| 1. |
- Haaksma, Miriam L., et al.
(author)
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Cognitive and functional progression in Alzheimer disease : A prediction model of latent classes
- 2018
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 33:8, s. 1057-1064
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Journal article (peer-reviewed)abstract
- Objective: We sought to replicate a previously published prediction model for progression, developed in the Cache County Dementia Progression Study, using a clinical cohort from the National Alzheimer's Coordinating Center.Methods: We included 1120 incident Alzheimer disease (AD) cases with at least one assessment after diagnosis, originating from 31 AD centres from the United States. Trajectories of the Mini-Mental State Examination (MMSE) and Clinical Dementia Rating sum of boxes (CDR-sb) were modelled jointly over time using parallel-process growth mixture models in order to identify latent classes of trajectories. Bias-corrected multinomial logistic regression was used to identify baseline predictors of class membership and compare these with the predictors found in the Cache County Dementia Progression Study.Results: The best-fitting model contained 3 classes: Class 1 was the largest (63%) and showed the slowest progression on both MMSE and CDR-sb; classes 2 (22%) and 3 (15%) showed moderate and rapid worsening, respectively. Significant predictors of membership in classes 2 and 3, relative to class 1, were worse baseline MMSE and CDR-sb, higher education, and lack of hypertension. Combining all previously mentioned predictors yielded areas under the receiver operating characteristic curve of 0.70 and 0.75 for classes 2 and 3, respectively, relative to class 1.Conclusions: Our replication study confirmed that it is possible to predict trajectories of progression in AD with relatively good accuracy. The class distribution was comparable with that of the original study, with most individuals being members of a class with stable or slow progression. This is important for informing newly diagnosed AD patients and their caregivers.
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| 2. |
- Hedna, Khedidja, 1978, et al.
(author)
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Psychoactive medication use and risk of suicide in long-term care facility residents
- 2022
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 37:3
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Journal article (peer-reviewed)abstract
- Objectives: To investigate psychoactive medication use and risk of suicide in long-term care facility (LTCF) residents aged 75 and above. A second aim was to investigate the role of psychiatric and medical conditions in the occurrence of suicide in LTCF residents. Methods: A Swedish national register-based cohort study of LTFC residents aged ≥75years between 1 January 2008 and 31 December 2015, and followed until 31 December 2016 (N=288,305). Fine and Gray regression models were used to analyse associations with suicide. Results: The study identified 110 suicides (15.8 per 100,000 person-years). Half of these occurred during the first year of residence. Overall, 54% of those who died by suicide were on hypnotics and 45% were on antidepressants. Adjusted sub-hazard ratio (aSHR) for suicide was decreased in those who were on antidepressants (aSHR 0.64, 95% confidence interval 0.42–0.97), even after the exclusion of residents who had healthcare contacts for dementia or were on anti-dementia drugs. The aSHR for suicide was more than two-fold higher in those who were on hypnotics (2.20, 1.46–3.31). Suicide risk was particularly elevated in those with an episode of self-harm prior to LTCF admittance (15.78, 10.01–24.87). Specialized care for depression was associated with increased risk, while medical morbidity was not. Conclusions: A lower risk of suicide in LTCF residents was found in users of antidepressants, while elevated risk was observed in those on hypnotics. Our findings suggest that more can be done to prevent suicide in this setting. © 2022 The Authors. International Journal of Geriatric Psychiatry published by John Wiley& Sons Ltd.
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| 3. |
- Johnell, Kristina, et al.
(author)
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Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults
- 2017
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 32:4, s. 414-420
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Journal article (peer-reviewed)abstract
- ObjectiveTo investigate whether psychotropics are associated with an increased risk of fall injuries, hospitalizations, and mortality in a large general population of older adults.MethodsWe performed a nationwide matched (age, sex, and case event day) case–control study between 1 January and 31 December 2011 based on several Swedish registers (n = 1,288,875 persons aged ≥65 years). We used multivariate conditional logistic regression adjusted for education, number of inpatient days, Charlson co-morbidity index, dementia and number of other drugs.ResultsAntidepressants were the psychotropic most strongly related to fall injuries (ORadjusted: 1.42; 95% CI: 1.38–1.45) and antipsychotics to hospitalizations (ORadjusted: 1.22; 95% CI: 1.19–1.24) and death (ORadjusted: 2.10; 95% CI: 2.02–2.17). Number of psychotropics was associated with increased the risk of fall injuries, (4 psychotropics vs 0: ORadjusted: 1.53; 95% CI: 1.39–1.68), hospitalization (4 psychotropics vs 0: ORadjusted: 1.27; 95% CI: 1.22–1.33) and death (4 psychotropics vs 0: ORadjusted: 2.50; 95% CI: 2.33–2.69) in a dose–response manner. Among persons with dementia (n = 58,984), a dose–response relationship was found between number of psychotropics and mortality risk (4 psychotropics vs 0: ORadjusted: 1.99; 95% CI: 1.76–2.25).ConclusionsOur findings support a cautious prescribing of multiple psychotropic drugs to older patients. © 2016 The Authors. International Journal of Geriatric Psychiatry Published by John Wiley & Sons, Ltd.
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| 4. |
- Kiejna, A, et al.
(author)
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Epidemiological studies of cognitive impairment and dementia across Eastern and Middle European countries (epidemiology of dementia in Eastern and Middle European Countries)
- 2011
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 26:2, s. 111-117
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Journal article (peer-reviewed)abstract
- Objective To determine the availability and the consistency of prevalence findings of epidemiological studies on cognitive impairment and dementia conducted in Eastern and Middle Europe.Methods We adopted a stepwise multimethod study approach consisting of iterative literature searches for epidemiological articles published between 1990 and 2006 and subsequent data analyses of published material, reanalyses of existing accessible epidemiological data sets and expert inquiries in Eastern and Middle European countries. Systematic computer-assisted searches used the keywords: "dementia", "Alzheimer", "cognitive impairment", "incidence", "prevalence", "epidemiology" in combination with the name of the relevant countries or "Europe" in English and Polish language. We supplemented the literature search with a review of the references in the articles that were identified during the initial search.Results We were able to find few regional and country-specific epidemiological studies of various kinds (population-based, cohort, cross-sectional studies) and conducted on different restricted population groups of patients (from neurological units, out-patients units, residential homes). No studies were identified from most of the countries taken under consideration and the ones we found were characterized by an immense diversity with a considerable degree of clinical and methodological variations. The few studies that there are suggest prevalence rates of dementia in Eastern Europe similar to those in Western Europe.Conclusions There is strong need for epidemiological studies in Eastern and Middle Europe, as well as for greater coordination and standardization of methods to improve the quality and comparability of epidemiological data to determine the prevalences' rates of dementia in all the EU countries.
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| 5. |
- Kåreholt, Ingemar, et al.
(author)
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Baseline leisure time activity and cognition more than two decades later
- 2011
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 26:1, s. 65-74
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Journal article (peer-reviewed)abstract
- Objective: Many studies of the relation between factors earlier in life and late-life cognition have a short follow-up time, often less than 10 years. Since cognitive decline can be present up to 20 years prior to dementia it is difficult to distinguish the direction of the relationships without a long follow-up. We analyzed the association between different types of leisure time activity at baseline and cognition more than 20 years later. A wide range of activities was included—political, mental, socio-cultural, social, physical, and organizational activities.Methods: Baseline studies were random Swedish samples aged 46–75 years (mean 57.4) (n = 1643) interviewed in 1968 or 1981. Activities were measured at baseline. Cognition was measured with items from the Mini-Mental State Examination in 1992, 2002, or 2004.Results: There was a significant association between later cognition and earlier political, mental, and socio-cultural activities controlling for age, age-square, sex, follow-up-time, mobility problems, symptoms of mental distress, employment status, education, adult and childhood socioeconomic status, income, smoking, and drinking. Physical activities had a significant association with cognition only among women. Organizational activities were not significant when controlling for all covariates. Social activities had no significant association. Including all covariates and all leisure activities simultaneously, only mid-life political and mental activities remained significantly related to later life cognition.Conclusions: These findings add support to the theory that various forms of engagement in mid-life can have a protective effect with respect to cognition in later life.
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| 6. |
- Nakabe, Takayo, et al.
(author)
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The personal cost of dementia care in Japan : A comparative analysis of residence types
- 2018
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 33:9, s. 1243-1252
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Journal article (peer-reviewed)abstract
- Objective: We aimed to quantify the personal economic burden of dementia care in Japan according to residence type. Methods: A cross-sectional online survey was conducted on 3841 caregivers of people with dementia. An opportunity cost approach was used to calculate informal care costs. All costs and the observed/expected (OE) ratio of costs were adjusted using patient sex, age, and care-needs levels, and compared among the residence types. Results: The mean daily informal care time was 8.2 hours, and the mean monthly informal care costs for community-dwelling people with dementia were US$1559. The OE ratio for informal care costs in community-dwelling patients was higher than in institutionalized patients. Conclusion: The inclusion of informal care costs reduced the differences in total personal costs among the residence types. The economic burden of informal care should be considered when quantifying dementia care costs.
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| 7. |
- Nordberg, Gunilla, et al.
(author)
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Time use and costs of institutionalised elderly persons with or without dementia : results from the Nordanstig cohort in the Kungsholmen Project - a population based study in Sweden
- 2007
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 22:7, s. 639-648
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Journal article (peer-reviewed)abstract
- Background The aging of the population has become a worldwide phenomenon. This leads to increased demand for services and with limited resources it is important to find a way to estimate how resources can be match to those with greatest need. Aims To analyse time use and costs in institutional care in relation to different levels of cognitive and functional capacity for elderly persons. Methods The population consisted of all institutionalised inhabitants, 75 + years, living in a rural community (n=176). They were clinically examined by physicians and inter-viewed by nurses. Staff and informal care-giving time was examined with the RUD (Resource Utilization in Dementia) instrument. Results Tobit regression analyses showed that having dementia increased the amount of ADL care time with 0.9 h when compared to those not having dementia, whereas each loss of an ADL function (0-6) added 0.6 h of ADL care time. Analysing the total care time use, the presence of dementia added more than 9 h, while each loss of one ADL function added 2.9 h. There were some informal care contributions, however with no correlation to severity in dependency. The estimated cost for institutional care increased with more than 85% for people being dependent in 5-6 ADL activities compared to persons with no functional dependency, and with 30% for persons with dementia compared to the non-demented. Conclusion There is a variation in time use in institutional settings due to differences in ADL dependency but also whether dementia is present or not. This variation has implications for costs of institutional care.
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| 8. |
- Pantzar, Alexandra, et al.
(author)
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Cognitive performance in unipolar old-age depression : a longitudinal study
- 2017
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 32:6, s. 675-684
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Journal article (peer-reviewed)abstract
- Objective: Previous studies on cognitive deficits in acute and remitted states of old-age depression have shown mixed findings. The episodic nature of depression makes repeated assessment of cognitive performance important in order to address reversibility and stability of cognitive deficits. Methods: Dementia-free older participants (>= 60 years) from the population-based Swedish National Study on Aging and Care in Kungsholmen who completed neuropsychological testing at baseline (T1) and follow-up (T2) formed the basis of the study sample. Participants were grouped according to depression status at T1 and T2: depressed-remitted (n=32), remitted-depressed (n=45), and nondepressed-depressed (n=29). These groups were compared with a group of randomly selected and matched (age, gender, education, and follow-up time) healthy controls (n=106) over a period of maximum 6 years. Results: Mixed ANCOVAs, controlling for age and gender, revealed depression-related deficits for processing speed, attention, executive function, and category fluency. In remitted states, only processing speed and attention were affected. However, these deficits were attenuated after exclusion of persons using benzodiazepine medications. A general pattern of cognitive decline was observed across all groups for processing speed, executive function, category fluency, and episodic and semantic memory; persons transitioning from a nondepressed to depressed state tended to show exacerbated cognitive decline. Conclusions: The results support the notion that cognitive deficits in depression may be more transient than stable. Consequently, cognitive deficits in depression might be regarded as potential treatment targets rather than stable vulnerabilities. As such, repeated assessment of cognitive functioning may provide an additional marker of treatment response.
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| 9. |
- Sköldunger, Anders, et al.
(author)
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Net costs of dementia in Sweden - an incidence based 10 year simulation study
- 2012
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 27:11, s. 1112-1117
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Journal article (peer-reviewed)abstract
- BackgroundAging of the population results in increasing number people suffering from dementia, and this will have a great impact on costs for the society. Because of the long duration of dementia disorders, it is difficult to collect empirical data for the whole survival period of incident cases. Therefore, modeling approaches are frequently used. The purpose of this study was to describe the costs of an incident dementia cohort with progression modeling.MethodsEpidemiological data indicated that the incidence of dementia in Sweden was 24,000 people in 2005. Thus, incident cases were run in a Markov model for 10 cycles of 1 year each. Severity state specific costs were used and defined by Clinical Dementia Rating scale.ResultsTotal cost for the cohort was 27.24 billion Swedish Krona (SEK). The mean cost per person and year was 269,558 SEK. Total cost for long-term institutional care was 21 billion SEK during the modeled period.ConclusionCost of long-term institutional care is the major cost driver, even in mild dementia.
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| 10. |
- Solomon, Alina, et al.
(author)
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Comorbidity and the rate of cognitive decline in patients with Alzheimer dementia
- 2011
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In: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 26:12, s. 1244-1251
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Journal article (peer-reviewed)abstract
- Methods: One hundred and two AD outpatients examined at the Psychiatry Department of the CF2 Polyclinic in Bucharest, Romania and re-evaluated after 2 years. Comorbidity was rated using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Results: Baseline mean age (SD) was 75.4 (8.2) years, median CDR (range) was 2 (1-3), and mean MMSE (SD) 14.2 (4.9). MMSE declined to 11.2 (4.8) during follow-up. Baseline mean total CIRS-G score (SD) was 13.8 (5.4), median number of endorsed categories (range) was 8 (1-14), and mean severity index (SD) 1.9 (0.4). Main comorbidity areas were cardiovascular, ear, nose and throat, genitourinary, musculoskeletal/integument, and neurological. Severity of comorbidity increased with dementia severity (p < 0.001). Baseline comorbidity was related to increased rate of cognitive decline; truncated regression coefficients (p-values) were 0.01 (0.02) for CIRS-G total score, and 0.15 (0.006) for severity index (controlled for age, sex, education, and AD treatment). Faster cognitive decline was associated with faster functional decline: OR (95% CI) was 5.2 (1.9-13.6) for increased rate of ADL change and 3.8 (1.0-14.1) for increased rate of IADL change (controlled for age, sex, education, AD medication, and comorbidity). Comorbidity tended to increase functional decline; however, the associations were not statistically significant. Conclusions: In this group of patients with AD, comorbidity increased the rate of cognitive decline. Considering comorbidity instead of focusing on separate conditions may be more helpful in managing AD.
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