| 1. |
- Imtiaz, Bushra, et al.
(författare)
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Oophorectomy, Hysterectomy, and Risk of Alzheimer's Disease : A Nationwide Case-Control Study
- 2014
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 42:2, s. 575-581
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Tidskriftsartikel (refereegranskat)abstract
- Background: Association between oophorectomy and/or hysterectomy and dementia in context of hormone therapy (HT) use is ambiguous. Objective: To assess whether oophorectomy, hysterectomy, and hysterectomy with bilateral oophorectomy are related to risk of Alzheimer's disease (AD), whether the possible indication for surgery plays a role, and if the associations are modified by HT. Methods: Our nationwide register based case-control (1 : 1) study included all women with clinically-verified AD diagnoses, residing in Finland on December 31, 2005 (n of cases = 19,043, n of controls = 19,043). AD cases, diagnosed according to NINCS-ADRDA and the DSM-IV criteria, were identified from Special Reimbursement Register. Information on HT use was collected from national prescription register, and data on surgery and uterine/ovarian/cervical cancer were obtained from the hospital discharge register. Most of the women (91.8%) were over 51 years of age when the surgery was performed. Results: Oophorectomy, hysterectomy, and hysterectomy with bilateral oophorectomy were associated with lower risk of AD (OR/95% CI: 0.85/0.75-0.97, 0.89/0.81-0.97 and 0.85/0.75-0.98, respectively) among women without the history of uterine/ovarian/cervical cancer, although the absolute risk difference was small. The association was not evident in women with uterine/ovarian/cervical cancer history (3.00 /0.20-44.87 for all surgeries). The associations were not modified by HT use, which was independently associated with AD risk, with longer use showing protective association. Conclusion: Our findings indicate that oophorectomy with or without hysterectomy after commencement of natural menopause is not an important determinant of AD risk in older age and support the critical window hypothesis for HT use.
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| 2. |
- Koponen, Marjaana, et al.
(författare)
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Incidence of antipsychotic use in relation to diagnosis of Alzheimer's disease among community-dwelling persons
- 2015
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Ingår i: British Journal of Psychiatry. - : Royal College of Psychiatrists. - 0007-1250 .- 1472-1465. ; 207:5, s. 444-449
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Tidskriftsartikel (refereegranskat)abstract
- Background Behavioural and psychological symptoms of dementia are frequently treated with antipsychotics. Aims To determine the incidence of antipsychotic use in relation to diagnosis of Alzheimer's disease. Method Cohort of all community-dwellers in Finland diagnosed with Alzheimer's disease in 2005 and matched controls. All antipsychotics dispensed between 1995 and 2009 were extracted from the Finnish National Prescription Register. Results Altogether 1996/6087 (32.8%) persons with Alzheimer's disease initiated antipsychotic use. The incidence of antipsychotic use was fivefold among persons with Alzheimer's disease compared with controls, started to increase 2-3 years before diagnosis and was highest during the first 6 months after diagnosis. Conclusions A distinct increase in antipsychotic initiations occurs in the same time window as Alzheimer's disease diagnosis.
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| 3. |
- Liau, Shin J., et al.
(författare)
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Medication Management in Frail Older People : Consensus Principles for Clinical Practice, Research, and Education
- 2021
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 22:1, s. 43-49
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Tidskriftsartikel (refereegranskat)abstract
- Frailty is a geriatric condition associated with increased vulnerability to adverse drug events and medication-related harm. Existing clinical practice guidelines rarely provide medication management recommendations specific to frail older people. This report presents international consensus principles, generated by the Optimizing Geriatric Pharmacotherapy through Pharmacoepidemiology Network, related to medication management in frail older people. This consensus comprises 7 principles for clinical practice, 6 principles for research, and 4 principles for education. Principles for clinical practice include (1) perform medication reconciliation and maintain an up-to-date medication list; (2) assess and plan based on individual's capacity to self-manage medications; (3) ensure appropriate prescribing and deprescribing; (4) simplify medication regimens when appropriate to reduce unnecessary burden; (5) be alert to the contribution of medications to geriatric syndromes; (6) regularly review medication regimens to align with changing goals of care; and (7) facilitate multidisciplinary communication among patients, caregivers, and healthcare teams. Principles for research include (1) include frail older people in randomized controlled trials; (2) consider frailty status as an effect modifier; (3) ensure collection and reporting of outcome measures important in frailty; (4) assess impact of frailty on pharmacokinetics and pharmacodynamics; (5) encourage frailty research in under-researched settings; and (6) utilize routinely collected linked health data. Principles for education include (1) provide undergraduate and post-graduate education on frailty; (2) minimize low-value care related to medication management; (3) improve health and medication literacy; and (4) incorporate evidence in relation to frailty into clinical practice guidelines. These principles for clinical practice, research and education highlight different considerations for optimizing medication management in frail older people. These principles can be used in conjunction with existing best practice guidelines to help achieve optimal health outcomes for this vulnerable population. Implementation of the principles will require multidisciplinary collaboration between healthcare professionals, researchers, educators, organizational leaders, and policymakers.
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| 4. |
- Tolppanen, Anna-Maija, et al.
(författare)
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History of Medically Treated Diabetes and Risk of Alzheimer Disease in a Nationwide Case-Control Study
- 2013
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 36:7, s. 2015-2019
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE-Type 2 diabetes in midlife or late life increases the risk of Alzheimer disease (AD), and type 1 diabetes has been associated with a higher risk of detrimental cognitive outcomes, although studies from older adults are lacking. We investigated whether individuals with AD were more likely to have a history of diabetes than matched controls from the general aged population. RESEARCH DESIGN AND METHODS-Information on reimbursed diabetes medication (including both type 1 and 2 diabetes) of all Finnish individuals with reimbursed AD medication in 2005 (n = 28,093) and their AD-free control subjects during 1972-2005 was obtained from a special reimbursement register maintained by the Social Insurance Institute of Finland. RESULTS-The prevalence of diabetes was 11.4% in the whole study population, 10.7% (n = 3,012) among control subjects, and 12.0% (n = 3,372) among AD case subjects. People with AD were more likely to have diabetes than matched control subjects (unadjusted OR 1.14 [95% CI 1.08-1.20]), even after adjusting for cardiovascular diseases (OR 1.31 [1.22-1.41]). The associations were stronger with diabetes diagnosed at midlife (adjusted OR 1.60 [1.34-1.84] and 1.25 [1.16-1.36] for midlife and late-life diabetes, respectively). CONCLUSIONS-Individuals with clinically verified AD are more likely to have a history of clinically verified and medically treated diabetes than the general aged population, although the difference is small.
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| 5. |
- Tolppanen, Anna-Maija, et al.
(författare)
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Incidence of stroke in people with Alzheimer disease : a national register-based approach
- 2013
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Ingår i: Neurology. - 0028-3878 .- 1526-632X. ; 80:4, s. 353-358
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Stroke increases the risk of dementias, including Alzheimer disease (AD), but it is unknown whether persons with AD have a higher risk of strokes. We investigated whether noninstitutionalized persons with AD were more likely to experience incident stroke than persons without AD and whether there are differences in the incidence of ischemic or hemorrhagic strokes.Methods: We performed a register-based matched cohort study including all community-dwelling persons with verified clinical diagnosis of AD, residing in Finland on December 31, 2005, and a single age-, sex-, and region of residence–matched comparison person without AD for each individual with AD (n = 56,186, mean age 79.6 [SD 6.9] years). Persons with previous strokes and their matched participants were excluded, leaving 50,808 individuals with 2,947 incident strokes occurring between January 1, 2006, and December 31, 2009. Diagnosis of AD was based on prescription reimbursement register and diagnosis of stroke on hospital discharge register of Finland.Results: AD dementia was not associated with risk of all strokes or ischemic strokes, but the risk of hemorrhagic strokes was higher among persons with AD (adjusted hazard ratio [95% confidence interval] 1.34 [1.12–1.61]). When the associations were analyzed according to age groups, AD was associated with higher risk of all strokes, regardless of etiology, in the 2 youngest age groups, but not in the older groups. Similar associations were observed when the results were categorized according to age at diagnosis.Conclusions: Our findings suggest that persons with AD dementia, especially younger patients, have higher risk of hemorrhagic strokes.
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