| 1. |
- Aguero-Torres, H, et al.
(författare)
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Rethinking the dementia diagnoses in a population-based study : What is Alzheimer's disease and what is vascular dementia? A study from the Kungsholmen Project
- 2006
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Ingår i: Dementia and Geriatric Cognitive Disorders. - Basel : Karger. - 1420-8008 .- 1421-9824. ; 22:3, s. 244-249
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the hypothesis that older adults often are affected by more than one disease, making the differential diagnosis between Alzheimer’s disease (AD) and vascular dementia (VaD) difficult. Methods: Incident dementia cases (n = 308) from a population-based longitudinal study of people 75+ years were investigated. The DSM-III-R criteria were used for the clinical diagnosis of dementia. Data on vascular disorders (hypertension, cerebrovascular and ischemic heart diseases, heart failure, atrial fibrillation, diabetes) as well as type of onset/course of dementia were used retrospectively to reclassify dementias. Results: Only 47% of the AD cases were reclassified as pure AD without any vascular disorder. Among subjects with AD and with a vascular component, cerebrovascular disease was the most common (41%). Only 25% of VaD were reclassified as pure VaD. Further, 26% of the pure AD subjects developed a vascular disorder in the following 3 years. Conclusions: Both vascular and degenerative mechanisms may often contribute to the expression of dementia among the elderly. Most of the AD cases have vascular involvements, and pure dementia types in very old subjects constitute only a minority of dementia cases.
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| 2. |
- Fratiglioni, L, et al.
(författare)
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Epidemiology of the dementias of old age
- 2008
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Ingår i: The Oxford Textbook of Old Age Psychiatry. - Oxford : Oxford University Press. - 9780199298099 ; , s. 391-406
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 3. |
- Fratiglioni, Laura, et al.
(författare)
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Multisjuklighet och demens : Vad kan förebyggas?
- 2006
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Andelen äldre ökar i hela världen. Det återspeglar en förbättrad hälsa och en starkare samhällsekonomi. Samtidigt innebär det att allt fler drabbas av åldersrelaterade sjukdomar. Denna rapport är ett led i Statens folkhälsoinstituts arbete med att generellt öka kunskapen om vikten av förebyggande insatser bland äldre. Här belyses i vilken utsträckning multisjuklighet och demenssjukdomar kan förebyggas. Rapporten vänder sig till politiker och tjänstemän i kommuner och landsting samt företrädare för pensionärsorganisationer som arbetar med folkhälsoarbete bland äldre. Multisjuklighet är det vanligaste sjukdomspanoramat hos äldre. Kvinnor och personer med låg utbildning är mest drabbade. I dag vet man inte hur multisjuklighet kan förebyggas, men effekterna av multisjuklighet kan underlättas med mer samordnade insatser av samhället.Demens tillhör våra vanligaste folksjukdomar, men är ovanligt före 60 års ålder. Vid 95 års ålder har 50 procent av befolkningen en demenssjukdom. Demens förkortar livet och orsakar funktionellt beroende och flytt till särskilt boende. I nuläget finns det två möjliga strategier för att minska risken för demens. Vi vet att det är viktigt med god kontroll av blodtrycket både i medelåldern och vid högre åldrar. Vi vet också att det är värdefullt med ett mentalt aktivt och socialt integrerat liv i ålderdomen.Rapporten har skrivits av professor Laura Fratiglioni och docent Eva von Strauss på Aging Research Center, Karolinska Institutet, och Stiftelsen Stockholms Läns Äldrecentrum på uppdrag av Statens folkhälsoinstitut.
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| 4. |
- Fratiglioni, Laura, et al.
(författare)
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Prevention of Alzheimer's disease and dementia : Major findings from the Kungsholmen Project
- 2007
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Ingår i: Physiology and Behavior. - : Elsevier. - 0031-9384 .- 1873-507X. ; 92:1-2, s. 98-104
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Tidskriftsartikel (refereegranskat)abstract
- The aging of the population is a worldwide phenomenon, and studying age-related diseases has become a relevant issue from both a scientific and a public health perspective. This review summarises the major findings concerning prevention of Alzheimer's disease (AD) and other dementias from a population-based study, the Kungsholmen Project. The study addresses risk- and protective factors for AD and dementia from a lifetime perspective: at birth, during childhood, in adult life, and in old age. Although many aspects of the dementias are still unclear, some risk factors have been identified and interesting hypotheses have been suggested for other putative risk or protective factors. At the moment it is also possible to delineate some preventative strategies for dementia.
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| 5. |
- Marengoni, A, et al.
(författare)
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The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons : A community-based, longitudinal study
- 2009
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell. - 0954-6820 .- 1365-2796. ; 265:2, s. 288-295
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Tidskriftsartikel (refereegranskat)abstract
- Objective. We aimed to disentangle the effect of chronic multimorbidity and disability on 3-year functional decline and survival in the elderly.Design. Prospective cohort study with a mean of follow-up of 2.8 years.Setting. Swedish elderly persons from the Kungsholmen Project (1987–2000).Subjects. A total of 1099 subjects, 77–100 years old, living in the community and institutions.Main outcome measurements. Medical diagnoses (based on clinical examination, drug use, medical records and blood tests), and functional assessment (according to Katz Index) at baseline were investigated in relation to functional decline and death occurring during follow-up.Results. At baseline, 12.1% of participants had disability, and 52.3% were affected by multimorbidity. During follow-up, 363 persons died and 85 worsened in functioning. The number of chronic conditions incrementally increased the risk of functional decline [hazard ratio (HR) increased from 1.5 in subjects with one disease to 6.2 in persons with 4+ diseases]. However, this was not the case for mortality, as the HR of death was the same for people with one disease as well as 4+ diseases (HR = 2.3). Baseline disability had the highest impact on survival, independently of number of diseases [HR = 8.1; 95% confidence interval (CI) = 4.8–13.7 in subjects with one disease and HR = 7.7; 95% CI = 4.7–12.6 in those with 2+ diseases].Conclusions. In the elderly subjects, chronic disability rather than multimorbidity emerged as the strongest negative prognostic factor for functionality and survival.
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| 6. |
- Mecocci, P, et al.
(författare)
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Cognitive Impairment Is the Major Risk Factor for Development of Geriatric Syndromes during Hospitalization : Results from the GIFA Study
- 2005
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Ingår i: Dementia and Geriatric Cognitive Disorders. - Basel : Karger. - 1420-8008 .- 1421-9824. ; 20:4, s. 262-269
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To detect the main factors associated with the occurrence of specific geriatric syndromes (namely pressure sores, fecal incontinence, urinary incontinence and falls) in elderly patients during hospitalization. Design: Observational prospective study. Setting: Eighty-one community and university hospitals throughout Italy. Participants: 13,729 patients aged 65 years and more, consecutively admitted to medical or geriatric acute wards during 20 months in the period between 1991 and 1998. Measurements: Occurrence of pressure sores, fecal incontinence, urinary incontinence and falls during the stay in hospital. Results: Pressure sores were already present in 3% of hospitalized subjects, fecal incontinence in 7.3%, while urinary incontinence, evaluated on a subgroup of total population (4,268 subjects), had a prevalence of 22.3%. During hospitalization (mean stay of 15 days), 74 subjects developed new pressure sores, 55 became fecal and 35 urinary incontinent, and 279 subjects had at least one episode of fall. In multivariate analyses, cognitive impairment, advanced age (85+ years), length of stay (more than 3 weeks) and severe disability were the main independent predictors of development of the four geriatric syndromes, with cognitive impairment as the most significant risk factor for all the four outcomes (OR 4.9, 95% CI 2.4–9.9 for pressure sores; OR 6.3, 95% CI 3.0–13.0 for fecal incontinence; OR 5.3, 95% CI 2.3–12.0 for urinary incontinence; OR 1.6, 95% CI 1.2–2.3 for falls). Conclusion: Very old people have a significant increased risk of several geriatric syndromes during the stay in hospital, particularly if it is long and they are cognitively impaired. A standardized comprehensive geriatric evaluation at admission could be helpful in detecting all subjects at risk and preventing the development of hospital-acquired geriatric syndromes.
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| 7. |
- Ngandu, T, et al.
(författare)
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Education and dementia : What lies behind the association?
- 2007
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Ingår i: Neurology. - : Lippincott Williams & Wilkins. - 0028-3878 .- 1526-632X. ; 69:14, s. 1442-1450
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Tidskriftsartikel (refereegranskat)abstract
- Background: Low education seems to be associated with an increased risk of dementia and Alzheimer disease (AD). People with low education have unhealthier lifestyles and more cardiovascular risk factors, but it is unclear how this affects the association between education and dementia.Methods: Participants of the Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study were derived from random, population-based samples previously studied in a survey in 1972, 1977, 1982, or 1987. After an average follow-up of 21 years, 1,449 individuals (72%) aged 65 to 79 participated in a re-examination in 1998.Results: Compared to individuals with formal education of 5 years or less, those with 6 to 8 years of education had OR of 0.57 (95% CI 0.29 to 1.13), and those with 9 years of education or more had OR of 0.16 (95% CI 0.06 to 0.41) for dementia. The corresponding ORs for AD were 0.49 (0.24 to 1.00) and 0.15 (0.05 to 0.40). The associations remained unchanged after adjustments for several demographic, socioeconomic, vascular, and lifestyle characteristics. The results were similar among both men and women. ApoE4 did not modify the association, but the risk of dementia and AD was very low among ApoE4 noncarriers with high education.Conclusions: The association between low education and dementia is probably not explained by the unhealthy lifestyles of the less educated compared with higher educated persons. Higher educated persons may have a greater cognitive reserve that can postpone the clinical manifestation of dementia. Unhealthy lifestyles may independently contribute to the depletion of this reserve or directly influence the underlying pathologic processes.GLOSSARY: AD = Alzheimer disease; CAIDE = Cardiovascular Risk Factors, Aging and Dementia; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th edition; MMSE = Mini-Mental State Examination; NINCDS-ADRDA = National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association; SBP = systolic blood pressure.
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| 8. |
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| 9. |
- Nordberg, G, et al.
(författare)
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The amount of informal and formal care among non-demented and demented elderly persons : - results from a Swedish population-based study
- 2005
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Ingår i: International Journal of Geriatric Psychiatry. - : John Wiley & Sons. - 0885-6230 .- 1099-1166. ; 17, s. 334-335
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundDeveloped countries are experiencing a dramatic increase in the proportion of elderly persons, as well as a progressive aging of the elderly population itself. Knowledge regarding the amount of formal and informal care and its interaction at population-based level is limited.ObjectivesTo describe the amount of formal and informal care for non-demented and demented persons living at home in a population-based sample.MethodsThe population consisted of all inhabitants, 75 + years, living in a rural community (n = 740). They were clinically examined by physicians and interviewed by nurses. Dementia severity was measured according to Washington University Clinical Dementia Rating Scale (CDR). Informal and formal care was examined with the RUD (Resource Utilization in Dementia) instrument.ResultsThe amount of informal care was much greater than formal care and also greater among demented than non-demented. There was a relationship between the severity of the congnitive decline and the amount of informal care while this pattern was weaker regarding formal care. Tobit regression analyses showed a clear association between the number of hours of informal and formal care and cognitive decline although this pattern was much stronger for informal than formal care.ConclusionsInformal care substitutes rather than compliments formal care and highlights the importance of future studies in order to truly estimate the amount of informal and formal care and the interaction between them. This knowledge will be of importance when planning the use of limited resources, and when supporting informal carers in their effort to care for their intimates.
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| 10. |
- Nordberg, Gunilla, et al.
(författare)
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Time use and costs of institutionalised elderly persons with or without dementia : results from the Nordanstig cohort in the Kungsholmen Project - a population based study in Sweden
- 2007
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Ingår i: International Journal of Geriatric Psychiatry. - : Wiley. - 0885-6230 .- 1099-1166. ; 22:7, s. 639-648
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Tidskriftsartikel (refereegranskat)abstract
- Background The aging of the population has become a worldwide phenomenon. This leads to increased demand for services and with limited resources it is important to find a way to estimate how resources can be match to those with greatest need. Aims To analyse time use and costs in institutional care in relation to different levels of cognitive and functional capacity for elderly persons. Methods The population consisted of all institutionalised inhabitants, 75 + years, living in a rural community (n=176). They were clinically examined by physicians and inter-viewed by nurses. Staff and informal care-giving time was examined with the RUD (Resource Utilization in Dementia) instrument. Results Tobit regression analyses showed that having dementia increased the amount of ADL care time with 0.9 h when compared to those not having dementia, whereas each loss of an ADL function (0-6) added 0.6 h of ADL care time. Analysing the total care time use, the presence of dementia added more than 9 h, while each loss of one ADL function added 2.9 h. There were some informal care contributions, however with no correlation to severity in dependency. The estimated cost for institutional care increased with more than 85% for people being dependent in 5-6 ADL activities compared to persons with no functional dependency, and with 30% for persons with dementia compared to the non-demented. Conclusion There is a variation in time use in institutional settings due to differences in ADL dependency but also whether dementia is present or not. This variation has implications for costs of institutional care.
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