Background: Chronic stress triggers the dysregulation of hypothalamic-pituitary-adrenal (HPA) axis which is characterized by altered diurnal cortisol patterns and increased basal cortisol levels. This dysregulation has been found in Alzheimer's Disease (AD), but its link with AD-related biomarkers remains underexplored. This systematic review aims to synthesize the current knowledge regarding the association between cortisol and biomarkers related to AD.

Methods: Keywords and phrases related to cortisol and AD-related biomarkers were used to search the MEDLINE database via PubMed and OVID interfaces up to January 2024. Studies focused on the association between cortisol levels and genetic, neuroimaging, and fluid biomarkers related to AD. Additionally, sex differences in the associations between cortisol and AD-related markers were explored.

Results: A total of 2465 studies were identified, 54 of which were included in the systematic review. Most included studies were cross-sectional (91%), and measured blood (51.9%) or salivary (44%) cortisol. Only 6.8% of studies had reported on sex differences. Studies assessing the relationship between diurnal cortisol patterns and novel AD-related biomarkers remain scarce. Elevated cortisol levels tended to be associated with AD-related biomarkers, although associations were dependent on the cortisol measurement strategy and study populations.

Conclusion: Findings have been mixed, partly due to differences in cortisol measurement methodologies, including the timing and source of cortisol assessment. More longitudinal studies are needed to determine whether cortisol dysregulation preceded pathological changes related to AD.

Background: Many clinically relevant aspects of health are expressed through behavior, affect, and interaction, and therefore rely on observation rather than instrumental measurement; yet such information is often documented infrequently in routine care. Dementia, and particularly behavioral and psychological symptoms of dementia (BPSD), is a relevant case because symptoms fluctuate across time and context. Little is known about how structured daily symptom assessment can be integrated into routine dementia care practice. Objective: This pilot study aimed to investigate whether structured daily observation of BPSD, supported by digital documentation, can be incorporated into everyday residential dementia care. Methods: A convergent mixed methods design was applied across 4 nursing home units in southern Sweden. Feasibility was operationalized through 4 focus areas (implementation, practicality, acceptability, and integration), with adherence to the registration routine as the primary feasibility outcome. Quantitative data comprised structured registrations collected daily by care staff over 90 days for 8 residents with BPSD, analyzed descriptively, and interpreted using selected NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework domains to contextualize variation in symptom patterns, adherence, and registration practices. Semistructured dyadic interviews were analyzed using deductive content analysis guided by the same domains, with integration occurring at the analytical and interpretive stages. Results: A total of 21,993 item-level registrations were completed: 19,123 NPI-NH (Neuropsychiatric Inventory-Nursing Home version) symptom ratings, recorded across 1623 shift registrations (1 per resident per shift), and 2870 individually selected variables. Overall adherence to the registration routine averaged 75% across shifts but varied considerably between residents (range 33%-90%) and between staff members. Mean time per shift registration decreased from 77.1 seconds in the initial 30-day period to 46.2 seconds in the final 30-day period (P=.008). Symptom prevalence varied widely across NPI domains (7.5% to 38.1% of observation days), and daily symptom counts varied both between and within residents. The routine was experienced as technically straightforward and easy to incorporate into daily work. At the same time, challenges emerged, including time constraints, inconsistent participation, varying levels of interpretive confidence, and difficulties distinguishing among overlapping symptoms. Organizational routines and team stability were central to sustaining staff engagement. Conclusions: The high number of completed registrations indicates that daily observations can be integrated into daily dementia care. The participants perceived it as meaningful and useful. Feasibility was primarily influenced by organizational and interpretive factors rather than technical constraints. Further research should explore strategies to support shared routines and sustain engagement over time.

To address the challenge of labor market shortages, and workforce aging, this cross-sectional study explore the individual, work, and family factors associated with early (age <= 64) or late (age >= 66) expected retirement timing (ERT) among older long-term care (LTC) workers in Sweden. Data were drawn from the Swedish Longitudinal Occupational Survey of Health in 2018, comprising a sample of men and women aged 50-64 (n=550), working in LTC for older people. The results suggest that higher job demands and higher job satisfaction increase the likelihood of older LTC workers' early ERT. Shorter tenure and factors in work that enhance family life were associated with increased likelihood for late ERT.

BACKGROUND: Behavioral and Psychological Symptoms of Dementia (BPSD) affect up to 90% of people living with dementia and present significant challenges for individuals, relatives, and care staff, often impacting quality of life and care provision. Despite the high prevalence and fluctuating nature, BPSD are often monitored infrequently in routine care, limiting opportunities for timely, person-centered interventions. Digital tools that support frequent and individualized symptom monitoring may help bridge this gap.

METHODS: This study explored contextual factors, including barriers, facilitators, needs, and expectations, relevant to the potential implementation of Daily-BPSD, a digital tool designed to support individualized and frequent monitoring of BPSD in Swedish nursing homes. This participatory design study was conducted in two stages. Preparatory semi-structured interviews with disability care staff guided the initial design of the Daily-BPSD prototype, followed by research circles with nursing home staff and relatives. Data were analyzed thematically.

RESULTS: The analysis generated six themes: (1) implementation and adoption, (2) usability and accessibility, (3) communication and collaboration, (4) value for care and people with dementia, (5) training and support, and (6) the selection and interpretation of relevant variables to monitor. The findings were interpreted in relation to established determinants of technology acceptance, providing a structured understanding of factors shaping the anticipated adoption of Daily-BPSD.

CONCLUSION: Findings emphasize the need to align digital tools with everyday work routines, ensure adequate training, and address infrastructural conditions for reliable use. By outlining conditions that may enable or hinder daily monitoring of BPSD, this study contributes to the development phase of complex intervention design. It provides a foundation for further refinement and feasibility testing of Daily-BPSD in dementia care.

Cardiovascular risk factors are often undertreated in patients with dementia. Renin-angiotensin system inhibitors (RASI) are first-line treatments for hypertension. We examined the association between RASI and all-cause mortality in hypertensive patients with and without dementia, comparing angiotensin-converting enzyme inhibitors (ACEI) to angiotensin receptor blockers (ARB); and selected individual agents. This nationwide register-based cohort study included data from Swedish national registries 2007-2018. The study included 158 176 hypertensive patients with exposure to RASI medications (21 152 RASI users and 137,024 non-users), after excluding prevalent users. Propensity score matching was used to balance measured confounders. Cox regressions compared mortality risk among RASI users versus non-users, ACEI users versus ARB users, and users of enalapril, ramipril, losartan, and candesartan versus other RASI users. RASI use was associated with lower all-cause mortality (hazard ratio[HR] 0.93, 95% confidence interval[CI] 0.91-0.95, p< 0.001) in the full cohort, and among patients with dementia (HR 0.88, 95% CI 0.85-0.92). Compared to ACEI, ARB were associated with lower mortality in the full cohort (HR 0.90, 95% CI 0.85-0.96), but results were not significant in patients with dementia. The comparison of the individual drugs were consistent with class-level findings. RASI use was associated with lower all-cause mortality among older hypertensive patients, including those with dementia. These observational findings support continued attention to evidence-based hypertension treatment in patients with dementia.

Introduction: Short and long sleep duration as well as poor sleep quality have been linked to higher prevalence of metabolic disorders. However, it is still unclear how diverse sleep variables relate to different metabolic pathways. This study examines how different features of sleep health relate to serum metabolites.

Materials and methods: The study used data from 197 healthy individuals aged 20-79 (Females n=103) from the IronAge study performed at Karolinska Institutet in Sweden. Sleep variables were assessed with the Karolinska Sleep Questionnaire, where the following variables were computed: sleep duration, sleep debt, midpoint, social jetlag (i.e., the discrepancy between midpoint on free and workdays), napping frequency and sleep quality. Morning fasting blood samples were collected and 1H NMR spectroscopy was utilized for metabolomic analysis. The metabolites were categorized according to their major metabolic pathways: amino acid, lipid, carbohydrate, energy and gut microbiota. Linear regressions were performed to examine the relationship between each sleep variable and metabolite.

Results: Sleep duration, midpoint of sleep on free days, social jetlag and chronotype associated with eight metabolites at a significance level of p<0.01. Notably, midpoint associated with most metabolites spanning multiple pathways. A later midpoint was associated with higher levels of metabolites in the lipid pathway, and lower levels in the amino acid and energy pathway.

Conclusions: These observations indicate that sleep timing features, midpoint and social jetlag, have a stronger relationship with morning metabolism than other sleep health dimensions. Following replication in larger samples, these complex relationships may hold potential for health promotion.

Introduction: Physical and cognitive impairment constitute significant threats to healthy aging and the maintenance of independence but may be preventable through reduction of modifiable risk factors. While chronic stress has been linked to cognitive and physical function separately, few studies have accounted for combined decline. This study assessed associations between exposure to stressful life events (SLEs) and cognitive decline, physical decline, and combined physical and cognitive decline. Methods: Data were taken from the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) cohort study of community-dwelling older adults in Finland (n = 701). SLE exposure was assessed retrospectively at baseline using a 32-item questionnaire. Cognitive function (mean z score) was based on 5 cognitive tests, while physical function was based on self-reported mobility and ability to perform activities of daily living. Both were assessed at baseline and follow-up (mean 8.3 years). A combined physical-cognitive function score was created by multiplying the cognitive and physical function scores. Multivariate multiple linear regression was conducted to assess associations between SLE exposure and decline in physical/cognitive function over time. Results: Greater lifetime SLE exposure was associated with cognitive decline only in the presence of simultaneous physical decline. Recent SLEs were associated with cognitive decline alone, while non-recent SLEs were associated with physical decline. Acute SLEs (sudden onset, short duration), especially those related to bereavement, were associated with cognitive and physical decline individually and combined, while chronic SLEs (extended duration) were not. Conclusion: Both physical and cognitive function should be accounted for to understand the role of chronic stress in aging. Associations appear to depend on stress type and timing, providing insight into the temporal dynamics linking stressor exposure, cognitive decline, and physical decline.

OBJECTIVE: Test the hypothesis that depressive symptoms are associated with cognitive performance and that cortisol levels may explain this association independently of Alzheimer's Disease (AD) biomarker levels.

DESIGN: Longitudinal observational study.

SETTING: Memory clinic, Karolinska University Hospital, Stockholm, Sweden.

PARTICIPANTS: Consecutive patients (n = 162) who agreed to take part in the Cortisol and Stress in AD (Co-STAR) study during 2014-2017 and had data available for variables of interest.

MEASUREMENTS: Participants rated their depressive symptoms using the Geriatric Depression Scale (GDS) and collected diurnal salivary cortisol samples at home. Cognitive performance was assessed by standardized cognitive tests in the following domains: memory, working memory, processing speed, perceptual reasoning, and general cognitive function. Dementia, mild cognitive impairment (MCI), and subjective cognitive decline (SCD) were diagnosed as part of the clinical work-up. We determined the associations between GDS and cognitive domain scores using linear regressions, including cortisol levels as covariates. We also tested if cerebrospinal fluid (CSF) AD biomarkers amyloid β42 (Aβ42) and tau proteins modified these associations.

RESULTS: The GDS score was negatively associated with performance in working memory and processing speed, independently of cortisol levels. These associations were no longer significant after introducing AD biomarkers as covariates. Baseline GDS score was not associated with change in memory or processing speed at follow-up.

CONCLUSIONS: The underlying amyloid pathology may affect the association between depressive symptoms and cognitive performance in memory clinic patients.

The study investigated the relationship between how child welfare social workers (n = 309) assessed their first-line managers' leadership and how they perceived their working conditions. A cross-sectional survey, based on the QPS Nordic questionnaire, was conducted in Stockholm County, Sweden. The analyses focused on the extent to which social workers assessed the leadership of their first-line managers to be empowering, supportive, and fair, and how they perceived quantitative demands, learning demands, control of decisions, role clarity, and role conflicts at work. Supportive leadership was most clearly related to working conditions and was significantly associated with how all working conditions were perceived. The more supportive the social workers assessed the leadership to be, the lower they perceived quantitative demands, learning demands, and role conflicts, along with more control of decisions and role clarity. There were less frequent associations between how working conditions were perceived and how fair leadership and empowering leadership, respectively, were assessed. The importance of leadership is underlined, especially in regard to supporting the social workers when needed. The findings show the importance of child welfare organizations ensuring that managers can provide consistent support and guidance in relation to problems and dilemmas the social workers might encounter. This article investigates the relationship between how 309 child welfare social workers assess their first-line managers' leadership and how they perceive their working conditions. A questionnaire was distributed to child welfare social workers in Stockholm County, Sweden. The results show that support from the manager was the most important for how the social workers perceive their working conditions. The more support the social workers received, the better they perceived their working conditions to be. There was a clear relationship between perceiving one's manager as fair and perceiving lower demands in terms of time pressure and the amount of work one was expected to complete. In contrast, experiencing leadership as empowering was less important for how the social workers perceived their working conditions. The takeaway message for social work practice is that leadership is important, especially that social workers receive help and support when needed.

PURPOSE OF THE RESEARCH: Stress has a clear impact on health and function. Yet, little is known about how different stressors (factors that cause stress) in various contexts throughout the life course impact cognitive and physical aging. The study aimed to investigate if different types of stressors predicted cognitive and physical impairment in late life. The role of social support and internal locus of control was also investigated.

MATERIAL AND METHODS: Two individually linked studies of Swedish nationally representative samples provided longitudinal data over 21 years, including retrospective childhood data (n = 1086). Indicators of work and financial stressors were assessed at late midlife (M=62 years) and financial stressors at early late life (M=70). Social support and internal locus of control were assessed at the mean ages of 62 and 70 years. Physical and cognitive impairment were assessed at late life (M=83). Path analyses were conducted with maximum likelihood estimation and adjusted for smoking, age, sex, educational attainment, and follow-up period.

RESULTS: Work stressors were associated with physical and cognitive impairment directly. Work stressors were also associated with financial stressors, which, in turn, were associated with physical impairment. Childhood conflicts were associated with less social support, and less social support was associated with worse cognitive aging. Internal locus of control was not associated with cognitive and physical impairment.

CONCLUSIONS: This study confirms that stressors earlier in life predict cognitive and physical aging, but that different types of stressors have different paths to impact impairment in late life.