| 1581. |
- Nilsson, Maria H, et al.
(author)
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Walking difficulties is the main contributor to fear of falling in people with Parkinson’s disease
- 2017
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In: - : Oxford University Press (OUP). ; , s. 1389-1389
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Conference paper (peer-reviewed)abstract
- Fear of falling is more common and pronounced in people with Parkinson’s disease than in controls. We conducted a series of studies that used multivariable regression analyses to identify explanatory factors of fear of falling in people with Parkinson’s disease. Three independent samples were used. The first study (n=154) was a postal survey study that used well-established self-rating scales. The second study replicated the first one by using a clinical sample (n=104) and added unexplored motor aspects (e.g., gait speed, functional balance performance) as well as global cognition. The third clinical study (n=241) included independent variables that focused on personal (e.g. general self-efficacy) and environmental factors as well as Parkinson-related disabilities. In all three studies, walking difficulties was the strongest explanatory (60–68%) factor. The results imply that walking difficulties in daily life should be the primary target in order to reduce fear of falling in people with Parkinson’s disease.
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| 1582. |
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| 1583. |
- Norberg, Astrid, 1939-, et al.
(author)
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Self-transcendence (ST) among very old people : its associations to social and medical factors and development over five years
- 2015
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In: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 61:2, s. 247-253
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Journal article (peer-reviewed)abstract
- AIMS AND OBJECTIVES: The aims of this study were to describe the associations between ST and psychological and physical wellbeing among oldest old people and to test the influence of negative life events on ST, and the predictive value of the self-transcendence scale (STS) for mortality.BACKGROUND: ST has been identified as a valuable resource for transcending psychological and physical suffering and has been related to psychological wellbeing and higher quality of life.DESIGN: The study design was correlational, prospective, and longitudinal.SETTINGS: The participants were recruited from a medium-sized town and from an adjacent rural area in northern Sweden.METHOD: The sample consisted of 190 participants (123 women and 67 men) who completed the STS. At a 5-year follow-up, 55 people (29.5%) were alive and able to complete the assessments again.RESULTS: ST was positively associated with psychological wellbeing, self-rated health, having someone to talk with and being able to go outdoors independently. Diagnoses of depression, dementia disease, and osteoporosis were associated with lower STS scores as were living in a residential care facility, and feeling lonely. There was a significant relationship between the index of negative life events and ST between baseline and follow-up. More negative life events were associated with a larger decline in STS scores over five years.CONCLUSION: ST is an important source for wellbeing among the oldest old, and the accumulation of negative life events might threaten the ability to transcend setbacks.
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| 1584. |
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| 1585. |
- Nordström, Peter, et al.
(author)
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Bisphosphonate Use After Hip Fracture in Older Adults : A Nationwide Retrospective Cohort Study
- 2017
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In: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 18:6, s. 515-521
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Journal article (peer-reviewed)abstract
- Objectives: The aim of this study was to investigate the association between bisphosphonate use and the risk of new fracture in a nationwide cohort of individuals with previous hip fractures, with emphasis on individuals above 80 years of age. Design, setting, and participants: From a nationwide cohort with hip fracture (2006-2012) (n = 93, 601), each individual prescribed bisphosphonates after hip fracture (n = 5845) was matched with up to three individuals not prescribed bisphosphonates, resulting in a cohort of 21,363 individuals. Main outcome measure: A new hip fracture. Results: During a mean follow-up period of 2.98 (range, 0.02-8) years, 4581 fractures occurred in the cohort. Before the initiation of bisphosphonate therapy, individuals later prescribed bisphosphonates had an increased risk of hip fracture (multivariable adjusted odds ratio [OR], 2.63; 95% confidence interval [CI], 2.23-3.24) compared with controls. In the period after bisphosphonate therapy initiation, individuals prescribed bisphosphonates had a lower risk of hip fracture (multivariable adjusted hazard ratio [HR], 0.76; 95% CI, 0.65-0.90) compared with controls. Similar effects were seen after the initiation of bisphosphonates in individuals aged more than 80 years (HR, 0.79; 95% CI, 0.62-0.99). In contrast, the initiation of bisphosphonate therapy did not influence the risk of injurious falls not resulting in fracture (HR, 0.95; 95% CI, 0.86-1.05). Conclusion: Bisphosphonate use was associated with a decreased risk of hip fracture in this nationwide cohort of older men and women, with similar risk reductions in individuals older than 80 years.
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| 1586. |
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| 1587. |
- Nylander, Lena, et al.
(author)
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Vuxna med utvecklingsstörning en eftersatt grupp i sjukvården.
- 2014
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In: Läkartidningen. - 0023-7205. ; 111, s. 49-49
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Journal article (peer-reviewed)abstract
- Adults with intellectual developmental disorder are at considerable risk of somatic as well as psychiatric illness, but seldom have access to services on equal conditions as adults without intellectual developmental disorder. The symptoms of illness are often difficult to interpret, due to communication difficulties, and examinations may be difficult to carry out. Patients with moderate/severe/profound intellectual disability therefore need »interpreters« and to be given sufficient time when making clinic visits. Patients with intellectual disability have excess mortality from somatic illness and are at risk for suboptimal treatment with psychotropic medications.
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| 1588. |
- Nyström, Helena, 1985-
(author)
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Parkinson’s disease : the prodromal phase and consequences with respect to working life
- 2016
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Doctoral thesis (other academic/artistic)abstract
- Background: Parkinson’s disease (PD) is a common, progressive neurodegenerative disorder, recognized by the motor symptoms of bradykinesia, tremor, rigidity, and postural impairment. At clinical onset, extensive amounts of dopaminergic neurons have already been lost. The duration of this prodromal phase is uncertain, and it is thought to include predominantly non-motor symptoms. The progressive nature and the symptoms of PD are disabling and reduces the quality of life. Among patients affected in working age, early cessation of employment is common, and such socioeconomic consequences of PD may contribute to an impaired quality of life. The aims of this thesis were to investigate the life situation for people affected by PD in working age, with attention to factors of importance for quality of life and working situation, and to evaluate long-term associations between potential prodromal signs and the later development of PD.Methods: We used a postal survey to investigate the self-perceived life situation among working-aged individuals with PD compared to matched controls, with a specific attention to socioeconomic consequences of disease (paper I). To investigate risk markers preceding the diagnosis of PD (paper II-IV), we used data from nationwide registers. Study II was performed as a cohort study, based on the Swedish Military Service Conscription Register, and study III-IV were performed as nested case-control studies based on a cohort comprising all Swedish citizens aged ≥50 years in 2005.Results: In the survey study (paper I), 38% of the PD participants and 9% of the controls were dissatisfied with life as a whole, and the working situation was an independent risk factor for dissatisfaction with life. In total, 59% of the PD participants had reduced working hours or stopped working due to PD, and many PD participants struggled to cope with their work demands. Support from employer was associated with a higher likelihood to remain employed.We found that low muscle strength in young adulthood, (paper II) and depression (paper III) were associated with an increased risk of PD over follow-up times of more than 2 decades, and that patients with PD were at increased risk of fall-related injuries, hip fractures in particular, a decade or more before the PD diagnosis (paper IV). For depression and fall-related injuries, the association with PD was clearly time-dependent, strongest in the last years before the diagnosis of PD.Conclusions: The results suggest that the prodromal phase of PD may last for more than 2 decades and include also motor symptoms. The consequences of PD include a reduced quality of life associated with the working situation. Employer’s support appear to be particularly important for a successful vocational rehabilitation.
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| 1589. |
- Nägga, Katarina, et al.
(author)
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Cerebral inflammation is an underlying mechanism of early death in Alzheimer's disease : a 13-year cause-specific multivariate mortality study
- 2014
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In: Alzheimer's Research & Therapy. - : BioMed Central. - 1758-9193. ; 6:4
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Although Alzheimer's disease (AD) is associated with early death, its life expectancy differs greatly between patients. A better understanding of this heterogeneity may reveal important disease mechanisms underlying the malignancy of AD. The aim of this study was to examine the relation between AD pathologies and early death in AD caused by dementia.METHODS: At a memory clinic, 247 referred consecutive patients with AD were monitored during 12.6 ± 1.6 years. Multivariate Cox regression analyses were performed with baseline measures of amyloid beta (Aβ) pathology (APOE genotype, cerebrospinal fluid (CSF) Aβ42) tau pathology (CSF phosphorylated tau and total tau), cerebrovascular pathology (white-matter lesions and CSF/serum albumin ratio), neuroinflammatory pathology (CSF soluble vascular cell adhesion molecule-1, sVCAM-1), frontal, temporal, and central brain atrophies, global cognition, sex, and age. Comorbidities and medications also were analyzed. All continuous variables were transformed to z scores to compare hazard ratios (HRs) and 95% confidence intervals (CIs).RESULTS: At follow-up, 89% of the patients had died. The mean survival time was 6.4 ± 3.0 years. The AD pathology that independently predicted an early death caused by dementia was cerebral inflammation (sVCAM-1; HR, 1.32; 95% CI, 1.07-1.64). Other independent predictors were lower global cognition (HR, 0.51; 95% CI, 0.43-0.61), frontal atrophy (HR, 1.38; 95% CI, 1.12-1.70), and medial temporal atrophy (HR, 1.23; 95% CI, 1.02-1.49). When examining death caused by dementia and related causes (vascular diseases and infections), age (HR, 1.23; 95% CI, 1.04-1.46) and cerebrovascular pathology (white-matter lesions: HR, 1.17; 95% CI, 1.01-1.36; and CSF/serum albumin ratio: HR, 1.16; 95% CI, 1.001-1.34) were also significant risk factors in addition to the previous variables. No comorbidity or medication was significant in the specific-cause models.CONCLUSIONS: This is the first study to link neuroinflammation independently to early death in AD and, hence, a rapidly progressing disease. Frontal and medial temporal atrophies and low cognition were also significant predictors. These are probably downstream biomarkers that reflect neuronal degeneration and late-stage disease. Our results suggest that inflammation, and not amyloid or tau pathology, is an independent underlying mechanism in the malignancy of AD.
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| 1590. |
- Nägga, Katarina, 1962-, et al.
(author)
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Increased levels of hyaluronic acid in cerebrospinal fluid in patients with vascular dementia
- 2014
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In: Journal of Alzheimer's Disease. - : IOS Press. - 1387-2877 .- 1875-8908. ; 42:4, s. 1435-1441
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Journal article (peer-reviewed)abstract
- Hyaluronic acid (HA) has been shown to affect angiogenesis and the function of the blood-brain barrier, and a crucial role for HA in atherosclerosis has been described. We have recently demonstrated changes in the levels of HA in cerebrospinal fluid (CSF) in patients with Alzheimer's disease (AD) with documented vascular alterations. To further investigate if the level of HA in CSF can be used as a clinical diagnostic biomarker to identify vascular pathology in dementia, we analyzed the levels of HA in the CSF of patients with vascular dementia (VaD) (n = 46), AD (n = 45), and controls without dementia (n = 26). In line with our previous data, we found significantly increased levels of HA in CSF from patients with VaD compared with controls, whereas the levels of HA in patients with AD were found to be unaltered compared with controls and patients with VaD. We also detected increased levels of HA in individuals with vascular changes determined as significant white matter changes or previous infarction on cranial computed tomography or magnetic resonance imaging, compared with individuals without these findings. Furthermore, we found a significant positive correlation between the levels of HA and the CSF/serum albumin ratio, an indicator of blood-brain barrier integrity, in patients with VaD and AD, supporting the role of HA in vascular changes in the brain. Our results indicate a potential diagnostic value for the detection of vascular brain changes in dementia using CSF levels of HA, but emphasize the importance of further development of more sensitive HA assays.
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