| 1. |
- Atti, Anna Rita, et al.
(författare)
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Cognitive Impairment after Age 60 : clinical and Social Correlates in the "Faenza Project"
- 2010
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 21:4, s. 1325-1334
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Tidskriftsartikel (refereegranskat)abstract
- A total of 7,389 dementia-free elderly (60–102 years old) enrolled in the "Faenza Project" (Northern Italy) were clinically evaluated by nurses and physicians with the aim of detecting the independent and combined association of medical and social factors with cognitive status. Cognitive Impairment No Dementia (CIND) was defined for MMSE scores ⩽ 2 standard deviations than the age- and education-corrected mean score obtained by the non-demented persons of the Faenza cohort. Logistic Regression analysis was used to estimate Odds Ratios and 95% Confidence Intervals (OR, 95%CI) for CIND. The diagnostic procedure identified 402 (5.4%) CIND cases. Diabetes (OR, 95%CI=1.6, 1.2–2.2), stroke (OR, 95%CI=1.9, 1.4–2.6), and depressive symptoms (OR, 95%CI=1.9, 1.4–2.7) emerged as the most relevant medical comorbidities of CIND. Low education (OR, 95%CI=1.8, 1.1–2.9), low Socio Economic Status (SES) (OR, 95%CI=1.5, 1.1–2.1), and unmarried status (OR, 95%CI=1.7, 1.2–2.5) were associated with CIND. Medical and social factors were independently related to CIND occurrence. In comparison to subjects without any of the above mentioned conditions, subjects with one medical and one social factor had an OR, 95%CI for CIND equal to 6.0, 2.9–12.4. The strength of the association increased when more of those conditions occurred in combination, suggesting a synergistic effect. Despite some methodological limitations, data from this cross-sectional population-based Italian study show that low education, low SES, unmarried status together with diabetes, stroke, and depressive symptoms are related to cognitive impairment in the general population. The interaction of medical and social factors further increases the probability of CIND.
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| 2. |
- Atti, Anna Rita
(författare)
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The effect of somatic disorders on brain aging and dementia : findings from population studies
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral thesis investigates the effect of somatic disorders on dementia, Alzheimer s disease (AD) and brain aging in late-life. The data for the studies are provided by the Kungsholmen Project (Studies I and II) and the Faenza Project (Studies III and IV). The Kungsholmen Project is a population-based longitudinal study on aging and dementia carried out on 75+ years old people, living in Stockholm, Sweden. The Faenza Project is a cross-sectional population-based study on dementia and cognitive impairment involving persons over 60 years, living in a wealthy area in Northern Italy. The major findings are summarized below. Study I. The hypothesis that anemia may increase the risk of dementia and AD was investigated using three-year follow-up data. Subjects who fulfilled WHO criteria for anemia (hemoglobin < 130 g/L for men and < 120 g/L for women) were at higher risk of developing dementia (HR: 1.6, 95% CI: 1.1-2.4). In persons with good baseline cognition (Mini-Mental State Examination (MMSE) >= 26, n=1,139) the association was stronger, and still significant after adjustment for conditions potentially related to anemia and dementia such as chronic diseases, inflammatory markers, and indicators of nutritional status. Using different definitions for anemia, a dose-response relationship between low hemoglobin concentration and incident dementia was observed: the lower the cut-off, the higher the probability of dementia. Study II. The relationship between body weight and dementia (or AD) was investigated using three-, six-, nine-year follow-up data. No association was detected between being underweight and dementia. Even after extensive adjustment, subjects with Body Mass Index (BMI) >= 25 had a lower risk of developing dementia than normal-weight subjects over nine years (HR: 0.8, 95% CI: 0.6 0.96). These results were confirmed also when the analysis was restricted to the cases occurring between three and nine, or between six and nine years of follow-up. Severe changes in BMI between baseline and three years of follow-up were associated with incident dementia in the following three years. Study III. The independent and combined effect of medical and social factors on cognitive status was investigated in the Faenza Project. A person was diagnosed with Cognitive Impairment No Dementia (CIND) if he/she scored two or more standard deviations lower than non-demented subjects on the adjusted MMSE. The diagnostic procedure identified 402 CIND cases (5.4%). Diabetes (OR: 1.6, 95% CI: 1.2-2.2), stroke (OR: 1.9, 95% CI: 1.4-2.6), and depressive symptoms (OR: 1.9, 95% CI: 1.4-2.7) were the most relevant associated medical comorbidities. The strength of the association increased when these conditions occurred in combination. Low education (OR: 1.8, 95% CI: 1.1-2.9), low socioeconomic status (OR: 1.5, 95% CI: 1.1-2.1), and unmarried status (OR: 1.7, 95% CI: 1.2-2.5) were also independently associated with CIND. Medical and social factors had a strong synergistic effect. Persons with at least one medical and one social factor were six times more likely to be diagnosed as CIND. Study IV. To investigate the relation between perceived cognitive decline and mental and somatic comorbidity we considered the non-demented, cognitively unimpaired cohort of the Faenza Project (n=6,825). According to the Global Deterioration Scale (GDS), 20.1 % and 8.3% of participants reported very mild or mild cognitive decline, respectively. Diseases significantly associated with perceived cognitive decline were stroke (OR: 1.8; 95% CI: 1.3-2.3), malignancy (OR: 2.7, 95% CI: 1.3-5.7), cardiovascular disorders (OR: 1.7, 95% CI: 1.2-2.3), diabetes (OR: 1.6; 95% CI: 1.2-2.2), and depressive and anxiety symptoms (OR: 3.7, 95% CI: 2.4-4.2; OR: 1.6, 95% CI: 1.2-2.1). Mental, cardiovascular, and respiratory diseases accounted for the discrepancy between perceived cognitive decline and cognitive performance. Conclusions. The findings support the hypothesis that several somatic disorders might affect brain aging and dementia. This thesis suggests that late-life anemia is a risk factor for dementia, that diabetes, stroke, and depressive symptoms are clinical correlates of CIND, and that mental and somatic morbidity accounts for the discrepancy between perceived cognitive decline and cognitive performance. Finally, we do not confirm being overweight in late-life as a risk factor for dementia, but we suggest that weight loss is a good predictor of incipient dementia.
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| 3. |
- Pantzar, Alexandra, et al.
(författare)
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Cognitive deficits in unipolar old-age depression : a population-based study
- 2014
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Ingår i: Psychological Medicine. - : Cambridge University Press. - 0033-2917 .- 1469-8978. ; 44:5, s. 937-947
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionRecognition of cognitive deficits in old-age depression is especially important since they contribute to poor function outcome, have strong implications for coping abilities and treatment compliance. However, substantial variability in cognitive deficits among older depressed persons has been reported. Clinical and demographic characteristics are likely to have contributed to inconsistencies in previous findings.ObjectiveTo assess effects of unipolar depression on cognitive performance in a population-based sample of elderly persons (60+ years).MethodsAn extensive cognitive test battery was administered. Eighty-nine persons fulfilled ICD-10 criteria for unipolar depression (mild, n=48; moderate; n=38, severe; n=3) after thorough screening for dementia (DSM-IV criteria), psychiatric comorbidities, antidepressant pharmacotherapy, and lastly preclinical dementia.ResultsUnipolar old-age depression was associated with deficits in processing speed, attention, executive function, verbal fluency, and episodic free recall. No depression-related deficits were observed in short-term memory, semantic memory, or spatial ability. Increasing age did not exacerbate the cognitive deficits in old-age depression. The cognitive deficits remained significant after exclusion of persons with preclinical dementia, except free recall, where performance differences were at trend level.ConclusionsCognitive deficits in unipolar old-age depression involve a number of cognitive domains, and are also present among persons with mild depression. Importantly, no statistically significant performance differences between mild and moderate/severe depression were observed. Given the prevalence of depression in older populations, the impact of this disorder on cognitive functioning may be relatively large at the population level.
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| 4. |
- Pantzar, Alexandra, et al.
(författare)
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Cognitive performance in unipolar old-age depression : a longitudinal study
- 2017
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 32:6, s. 675-684
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Tidskriftsartikel (refereegranskat)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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| 5. |
- Pantzar, Alexandra, et al.
(författare)
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Effects of psychiatric history on cognitive performance in old-age depression
- 2015
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive deficits in old-age depression vary as a function of multiple factors; one rarely examined factor is long-term psychiatric history. We investigated effects of psychiatric history on cognitive performance in old-age depression and in remitted persons. In the population-based Swedish National Study on Aging and Care in Kungsholmen study, older persons (>= 60 years) without dementia were tested with a cognitive battery and matched to the Swedish National Inpatient Register (starting 1969). Participants were grouped according to current depression status and psychiatric history and compared to healthy controls (n = 96). Group differences were observed for processing speed, attention, executive functions, and verbal fluency. Persons with depression and psychiatric inpatient history (n = 20) and late-onset depression (n = 49) performed at the lowest levels, whereas cognitive performance in persons with self-reported recurrent unipolar depression (n = 52) was intermediate. Remitted persons with inpatient history of unipolar depression (n = 38) exhibited no cognitive deficits. Heart disease burden, physical inactivity, and cumulative inpatient days modulated the observed group differences in cognitive performance. Among currently depressed persons, those with inpatient history, and late onset performed at the lowest levels. Importantly, remitted persons showed no cognitive deficits, possibly reflecting the extended time since the last admission (m = 15.6 years). Thus, the present data suggest that cognitive deficits in unipolar depression may be more state- than trait-related. Information on profiles of cognitive performance, psychiatric history, and health behaviors may be useful in tailoring individualized treatment.
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| 6. |
- Pantzar, Alexandra, et al.
(författare)
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Interactive effects of KIBRA and CLSTN2 polymorphisms on episodic memory in old-age unipolar depression
- 2014
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Ingår i: Neuropsychologia. - : Elsevier BV. - 0028-3932 .- 1873-3514. ; 62, s. 137-142
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Tidskriftsartikel (refereegranskat)abstract
- The KIBRA (rs17070145) C-allele and the CLSTN2 (rs6439886) T-allele have both been associated with poorer episodic memory performance. Given that episodic memory is affected in depression, we hypothesized that the combination of these risk alleles would be particularly detrimental to episodic memory performance in depressed persons. In the population-based SNAC-K study, 2170 participants (>= 60 years) without dementia (DSM-IV criteria) and antidepressant pharmacotherapy were clinically examined and diagnosed following ICD-10 criteria for unipolar depression, and genotyped for KIBRA and CLSTN2. Participants were categorized according to unipolar depression status (yes, no) and genotype combinations (KIBRA: CC, any T; CLSTN2: TT, any C). Critically, a three-way interaction effect showed that the CC/TT genotype combination was associated with poorer episodic recall and recognition performance only in depressed elderly persons, with depressed CC/TT carriers consistently performing at the lowest level. This finding supports the view that effects of genetic polymorphisms on cognitive functioning may be most easily disclosed at suboptimal levels of cognitive ability, such as in old-age depression.
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| 7. |
- Sjöberg, Linnea, et al.
(författare)
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Prevalence of depression : Comparisons of different depression definitions in population-based samples of older adults
- 2017
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 221, s. 123-131
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depression prevalence in older adults varies largely across studies, which probably reflects methodological rather than true differences. This study aims to explore whether and to what extent the prevalence of depression varies when using different diagnostic criteria and rating scales, and various samples of older adults. Methods: A population-based sample of 3353 individuals aged 60-104 years from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were examined in 2001-2004. Point prevalence of depression was estimated by: 1) diagnostic criteria, ICD-10 and DSM-IV-TR/DSM-5; 2) rating scales, MADRS and GDS-15; and 3) self-report. Depression prevalence in sub-samples by dementia status, living place, and socio-demographics were compared. Results: The prevalence of any depression (including all severity grades) was 4.2% (moderate/severe: 1.6%) for ICD-10 and 9.3% (major: 2.1%) for DSM-IV-TR; 10.6% for MADRS and 9.2% for GDS-15; and 9.1% for selfreport. Depression prevalence was lower in the dementia-free sample as compared to the total population. Furthermore, having poor physical function, or not having a partner were independently associated with higher depression prevalence, across most of the depression definitions. Limitations: The response rate was 73.3% and this may have resulted in an underestimation of depression. Conclusion: Depression prevalence was similar across all depression definitions except for ICD-10, showing much lower figures. However, independent of the definition used, depression prevalence varies greatly by dementia status, physical functioning, and marital status. These findings may be useful for clinicians when assessing depression in older adults and for researchers when exploring and comparing depression prevalence across studies.
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