| 1. |
- Johansson, Lena, 1972, et al.
(författare)
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Common psychosocial stressors in middle-aged women related to longstanding distress and increased risk of Alzheimer’s disease: a 38 year longitudinal population study
- 2013
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 3:9
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the relation among psychosocial stressors, long-standing distress and incidence of dementia, in a sample of women followed from midlife to late life. DESIGN: Prospective longitudinal population study. SETTING: The analyses originate from the prospective population study of women in Gothenburg, Sweden, a representative sample of women examined in 1968 (participation rate 90%) and re-examined in 1974, 1980, 1992, 2000 and 2005. PARTICIPANTS: 800 women born in 1914, 1918, 1922 and 1930 who were systematically selected for a psychiatric examination at baseline, in 1968. PRIMARY AND SECONDARY OUTCOME MEASURES: 18 psychosocial stressors (eg, divorce, widowhood, work problems and illness in relative) were obtained at baseline. Symptoms of distress were measured according to a standardised question at each study wave. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data, and measured through the whole study period. RESULTS: During the 37 years of follow-up, 153 women developed dementia (104 of those had Alzheimer's disease (AD)). Number of psychosocial stressors in 1968 was associated (HR, 95% CI) with higher incidence of dementia (1.15, 1.04 to 1.27) and AD (1.20, 1.07 to 1.35) between 1968 and 2005, in multivariate Cox regressions. Number of psychosocial stressors in 1968 was also associated (OR, 95% CI) with distress in 1968 (1.48, 1.32 to 1.67), 1974 (1.31, 1.17 to 1.46), 1980 (1.27, 1.11 to 1.45), 2000 (1.39, 1.14 to 1.70) and 2005 (1.35, 1.02 to 1.79), in multivariate logistic regressions. Number of psychosocial stressors (HR 1.17, 95% CI 1.03 to 1.33) and long-standing distress (1968-1974-1980) (HR 1.58, 95% CI 1.03 to 2.45) were independently associated with AD. CONCLUSIONS: Our study shows that common psychosocial stressors may have severe and long-standing physiological and psychological consequences. However, more studies are needed to confirm these results and investigate whether more interventions such as stress management and behavioural therapy should be initiated in individuals who have experienced psychosocial stressors.
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| 2. |
- Johansson, Lena, 1972, et al.
(författare)
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Midlife personality and risk of Alzheimer disease and distress: A 38-year follow-up.
- 2014
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Ingår i: Neurology. - 0028-3878 .- 1526-632X. ; 83:17, s. 1538-44
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the association between midlife neuroticism and extraversion and development of late-life dementia and long-standing distress in a sample of women followed for 38 years. METHODS: A population-based sample of 800 women, aged 38 to 54 years, was examined in 1968, with subsequent examinations in 1974, 1980, 1992, 2000, and 2005. Neuroticism and extraversion were assessed using the Eysenck Personality Inventory at baseline. Distress was measured according to a standardized question at each study wave. Dementia was diagnosed according to DSM-III-R criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. RESULTS: During the 38-year follow-up, 153 women developed dementia; Alzheimer disease (AD) dementia was diagnosed in 104 of these. A higher degree of neuroticism in midlife was associated with increased risk of AD dementia and long-standing distress over 38 years. The association between neuroticism and AD dementia diminished after adjusting for long-standing distress. Extraversion was associated with a lower degree of long-standing distress, but had no impact on AD dementia. When the 2 personality dimensions were combined, high neuroticism/low extraversion showed the highest risk of AD dementia. CONCLUSIONS: Our study suggests that midlife neuroticism is associated with increased risk of AD dementia, and that distress mediates this association. The results have clinical implications because a group of women at risk of AD dementia is identified.
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| 3. |
- Johansson, Lena, 1972, et al.
(författare)
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Midlife Psychological Distress Associated With Late-Life Brain Atrophy and White Matter Lesions: A 32-Year Population Study of Women.
- 2012
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Ingår i: Psychosomatic medicine. - 0033-3174. ; 74:2, s. 120-125
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Tidskriftsartikel (refereegranskat)abstract
- Long-standing psychological distress increases the risk of dementia, especially Alzheimer's disease. The present study examines the relationship between midlife psychological distress and late-life brain atrophy and white matter lesions (WMLs), which are common findings on neuroimaging in elderly subjects. A population-based sample of 1462 women, aged 38 to 60 years, was examined in 1968, with subsequent examinations in 1974, 1980, 1992, and 2000. Computed tomography (CT) of the brain was done in 379 survivors in 2000, and of those, 344 had responded to a standardized question about psychological distress in 1968, 1974, and 1980. WMLs, cortical atrophy, and central atrophy (ventricular sizes) were measured at CT scans. Compared with women reporting no distress, those reporting frequent or constant distress at one examination or more (in 1968, 1974, and 1980) more often had moderate-to-severe WMLs (multiadjusted odds ratio = 2.39, 95% confidence interval = 1.16-4.92) and moderate-to-severe temporal lobe atrophy (multiadjusted odds ratio = 2.51, 95% confidence interval = 1.04-6.05) on brain CT in 2000. Frequent/constant distress was also associated with central brain atrophy, that is, higher bicaudate ratio, higher cella media ratio, and larger third-ventricle width. Long-standing psychological distress in midlife increases risks of cerebral atrophy and WMLs on CT in late life. More studies are needed to confirm these findings and to determine potential neurobiological mechanisms of these associations.
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| 4. |
- Johansson, Lena, 1972, et al.
(författare)
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Midlife psychological stress and risk of dementia: a 35-year longitudinal population study.
- 2010
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Ingår i: Brain : a journal of neurology. - : Oxford University Press (OUP). - 1460-2156. ; 133:8, s. 2217-2224
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Tidskriftsartikel (refereegranskat)abstract
- The number of people with dementia has increased dramatically with global ageing. Nevertheless, the pathogeneses of these diseases are not sufficiently understood. The present study aims to analyse the relationship between psychological stress in midlife and the development of dementia in late-life. A representative sample of females (n = 1462) aged 38-60 years were examined in 1968-69 and re-examined in 1974-75, 1980-81, 1992-93 and 2000-03. Psychological stress was rated according to a standardized question in 1968, 1974 and 1980. Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders criteria based on information from neuropsychiatric examinations, informant interviews, hospital records and registry data. During the 35-year follow-up, 161 females developed dementia (105 Alzheimer's disease, 40 vascular dementia and 16 other dementias). We found that the risk of dementia (hazard ratios, 95% confidence intervals) was increased in females reporting frequent/constant stress in 1968 (1.60, 1.10-2.34), in 1974 (1.65, 1.12-2.41) and in 1980 (1.60, 1.01-2.52). Frequent/constant stress reported in 1968 and 1974 was associated with Alzheimer's disease. Reporting stress at one, two or three examinations was related to a sequentially higher dementia risk. Compared to females reporting no stress, hazard ratios (95% confidence intervals) for incident dementia were 1.10 (0.71-1.71) for females reporting frequent/constant stress at one examination, 1.73 (1.01-2.95) for those reporting stress at two examinations and 2.51 (1.33-4.77) at three examinations. To conclude, we found an association between psychological stress in middle-aged women and development of dementia, especially Alzheimer's disease. More studies are needed to confirm our findings and to study potential neurobiological mechanisms of these associations.
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| 5. |
- Bäckman, Kristoffer, 1979, et al.
(författare)
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37 years of body mass index and dementia: observations from the prospective population study of women in Gothenburg, Sweden.
- 2012
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Ingår i: Journal of Alzheimer's disease : JAD. - 1875-8908. ; 28:1, s. 163-71
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Tidskriftsartikel (refereegranskat)abstract
- Level of adiposity is linked to dementia in epidemiological studies. Overweight and obesity in mid- and late-life may increase risk for dementia, whereas decline in body weight or body mass index (BMI) and underweight in years preceding and at the time of a dementia diagnosis may also relate to dementia. Longitudinal studies with sufficient follow-up are necessary to estimate trajectories that allow better understanding of the relationship between adiposity indices and dementia over the life course. We evaluated the natural history of BMI in relationship to clinical dementia over 37 years in the Prospective Population Study of Women (PPSW) in Sweden. PPSW is a systematic sample of 1462 women born 1908, 1914, 1918, 1922, and 1930 and aged 38-60 years at baseline. Examinations occurred in 1968, 1974, 1980, 1992, 2000, and 2005. Statistical analyses were conducted using mixed effects regression models. Trajectories of BMI over 37 years as a function of age differed between women who did versus did not develop dementia. Women developing dementia evidenced a lesser increase in BMI from age 38 to 70 years. After age 70, the BMI slope decreased similarly (no "accelerated decline") irrespective of dementia status. A lower BMI before and during dementia onset was observed. Women with similar BMI at mid-life exhibited a different pattern of BMI change as they approached late-life that was related to dementia onset. BMI may be a potential marker of dementia-related neuropathologies in the brain. Dementia is related to a common risk factor, BMI, from mid-to late-life.
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| 6. |
- Gustafson, Deborah, 1966, et al.
(författare)
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Leptin and dementia over 32 years-The Prospective Population Study of Women
- 2012
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Ingår i: Alzheimers & Dementia. - : Wiley. - 1552-5260 .- 1552-5279. ; 8:4, s. 272-277
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Tidskriftsartikel (refereegranskat)abstract
- Background: We have shown that high mid-life central adiposity may increase the risk for dementia after 32 years. Leptin, an adipose tissue hormone, is correlated with adiposity measures and may contribute to a better etiological understanding of the relationship between high adiposity and dementia. We explored the relationship between serum leptin in mid-life and dementia, which is a late-life outcome. Methods: A longitudinal cohort study, the Prospective Population Study of Women, in Gothenburg, Sweden, includes a representative sample of 1462 women followed from mid-life ages of 38 to 60 years to late-life ages of 70 to 92 years. Women were examined in 1968, 1974, 1980, 1992, and 2000 using neuropsychiatric, anthropometric, clinical, and other measurements. Serum leptin was measured on samples collected at the 1968 baseline examination, after storage at -20 degrees C for 29 years. Cox proportional hazards regression models estimated incident dementia risk by baseline leptin. Logistic regression models related leptin levels to dementia among surviving participants 32 years later. All models were adjusted for multiple potential confounders. Results: Mid-life leptin was not related to dementia risk using Cox or logistic regression models. This was observed despite positive baseline correlations between leptin and adiposity measures, and given our previous report of high mid-life waist-to-hip ratio being related to a twofold higher dementia risk. Conclusions: Leptin is not a mid-life marker of late-life dementia risk in this population sample of Swedish women born between 1908 and 1930. (C) 2012 The Alzheimer's Association. All rights reserved.
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| 7. |
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| 8. |
- Joas, Erik, 1983, et al.
(författare)
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Blood Pressure Trajectories From Midlife to Late Life in Relation to Dementia in Women Followed for 37 Years
- 2012
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Ingår i: Hypertension. - 0194-911X .- 1524-4563. ; 59:4, s. 796-801
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Tidskriftsartikel (refereegranskat)abstract
- Abstract. Higher midlife blood pressure increases risk for dementia. To further understand the relation between blood pressure and dementia, it is necessary to examine evolution of blood pressure from midlife to late life. We examined blood pressure trajectories using linear mixed models in a representative sample of middle aged women (N1462) who were followed from 1968–1969 until 2005–2006 with comprehensive medical and neuropsychiatric examinations. Dementia was diagnosed according to established criteria. Among those not treated with antihypertensives, higher systolic blood pressure at baseline but not blood pressure trajectories from 1968 to 1992 was associated with dementia and Alzheimer disease. Those with history of antihypertensive treatment had higher baseline systolic blood pressure than those who were never treated. In this group, those who developed dementia and Alzheimer disease had lower baseline systolic blood pressure and steeper increase in systolic blood pressure from 1968 to 1992 than those who did not. A steeper decline in systolic blood pressure during the later part of the study was observed in those who developed dementia regardless of antihypertensive treatment. The latter association was attenuated or disappeared when adjusting for body mass index. The association between blood pressure and dementia is complex and influenced by antihypertensive treatment. The findings emphasize the importance of detecting increased blood pressure in midlife and controlling blood pressure in those treated. Whether the trajectory of blood pressure is a risk factor or part of the clinical course of dementia needs to be elucidated.
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| 9. |
- Lak, Vincent Wai-Ming, et al.
(författare)
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Secular trends in lung function and its relation to survival in Swedish 75 year olds 1976-2006
- 2012
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Ingår i: Age and Ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 41:6, s. 735-740
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Tidskriftsartikel (refereegranskat)abstract
- Background: several studies have found that lung function correlates with survival in older people. We examined secular trends in lung function and its relation to survival in Swedish 75 year olds. Method: representative samples from the general population in Gothenburg, Sweden, were examined at the age of 75 in 1976-77 (n = 743) and 2005-06 (n = 765) with comprehensive somatic and psychiatric examinations. Lung function was measured as peak expiratory flow (PEF). Results: the mean PEF was higher in 75 year olds examined 2005-06 compared with those examined 1976-77 both among women (339 versus 307 l/min; P < 0.001) and men (490 versus 400 l/min, P < 0.001). The birth cohort effect was still significant after adjusting for a number of confounders. PEF correlated with survival between age 75 and 78 years among those examined in 1976-77 both in women (OR per 10 l/min increase in PEF = 1.112, 95% CI: 1.047-1.182) and in men (OR = 1.040, 95% CI: 1.015-1.066), but not in those examined 2005-06 (women: OR = 1.071, 95% CI: 0.965-1.188; men: OR = 1.000, 95% CI: 0.957-1.046). Conclusion: we found better lung function in the later-born cohort of 75 year olds, which was only partially explained by changes in smoking, height and weight, physical activity, socio-economic/educational factors and pulmonary/cardiovascular morbidity. The association between better lung function and short-term survival was strong in 1976-77, but had disappeared in 2005-06. More studies are needed to elucidate the role of lung function for long-term survival and identify other factors that explain the secular trends in lung function.
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| 10. |
- Mielke, Michelle M., et al.
(författare)
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The 32-year relationship between cholesterol and dementia from midlife to late life.
- 2010
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Ingår i: Neurology. - 0028-3878. ; 75:21, s. 1888-95
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cellular and animal studies suggest that hypercholesterolemia contributes to Alzheimer disease (AD). However, the relationship between cholesterol and dementia at the population level is less clear and may vary over the lifespan. Methods: The Prospective Population Study of Women, consisting of 1,462 women without dementia aged 38–60 years, was initiated in 1968–1969 in Gothenburg, Sweden. Follow-ups were conducted in 1974–1975, 1980–1981, 1992–1993, and 2000–2001. All-cause dementia was diagnosed according to DSM-III-R criteria and AD according to National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer's Disease and Related Disorders Association criteria. Cox proportional hazards regression examined baseline, time-dependent, and change in cholesterol levels in relation to incident dementia and AD among all participants. Analyses were repeated among participants who survived to the age of 70 years or older and participated in the 2000–2001 examination. Results: Higher cholesterol level in 1968 was not associated with an increased risk of AD (highest vs lowest quartile: hazard ratio [HR] 2.82, 95% confidence interval [CI] 0.94–8.43) among those who survived to and participated in the 2000–2001 examination. While there was no association between cholesterol level and dementia when considering all participants over 32 years, a time-dependent decrease in cholesterol over the follow-up was associated with an increased risk of dementia (HR 2.35, 95% CI 1.22–4.58). Conclusion: These data suggest that midlife cholesterol level is not associated with an increased risk of AD. However, there may be a slight risk among those surviving to an age at risk for dementia. Declining cholesterol levels from midlife to late life may better predict AD risk than levels obtained at one timepoint prior to dementia onset. Analytic strategies examining this and other risk factors across the lifespan may affect interpretation of results.
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