to be inpatients in the 3 months preceding death, after controlling for residence in institutional care, neither gender nor marital status was statistically significant when included in the same model. In summary, the determining factor for home help utilisation seemed to be access to informal care, whereas gender differences in health status could explain women’s higher probability of dying in institutional care.

  • 44.
    Lennartsson, Carin
    et al.
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University.
    Agahi, Neda
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University.
    Hols-Salén, Linda
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University.
    Kelfve, Susanne
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Lundberg, Olle
    Center for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet.
    Parker, Marti G.
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University.
    Thorslund, Mats
    Aging Research Center (ARC), Karolinska Institutet/Stockholm University.
    Data Resource Profile: The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD)2014In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 43, no 3, 731-738 p.Article in journal (Refereed)
    Abstract [en]

    As the number and proportion of very old people in the population increase, there is a need for improved knowledge about their health and living conditions. The SWEOLD interview surveys are based on random samples of the population aged 77+years. The low non-response rates, the inclusion of institutionalized persons and the use of proxy informants for people unable to be interviewed directly ensure a representative portrayal of this age group in Sweden. SWEOLD began in 1992 and has been repeated in 2002, 2004 and 2011. The survey is based on another national survey, the Swedish Level of Living Survey (LNU), started in 1968 with 10-year follow-up waves. This longitudinal design provides additional data collected when SWEOLD participants were in middle age and early old age. The SWEOLD interviews cover a wide range of areas including health and health behaviour, work history, family, leisure activities and use of health and social care services. Socio-economic factors include education, previous occupation and available cash margin. Health indicators include symptoms, diseases, mobility and activities of daily living (ADL). In addition to self-reported data, the interview includes objective tests of lung function, physical function, grip strength and cognition. The data have been linked to register data, for example for income and mortality follow-ups. Data are available to the scientific community on request. More information about the study, data access rules and how to apply for data are available at the website (www.sweold.se).

  • 45. Lennartsson, Carin
    et al.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Parker, Marti G
    The health of the oldest old in Sweden deteriorated between 1992 and 2002 - is it better or worse in 2011?2012In: The 21st Nordic Congress of Gerontology, Dilemmas in Ageing Societies, Abstracts and Program, Copenhagen, Denmark, June 10th - 13th, 2012, 2012, 153- p.Conference paper (Refereed)
    Abstract [en]

    Objectives: Sweden has one of the highest proportions ofpeople aged over 80 in the world and life expectancy at higherages is continuing to increase. At the beginning of the 21stcentury a Swedish study of the oldest old showed an increase inhealth problems in this group between 1992 and 2002. Thisstudy looks at data gathered in 2010/2011 to see if the healthstatus in this very old population has continued to deteriorate.Material and methods: The question was tested with theSwedish Panel Study of Living Conditions of the Oldest Old(SWEOLD) — a nationally representative interview survey ofpeople aged 77+ (n~600). SWEOLD has a high response rate andincludes institutionalized persons and persons, for example withcognitive impairments, who are interviewed indirectly using aproxy.Results: Several health indicators, including objective tests ofphysical and lung function, showed a significant worsening ofhealth for both women and men between 1992 and 2002. Newcross-sectional analyses show neither an improvement nordeterioration in self reported health problems. For example,reports of pain in the shoulders, back pain, problems climbingthe stairs, anxiety and nervousness, have not changed significantlysince 2002. Also the proportion of people reporting poorself-rated health has been stable at a level of about 12% overthe years 2002, 2004 and 2010/2011. By contrast, the objectivetest of lung function has continued to worsen over this period.Conclusions: The preliminary conclusions are that the deteriorationof health seen between 1992 and 2002 has not continued.Nor are there any signs of improvement, at least whenconsidering subjective measures. These results will be discussedwith a special emphasis on the type of health outcomes, genderdifferences and methodological issues.

  • 46.
    Lundgren, Dan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Ernsth Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Municipal eldercare: Leadership differences in nursing homes and home help services2015In: Article in journal (Other academic)
    Abstract [en]

    Eldercare organizations have become increasingly multifaceted, and leaders play an important role in such organizations. This study used the developmental leadership questionnaire (DLQ) to compare perceptions of leadership in nursing homes with perceptions of leadership in home help services for older adults. A total of 21 leaders and 95 subordinates responded. Almost all were women; only seven men participated. Both leaders and subordinates perceived more positive leadership styles in nursing homes than in home help services. Leaders self-evaluations showed significant differences in the variables “promoting creativity” (p = 0.021), “management-related competencies” (p = 0.022), “capacity to cope with stress” (p = 0.002), and “results of leadership” (p = 0.034). Evaluations of leaders by subordinates showed significant differences in “not overcontrolling” (p = 0.018). Our findings suggest that the social service should recognize the differences in the way nursing homes and home help services are organized and should recruit leaders with traits and behaviours desirable to each setting.

  • 47.
    Lundgren, Dan
    et al.
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Ernsth-Bravell, Marie
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Leadership and the psychosocial work environment in old age care2016In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 11, no 1, 44-54 p.Article in journal (Refereed)
    Abstract [en]

    Aims and objectives

    To study leadership factors and their associations with psychosocial work environmental among nursing assistants who are engaged in old age care and to analyse (i) differences in the assessment of leadership factors and the assessment of psychosocial work environmental in nursing homes and home help services and (ii) the association between the psychosocial work environment and factors that are related to leadership in nursing homes and home help services.

    Background

    Leadership factors are an important element of the psychosocial work environment in old age care. The physical distance between leaders and nursing assistants is larger in home help services than in nursing homes. Therefore, it is important to study leadership separately in nursing homes and home help services.

    Design

    Assessments from 844 nursing assistants in nursing homes and 288 in home help services (45 nursing homes and 21 home help service units) were analysed.

    Methods

    The data were analysed using linear regression. Age, gender, number of staff at the unit, number of years at the current working unit and educational level were controlled in Model 1. Summarised indexes that were based on all independent variables except the main independent variable were additionally controlled in Model 2.

    Results

    Psychosocial work environment was related to leadership factors, but stronger associations occurred more frequently in nursing homes than in home help services. Empowering leadership, support from superiors, the primacy of human resources and control over decisions were associated with higher assessments on all the variables that were related to the psychosocial work environment in both the nursing homes and home help services.

    Conclusions

    Organisational differences in conducting leadership in old age care must be considered. Some leadership characteristics are better prerequisites for creating and maintaining a positive psychosocial work environment for nursing assistants in nursing homes and home help services.

    Implications for practice

    Due to the differences in organisational settings, it is important to consider the differences in prerequisites in conducting leadership. To influence nursing assistants' performance and to increase quality in old age care in the long term, appropriate leadership is necessary.

  • 48.
    Mangialasche, F
    et al.
    University of Perugia.
    Solomon, A
    University of Eastern Finland.
    Kåreholt, I
    Jönköping University, School of Health Science, HHJ. Ageing - living conditions and health. Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Hooshmand, B
    Karolinska Institutet.
    Cecchtti, R
    University of Perugia.
    Fratiglioni, L
    Karolinska Institutet.
    Soininen, H
    University of Eastern Finland.
    Laatikainen, T
    University of Eastern Finland.
    Mecocci, P
    University of Perugia.
    Kivipelto, M
    University of Eastern Finland.
    Serum levels of vitamin E forms and risk of cognitive impairment in a Finnish cohort of older adults2013In: Experimental Gerontology, ISSN 0531-5565, E-ISSN 1873-6815, Vol. 48, no 12, 1428-1435 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Vitamin E includes eight natural antioxidant compounds (four tocopherols and four tocotrienols), but α-tocopherol has been the main focus of investigation in studies of cognitive impairment and Alzheimer's disease.

    OBJECTIVE: To investigate the association between serum levels of tocopherols and tocotrienols, markers of vitamin E oxidative/nitrosative damage (α-tocopherylquinone, 5-nitro-γ-tocopherol) and incidence of cognitive impairment in a population-based study.

    DESIGN: A sample of 140 non-cognitively impaired elderly subjects derived from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study was followed-up for 8years to detect cognitive impairment, defined as development of mild cognitive impairment (MCI) or Alzheimer's dementia. The association between baseline serum vitamin E and cognitive impairment was analyzed with multiple logistic regression after adjusting for several confounders.

    RESULTS: The risk of cognitive impairment was lower in subjects in the middle tertile of the γ-tocopherol/cholesterol ratio than in those in the lowest tertile: the multiadjusted odds ratio (OR) with 95% confidence interval (CI) was 0.27 (0.10-0.78). Higher incidence of cognitive impairment was found in the middle [OR (95% CI): 3.41 (1.29-9.06)] and highest [OR (95% CI): 2.89 (1.05-7.97)] tertiles of the 5-NO2-γ-tocopherol/γ-tocopherol ratio. Analyses of absolute serum levels of vitamin E showed lower risk of cognitive impairment in subjects with higher levels of γ-tocopherol, β-tocotrienol, and total tocotrienols.

    CONCLUSIONS: Elevated levels of tocopherol and tocotrienol forms are associated with reduced risk of cognitive impairment in older adults. The association is modulated by concurrent cholesterol concentration. Various vitamin E forms might play a role in cognitive impairment, and their evaluation can provide a more accurate measure of vitamin E status in humans.

  • 49. Meinow, Bettina
    et al.
    Kåreholt, Ingemar
    Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology.
    Parker, Marti G
    Recent trends in complex health problems in the oldest old in Sweden 1992-20102012In: The Gerontologist, 52, Issue S1: 2012 GSA Annual Scientific Meeting Abstracts / [ed] Rachel Pruchno, PhD, Washington: Gerontological society , 2012, 329- p.Conference paper (Refereed)
    Abstract [en]

    Studies addressing multiple morbid conditions in elderly populationsusually focus on disease and physiological indicators relevant forthe medical care system. Few studies include both medical and functionalindicators, which together indicate the need for integrated carefrom different providers of medical and long-term care (home-help,institutional care) as well as informal caregivers. When assessing eldercareneeds and the wellbeing of the oldest old, trends of complex healthproblems seem more useful than single health items that may followdiverse trends over time. This study identified severe problems in threehealth domains (health items/symptoms, mobility, cognition/communication)in three nationally representative samples of the Swedish populationaged 77+, including institutionalized people and proxy interviewsfor those who were too frail to be interviewed themselves. Peoplewith severe problems in two/three domains were considered havingcomplex health problems. Changes in the proportion of people withcomplex health problems between 1992, 2002 and 2010 were analysedwith logistic regressions as well as differences according to age, gender,and education. Results showed a significant increase of elderly peoplewith complex health problems from 19% in 1992 to 26% in 2002.Between 2002 and 2010/11 there has been no significant change. Gender,age and education had significant independent effects on the oddsof having complex health problems. Patterns were similar for men andwomen. From a social policy perspective, stable prevalence rates ofcomplex health problems among the oldest old since 2002 emphasizethe continuing need for extensive collaboration between medical andsocial services.

  • 50. Meinow, Bettina
    et al.
    Kåreholt, Ingemar
    Jönköping University, School of Health Science, HHJ, Institute of Gerontology.
    Thorslund, Mats
    Recent trends in complex health problems in the oldest old in Sweden 1992-2010/112012In: The 21st Nordic Congress of Gerontology, Dilemmas in Ageing Societies, Abstracts and Program, Copenhagen, Denmark, June 10th - 13th, 2012, 2012, 206- p.Conference paper (Refereed)
    Abstract [en]

    Studies addressing multiple morbid conditions in elderlypopulations usually focus on disease and physiological indicatorsrelevant for the medical care system. Few studies include bothmedical and functional indicators, which together can indicatethe need for integrated care from several different serviceproviders of medical and long-term care (home-help, institutionalcare) as well as informal caregivers. When assessingeldercare needs and the wellbeing of the oldest old, trends ofcomplex health problems seem more useful than single healthitems that may follow diverse trends over time.This study identified severe problems in three health domains(health items/symptoms, mobility, cognition/communication) inthree nationally representative samples of the Swedishpopulation aged 77+ (1992: n=537; 2002: n=561; 2010: n=841),including institutionalized people and proxy interviews for thosewho were too frail to be interviewed themselves.People with severe problems in two/three domains wereconsidered having complex health problems. Changes in theprevalence of people with complex health problems between1992, 2002 and 2010 were analysed with logistic regressions aswell as differences according to age, gender, and education.Results showed a significant increase of elderly people withcomplex health problems from 19% in 1992 to 26% in 2002.Between 2002 and 2010/11 there has been no significant change.Gender, age and education had significant independent effectson the odds of having complex health problems. Patterns weresimilar for men and women.A preliminary conclusion is that the deterioration in healthamong the oldest old between 1992 and 2002 has levelled out.Results will be discussed with a special emphasis on methodologicalissues. From a social policy perspective, rather stableprevalence rates of complex health problems among the oldestold since 2002 emphasize the need for extensive collaborationbetween medical and social services.

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