| 1621. |
- Povoroznyuk, V., et al.
(author)
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FRAX-Based Intervention Thresholds for Osteoporosis Treatment in Ukraine
- 2021
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In: Journal of Osteoporosis. - : Hindawi Limited. - 2090-8059 .- 2042-0064. ; 2021
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Journal article (peer-reviewed)abstract
- Objectives. Osteoporosis, in addition to its consequent fracture burden, is a common and costly condition. FRAX(R) is a well-established, validated, web-based tool which calculates the 10-year probability of fragility fractures. A FRAX model for Ukraine has been available since 2016 but its output has not yet been translated into intervention thresholds for the treatment of osteoporosis in Ukraine; we aimed to address this unmet need in this analysis. Methods. In a referral population sample of 3790 Ukrainian women, 10-year probabilities of major osteoporotic fracture (MOF) and hip fracture separately were calculated using the Ukrainian FRAX model, with and without femoral neck bone mineral density (BMD). We used a similar approach to that first proposed by the UK National Osteoporosis Guideline Group, whereby treatment is indicated if the probability equals or exceeds that of a woman of the same age with a prior fracture. Results. The MOF intervention threshold in females (the age-specific 10-year fracture probability) increased with age from 5.5% at the age of 40 years to 11% at the age of 75 years where it plateaued and then decreased slightly at age 90 (10%). Lower and upper thresholds were also defined to determine the need for BMD, if not already measured; the approach targets BMD measurements to those at or near the intervention threshold. The proportion of the referral populations eligible for treatment, based on prior fracture or similar or greater probability, ranged from 44% to 69% depending on age. The prevalence of the previous fracture rose with age, as did the proportion eligible for treatment. In contrast, the requirement for BMD testing decreased with age. Conclusions. The present study describes the development and application of FRAX-based assessment guidelines in Ukraine. The thresholds can be used in the presence or absence of access to BMD and optimize the use of BMD where access is restricted.
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| 1622. |
- Praetorius, Marcus, 1982, et al.
(author)
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Substantial effects of APOE ε4 on memory decline in very old age: Longitudinal findings from a population-based sample
- 2013
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In: Neurobiology of Aging. - : Elsevier BV. - 0197-4580. ; 34:12, s. 2734-2739
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Journal article (peer-reviewed)abstract
- We examined associations between the apolipoprotein E (APOE) epsilon 4 allele and levels of performance and rates of change in cognition in late life taking incident dementia into account. The sample consisted of 482 nondemented individuals, aged 80 years and older at baseline, drawn from the OCTO twin study. A battery of 10 cognitive tests was administered at 5 occasions with measurements intervals of 2 years. We fitted hierarchical linear models with time specified as time to death and controlled for baseline age, sex, education, stroke, cardiovascular disease, hypertension, diabetes, and incident dementia. The epsilon 4 allele was significantly associated with lower levels of performance or steeper rate of decline in all 7 memory tests. Largest effect sizes were found in tests of delayed recall and recognition memory. The effects of the APOE epsilon 4 allele were, however, reduced to a nonsignificant level in all tests except 1 after accounting for incident dementia. The findings support the notion that the APOE epsilon 4 allele is associated with substantial memory decline in very old age, but as expected, the effect is largely related to incident dementia. (C) 2013 Elsevier Inc. All rights reserved.
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| 1623. |
- Puschmann, Andreas, et al.
(author)
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Diagnosis and Treatment of Common Forms of Tremor
- 2011
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In: Seminars in Neurology. - : Georg Thieme Verlag KG. - 0271-8235 .- 1098-9021. ; 31:1, s. 65-77
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Journal article (peer-reviewed)abstract
- Tremor is the most common movement disorder presenting to an outpatient neurology practice and is defined as a rhythmical, involuntary oscillatory movement of a body part. The authors review the clinical examination, classification, and diagnosis of tremor. The pathophysiology of the more common forms of tremor is outlined, and treatment options are discussed. Essential tremor is characterized primarily by postural and action tremors, may be a neurodegenerative disorder with pathologic changes in the cerebellum, and can be treated with a wide range of pharmacologic and nonpharmacologic methods. Tremor at rest is typical for Parkinson's disease, but may arise independently of a dopaminergic deficit. Enhanced physiologic tremor, intention tremor, and dystonic tremor are discussed. Further differential diagnoses described in this review include drug- or toxin-induced tremor, neuropathic tremor, psychogenic tremor, orthostatic tremor, palatal tremor, tremor in Wilson's disease, and tremor secondary to cerebral lesions, such as Holmes' tremor ( midbrain tremor). An individualized approach to treatment of tremor patients is important, taking into account the degree of disability, including social embarrassment, which the tremor causes in the patient's life.
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| 1624. |
- Puschmann, Andreas
(author)
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Heredity in Parkinson's disease. From rare mutations to common genetic risk factors.
- 2011
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Doctoral thesis (other academic/artistic)abstract
- This study investigated genetic causes of Parkinson's disease (PD) and parkinsonism in southern Sweden. The extensive Lister Family with parkinsonism caused by duplications and triplications of the gene for alpha-synuclein (SNCA) was studied. Clinical, genetic and genealogical data were compiled and evaluated. Thirty-five family members with parkinsonism were identified. They share a characteristic clinical subtype of parkinsonism with marked dysfunction of the autonomic nervous system, behavioral changes and cognitive decline. The clinical phenotype, heredity and genetic background of 132 probands from Southern Sweden with PD or parkinsonism was examined. The SNCA, LRRK2, EIF4G1, VPS35, PINK1, ATXN2 and ATXN3 genes were analyzed in all probands; the PARKIN, PINK1 and DJ1 genes were tested in a subgroup of 23 patients with young onset or marked heredity. DNA from the brain tissue of 7 patients with parkinsonism was also analyzed. Common genetic risk factors in DNA samples collected within this study were analyzed in collaboration with other research groups. Gene screening identified two rare causative mutations, SNCA A53T and LRRK2 N1437H. An additional patient was compound heterozygous for PARKIN R275W and R275Q mutations. Detailed information on their clinical picture is presented. We present the first neuropathological description of a patient with PD and LRRK2 N1437H mutation, showing pronounced ubiquitin and moderate alpha-synuclein pathology. A heterozygous PINK1 G411S mutation was present in two PD patients but showed no clear co-segregation with the disease in their families. Screening of 1,107 patients and controls as well as meta-analysis of published reports from 7,800 individuals revealed that the PINK1 G411S mutation is a rare risk variant with a relatively large effect size (odds ratios 4.06-8.42). One multicenter study confirmed that common variants in the SNCA and MAPT genes modify PD risk, and was large enough to refute gene-gene interaction between the MAPT and SNCA variants. These results suggest that specific mutations in PD-genes cause characteristic disease subtypes. Despite extensive screening and a high proportion of familial cases, known pathogenic mutations could only explain a small proportion of parkinsonism in this cohort. This may indicate that mutations causing parkinsonism in the Scandinavian population remain to be discovered. Alternatively, familial clustering and sporadic occurrence of PD may be explained by combinations of rare variants with relatively large effect size, such as PINK1 G411S.
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| 1625. |
- Rahm Hallberg, Ingalill, 1944-
(author)
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Vocally disruptive behaviour in severely demented patients in relation to institutional care provided
- 1990
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Doctoral thesis (other academic/artistic)abstract
- Thirty-seven patients identified as vocally disruptive and a control group, selected from 264 patients at psychogeriatric wards were studied. Tape-recordings of their vocal behaviour, ratings of their functional performance and symptoms related to dementia, observations of their behaviour, activities and interaction with caregivers were performed. Seventeen plus sixteen caregivers were interviewed to give their interpretation of the experience behind the behaviour and describe their own experience of it. The severely demented vocally disruptive patients were found to be significantly more physically dependant, disorientated at the ward and prone to confusional reactions but they had a more preserved speech performance than the controls. The vocal activity expressed such as helplessness, pain, fear and protest. Some were emotionally indifferent and a few expressed positive emotions. Caregivers interpreted the behaviour as an expression of anxiety related to such as abandonment, dissolution and loss of autonomy. They also expressed a strong wish to comfort the patients but felt unable to do so. The patients' daily life was characterized by idleness and solitude. Caring activities and interactions were dominated by physical procedures performed in a fragmentary and rapid way. Two hypotheses are generated. 1. Vocally disruptive behaviour develops influenced by sensory deprivation and the brain damage. 2. The care provided is influenced by caregivers experiencing anxiety in the patients as well as experiencing a conflict between the care they would like to provide and the care they actually provide. This evokes anxiety in them which elicits defence mechanisms leading to emotional withdrawal from the patients and task oriented care. The results are discussed in a nursing perspective based on existential thoughts, psychoanalytic and psychosocial theory.
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| 1626. |
- Rantakokko, Merja, et al.
(author)
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Task Modifications in Walking Postpone Decline in Life-Space Mobility Among Community-Dwelling Older People : A 2-year Follow-up Study
- 2017
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In: Journals of Gerontology. Series A: Biological Sciences & Medical Sciences. - : Oxford University Press (OUP). - 1758-535X. ; 72:9, s. 1252-1256
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Journal article (peer-reviewed)abstract
- Background: Task modification refers to performing a task differently than before. While task modification in walking may be a sign of looming walking difficulty, it may also be adaptive in and postpone the decline in life-space mobility. However, this has not been studied. This study examined whether changes in life-space mobility over a 2-year period differ between people who at baseline report no walking difficulty and no task modification, those who report no walking difficulty but task modification, and those who report walking difficulty.Methods: Community-dwelling people aged 75-90 years were interviewed face-to-face at baseline (N = 848), and over phone one (n = 816) and two (n = 761) years later. Life-space mobility was assessed annually with the Life-Space Assessment (range 0-120, higher scores indicate better life-space mobility). Self-reported ability to walk 2 km was assessed at baseline and categorized into "no difficulty," "no difficulty but task modifications" (reduced frequency, given up walking, walking slower or resting during walking) and "difficulty." The analyses were adjusted for age, gender, number of chronic conditions, cognitive impairment, lower extremity performance and education.Results: The life-space mobility score was highest and remained stable over 2-years among those with no walking difficulties at baseline and lowest and showing a steady decline among those with walking difficulties. Those with task modifications formed the middle group. They showed no marked changes in life-space mobility during the first year, but significant decline during the second year.Conclusion: Task modifications in walking may help community-dwelling older people to postpone life-space mobility decline.
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| 1627. |
- Risberg, Jarl, et al.
(author)
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99mTC-HMPAO-SPECT related to clinical findings in patients with subjective experience of memory deficit
- 2004
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In: Proceedings of the 8th Nordic Meeting in Neuropsychology.
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Conference paper (peer-reviewed)abstract
- Objective. The aim was to evaluate cognitive impairments, psychiatric symptoms and cerebral blood flow (CBF) patterns in middle-aged and younger old patients with subjective experience of memory deficits. Methods. The CBF was measured by 99m-Tc-HMPAO-SPECT. The study group was heterogeneous with patients fulfilling criteria for dementia (n=13) and patients with mild cognitive impairment (MCI; n= 24) as well as with not verified cognitive impairment (Non-MCI; n=17). The MCI patients were subdivided into two groups. The MCI type 1 group (n=14) had isolated memory impairments while the MCI type 2 group (n=10) had memory impairments together with slight verbal and/or visuospatial disturbances. Results. The MCI type 1 group showed lower blood flow in the left middle/inferior gyrus and in parts of the left inferior parietal lobe compared to the Non-MCI group. The MCI type 2 group showed reductions in the left anterior medial temporal lobe as well as in parts of the posterior cingulate gyrus. The Non-MCI patients reported high incidence (70%) of long-lasting psychosocial stress. Conclusions. The combination of clinical and CBF data provides diagnostically meaningful information about regional brain dysfunction in patients with memory deficits.
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| 1628. |
- Rizzuto, Debora, et al.
(author)
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Personality and Survival in Older Age : The Role of Lifestyle Behaviors and Health Status
- 2017
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In: The American journal of geriatric psychiatry. - : Elsevier BV. - 1064-7481 .- 1545-7214. ; 25:12, s. 1363-1372
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Journal article (peer-reviewed)abstract
- Objective: We intended to assess the relationship between personality and survival in an older population and to explore the role of lifestyle behaviors and health status as potential mediators. Design: Population-based cohort study. Setting: Swedish National Study of Aging and Care in Kungsholmen, Sweden. Participants: 2,298 adults aged 60 or more years, without dementia or depression, followed for 11 years. Measurements: Personality (extraversion, neuroticism, and openness) was assessed with a shortened version of the NEO-Five Factor Inventory. We tested whether personality affected mortality and examined the potential mediating effect of health status (body mass index, number of chronic diseases, impairment in instrumental activities of daily living, and C-reactive protein) and lifestyle behaviors (leisure activities, social network, smoking, and alcohol consumption). Results: Over 11 years of follow-up, higher levels of extraversion were associated with a 14% reduction in mortality. Examination of different combinations of personality traits showed that independent of levels of neuroticism and openness, high extraversion were associated with up to 65% lower mortality. Decomposing the effect of extraversion on mortality, we found that the majority (44%) of the beneficial effect was mediated by healthy lifestyle behaviors. Health status accounted for 5% of the association. Conclusions: Extroverted people, who are characterized by higher optimism and high self-efficacy, are prone to healthier behaviors and better health, which may result in longer survival. These results highlight the importance of a healthy lifestyle in survival.
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| 1629. |
- Roheger, Mandy, et al.
(author)
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Mortality and nursing home placement of dementia patients in rural and urban areas : a cohort study from the Swedish Dementia Registry.
- 2018
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In: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 32:4, s. 1308-1313
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Journal article (peer-reviewed)abstract
- BACKGROUND: Life in rural and urban areas differs in regard to social support and health care. Our aim was to examine the association between nursing home placement and survival of patients with dementia living in urban vs. rural areas.METHODS: We performed a longitudinal cohort study of patients with dementia at time of diagnosis (n = 58 154) and at first follow-up (n = 21 522) including patients registered from 2007 through 2014 in the Swedish Dementia Registry (SveDem). Descriptive statistics are shown. Odds ratios with 95% CI are presented for nursing home placement and hazard ratios for survival analysis.RESULTS: In age- and sex-adjusted analyses, patients living in urban areas were more likely to be in nursing homes at the time of dementia diagnosis than patients in rural areas (1.49, 95% CI: 1.29-1.73). However, there were no differences in rural vs urban areas in either survival after dementia diagnosis (urban: 0.99, 0.95-1.04, intermediate: 1.00, 0.96-1.04), or nursing home placement at first follow-up (urban: 1.00, 0.88-1.13; intermediate: 0.95, 0.85-1.06).CONCLUSION: Persons with dementia living in rural areas are less likely to live in a nursing home than their urban counterparts at the time of dementia diagnosis, but these differences disappear by the time of first follow-up. Differences in access to nursing homes between urban and rural settings could explain these findings. Results should be considered in the future healthcare decisions to ensure equality of health care across rural and urban areas.
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| 1630. |
- Rongve, A, et al.
(author)
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[Alzheimer's disease and genetics]
- 2013
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In: Tidsskrift for den Norske laegeforening : tidsskrift for praktisk medicin, ny raekke. - : Norwegian Medical Association. - 0807-7096. ; 133:14, s. 1449-52
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Journal article (peer-reviewed)
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