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- Haaksma, Miriam L., et al.
(författare)
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The Impact of Frailty and Comorbidity on Institutionalization and Mortality in Persons With Dementia : A Prospective Cohort Study
- 2019
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 20:2, s. 165-170
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The predictive value of frailty and comorbidity, in addition to more readily available information, is not widely studied. We determined the incremental predictive value of frailty and comorbidity for mortality and institutionalization across both short and long prediction periods in persons with dementia.Design: Longitudinal clinical cohort study with a follow-up of institutionalization and mortality occurrence across 7 years after baseline.Setting and Participants: 331 newly diagnosed dementia patients, originating from 3 Alzheimer centers (Amsterdam, Maastricht, and Nijmegen) in the Netherlands, contributed to the Clinical Course of Cognition and Comorbidity (4C) Study.Measures: We measured comorbidity burden using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and constructed a Frailty Index (FI) based on 35 items. Time-to-death and time-to-institutionalization from dementia diagnosis onward were verified through linkage to the Dutch population registry.Results: After 7 years, 131 patients were institutionalized and 160 patients had died. Compared with a previously developed prediction model for survival in dementia, our Cox regression model showed a significant improvement in model concordance (U) after the addition of baseline CIRS-G or FI when examining mortality across 3 years (FI: U = 0.178, P = .005, CIRS-G: U = 0.180, P = .012), but not for mortality across 6 years (FI: U = 0.068, P = .176, CIRS-G: U = 0.084, P = .119). In a competing risk regression model for time-to-institutionalization, baseline CIRS-G and FI did not improve the prediction across any of the periods.Conclusions: Characteristics such as frailty and comorbidity change over time and therefore their predictive value is likely maximized in the short term. These results call for a shift in our approach to prognostic modeling for chronic diseases, focusing on yearly predictions rather than a single prediction across multiple years. Our findings underline the importance of considering possible fluctuations in predictors over time by performing regular longitudinal assessments in future studies as well as in clinical practice.
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- Pyko, A., et al.
(författare)
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Long-term transportation noise exposure and incidence of ischaemic heart disease and stroke: a cohort study
- 2019
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Ingår i: Occupational and environmental medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 76:4, s. 201-207
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Tidskriftsartikel (refereegranskat)abstract
- Background There is limited evidence from longitudinal studies on transportation noise from different sources and development of ischaemic heart disease (IHD) and stroke. Objectives T his cohort study assessed associations between exposure to noise from road traffic, railway or aircraft and incidence of IHD and stroke. Methods I n a cohort of 20 012 individuals from Stockholm County, we estimated long-term residential exposure to road traffic, railway and aircraft noise. National Patient and Cause-of-Death Registers were used to identify IHD and stroke events. Information on risk factors was obtained from questionnaires and registers. Adjusted HR for cardiovascular outcomes related to source-specific noise exposure were computed using Cox proportional hazards regression. Results N o clear or consistent associations were observed between transportation noise and incidence of IHD or stroke. However, noise exposure from road traffic and aircraft was related to IHD incidence in women, with HR of 1.11 (95% CI 1.00 to 1.22) and 1.25 (95% CI 1.09 to 1.44) per 10 dB L den, respectively. For both sexes taken together, we observed a particularly high risk of IHD in those exposed to all three transportation noise sources at= 45 dB L den, with a HR of 1.57 (95% CI 1.06 to 2.32), and a similar tendency for stroke (HR 1.42; 95% CI 0.87 to 2.32). Conclusion N o overall associations were observed between transportation noise exposure and incidence of IHD or stroke. However, there appeared to be an increased risk of IHD in women exposed to road traffic or aircraft noise as well as in those exposed to multiple sources of transportation noise.
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- Gaidos, E., et al.
(författare)
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Zodiacal exoplanets in time (ZEIT) - II. A 'super-Earth' orbiting a young K dwarf in the Pleiades Neighbourhood
- 2017
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Ingår i: Monthly notices of the Royal Astronomical Society. - : Oxford University Press. - 0035-8711 .- 1365-2966. ; 464:1, s. 850-862
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Tidskriftsartikel (refereegranskat)abstract
- We describe a 'super-Earth'-size (2.30 +/- 0.16 R-circle plus)planet transiting an early K-type dwarf star in the Campaign 4 field observed by the K2 mission. The host star, EPIC 210363145, was identified as a candidate member of the approximately 120 Myr-old Pleiades cluster based on its kinematics and photometric distance. It is rotationally variable and exhibits near-ultraviolet emission consistent with a Pleiades age, but its rotational period is approximate to 20 d and its spectrum contains no H alpha emission nor the Li I absorption expected of Pleiades K dwarfs. Instead, the star is probably an interloper that is unaffiliated with the cluster, but younger (less than or similar to 1.3 Gyr) than the typical field dwarf. We ruled out a false positive transit signal produced by confusion with a background eclipsing binary by adaptive optics imaging and a statistical calculation. Doppler radial velocity measurements limit the companion mass to <2 times that of Jupiter. Screening of the light curves of 1014 potential Pleiades candidate stars uncovered no additional planets. An injection-and-recovery experiment using the K2 Pleiades light curves with simulated planets, assuming a planet population like that in the Kepler prime field, predicts only 0.8-1.8 detections (versus similar to 20 in an equivalent Kepler sample). The absence of Pleiades planet detections can be attributed to the much shorter monitoring time of K2 (80 d versus 4 yr), increased measurement noise due to spacecraft motion, and the intrinsic noisiness of the stars.
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- Haaksma, Miriam L., et al.
(författare)
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Predicting Cognitive and Functional Trajectories in People With Late-Onset Dementia : 2 Population-Based Studies
- 2019
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 20:11, s. 1444-1450
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Previous studies have shown large heterogeneity in the progression of dementia, both within and between patients. This heterogeneity offers an opportunity to limit the global and individual burden of dementia through the identification of factors associated with slow disease progression in dementia. We explored the heterogeneity in dementia progression to detect disease, patient, and social context factors related to slow progression. Design: Two longitudinal population-based cohort studies with follow-up across 12 years. Setting and Participants: 512 people with incident dementia from Stockholm (Sweden) contributed to the Kungsholmen Project and the Swedish National Study of Aging and Care in Kungsholmen. Methods: We measured cognition using the Mini-Mental State Examination and daily functioning using the Katz Activities of Daily Living Scale. Latent classes of trajectories were identified using a bivariate growth mixture model. We then used bias-corrected logistic regression to identify predictors of slower progression. Results: Two distinct groups of progression were identified; 76% (n = 394) of the people with dementia exhibited relatively slow progression on both cognition and daily functioning, whereas 24% (n = 118) demonstrated more rapid worsening on both outcomes. Predictors of slower disease progression were Alzheimer's disease (AD) dementia type [odds ratio (OR) 2.07, 95% confidence interval (CI) 1.15-3.71], lower age (OR 0.88, 95% CI 0.83-0.94), fewer comorbidities (OR 0.77, 95% CI 0.66-0.90), and a stronger social network (OR 1.72, 95% CI 1.01-2.93). Conclusions/Implications: Lower age, AD dementia type, fewer comorbidities, and a good social network appear to be associated with slow cognitive and functional decline. These factors may help to improve the counseling of patients and caregivers and to optimize the planning of care in dementia.
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