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- Karp, Anita
(författare)
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Psychosocial factors in relation to development of dementia in late-life : a life course approach within the Kungsholmen project
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis explored social and psychosocial factors from different phases in the lifespan and their relation to the occurrence of dementia and Alzheimer s Disease (AD) in late-life. Early life circumstances, such as education, midlife factors such as occupation, and an active and socially integrated late-life were investigated in relation to dementia and AD risk. All five studies are based on the Kungsholmen Project, a longitudinal population-based study of aging and dementia. The initial population consisted of all registered inhabitants who were 75 years and older and living in the Kungsholmen Parish in 1987. The major findings from the five research papers included in this thesis are summarized below. Study I. We found that frequent (daily-weekly) engagement in mental, social, or productive activities was inversely related to dementia incidence. Relative risks (RR) and 95% confidence intervals (CI) were 0.54 (95% CI: 0.34-0.87), 0.58 (95% CI: 0.37-0.91), and 0.58 (95% CI: 0.38-0.91), respectively. Similar results were found when these three factors were analyzed together in the same model. Study II. Less-educated subjects had a RR of 3.4 (95% CI: 2.0-6.0), and subjects with lower socioeconomic status (SES) had a RR of 1.6 (95% CI: 1.0-2.5) of developing AD. Low SES at 20 years of age, even when high at 40 or 60 years, was associated with increased risk. When both education and SES were introduced into the same model, only education remained significantly associated with AD. Study III. A mental, social, and physical component score was estimated for each leisure activity. RR of dementia for subjects with higher mental, physical, and social component score sums were 0.71 (95% CI: 0.49-1.03), 0.61 (95% CI: 0.42-0.87), and 0.68 (95% CI: 0.47-0.99), respectively. The most beneficial effect was present for subjects with high scores in all or in two of the components. Study IV. We found that inactivity, depressive symptoms, but not social network, were independently associated with increased risk of dementia. However, to be inactive, have depressive symptoms, and simultaneously have a limited/poor social network compared to having none of these factors showed the strongest association to dementia (RR=5.4, 95% CI: 2.1-13.9). Study V. Complex work with data and people was associated with reduced risk of dementia (RR = 0.85, 95% CI: 0.75-0.96, RR = 0.88, 95% CI: 0.80-0.97 respectively). When education was included in the model these associations were no longer significant. The association between education and AD/dementia, however, was modified by the highest levels of complexity which had a protective effect even among lower-educated subjects (RR = 0.52, 95% CI: 0.29-0.95). Summary. The five studies in the thesis identified several sources of cognitive stimulation throughout the lifespan and indicated that education above elementary level, higher levels of work complexity, and a broad spectrum of activities in old age are all related to decreased risk of dementia. The cognitive reserve model can be applied throughout the life course, from childhood to adulthood and late-life, and cognitive ability is modifiable at all stages of life. Conversely, dementia risk is increased by inactivity, loneliness, and low mood; and social isolation intensified the effect of these factors.
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- Marengoni, Alessandra, et al.
(författare)
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Aging with multimorbidity : A systematic review of the literature
- 2011
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Ingår i: Ageing Research Reviews. - : Elsevier BV. - 1568-1637 .- 1872-9649. ; 10:4, s. 430-439
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Forskningsöversikt (refereegranskat)abstract
- A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients.
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- Qiu, Chengxuan, et al.
(författare)
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Lifetime principal occupation and risk of Alzheimer's disease in the Kungsholmen project
- 2003
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Ingår i: American Journal of Industrial Medicine. - : Wiley. - 0271-3586 .- 1097-0274. ; 43:2, s. 204-211
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundSome studies suggest that manual work is associated with dementia. This study is aimed at identifying the specific occupational categories that may be related to dementia.MethodsA cohort of 913 non-demented subjects aged 75 + years was longitudinally examined twice over 6 years to detect incident dementia using the DSM-III-R diagnostic criteria. The lifetime longest occupations of all subjects were divided into different categories according to the occupation-based classification system. Data were analyzed with Cox models.ResultsDuring the follow-up period, 260 subjects were diagnosed with dementia (197 with Alzheimer's disease). Manual work was associated with an increased risk of dementia, and the association was dependent on educational level. Compared with non-manual work, manual work involving goods production had a multi-adjusted relative risk (95% CI) of 1.6 (1.0–2.5, P = 0.046) for Alzheimer's disease and 1.4 (0.9–2.1) for dementia.ConclusionsAn association between goods production, manual work and Alzheimer's disease found in this study suggests that factors in the mid-twentieth century goods production environment may be involved in the development of Alzheimer's disease.
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- Wang, Hui-Xin, et al.
(författare)
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Psychosocial stress at work is associated with increased dementia risk in late life
- 2012
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Ingår i: Alzheimer's & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 8:2, s. 114-120
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To test the hypothesis that high job stress during working life might lead to an increased risk of dementia and Alzheimer's disease (AD) in late life. Methods: A dementia-free cohort of 913 community dwellers, aged 75+ years, from the Kungsholmen Project, a population-based follow-up study carried out in Stockholm, Sweden, was followed up for an average of 6 years to detect incident dementia and AD (third revised Diagnostic and Statistical Manual of Mental Disorders). Information on the lifespan work activities was collected. Psychological stress at work was estimated for the longest period of occupation as well as for all occupations by using a validated psychosocial job exposure matrix on two dimensions: job control and job demands. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of dementia and AD in relation to different levels of job stress. Results: Low level of job control was associated with higher multivariate adjusted risk of dementia (HR = 1.9, 95% CI: 1.2-3.0) and AD (HR = 2.2, 95% CI: 1.2-3.9). Low level of job demands alone was not significantly associated with increased dementia risk. When the two dimensions were combined into a four-category job strain model, both high job strain (low control/high demands) and passive strain (both low control and demands) were related to higher risk of dementia and AD as compared with active job strain (both high). Vascular disorders did not mediate the observed associations. Conclusion: Lifelong work-related psychosocial stress, characterized by low job control and high job strain, was associated with increased risk of dementia and AD in late life, independent of other known risk factors.
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