| 1. |
- Algotsson, Charlotte, et al.
(författare)
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Prevalence and functional impact of parkinsonian signs in older adults from the Good Aging in Skåne study : Parkinsonian signs in older adults
- 2023
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Ingår i: Parkinsonism and Related Disorders. - 1873-5126. ; 111, s. 1-7
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionMild parkinsonian signs (MPS) have been characterized by several definitions, using the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). We aimed to investigate the prevalence of MPS and their association with functional level and comorbidities in the oldest old.MethodCommunity-dwelling older adults (n = 559, median age 85, range 80–102 years) were examined regarding MPS, possible parkinsonism (PP) and subthreshold parkinsonism (SP) according to four previously used definitions and concerning the impact of parkinsonian signs on cognitive, physical, and autonomic function. MPS, PP and SP are different terms describing a very similar phenomenon and there is no gradation between these. In two of the four definitions more advanced symptoms were categorized as parkinsonism.ResultsMedian UPDRS score in the whole study group was 10 points (range: 0–58) and was predominated by bradykinesia. MPS/PP/SP were present in 17–85%, and parkinsonism in 33–71% of the cohort. Independently of age and gender, MPS/PP/SP and especially parkinsonism, were associated with a higher risk of fear of falling and accomplished falls, with lower: cognition, ADL, physical activity and quality of life, and with urinary incontinence, obstipation and orthostatic intolerance.ConclusionsIn a population of older adults above 80 years, MPS are highly prevalent as well as more advanced symptoms defined as parkinsonism, and only 9–17% of the cohort is symptom-free. Predominance of bradykinesia in the oldest old might indicate a need for revision of MPS definitions to improve their sensibility.
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| 2. |
- André-Petersson, Lena, et al.
(författare)
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Cognitive abnormalities and cerebral perfusion defects in a community-dwelling cohort of elderly men with MMSE within the normal range
- 2018
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Ingår i: Aging, Neuropsychology, and Cognition. - : Informa UK Limited. - 1382-5585 .- 1744-4128. ; 25:2, s. 200-212
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Mini Mental State Examination’s (MMSE’s) sensitivity in its upper level is questioned, hence we investigated cognitive abnormalities and defects in regional cerebral blood flow (rCBF) in elderly with MMSE scores ≥24. Methods: One hundred and four men at age 81 with MMSE scores ≥24 (mean 28.4 ± 1.7), no dementia or stroke, were examined with neuropsychological test battery, and their rCBF was estimated using 99mTc-HMPAO SPECT. Results: MMSE was very sparsely correlated with rCBF. Instead, visuo-spatial tests were correlated with rCBF in parietal and occipital lobe, verbal tests with rCBF in frontal and temporal-parietal lobes, and most of all between Digit Symbol and all rCBF regions, especially in subcortical gray and white matter. In a cluster of low achievers, test of Synonyms, followed by Digit Symbol and Benton test, had highest discriminatory importance. Low achievers had generalized rCBF changes especially in subcortical areas. Only lower scores on two MMSE items, figure drawing and calculation, could discriminate the clusters. Conclusion: A substantial number of octogenarian men with MMSE ≥ 24p have widespread rCBF changes corresponding to a decreased speeded performance and verbal capacity.
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| 3. |
- Axelsson, Johan, et al.
(författare)
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Low ambulatory blood pressure is associated with lower cognitive function in healthy elderly men.
- 2008
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Ingår i: Blood Pressure Monitoring. - 1473-5725. ; 13:5, s. 269-275
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Low blood pressure (BP) has been found to be associated with cerebrovascular damage in the elderly. Studies of the relation of ambulatory BP to cognitive function in elderly persons aged 80 years or above is lacking, however. METHODS: Ninety-seven 81-year-old men from the population study 'Men born in 1914' underwent ambulatory BP monitoring and were given a cognitive test battery, 79 subjects completing all six tests. Low ambulatory systolic blood pressure (SBP) was defined as <130 mmHg and low ambulatory diastolic blood pressure (DBP) as <80 mmHg (corresponding in terms of office BP to approximately <140 and <90 mmHg, respectively). Odds ratios (OR) for lower cognitive function were calculated using a forward stepwise logistic regression model, controlling for confounding factors. RESULTS: Subjects with ambulatory SBP <130 mmHg had higher OR values for daytime (OR 2.6; P=0.037), nighttime (OR 3.6; P=0.032) and 24h (OR 2.6; P=0.038) BP measurements. A lower cognitive function was associated with lower nighttime SBP and DBP levels and lower 24-h mean SBP compared to subjects with higher cognitive function. OR values connected to low nocturnal SBP, had a tendency to be particularly high among subjects on anti-hypertensive drugs (OR 9.1; P=0.067, n.s.). CONCLUSION: Ambulatory SBP levels <130 mmHg and lower nighttime SBP and DBP were associated with lower cognitive function in healthy elderly men. Further investigation is needed to ascertain the effects of the presently recommended treatment goal of <140 mmHg for office SBP also on elderly over 80 years of age.
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| 4. |
- Bronge, William, et al.
(författare)
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Epidemiology and functional impact of early peripheral neuropathy signs in older adults from a general population
- 2024
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Ingår i: Gerontology. - 1423-0003. ; 70:3, s. 257-268
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Peripheral neuropathy (PN) becomes more common with increasing life expectancy, but general population prevalence estimates are lacking. We investigated an epidemiological distribution of signs of PN among 2,996 community-dwelling participants in Good Aging in Skåne Study, age 60–97, and their impact on physical and autonomic function. Methods: Signs of PN were measured with Utah Early Neuropathy Scale (UENS). Associations between UENS and physical tests, pain, and dysautonomic phenomena were calculated for each sex, adjusted for age, with estimated marginal means (EMM) and odds ratios (ORs) in four UENS quantiles (Q1–Q4). Results: Participants in Q4 had worse EMM for: time to complete Timed Up and Go test (Q4–Q1: male 10.8–9.6 s; female 11.7–10.2 s), 15 m Walk test (Q4–Q1: male 11.1–9.9 s; female 11.2–10.4 s), and fewer repetitions in Step test (Q4–Q1: male 15.2–17.0 steps; female 14.5–15.8 steps). Higher OR of failing one-leg balance 60 s test {male 2.5 (confidence interval [CI] 95%: 1.7–3.8); female 2.1 (1.1–3.2)}, Foam Pad Balance test (male 4.6 [CI 95%: 3.2–6.7]; female 1.8 [1.3–2.6]), and lower physical quality of life were seen in Q4 compared to Q1. Participants in Q4 had higher OR for walking aid usage, falls, fear of falling, pain, and urinary incontinence, while in males, higher OR for orthostatic intolerance, fecal incontinence, and constipation. Conclusions: In a general population, 20–25% of older adults who have highest UENS scores, a sensitive measure of early PN, express slower gait, worse balance, lower quality of life, pain, falls and fear of falling, and autonomic symptoms.
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| 5. |
- Ellström, Katarina, et al.
(författare)
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Associations of carotid artery flow parameters with MRI markers of cerebral small vessel disease and patterns of brain atrophy
- 2023
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Ingår i: Journal of Stroke & Cerebrovascular Diseases. - : Elsevier BV. - 1532-8511 .- 1052-3057. ; 32:3
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: A growing body of evidence links age related brain pathologies to systemic vascular processes. We aimed to study the prevalence and interrelations between magnetic resonance imaging (MRI) markers of cerebral small vessel disease and patterns of brain atrophy, and their association to carotid duplex ultrasound flow parameters.MATERIALS AND METHODS: We investigated a population based randomised cohort of older adults (n=391) aged 70-87, part of the Swedish Good Aging in Skåne Study. Peak systolic and end diastolic velocities of the carotid arteries were measured by ultrasound, and resistivity- and pulsatility indexes were calculated. Subjects with increased peak systolic velocity indicating carotid stenosis were excluded from analysis. Nine MRI findings were rated by visual scales: white matter changes, pontine white matter changes, microbleeds, lacunar infarctions, medial temporal lobe atrophy, global cortical atrophy, parietal atrophy, precuneus atrophy and central atrophy.RESULTS: MRI pathologies were found in 80% of subjects. Mean end diastolic velocity in common carotid arteries was inversely associated with white matter hyperintensities (OR=0.92; p=0.004), parietal lobe atrophy (OR=0.94; p=0.039), global cortical atrophy (OR=0.90; p=0.013), precuneus atrophy (OR=0.94; p=0.022), "number of CSV pathologies" (β=-0.07; p<0.001) and "MRI-burden score" (β=-0.11; p<0.001), after adjustment for age and sex. The latter three were also associated with pulsatility and resistivity indexes.CONCLUSIONS: Low carotid end diastolic velocity, as well as increased carotid resistivity and pulsatility, were associated with signs of cerebral small vessel disease and patterns of brain atrophy, indicating a vascular component in the process of brain aging.
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| 6. |
- Elmståhl, Sölve, et al.
(författare)
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A study of regional cerebral blood flow using 99mTc-HMPAO-SPECT in elderly women with senile dementia of alzheimer’s type
- 1994
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Ingår i: Dementia and Geriatric Cognitive Disorders. - : S. Karger AG. - 1420-8008 .- 1421-9824. ; 5:6, s. 302-309
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Tidskriftsartikel (refereegranskat)abstract
- Thirteen women with senile dementia of Alzheimer’s type (SDAT) according to NINCDS-ADRDA and 21 age-matched control women, aged 75-96 years, were investigated with clinical examination, dementia rating scales and single photon emission computed tomography (SPECT) using99mTc-hexamethylpropyleneamine oxime (HM-PAO) as a tracer of regional cortical blood flow. The aim was to study whether typical SPECT findings of SDAT were seen also in the very old having the disease for a longer period. Neuropsychological assessment with vocabulary and spatial tests was performed in the control women, and the results were divided in three subgroups, normal, borderline and abnormal. Regional perfusion values, expressed as a ratio between cortical and cerebellar HM-PAO uptake, were lower in frontal, temporoparietal and occipital cortices in SDAT patients than in controls. The SDAT patients had the lowest uptake in the posterior temporoparietal region (0.67 ± 0.06) and the corresponding value in the controls (0.79 ± 0.05) differed significantly, p < 0.0001. The interhemispheric ratio between right and left posterior temporoparietal regions was 0.99 ± 0.05. Nine of the control women (43%) had pathological SPECT with hemispheric asymmetries in 6 cases and bilateral temporooccipital reductions in 3 women. The neuropsychological assessment matched the findings in 7 of these women. One of the control women was judged as pathological and 10 women as borderline according to the spatial and vocabulary tests. Four of the 10 women with borderline results had normal SPECT. The sensitivity of the assessment to detect abnormalities compared to SPECT was 78% if borderline and abnormal results were expressed as true-positive cases. The specificity was 67%. The results showed a high degree of pathological findings according to SPECT and neuropsychological assessment in otherwise healthy elderly women.
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| 7. |
- Elmståhl, Sölve, et al.
(författare)
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Association between cerebral microbleeds and hypertension in the Swedish general population “Good Aging in Skåne” study
- 2019
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Ingår i: Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 21:8, s. 1099-1107
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Tidskriftsartikel (refereegranskat)abstract
- Cerebral microbleeds (CMB) on MRI are frequent in healthy aging individuals but precede ischemic and hemorrhagic stroke and dementia. Different etiologies have been suggested for nonlobar CMB, which have a stronger connection to hypertension (HT) than do lobar CMB. This study aimed to investigate the prevalence of CMB and the association between nonlobar/lobar CMB and different blood pressure (BP) and HT treatment conditions in a longitudinal, population-based cohort of the Good Aging in Skåne (GÅS) study. White matter hyperintensities (WMH), CMB, atrophies, and infarctions were identified with brain 3T MRI, and BP parameters were examined in 344 randomly selected subjects between 70 and 87 years old. CMB were observed in 26% of the whole cohort, increasing from 19% of subjects in their 70s to 30% of those over 80 years of age. Of these subjects, 38% had multiple CMB, and 59% had a lobar localization. CMB were associated with severe confluent WMH (odds ratio = 7.02; 2.16-18.84). Increasing age, being male, and having HT, impaired cognition, or a history of angina pectoris were associated with CMB. Both lobar and nonlobar CMB were associated with HT. Nonlobar CMB were particularly associated with increased BP, pulse pressure, controlled HT, and uncontrolled HT. After controlling for sex and HT, age was no longer a risk factor for CMB In conclusion, sex and HT are the major risk factors for CMB, especially nonlobar CMB, which suggests stricter implementation of recommended guidelines for HT treatment in the elderly.
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| 8. |
- Elmståhl, Sölve, et al.
(författare)
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Incidence of cerebral small vessel disease-related MR markers in the Swedish general population 'Good Aging in Skåne'(GÅS) study
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Ingår i: Journal of Neurology. - 1432-1459.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVES: Cerebral small vessel disease (CSVD) is associated to cognitive decline and dementia. Neuroimaging changes of CSVD are highly prevalent above 80 years. Only few studies report on incidence of CSVD in high age. We have investigated the incidence and prevalence of magnetic resonance imaging (MRI) markers of CSVD and risk factors in the general older population.METHODS: As part of the general population Good Aging in Skåne cohort study (GÅS), 241 persons (mean age 76.3 years) underwent two brain MRI, 3-T scanner with a mean interval of 5.9 years. The incidence of white matter hyperintensities (WMH), lacunar infarction, cerebral atrophies and cerebral microbleeds (CMB) were calculated and the relationship to risk factors analysed by a multivariate regression analysis. Medial temporal lobe atrophy (MTA) was graded according to Scheltens'18 scale and CMB were defined as having > 1 small (0.2-0.5 cm) hypointense lesion.RESULTS: The 6-year incidence of CMB, WMH and MTA were, 19%, 17% and 13% respectively, corresponding to 170/1,000 py., 172/1,000 py., and respectively 167/1,000 py. The incidence of CSVD according to the modified STRIVE score was 33%, 169/1,000 py and the prevalence at baseline was 73%. Moderate to high intake of alcohol was related to increased incidence of MTA and higher STRIVE score. Exposure to smoking was related to higher incidence of CMB and higher STRIVE score, adjusted for other known risk factors.CONCLUSION: CSVD is highly prevalent in the general older population and the 6-year incidence of WMH, CMB and MTA ranges from 13 to 19 percent. The modifiable lifestyle factors: smoking, and moderate alcohol intake are related to incident CSVD.
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| 9. |
- Furuäng, Linda, et al.
(författare)
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Cardiac ventricular dimensions predict cognitive decline and cerebral blood flow abnormalities in aging men.
- 2013
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 13:May,15
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Tidskriftsartikel (refereegranskat)abstract
- The aims of this study are to examine possible associations between left cardiac ventricular measures in sixth decade and cognitive performance, both cross sectionally and longitudinally, and to examine if left cardiac ventricular measures could predict future changes in cerebral blood flow (CBF).
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| 10. |
- Furuäng, Linda, et al.
(författare)
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Reduced cerebral perfusion in elderly men with silent myocardial ischaemia and nocturnal blood pressure dipping
- 2011
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Ingår i: Atherosclerosis. - : Elsevier BV. - 1879-1484 .- 0021-9150. ; 214:1, s. 231-236
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Knowledge about the impact of cardiovascular disease on cerebral autoregulation and cognition in aging is sparse. The aim of our study is to examine the association between cerebral blood flow (CBF), silent ST segment depression (STDE) on ambulatory ECG (LTER) and nocturnal blood pressure variations in elderly men. METHODS: In a cross-sectional cohort study "Men born in 1914", eighty 83-year-old men were examined by CBF, LTER and ambulatory blood pressure monitoring (ABPM). The presence and the degree of STDE were analyzed in relation to regional CBF in nocturnal blood pressure dippers/non-dippers. RESULTS: Fourty-five (56%) study subjects had STDE, 25 at both day and night and 20 only daytime. Subjects with STDE expressed lower CBF in left frontal, temporal, inferior parietal regions and bilateral superior parietal regions compared to men without STDE. Low regional CBF was most frequent in subjects with daytime STDE. Subjects with nocturnal diastolic blood pressure dip and STDE (22 subjects; 35%) had lower mean CBF in the parietal lobe and also correlation between STDE and CBF (r=0.31-0.44, p=0.056-0.006) compared to non-dippers with STDE. The lowest CBF in nocturnal dippers was observed in subjects with maximal STDE daytime. CONCLUSION: Silent myocardial ischemia may contribute to cerebrovascular disease in non-demented elderly men. Cerebral perfusion seems to be most vulnerable to myocardial ischemia in elderly with nocturnal blood pressure dipping.
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