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- Hoogendijk, Emiel O., et al.
(författare)
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Gait speed as predictor of transition into cognitive impairment: Findings from three longitudinal studies on aging
- 2020
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Ingår i: Experimental Gerontology. - : Elsevier BV. - 0531-5565 .- 1873-6815. ; 129
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Tidskriftsartikel (refereegranskat)abstract
- © 2019 The Authors Objectives: Very few studies looking at slow gait speed as early marker of cognitive decline investigated the competing risk of death. The current study examines associations between slow gait speed and transitions between cognitive states and death in later life. Methods: We performed a coordinated analysis of three longitudinal studies with 9 to 25 years of follow-up. Data were used from older adults participating in H70 (Sweden; n = 441; aged ≥70 years), InCHIANTI (Italy; n = 955; aged ≥65 years), and LASA (the Netherlands; n = 2824; aged ≥55 years). Cognitive states were distinguished using the Mini-Mental State Examination. Slow gait speed was defined as the lowest sex-specific quintile at baseline. Multistate models were performed, adjusted for age, sex and education. Results: Most effect estimates pointed in the same direction, with slow gait speed predicting forward transitions. In two cohort studies, slow gait speed predicted transitioning from mild to severe cognitive impairment (InCHIANTI: HR = 2.08, 95%CI = 1.40–3.07; LASA: HR = 1.33, 95%CI = 1.01–1.75) and transitioning from a cognitively healthy state to death (H70: HR = 3.30, 95%CI = 1.74–6.28; LASA: HR = 1.70, 95%CI = 1.30–2.21). Conclusions: Screening for slow gait speed may be useful for identifying older adults at risk of adverse outcomes such as cognitive decline and death. However, once in the stage of more advanced cognitive impairment, slow gait speed does not seem to predict transitioning to death anymore.
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| 2. |
- Peters, Ruth, et al.
(författare)
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An investigation of antihypertensive class, dementia, and cognitive decline: A meta-analysis.
- 2020
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Ingår i: Neurology. - 1526-632X. ; 94:3
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Tidskriftsartikel (refereegranskat)abstract
- High blood pressure is one of the main modifiable risk factors for dementia. However, there is conflicting evidence regarding the best antihypertensive class for optimizing cognition. Our objective was to determine whether any particular antihypertensive class was associated with a reduced risk of cognitive decline or dementia using comprehensive meta-analysis including reanalysis of original participant data.To identify suitable studies, MEDLINE, Embase, and PsycINFO and preexisting study consortia were searched from inception to December 2017. Authors of prospective longitudinal human studies or trials of antihypertensives were contacted for data sharing and collaboration. Outcome measures were incident dementia or incident cognitive decline (classified using the reliable change index method). Data were separated into mid and late-life (>65 years) and each antihypertensive class was compared to no treatment and to treatment with other antihypertensives. Meta-analysis was used to synthesize data.Over 50,000 participants from 27 studies were included. Among those aged >65 years, with the exception of diuretics, we found no relationship by class with incident cognitive decline or dementia. Diuretic use was suggestive of benefit in some analyses but results were not consistent across follow-up time, comparator group, and outcome. Limited data precluded meaningful analyses in those ≤65 years of age.Our findings, drawn from the current evidence base, support clinical freedom in the selection of antihypertensive regimens to achieve blood pressure goals.The review was registered with the international prospective register of systematic reviews (PROSPERO), registration number CRD42016045454.
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| 3. |
- Skoog, Johan, 1985
(författare)
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Sleep and cognition in old age: Birth cohort differences, dementia, and biomarkers of Alzheimer´s disease
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The focus for this thesis is on two major determinants of health and wellbeing in older people, namely subjective sleep disturbance and cognition. Data were drawn from the H70 Birth Cohort Studies, comprising representative samples of older people living in Gothenburg, Sweden. In Study I, we examined birth cohort differences regarding prevalence of insomnia (i.e., difficulties initiating sleep, maintaining sleep, and early morning awakenings) in two cohorts of 70-year-olds born three decades apart and followed over nine years. The later-born cohort showed lower prevalence ofinsomnia atage 70 compared with theearlier-born cohort. However, the prevalence of insomnia increased with age in the later-born but was stable in the earlier-born cohort. In Study II, we investigated cognitive status and change measured by the Mini-Mental State Examination (MMSE) among 97-year-olds followed over three years. We found that MMSE scores at baseline were related to dementia at baseline, but not to development of dementia during follow-up. Those who died during the three-year follow-up had lower MMSE scores than those who survived. Furthermore, participants with more education had higher MMSE scores, but there was no association between education and cognitive change. In Study III, which was a multicenter study, including additional samples from Stockholm and Finland, we investigated whether poor sleep in midlife and late life was associated with an elevated risk of developing dementia in late life. We found that midlife insomnia and late-life terminal insomnia (i.e., early morning awakenings) and long sleep duration were associated with a higher late-life dementia risk. In Study IV, we investigated if poor sleep was related to cerebrospinal fluid (CSF) markers of Alzheimer’s disease (AD) and if these associations were moderated by possession of the apolipoprotein (APOE) ε4 allele. We found that reduced sleep, increased sleep and taking sleep medication were associated with markers of amyloid plaque accumulation (amyloid β 42/40 ratio). However, among APOEε4-carriers, reduced sleep was also associated with markers of AD-related neurodegeneration (total tau, phosphorylated tau) and synaptic dysfunction (neurogranin). Conclusions: The main findings from the thesis imply that agerelated increases in the prevalence of insomnia are postponed to higher ages in later-born cohorts. Education can still account for individual differences in cognitive performance even at these advanced ages but might not protect against cognitive decline. Different types of sleep problems may play varying roles duringthe life courseconcerning dementia risk whereinsomnia could potentially be more important in midlife while terminal insomnia or long sleep duration may be more critical later in life. In addition, sleep may play a vital role in the early processes of AD by potentially decreasing clearance or increasing production of amyloid β. A better understanding of sleep disturbances and cognition in old age may guide clinicians in making health caredecisions andwhen designingperson-oriented interventions that improveshealth and wellbeing in future older generations.
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