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  • 51.
    Berndt, Hanna
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Gothenburg University, Sweden.
    Fors, Stefan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Childhood living conditions, education and health among the oldest old in Sweden2016In: Ageing & Society, ISSN 0144-686X, E-ISSN 1469-1779, Vol. 36, no 3, p. 631-648Article in journal (Refereed)
    Abstract [en]

    The objectives were to investigate the associations between social and financial living conditions in childhood, education and morbidity in old age. The study population (N = 591; 76+ years old) was assembled from two nationally representative Swedish surveys, in 1968 and 2011, that together made longitudinal analysis possible. Morbidity in old age comprised self-reported measures of musculoskeletal disorders, cardiovascular disease, self-rated health and impaired mobility. There were no independent associations between adverse childhood living conditions and morbidity. However, adverse childhood living conditions were associated with an increased likelihood of low education. Moreover, low education was associated with a higher probability of health problems in old age. The results did not show any associations between adverse childhood conditions and late-life morbidity. However, adverse childhood conditions were associated with lower levels of education which, in turn, was associated with health problems and attrition from the study. These results suggest that adverse childhood conditions may indeed be associated with health and survival in old age, but mainly through mechanisms acting earlier in the lifecourse.

  • 52. Berner, Jessica
    et al.
    Comijs, Hannie
    Elmståhl, Sölve
    Weimer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Sanmartin Berglund, Johan
    Anderberg, Peter
    Deeg, Dorly
    Maintaining cognitive function with internet use: a two-country, six-year longitudinal study2019In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 31, no 7, p. 929-936Article in journal (Refereed)
    Abstract [en]

    Objectives: Maintaining good cognitive function with aging may be aided by technology such as computers, tablets, and their applications. Little research so far has investigated whether internet use helps to maintain cognitive function over time.

    Design: Two population-based studies with a longitudinal design from 2001/2003 (T1) to 2007/2010 (T2).

    Setting: Sweden and the Netherlands.

    Participants: Older adults aged 66 years and above from the Swedish National Study on Ageing and Care (N = 2,564) and from the Longitudinal Aging Study Amsterdam (N = 683).

    Measurements: Internet use was self-reported. Using the scores from the Mini-Mental State Examination (MMSE) from T1 and T2, both a difference score and a significant change index was calculated. Linear and logistic regression analysis were performed with difference score and significant change index, respectively, as the dependent variable and internet use as the independent variable, and adjusted for sex, education, age, living situation, and functional limitations. Using a meta-analytic approach, summary coefficients were calculated across both studies.

    Results: Internet use at baseline was 26.4% in Sweden and 13.3% in the Netherlands. Significant cognitive decline over six years amounted to 9.2% in Sweden and 17.0% in the Netherlands. Considering the difference score, the summary linear regression coefficient for internet use was -0.32 (95% CI: -0.62, -0.02). Considering the significant change index, the summary odds ratio for internet use was 0.54 (95% CI: 0.37, 0.78).

    Conclusions: The results suggest that internet use might play a role in maintaining cognitive functioning. Further research into the specific activities that older adults are doing on the internet may shine light on this issue.

  • 53. Berner, Jessica
    et al.
    Rennemark, Mikael
    Jogréus, Claes
    Anderberg, Peter
    Sköldunger, Anders
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wahlberg, Maria
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Elmståhl, Sölve
    Berglund, Johan
    Factors influencing Internet usage in older adults (65 years and above) living in rural and urban Sweden2015In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 21, no 3, p. 237-249Article in journal (Refereed)
    Abstract [en]

    Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.

  • 54. Besga, A.
    et al.
    Cedazo-Minguez, A.
    Kåreholt, I.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Solomon, A.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Björkhem, I.
    Winblad, B.
    Leoni, V.
    Hooshmand, B.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Spulber, G.
    Gonzalez-Pinto, A.
    Kivipelto, M.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wahlund, L. O.
    Differences in brain cholesterol metabolism and insulin in two subgroups of patients with different CSF biomarkers but similar white matter lesions suggest different pathogenic mechanisms2012In: Neuroscience Letters, ISSN 0304-3940, E-ISSN 1872-7972, Vol. 510, no 2, p. 121-126Article in journal (Refereed)
    Abstract [en]

    Investigate possible associations of white matter hyperintensities (WMHs) with the metabolism of cholesterol and insulin in two subgroups of patients with memory complaints and different CSF A beta 42 and CSF tau levels. 59 patients from the memory clinic at Karolinska Hospital were included. Degree of WMHs was rated using the ARWMC scale and the following biomarkers were measured in CSF and plasma: insulin, cholesterol, lanosterol, lathosterol, and oxidized cholesterol metabolites. The WMHs in CSF control-like group correlated with increased brain cholesterol synthesis and reduced efflux of oxysterols and insulin in CSF. In the CSF AD-like group, the WMHs correlated with increased peripheral cholesterol metabolism. Despite having similar appearance on FLAIR images, the pathogenic mechanisms of WMHS are likely to be different in the two groups investigated.

  • 55. Biffi, Annalisa
    et al.
    Scotti, Lorenza
    Rea, Federico
    Lucenteforte, Ersilia
    Chinellato, Alessandro
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Università Cattolica del Sacro Cuore, Italy.
    Vitale, Cristiana
    Agabiti, Nera
    Sultana, Janet
    Roberto, Giuseppe
    Mugelli, Alessandro
    Corrao, Giovanni
    Adherence to Antidepressants and Mortality in Elderly Patients with Cardiovascular Disease2018In: Clinical drug investigation, ISSN 1173-2563, E-ISSN 1179-1918, Vol. 38, no 7, p. 593-602Article in journal (Refereed)
    Abstract [en]

    Background and Objective

    Conflicting findings from studies evaluating the association between use of antidepressant drugs and mortality have been reported. We tested the hypothesis that better adherence to antidepressant therapy may reduce mortality.

    Methods

    The cohort included 29,845 individuals aged >= 65 years from several Italian health units who were newly treated with antidepressant drugs after hospital discharge with a diagnosis for cardiovascular disease during 2008-2010. These individuals were observed from the first prescription until the end of data availability (i.e. 2012-2014, depending on the local database). During this period, information on (1) prescription of antidepressants and other medications and (2) death from any cause (outcome) was recorded. Proportional hazards models were fitted to estimate the association between better adherence to antidepressants (defined as proportion of days covered > 75%) and outcome, by adjusting and stratifying for several covariates.

    Results

    Patients with better adherence to antidepressants had a reduced mortality of 9% (95% CI 3-14). Patients who did not use other medicaments during follow-up had reduced mortality associated with better adherence to antidepressants of 21% (- 1-38), 14% (7-20), 20% (13-26) and 13% (7-19) for no users of antihypertensive agents, lipid-lowering agents, other cardiovascular drugs and antidiabetics, respectively.

    Conclusions

    Better adherence to antidepressants is associated with reduced all-cause mortality, mainly in patients who did not use other pharmacological treatments. Behavioural changes to enhance adherence among the elderly with cardiovascular disease might offer important benefits in reducing their mortality.

  • 56. Bjerkeli, Pernilla J.
    et al.
    Vicente, Raquel Perez
    Mulinari, Shai
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Merlo, Juan
    Overuse of methylphenidate: an analysis of Swedish pharmacy dispensing data2018In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, p. 1657-1665Article in journal (Refereed)
    Abstract [en]

    Purpose: To identify overuse of methylphenidate and to investigate patterns of overuse in relation to sociodemographic and clinical characteristics.

    Patients and methods: Swedish national, pharmacy dispensing data were analyzed for all 56,922 individuals aged 6-79 years, who filled a methylphenidate prescription between 2010 and 2011. Overuse was defined as having above 150% days covered by the dispensed amount during 365 days from the first prescription fill, assuming use at the maximum recommended daily dose.

    Results: In total, 4,304 individuals (7.6% of the methylphenidate users) were categorized as overusers. The risk of overuse increased with age (OR for 46-65 years vs 6-12 years 17.5, 95% CI 14.3-21.3), and was higher in men (OR 1.4, 95% CI 1.3-1.5) and individuals with low income (OR 1.1, 95% CI 1.0-1.2), as well as in individuals with an attention deficit hyperactivity disorder (ADHD) diagnosis (OR 1.4, 95% CI 1.3-1.6), health care visits (OR 1.3, 95% CI 1.2-1.4), previous ADHD medication use (OR 2.6, 95% CI 2.4-2.8), and previous diagnosis of mental and behavioral disorders due to psychoactive substance use (OR 2.1 95% CI 2.0-2.3).

    Conclusion: Among individuals using methylphenidate in Sweden, 7.6% receive amounts that are larger than what they should have a medical need for, assuming that they were using the maximum recommended daily dose 365 days per year. Notably, the prevalence of overuse was associated with previous diagnosis of alcohol and drug misuse. The prevalence was also positively associated with higher age and previous use of ADHD medication. These findings may point toward a link between exposure time and overuse. However, future studies with long-term data are needed to investigate this.

  • 57. Boccardi, Virginia
    et al.
    Calvani, Riccardo
    Limongi, Federica
    Marseglia, Anna
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Mason, Alexandra
    Noale, Marianna
    Rogoli, Domenico
    Veronese, Nicola
    Crepaldi, Gaetano
    Maggi, Stefania
    Consensus paper on the executive summary of the international conference on Mediterranean diet and health: a lifelong approach an Italian initiative supported by the Mediterranean Diet Foundation and the Menarini Foundation2018In: Nutrition, ISSN 0899-9007, Vol. 51-52, p. 38-45Article in journal (Refereed)
    Abstract [en]

    The Mediterranean Diet Foundation, in collaboration with the International Menarini Foundation, organized the International Conference on Mediterranean Diet and Health: A Lifelong Approach. The Conference was held in Ostuni (Puglia, Italy) from March 30 to April 1, 2017. The event received the endorsement of the American Federation for Aging Research, the Research Consortium Luigi Amaducci, the European Nutrition for Health Alliance, the European Union Geriatric Medicine Society, the Clinical Section of the International Association of Gerontology and Geriatrics European Region, the National Research Council Research Project on Aging, the Italian Society of Gerontology and Geriatrics, and the Italian Society of Clinical Nutrition and Metabolism.During the conference, results were presented from major studies on dietary interventions aiming to assess the efficacy of the Mediterranean diet in the prevention of chronic diseases and the potential underlying mechanisms. Twenty-six international speakers, in seven different sessions, discussed the biological basis, clinical impact, health policy, and behavioral implications of the Mediterranean diet, and its use in potential interventions for health promotion.

  • 58. Boraxbekk, Carl-Johan
    et al.
    Lundquist, Anders
    Nordin, Annelie
    Nyberg, Lars
    Nilsson, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Adolfsson, Rolf
    Free Recall Episodic Memory Performance Predicts Dementia Ten Years prior to Clinical Diagnosis: Findings from the Betula Longitudinal Study2015In: Dementia and geriatric cognitive disorders extra, E-ISSN 1664-5464, Vol. 5, no 2, p. 191-202Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Early dementia diagnosis is a considerable challenge. The present study examined the predictive value of cognitive performance for a future clinical diagnosis of late-onset Alzheimer's disease or vascular dementia in a random population sample. Methods: Cognitive performance was retrospectively compared between three groups of participants from the Betula longitudinal cohort. Group 1 developed dementia 11-22 years after baseline testing (n = 111) and group 2 after 1-10 years (n = 280); group 3 showed no deterioration towards dementia during the study period (n = 2,855). Multinomial logistic regression analysis was used to investigate the predictive value of tests reflecting episodic memory performance, semantic memory performance, visuospatial ability, and prospective memory performance. Results: Age-and education-corrected performance on two free recall episodic memory tests significantly predicted dementia 10 years prior to clinical diagnosis. Free recall performance also predicted dementia 11-22 years prior to diagnosis when controlling for education, but not when age was added to the model. Conclusion: The present results support the suggestion that two free recall-based tests of episodic memory function may be useful for detecting individuals at risk of developing dementia 10 years prior to clinical diagnosis.

  • 59. Borg, Saskia
    et al.
    Seubert, Janina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Lipids in Eating and Appetite Regulation - A Neuro-Cognitive Perspective2017In: European Journal of Lipid Science and Technology, ISSN 1438-7697, E-ISSN 1438-9312, Vol. 119, no 12, article id 1700106Article in journal (Refereed)
    Abstract [en]

    Foods high in dietary fat provide a particularly energy-rich source of nutrition. A preferred food choice in humans, their intake is thought to contribute substantially to the current obesity epidemic. Fat has recently been proposed to constitute a basic taste; yet, its diverse sensory properties in the olfactory and somatosensory domain, as well as its postingestive effects have made the exact attributes that make its consumption so appealing difficult to disentangle. Recent scientific advances have shed light on the different molecular mechanisms underlying the sensory detection of fat in the periphery, and described their relevance for perceptual experience and eating behavior. However, these different analysis levels are to date poorly integrated, both within each sensory modality, and from a multisensory perspective.

  • 60. Bottai, Matteo
    et al.
    Tjärnlund, Anna
    Santoni, Giola
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Werth, Victoria P.
    Pilkington, Clarissa
    de Visser, Marianne
    Alfredsson, Lars
    Amato, Anthony A.
    Barohn, Richard J.
    Liang, Matthew H.
    Singh, Jasvinder A.
    Aggarwal, Rohit
    Arnardottir, Snjolaug
    Chinoy, Hector
    Cooper, Robert G.
    Danko, Katalin
    Dimachkie, Mazen M.
    Feldman, Brian M.
    García-De La Torre, Ignacio
    Gordon, Patrick
    Hayashi, Taichi
    Katz, James D.
    Kohsaka, Hitoshi
    Lachenbruch, Peter A.
    Lang, Bianca A.
    Li, Yuhui
    Oddis, Chester V.
    Olesinka, Marzena
    Reed, Ann M.
    Rutkowska-Sak, Lidia
    Sanner, Helga
    Selva-O'Callaghan, Albert
    Song, Yeong Wook
    Vencovsky, Jiri
    Ytterberg, Steven R.
    Miller, Frederick W.
    Rider, Lisa G.
    Lundberg, Ingrid E.
    EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups: a methodology report2017In: RMD Open, E-ISSN 2056-5933, Vol. 3, no 2, article id e000507Article in journal (Refereed)
    Abstract [en]

    Objective To describe the methodology used to develop new classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIMs) and their major subgroups.

    Methods An international, multidisciplinary group of myositis experts produced a set of 93 potentially relevant variables to be tested for inclusion in the criteria. Rheumatology, dermatology, neurology and paediatric clinics worldwide collected data on 976 IIM cases (74% adults, 26% children) and 624 non-IIM comparator cases with mimicking conditions (82% adults, 18% children). The participating clinicians classified each case as IIM or non-IIM. Generally, the classification of any given patient was based on few variables, leaving remaining variables unmeasured. We investigated the strength of the association between all variables and between these and the disease status as determined by the physician. We considered three approaches: (1) a probability-score approach, (2) a sum-of-items approach criteria and (3) a classification-tree approach.

    Results The approaches yielded several candidate models that were scrutinised with respect to statistical performance and clinical relevance. The probability-score approach showed superior statistical performance and clinical practicability and was therefore preferred over the others. We developed a classification tree for subclassification of patients with IIM. A calculator for electronic devices, such as computers and smartphones, facilitates the use of the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria.

    Conclusions The new EULAR/ACR classification criteria provide a patient's probability of having IIM for use in clinical and research settings. The probability is based on a score obtained by summing the weights associated with a set of criteria items.

  • 61.
    Brehmer, Yvonne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Max Planck Institute for Human Development, Germany.
    Kalpouzos, Gregoria
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wenger, Elisabeth
    Lövdén, Martin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Plasticity of brain and cognition in older adults2014In: Psychological Research, ISSN 0340-0727, E-ISSN 1430-2772, Vol. 78, no 6, p. 790-802Article, review/survey (Refereed)
    Abstract [en]

    Aging is typically related to changes in brain and cognition, but the aging process is heterogeneous and differs between individuals. Recent research has started investigating the influence of cognitive and physical training on cognitive performance, functional brain activity, and brain structure in old age. The functional relevance of neural changes and the interactions among these changes following interventions is still a matter of debate. Here we selectively review research on structural and functional brain correlates of training-induced performance changes in healthy older adults and present exemplary longitudinal intervention studies sorted by the type of training applied (i.e., strategy-based training, process-specific training, and physical exercise). Although many training studies have been conducted recently, within each task domain, the number of studies that used comparable methods and techniques to assess behavioral and neural changes is limited. We suggest that future studies should include a multimodal approach to enhance the understanding of the relation between different levels of brain changes in aging and those changes that result from training. Investigating inter-individual differences in intervention-induced behavioral and neuronal changes would provide more information about who would benefit from a specific intervention and why. In addition, a more systematic examination of the time course of training-related structural and functional changes would improve the current level of knowledge about how learning is implemented in the brain and facilitate our understanding of contradictory results.

  • 62.
    Brehmer, Yvonne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tilburg University, the Netherlands.
    Nilsson, Jonna
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Berggren, Rasmus
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Schmiedek, Florian
    Lövdén, Martin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    The importance of the ventromedial prefrontal cortex for associative memory in older adults: A latent structural equation analysis2020In: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 209, article id 116475Article in journal (Refereed)
    Abstract [en]

    Older adults show relatively minor age-related decline in memory for single items, while their memory for associations is markedly reduced. Inter-individual differences in memory function in older adults are substantial but the neurobiological underpinnings of such differences are not well understood. In particular, the relative importance of inter-individual differences in the medio-temporal lobe (MTL) and the lateral prefrontal cortex (PFC) for associative and item recognition in older adults is still ambiguous. We therefore aimed to first establish the distinction between inter-individual differences in associative memory (recollection-based) performance and item memory (familiarity-based) performance in older adults and subsequently link these two constructs to differences in cortical thickness in the MTL and lateral PFC regions, in a latent structural equation modelling framework. To this end, a sample of 160 older adults (65-75 years old) performed three intentional itemassociative memory tasks, of which a subsample (n = 72) additionally had cortical thickness measures in MTL and PFC regions of interest available. The results provided support for a distinction between familiarity-based item memory and recollection-based associative memory performance in older adults. Cortical thickness in the ventro-medial prefrontal cortex was positively correlated with associative recognition performance, above and beyond any relationship between item recognition performance and cortical thickness in the same region and between associative recognition performance and brain structure in the MTL (parahippocampus). The findings highlight the relative importance of the ventromedial prefrontal cortex in allowing for intentional recollection-based associative memory functioning in older adults.

  • 63.
    Brehmer, Yvonne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Max Planck Institute for Human Development, Germany.
    Shing, Yee Lee
    Heekeren, Hauke R.
    Lindenberger, Ulman
    Bäckman, Lars
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Training-induced changes in subsequent-memory effects: No major differences among children, younger adults, and older adults2016In: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 131, p. 214-225Article in journal (Refereed)
    Abstract [en]

    The neural correlates of encoding mode, or the state of forming new memory episodes, have been found to change with age and mnemonic training. However, it is unclear whether neural correlates of encoding success, termed subsequent-memory (SM) effects, also differ by age and mnemonic skill. In a multi-session training study, we investigated whether SM effects are altered by instruction and training in a mnemonic skill, and whether such alterations differ among children, younger adults, and older adults. Before and after strategy training, fMRI data were collected while participants were memorizing word pairs. In all age groups, participants receiving training showed greater performance gains than control group participants. Analysis of task-relevant regions showed training-induced reductions in SM effects in left frontal regions. Reductions in SM effects largely generalized across age and primarily reflected greater training-induced activation increases for omissions than for remembered items, indicating that training resulted in more consistent use of the mnemonic strategy. The present results reveal no major age differences in SM effects in children, younger adults, and older adults.

  • 64.
    Brehmer, Yvonne
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Westerberg, Helena
    Bäckman, Lars
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Working-memory training in younger and older adults: training gains, transfer, and maintenance2012In: Frontiers in Human Neuroscience, ISSN 1662-5161, Vol. 6, no 63, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Working memory (WM), a key determinant of many higher-order cognitive functions, declines in old age. Current research attempts to develop process-specific WM training procedures, which may lead to general cognitive improvement. Adaptivity of the training as well as the comparison of training gains to performance changes of an active control group are key factors in evaluating the effectiveness of a specific training program. In the present study, 55 younger adults (20–30 years of age) and 45 older adults (60–70 years of age) received 5 weeks of computerized training on various spatial and verbal WM tasks. Half of the sample received adaptive training (i.e., individually adjusted task difficulty), whereas the other half-worked on the same task material but on a low task difficulty level (active controls). Performance was assessed using criterion, near-transfer, and far-transfer tasks before training, after 5 weeks of intervention, as well as after a 3-month follow-up interval. Results indicate that (a) adaptive training generally led to larger training gains than low-level practice, (b) training and transfer gains were somewhat greater for younger than for older adults in some tasks, but comparable across age groups in other tasks, (c) far-transfer was observed to a test on sustained attention and for a self-rating scale on cognitive functioning in daily life for both young and old, and (d) training gains and transfer effects were maintained across the 3-month follow-up interval across age.

  • 65. Broda, Anja
    et al.
    Bieber, Anja
    Meyer, Gabriele
    Hopper, Louise
    Joyce, Rachael
    Irving, Kate
    Zanetti, Orazio
    Portolani, Elisa
    Kerpershoek, Liselot
    Verhey, Frans
    de Vugt, Marjolein
    Wolfs, Claire
    Eriksen, Siren
    Rosvik, Janne
    Marques, Maria J.
    Goncalves-Pereira, Manuel
    Sjölund, Britt-Marie
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Gävle, Sweden.
    Woods, Bob
    Jelley, Hannah
    Orrell, Martin
    Stephan, Astrid
    Perspectives of policy and political decision makers on access to formal dementia care: expert interviews in eight European countries2017In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, article id 518Article in journal (Refereed)
    Abstract [en]

    Background: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers. Methods: Each ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics Complexity and Continuity of Care, Formal Services, and Public Awareness. Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries. Results: The analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness. Conclusions: Policy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.

  • 66. Brodaty, Henry
    et al.
    Breteler, Monique M.B.
    DeKoshy, Steven T.
    Dorenlot, Pascale
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Hock, Christoph
    Kenigsberg, Paul-Ariel
    Scheltens, Philip
    de Strooper, Bart
    The World of Dementia Beyond 20202011In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 59, no 5, p. 923-927Article in journal (Refereed)
    Abstract [en]

    Counterpoised against dire projections of the tripling of the prevalence of dementia over the next 40 years are major developments in diagnostic biomarkers, neuroimaging, the molecular biology of Alzheimer's disease (AD), epidemiology of risk and protective factors, and drug treatments—mainly targeting the amyloid pathway, tau protein, and immunotherapy—that may have the potential to modify the progression of AD. Drug combinations and presymptomatic treatments are also being investigated. Previous trials of dementia-modifying drugs have not shown benefit, and even if current Phase III trials prove successful, these drugs will not eradicate other dementias, could (if not curative) increase dementia duration and prevalence, and are unlikely to come onto the market before 2020. In the meantime, delaying the onset of dementia by even 2 years would have significant economic and societal effects. This article provides an overview of current achievements and potentials of basic and clinical research that might affect the development of dementia prevalence and care within the near future.

  • 67. Brose, Annette
    et al.
    Lovden, Martin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Schmiedek, Florian
    Daily Fluctuations in Positive Affect Positively Co-Vary With Working Memory Performance2014In: Emotion, ISSN 1528-3542, E-ISSN 1931-1516, Vol. 14, no 1, p. 1-6Article in journal (Refereed)
    Abstract [en]

    Positive affect is related to cognitive performance in multiple ways. It is associated with motivational aspects of performance, affective states capture attention, and information processing modes are a function of affect. In this study, we examined whether these links are relevant within individuals across time when they experience minor ups and downs of positive affect and work on cognitive tasks in the laboratory on a day-to-day basis. Using a microlongitudinal design, 101 younger adults (20-31 years of age) worked on 3 working memory tasks on about 100 occasions. Every day, they also reported on their momentary affect and their motivation to work on the tasks. In 2 of the 3 tasks, performance was enhanced on days when positive affect was above average. This performance enhancement was also associated with more motivation. Importantly, increases in task performance on days with above-average positive affect were mainly unrelated to variations in negative affect. This study's results are in line with between-person findings suggesting that high levels of well-being are associated with successful outcomes. They imply that success on cognitively demanding tasks is more likely on days when feeling happier.

  • 68. Brose, Annette
    et al.
    Schmiedek, Florian
    Lövdén, Martin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Max Planck Institute, Germany; Lund University, Sweden.
    Lindenberger, Ulman
    Daily variability in working memory is coupled with negative affect: the role of attention and motivation2012In: Emotion, ISSN 1528-3542, E-ISSN 1931-1516, Vol. 12, no 3, p. 605-617Article in journal (Refereed)
    Abstract [en]

    Across days, individuals experience varying levels of negative affect, control of attention, and motivation. We investigated whether this intraindividual variability was coupled with daily fluctuations in working memory (WM) performance. In 100 days, 101 younger individuals worked on a spatial N-back task and rated negative affect, control of attention, and motivation. Results showed that individuals differed in how reliably WM performance fluctuated across days, and that subjective experiences were primarily linked to performance accuracy. WM performance was lower on days with higher levels of negative affect, reduced control of attention, and reduced task-related motivation. Thus, variables that were found to predict WM in between-subjects designs showed important relationships to WM at the within-person level. In addition, there was shared predictive variance among predictors of WM. Days with increased negative affect and reduced performance were also days with reduced control of attention and reduced motivation to work on tasks. These findings are in line with proposed mechanisms linking negative affect and cognitive performance.

  • 69. Brose, Annette
    et al.
    Schmiedek, Florian
    Lövdén, Martin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lindenberger, Ulman
    Normal aging dampens the link between intrusive thoughts and negative affect in reaction to daily stressors2011In: Psychology and aging, ISSN 0882-7974, Vol. 26, no 2, p. 488-502Article in journal (Refereed)
    Abstract [en]

    We charted daily variations in intrusive thoughts to gain access to adult age differences in affective reactivity to daily stressors. On 100 days, 101 younger and 103 older adults reported stressors, intrusive thoughts, and negative affect. Although increments in intrusive thoughts were similar in both age groups on days with stressors, older adults' negative affect increased less than younger adults' on such days. In addition, (a) levels of intrusive thoughts and negative affect across study time were positively associated; (b) days with increased thoughts were days with increased negative affect; and (c) experiencing above-average intrusive thoughts about stressors strengthened affective reactions to stress. Relative to younger adults, all three associations were reduced in older adults. We tentatively conclude that normal aging dampens the stress-induced link between intrusive thoughts and affect. This dampening may contribute to preserved affective well-being and reduced affective reactivity to daily stress in old age.

  • 70. Brose, Annette
    et al.
    Voelkle, Manuel C.
    Lövdén, Martin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Max Planck Society, Germany .
    Lindenberger, Ulman
    Schmiedek, Florian
    Differences in the Between-Person and Within-Person Structures of Affect Are a Matter of Degree2015In: European Journal of Personality, ISSN 0890-2070, E-ISSN 1099-0984, Vol. 29, no 1, p. 55-71Article in journal (Refereed)
    Abstract [en]

    This study tested whether the structure of affect observed on the basis of between-person (BP) differences is equivalent to the affect structures that organize the variability of affective states within persons (WP) over time. Further aims were to identify individual differences in the degree of divergence between the WP and BP structure and examine its association to dispositional and contextual variables (neuroticism, extraversion, well-being and stress). In 100 daily sessions, 101 younger adults rated their mood on the Positive and Negative Affect Schedule. Variability of five negative affect items across time was so low that they were excluded from the analyses. We thus worked with a modified negative affect subscale. WP affect structures diverged reliably from the BP structure, with individual differences in the degree of divergence. Differences in the WP structural characteristics and the degree of divergence could be predicted by well-being and stress. We conclude that BP and WP structures of affect are not equivalent and that BP and WP variation should be considered as distinct phenomena. It would be wrong, for example, to conceive of positive and negative affect as independent at the WP level, as suggested by BP findings. Yet, individual differences in WP structural characteristics are related to stable BP differences, and the degree to which individuals' affect structures diverge from the BP structure can provide important insights into intraindividual functioning.

  • 71.
    Brozzoli, Claudio
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Lyon Neuroscience Research Center, France; University of Lyon, France; Hospices Civils de Lyon, France.
    Roy, Alice C.
    Lidborg, Linda H.
    Lövdén, Martin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Language as a Tool: Motor Proficiency Using a Tool Predicts Individual Linguistic Abilities2019In: Frontiers in Psychology, ISSN 1664-1078, E-ISSN 1664-1078, Vol. 10, article id 1639Article in journal (Refereed)
    Abstract [en]

    Different disciplines converge to trace language evolution from motor skills. The human ability to use tools has been advocated as a fundamental step toward the emergence of linguistic processes in the brain. Neuropsychological and neuroimaging research has established that linguistic functions and tool-use are mediated by partially overlapping brain networks. Yet, scholars still theoretically debate whether the relationship between tool-use and language is contingent or functionally relevant, since empirical evidence is critically missing. Here, we measured both linguistic production and tool-use abilities in the same participants, as well as manual and linguistic motor skills. A path analysis ruling out unspecific contributions from manual or linguistic motor skills, showed that motor proficiency using a tool lawfully predicts differences in individual linguistic production. In addition, more complex tool-use reveals stronger association between linguistic production and tool mastery. These findings establish the existence of shared cognitive processes between tool-use and language.

  • 72. Bruun Kristensen, Kasper
    et al.
    Karlstad, Øystein
    Martikainen, Jaana E.
    Pottegård, Anton
    Wastesson, Jonas W.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Zoega, Helga
    Schmidt, Morten
    Nonaspirin Nonsteroidal Antiinflammatory Drug Use in the Nordic Countries from a Cardiovascular Risk Perspective, 2000-2016: A Drug Utilization Study2019In: Pharmacotherapy, ISSN 0277-0008, E-ISSN 1875-9114, Vol. 39, no 2, p. 150-160Article in journal (Refereed)
    Abstract [en]

    Study Objective

    Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), particularly diclofenac and the newer selective cyclooxygenase (COX)-2 inhibitors, has accumulated over the last decade. Our objective was to examine whether the use of NSAIDs in the Nordic countries changed with the emerging evidence, regulatory statements, and clinical guidelines advocating caution for the use of specific NSAIDs.

    Design

    Drug utilization study.

    Data Sources

    Nationwide wholesale statistics and prescription registries in Denmark, Finland, Iceland, Norway, and Sweden (2000-2016).

    Measurements and Main Results

    Our main outcome measures were yearly total sales, expressed as number of sold defined daily doses (DDDs)/1000 inhabitants/day, and yearly prevalence of prescription use, expressed as number of prescription users per 1000 inhabitants. The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Total sales of NSAIDs increased in all countries and were highest in Iceland, with 74.3 DDDs/1000 inhabitants/day sold in 2016, followed by Finland (73.9), Sweden (54.4), Norway (43.8), and Denmark (31.8). Diclofenac use declined after 2008 in all countries but remained the most widely prescribed NSAID in Norway, with 63 prescription users/1000 inhabitants in 2016. Diclofenac sales also remained high in Iceland (12.7 DDD/1000 inhabitants/day), Norway (8.1), and Sweden (7.8). Since its introduction in 2003, the use of etoricoxib, a newer selective COX-2 inhibitor, increased in all countries except Denmark, with highest sales in Finland (6.7 DDD/1000 inhabitants/day in 2016).

    Conclusion

    Sales and prescription patterns of NSAIDs in the Nordic countries has changed along with the accumulating evidence for the cardiovascular risks of specific NSAIDs. However, given existing evidence on the cardiovascular risks associated with the use of diclofenac and etoricoxib, the persistent high use of diclofenac in Iceland, Norway, and Sweden, the persistent over-the-counter availability of diclofenac in Norway and Sweden, and the increasing use of etoricoxib in most of the Nordic countries pose a cardiovascular health concern.

  • 73. Burzynska, A Z
    et al.
    Nagel, I E
    Preuschhof, C
    Li, S-C
    Lindenberger, U
    Bäckman, Lars
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Heekeren, H R
    Microstructure of frontoparietal connections predicts cortical responsivity and working memory performance2011In: Cerebral Cortex, ISSN 1047-3211, E-ISSN 1460-2199, Vol. 21, no 10, p. 2261-2271Article in journal (Refereed)
    Abstract [en]

    We investigated how the microstructure of relevant white matter connections is associated with cortical responsivity and working memory (WM) performance by collecting diffusion tensor imaging and verbal WM functional magnetic resonance imaging data from 29 young adults. We measured cortical responsivity within the frontoparietal WM network as the difference in blood oxygenation level-dependent (BOLD) signal between 3-back and 1-back conditions. Fractional anisotropy served as an index of the integrity of the superior longitudinal fasciculi (SLF), which connect frontal and posterior regions. We found that SLF integrity is associated with better 3-back performance and greater task-related BOLD responsivity. In addition, BOLD responsivity in right premotor cortex reliably mediated the effects of SLF integrity on 3-back performance but did not uniquely predict 3-back performance after controlling for individual differences in SLF integrity. Our results suggest that task-related adjustments of local gray matter processing are conditioned by the properties of anatomical connections between relevant cortical regions. We suggest that the microarchitecture of white matter tracts influences the speed of signal transduction along axons. This in turn may affect signal summation at neural dendrites, action potential firing, and the resulting BOLD signal change and responsivity.

  • 74.
    Burzynska, A Z
    et al.
    Max Planck Institute for Human Development,.
    Preuschhof, C
    Max Planck Institute for Human Development,.
    Bäckman, Lars
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Nyberg, L
    Department of Radiation Sciences (Diagnostic Radiology) and Integrative Medical Biology (Physiology Section), Umeå University,.
    Li, S-C
    Max Planck Institute for Human Development,.
    Lindenberger, U
    Max Planck Institute for Human Development,.
    Heekeren, H R
    Max Planck Institute for Human Development,.
    Age-related differences in white matter microstructure: region-specific patterns of diffusivity2010In: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 49, no 3, p. 2104-2112Article in journal (Refereed)
    Abstract [en]

    We collected MRI diffusion tensor imaging data from 80 younger (20-32 years) and 63 older (60-71 years) healthy adults. Tract-based spatial statistics (TBSS) analysis revealed that white matter integrity, as indicated by decreased fractional anisotropy (FA), was disrupted in numerous structures in older compared to younger adults. These regions displayed five distinct region-specific patterns of age-related differences in other diffusivity properties: (1) increases in both radial and mean diffusivity; (2) increases in radial diffusivity; (3) no differences in parameters other than FA; (4) a decrease in axial and an increase in radial diffusivity; and (5) a decrease in axial and mean diffusivity. These patterns suggest different biological underpinnings of age-related decline in FA, such as demyelination, Wallerian degeneration, gliosis, and severe fiber loss, and may represent stages in a cascade of age-related degeneration in white matter microstructure. This first simultaneous description of age-related differences in FA, mean, axial, and radial diffusivity requires histological and functional validation as well as analyses of intermediate age groups and longitudinal samples.

  • 75. Burzynska, Agnieszka Z.
    et al.
    Garrett, Douglas D.
    Preuschhof, Claudia
    Nagel, Irene E.
    Li, Shu-Chen
    Bäckman, Lars
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Heekeren, Hauke R.
    Lindenberger, Ulman
    A Scaffold for Efficiency in the Human Brain2013In: Journal of Neuroscience, ISSN 0270-6474, E-ISSN 1529-2401, Vol. 33, no 43, p. 17150-17159Article in journal (Refereed)
    Abstract [en]

    The comprehensive relations between healthy adult human brain white matter(WM) microstructure and gray matter (GM) function, and their joint relations to cognitive performance, remain poorly understood. We investigated these associations in 27 younger and 28 older healthy adults by linking diffusion tensor imaging (DTI) with functional magnetic resonance imaging (fMRI) data collected during an n-back working memory task. We present a novel application of multivariate Partial Least Squares (PLS) analysis that permitted the simultaneous modeling of relations between WM integrity values from all major WM tracts and patterns of condition-related BOLD signal across all GM regions. Our results indicate that greater microstructural integrity of the major WM tracts was negatively related to condition-related blood oxygenation level-dependent (BOLD) signal in task-positive GM regions. This negative relationship suggests that better quality of structural connections allows for more efficient use of task-related GM processing resources. Individuals with more intact WM further showed greater BOLD signal increases in typical task-negative regions during fixation, and notably exhibited a balanced magnitude of BOLD response across task-positive and-negative states. Structure-function relations also predicted task performance, including accuracy and speed of responding. Finally, structure-function behavior relations reflected individual differences over and above chronological age. Our findings provide evidence for the role of WM microstructure as a scaffold for the context-relevant utilization of GM regions.

  • 76. Burzynska, Agnieszka Z.
    et al.
    Nagel, Irene E.
    Preuschhof, Claudia
    Gluth, Sebastian
    Bäckman, Lars
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Max Planck Institute for Human Development, Germany.
    Li, Shu-Chen
    Lindenberger, Ulman
    Heekeren, Hauke R.
    Cortical thickness is linked to executive functioning in adulthood and aging2012In: Human Brain Mapping, ISSN 1065-9471, E-ISSN 1097-0193, Vol. 33, no 7, p. 1607-20Article in journal (Refereed)
    Abstract [en]

    Executive functions that are dependent upon the frontal-parietal network decline considerably during the course of normal aging. To delineate neuroanatomical correlates of age-related executive impairment, we investigated the relation between cortical thickness and executive functioning in 73 younger (20-32 years) and 56 older (60-71 years) healthy adults. Executive functioning was assessed using the Wisconsin Card Sorting Test (WCST). Cortical thickness was measured at each location of the cortical mantle using surface-based segmentation procedures on high-resolution T1-weighted magnetic resonance images. For regions involved in WCST performance, such as the lateral prefrontal and parietal cortices, we found that thicker cortex was related to higher accuracy. Follow-up ROI-based analyses revealed that these associations were stronger in older than in younger adults. Moreover, among older adults, high and low performers differed in cortical thickness within regions generally linked to WCST performance. Our results indicate that the structural cortical correlates of executive functioning largely overlap with previously identified functional patterns. We conclude that structural preservation of relevant brain regions is associated with higher levels of executive performance in old age, and underscore the need to consider the heterogeneity of brain aging in relation to cognitive functioning.

  • 77.
    Bäckman, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Karlsson, Sari
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fischer, Håkan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Karlsson, Per
    Brehmer, Yvonne
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rieckmann, Anna
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    MacDonald, Stuart W. S.
    Farde, Lars
    Nyberg, Lars
    Dopamine D1 receptors and age differences in brain activation during working memory2011In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 32, no 10, p. 1849-1856Article in journal (Refereed)
    Abstract [en]

    In an fMRI study, 20 younger and 20 healthy older adults were scanned while performing a spatial working-memory task under two levels of load. On a separate occasion, the same subjects underwent PET measurements using the radioligand [11C] SCH23390 to determine dopamine D1 receptor binding potential (BP) in caudate nucleus and dorsolateral prefrontal cortex (DLPFC). The fMRI study revealed a significant load modulation of brain activity (higher load > lower load) in frontal and parietal regions for younger, but not older, adults. The PET measurements showed marked age-related reductions of D1 BP in caudate and DLPFC. Statistical control of caudate and DLPFC D1 binding eliminated the age-related reduction in load-dependent BOLD signal in left frontal cortex, and attenuated greatly the reduction in right frontal and left parietal cortex. These findings suggest that age-related alterations in dopaminergic neurotransmission may contribute to underrecruitment of task-relevant brain regions during working-memory performance in old age.

  • 78.
    Bäckman, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Nyberg, Lars
    Dopamine and training-related working-memory improvement2013In: Neuroscience and Biobehavioral Reviews, ISSN 0149-7634, E-ISSN 1873-7528, Vol. 37, no 9, p. 2209-2219Article, review/survey (Refereed)
    Abstract [en]

    Converging evidence indicates that the neurotransmitter dopamine (DA) is implicated in working-memory (WM) functioning and that WM is trainable. We review recent work suggesting that DA is critically involved in the ability to benefit from WM interventions. Functional MRI studies reveal increased striatal BOLD activity following certain forms of WM interventions, such as updating training. Increased striatal BOLD activity has also been linked to transfer of learning to non-trained WM tasks, suggesting a neural signature of transfer. The striatal BOLD signal is partly determined by DA activity. Consistent with this assertion, PET research demonstrates increased striatal DA release during updating of information in WM after training. Genetic studies indicate larger increases in WM performance post training for those who carry advantageous alleles of DA-relevant genes. These patterns of results corroborate the role of DA in WM improvement. Future research avenues include: (a) neuromodulatory correlates of transfer; (b) the potential of WM training to enhance DA release in older adults; (c) comparisons among different WM processes (i.e., updating, switching, inhibition) regarding regional patterns of training-related DA release; and (d) gene–gene interactions in relation to training-related WM gains.

  • 79.
    Bäckman, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Nyberg, Lars
    Soveri, Anna
    Johansson, Jarkko
    Andersson, Micael
    Dahlin, Erika
    Neely, Anna S.
    Virta, Jere
    Laine, Matti
    Rinne, Juha O.
    Effects of working-memory training on striatal dopamine release2011In: Science, ISSN 0036-8075, E-ISSN 1095-9203, Vol. 333, no 6043, p. 718-Article in journal (Refereed)
    Abstract [en]

    Updating of working memory has been associated with striato-frontal brain regions and phasic dopaminergic neurotransmission. We assessed raclopride binding to striatal dopamine (DA) D2 receptors during a letter-updating task and a control condition before and after 5 weeks of updating training. Results showed that updating affected DA activity before training and that training further increased striatal DA release during updating. These findings highlight the pivotal role of transient neural processes associated with D2 receptor activity in working memory.

  • 80.
    Bäckman, Lars
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Waris, Otto
    Johansson, Jarkko
    Andersson, Micael
    Rinne, Juha O.
    Alakurtti, Kati
    Soveri, Anna
    Laine, Matti
    Nyberg, Lars
    Increased dopamine release after working-memory updating training: Neurochemical correlates of transfer2017In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 7, article id 7160Article in journal (Refereed)
    Abstract [en]

    Previous work demonstrates that working-memory (WM) updating training results in improved performance on a letter-memory criterion task, transfers to an untrained n-back task, and increases striatal dopamine (DA) activity during the criterion task. Here, we sought to replicate and extend these findings by also examining neurochemical correlates of transfer. Four positron emission tomography (PET) scans using the radioligand raclopride were performed. Two of these assessed DAD2 binding (letter memory; n-back) before 5 weeks of updating training, and the same two scans were performed post training. Key findings were (a) pronounced training-related behavioral gains in the lettermemory criterion task, (b) altered striatal DAD2 binding potential after training during letter-memory performance, suggesting training-induced increases in DA release, and (c) increased striatal DA activity also during the n-back transfer task after the intervention, but no concomitant behavioral transfer. The fact that the training-related DA alterations during the transfer task were not accompanied by behavioral transfer suggests that increased DA release may be a necessary, but not sufficient, condition for behavioral transfer to occur.

  • 81. Bäckstrom, Caroline
    et al.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Thorstensson, Stina
    Golsäter, Marie
    Mårtensson, Lena B.
    Quality of couple relationship among first-time mothers and partners, during pregnancy and the first six months of parenthood2018In: Sexual & Reproductive HealthCare, ISSN 1877-5756, E-ISSN 1877-5764, Vol. 17, p. 56-64Article in journal (Refereed)
  • 82.
    Calderón-Larrañaga, Amaia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Liborio Vetrano, Davide
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Università Cattolica del Sacro Cuore, Italy; RCCS Fondazione Policlinico “A. Gemelli”, Italy.
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Grande, Giulia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Dekhtyar, Serhiy
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Psychological correlates of multimorbidity and disability accumulation in older adults2019In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 48, no 6, p. 789-796Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: attitudes toward life and health are emerging as important psychological contributors to health heterogeneity in ageing. We aimed to explore whether different psychological factors were associated with the rate of chronic disease and disability accumulation over time.

    Design: population-based cohort study between 2001 and 2010.

    Setting: Swedish National study on aging and care in Kungsholmen.

    Subjects: adults aged 60 and older (N = 2293).

    Methods: linear mixed models were employed to study the association of life satisfaction, health outlook, resistance to illness, sickness orientation, and health worry with the rate of accumulation of chronic diseases and impaired basic and instrumental activities of daily living. Models were adjusted for demographic, clinical, social, personality and lifestyle factors. Analyses were repeated after excluding individuals with multimorbidity or disability at baseline.

    Results: high life satisfaction and positive health outlook were consistently associated with a lower rate of accumulation and progression of multimorbidity (beta -0.064 95% confidence interval [CI] -0.116, -0.011; beta -0.065 95% CI -0.121, -0.008, respectively) and disability (beta -0.063 95% CI -0.098, -0.028; beta -0.042 95% CI -0.079, -0.004, respectively) over time. This was true even for people without multimorbidity or disability at baseline and after adjusting for all covariates.

    Conclusions: positive attitudes toward life in general and health in particular may be especially important in old age, when the cumulative effects of biological and environmental deficits lead to accelerated health decline. These findings should encourage researchers to use measures of psychological well-being to better understand the multifactorial and diverse process of ageing.

  • 83.
    Calderón-Larrañaga, Amaia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Santoni, Giola
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wang, Hui Xin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Rome, Italy.
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Rapidly developing multimorbidity and disability in older adults: does social background matter?2018In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 283, no 5, p. 489-499Article in journal (Refereed)
    Abstract [en]

    Background. Multimorbidity is among the most disabling geriatric conditions. In this study, we explored whether a rapid development of multi morbidity potentiates its impact on the functional independence of older adults, and whether different sociodemographic factors play a role beyond the rate of chronic disease accumulation. Methods. A random sample of persons aged >= 60 years (n = 2387) from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) was followed over 6 years. The speed of multimorbidity development was estimated as the rate of chronic disease accumulation (linear mixed models) and further dichotomized into the upper versus the three lower rate quartiles. Binomial negative mixed models were used to analyse the association between speed of multimorbidity development and disability (impaired basic and instrumental activities of daily living), expressed as the incidence rate ratio (IRR). The effect of sociodemographic factors, including sex, education, occupation and social network, was investigated. Results. The risk of new activity impairment was higher among participants who developed multi morbidity faster (IRR 2.4, 95% Cl 1.9-3.1) compared with those who accumulated diseases more slowly overtime, even after considering the baseline number of chronic conditions. Only female sex (IRR for women vs. men 1.6, 95% Cl 1.2-2.0) and social network (IRR for poor vs. rich social network 1.7, 95% Cl 1.3-2.2) showed an effect on disability beyond the rate of chronic disease accumulation. Conclusions. Rapidly developing multimorbidity is a negative prognostic factor for disability. However, sociodemographic factors such as sex and social network may determine older adults' reserves of functional ability, helping them to live independently despite the rapid accumulation of chronic conditions.

  • 84.
    Calderón-Larrañaga, Amaia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of the Sacred Heart, Italy; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Italy.
    Ferrucci, L.
    Mercer, S. W.
    Marengoni, A.
    Onder, G.
    Eriksdotter, M.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Multimorbidity and functional impairment-bidirectional interplay, synergistic effects and common pathways2019In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 285, no 3, p. 255-271Article, review/survey (Refereed)
    Abstract [en]

    This review discusses the interplay between multimorbidity (i.e. co-occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person's ability to perform everyday tasks). On the one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle. The circle may be further exacerbated by people's reduced ability to cope with treatment and care burden and physicians' fragmented view of health problems, which cause suboptimal use of health services and reduced quality of life and survival. Thus, the synergistic effects of medical diagnoses and functional status in adults, particularly older adults, emerge as central to assessing their health and care needs. Furthermore, common pathways seem to underlie multimorbidity, functional impairment and their interplay. For example, older age, obesity, involuntary weight loss and sedentarism can accelerate damage accumulation in organs and physiological systems by fostering inflammatory status. Inappropriate use or overuse of specific medications and drug-drug and drug-disease interactions also contribute to the bidirectional association between multimorbidity and functional impairment. Additionally, psychosocial factors such as low socioeconomic status and the direct or indirect effects of negative life events, weak social networks and an external locus of control may underlie the complex interactions between multimorbidity, functional decline and negative outcomes. Identifying modifiable risk factors and pathways common to multimorbidity and functional impairment could aid in the design of interventions to delay, prevent or alleviate age-related health deterioration; this review provides an overview of knowledge gaps and future directions.

  • 85.
    Calderón-Larrañaga, Amaia
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Aragon Health Sciences Institute (IACS), Spain.
    Vetrano, Davide L.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of Rome, Italy.
    Onder, Graziano
    Gimeno-Feliu, Luis A.
    Coscollar-Santaliestra, Carlos
    Carfí, Angelo
    Pisciotta, Maria S.
    Angleman, Sara
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Melis, René J. F.
    Santoni, Giola
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Mangialasche, Francesca
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Bernabei, Roberto
    Prados-Torres, Alexandra
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Italy.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Assessing and Measuring Chronic Multimorbidity in the Older Population: A Proposal for Its Operationalization2017In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 72, no 10, p. 1417-1423Article in journal (Refereed)
    Abstract [en]

    Background

    Although the definition of multimorbidity as the simultaneous presence of two or more chronic diseases is well established, its operationalization is not yet agreed. This study aims to provide a clinically driven comprehensive list of chronic conditions to be included when measuring multimorbidity.

    Methods

    Based on a consensus definition of chronic disease, all four-digit level codes from the International Classification of Diseases, 10th revision (ICD-10) were classified as chronic or not by an international and multidisciplinary team. Chronic ICD-10 codes were subsequently grouped into broader categories according to clinical criteria. Last, we showed proof of concept by applying the classification to older adults from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) using also inpatient data from the Swedish National Patient Register.

    Results

    A disease or condition was considered to be chronic if it had a prolonged duration and either (a) left residual disability or worsening quality of life or (b) required a long period of care, treatment, or rehabilitation. After applying this definition in relation to populations of older adults, 918 chronic ICD-10 codes were identified and grouped into 60 chronic disease categories. In SNAC-K, 88.6% had >= 2 of these 60 disease categories, 73.2% had >= 3, and 55.8% had >= 4.

    Conclusions

    This operational measure of multimorbidity, which can be implemented using either or both clinical and administrative data, may facilitate its monitoring and international comparison. Once validated, it may enable the advancement and evolution of conceptual and theoretical aspects of multimorbidity that will eventually lead to better care.

  • 86. Campbell, John
    et al.
    Ikegami, Naoki
    Gori, Cristiano
    Barbabella, Francesco
    Chomik, Rafal
    d'Amico, Francesco
    Holder, Holly
    Ishibashi, Tomoaki
    Johansson, Lennarth
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Komisar, Harriet
    Ring, Magnus
    Theobald, Hildegard
    How different countries allocate long-term care resources to older users: a comparative snapshot2016In: Long-term Care Reforms in OECD Countries: Successes and Failures / [ed] C. Gori, J. L. Fernandez, R. Wittenberg, Policy Press, 2016, p. 47-76Chapter in book (Refereed)
  • 87. Canevelli, Marco
    et al.
    Bruno, Giuseppe
    Grande, Giulia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Quarata, Federica
    Raganato, Riccardo
    Remiddi, Francesca
    Valletta, Martina
    Zaccaria, Valerio
    Vanacore, Nicola
    Cesari, Matteo
    Race reporting and disparities in clinical trials on Alzheimer's disease: A systematic review2019In: Neuroscience and Biobehavioral Reviews, ISSN 0149-7634, E-ISSN 1873-7528, Vol. 101, p. 122-128Article, review/survey (Refereed)
    Abstract [en]

    Introduction: Race is an important health determinant and should adequately be considered in research and drug development protocols targeting Alzheimer's disease (AD).

    Methods: A systematic review of available randomized controlled trials (RCTs) on the currently marketed treatments for AD was conducted with the aim of 1) documenting the reporting of race, and 2) exploring the impact of race on the efficacy and safety/tolerability of the considered medications.

    Results: Overall, 59.2% of the 49 retained RCTs reported information concerning the race of participants. Only a striking minority of enrolled patients was constituted of blacks and Hispanics. None on the retained studies reported results on the efficacy and safety/tolerability of the tested treatment separately for racial groups nor performed sensitivity analyses accounting for the race of participants.

    Discussion: Race has insufficiently been reported in previous interventional studies on AD. Its potential association with the effectiveness and safety/tolerability of the tested medications has completely been neglected.

  • 88. Cao, Zhi
    et al.
    Wang, Rui
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Cheng, Yangyang
    Yang, Hongxi
    Li, Shu
    Sun, Li
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wang, Yaogang
    Adherence to a healthy lifestyle counteracts the negative effects of risk factors on all-cause mortality in the oldest-old2019In: Aging, ISSN 1945-4589, E-ISSN 1945-4589, Vol. 11, no 18, p. 7605-7619Article in journal (Refereed)
    Abstract [en]

    In the study, we examined the extent to which the harmful effects of risk factors on all-cause mortality can be counteracted by healthy lifestyle practices in the oldest-old (80 years of age and older). A total of 17,660 oldest-old from China were followed up for up to 10 years. The data were analyzed using the Cox proportional hazard model with adjustment for potential confounders. We found that having a rural residence, not being married, having lower economic status, physical disability, impaired cognitive function, or comorbidity were all associated with an elevated risk of mortality. Using these factors, we computed a weighted risk score. Because never smoking, never drinking, doing physical exercise, having an ideal diet, and a normal weight were independently associated with lower mortality, we also combined them to compute a weighted protection score. Both scores were divided into lowest, middle, and highest groups using their tertiles. In joint effect analyses, participants with the combined highest-risk score and lowest-protection score profile had a nearly threefold higher joint death risk. These analyses show that adherence to a healthy lifestyle counteracts the negative effect of risk factors on all-cause mortality in the oldest-old by more than 20%.

  • 89.
    Caracciolo, B
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Bäckman, L
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Monastero, R
    Winblad, B
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fratiglioni, L
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    The symptom of low mood in the prodromal stage of mild cognitive impairment and dementia: a cohort study of a community dwelling elderly population2011In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 82, no 7, p. 788-793Article in journal (Refereed)
    Abstract [en]

    Objective To investigate the symptom of low mood as a predictor of mild cognitive impairment (MCI) and its progression to dementia, taking into account: (i) MCI severity, (ii) time of assessment and (iii) interaction with other factors.

    Methods 764 cognitively healthy elderly subjects living in the community, from the Kungsholmen Project. Participants were assessed by direct interview to detect low mood. Subjects were then followed for 6 years to identify those who developed MCI. People with incident MCI were followed for a further 3 years to assess progression to dementia.

    Results People with low mood at baseline had a 2.7-fold (95% CI 1.9 to 3.7) increased risk of developing MCI at follow-up. The association was stronger for amnestic MCI (aMCI: HR 5.8; 95% CI 3.1 to 10.9) compared with global cognitive impairment (other cognitive impairment no dementia, oCIND: HR 2.2; 95% CI 1.5 to 3.3). ApoE-ε4 interacted with low mood in a synergistic fashion, increasing the risk of aMCI, while no interaction with psychiatric, vascular, frailty related or psychosocial factors was observed. Low mood at baseline, as opposed to low mood co-occurring with MCI, was associated with a 5.3-fold (95% CI 1.2 to 23.3) increased risk of progression to dementia in aMCI. In contrast, no association was found in oCIND.

    Conclusion Low mood was more strongly associated with aMCI than with global cognitive impairment. Progression towards dementia was predicted only by low mood manifest in the prodromal stage of MCI. These findings indicate that low mood is particularly prominent in the very early stages of cognitive decline.

  • 90.
    Caracciolo, Barbara
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Gatz, Margaret
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Marengoni, Alessandra
    Pedersen, Nancy L.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Relationship of Subjective Cognitive Impairment and Cognitive Impairment No Dementia to Chronic Disease and Multimorbidity in a Nation-Wide Twin Study2013In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 36, no 2, p. 275-284Article in journal (Refereed)
    Abstract [en]

    We investigated the relation of subjective cognitive impairment (SCI) and cognitive impairment no dementia (CIND) to common chronic diseases of the elderly and multimorbidity, and assessed the contribution of genetic background and shared familial environment to these associations. Subjects were 11,379 dementia-free twin individuals aged >= 65 from the Swedish Twin Registry. SCI was defined as subjective complaint of cognitive change without objective cognitive impairment and CIND was defined according to current criteria. In unmatched, fully-adjusted regression models, mental, musculoskeletal, respiratory, and urological diseases were all significantly associated with increased odds ratios (ORs) of SCI and CIND. Circulatory and gastrointestinal diseases were related to SCI only, while endocrine diseases were associated with CIND. The adjusted ORs of multimorbidity were 2.1 [95% confidence intervals (95% CI): 1.8-2.3] for SCI and 1.5 for CIND (95% CI: 1.3-1.8). A dose-dependent relationship was observed between number of chronic diseases and ORs for SCI but not for CIND. In co-twin control analyses, the chronic diseases-SCI association was largely unchanged. On the other hand, the chronic diseases-CIND association was no longer statistically significant, except for cancer, where an increased OR was observed. In conclusion, chronic morbidity is associated with both SCI and CIND but disease profiles do not always overlap between the two cognitive syndromes. The association is stronger when diseases co-occur, especially for SCI. Genetic and early-life environmental factors may partially explain the association of CIND but not that of SCI with chronic diseases.

  • 91.
    Caracciolo, Barbara
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Gatz, Margaret
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Pedersen, Nancy L
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Differential distribution of subjective and objective cognitive impairment in the population: a nation-wide twin-study2012In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 29, no 2, p. 393-403Article in journal (Refereed)
    Abstract [en]

    We report the prevalence of subjective cognitive impairment (SCI) and cognitive impairment no dementia (CIND), their socio-demographic profile, and the contribution of genetic background and shared familial environment to SCI and CIND. Subjects were 11,926 dementia-free twin individuals aged ≥65 from the Swedish Twin Registry. SCI was defined as subjective complaint of cognitive change without objective cognitive impairment and CIND was defined according to current criteria. Overall prevalence rates of SCI and CIND were 39% (95% CI 38-39%) and 25% (95% CI 24-25%). In multivariate GEE models, both SCI and CIND were older compared with people without any cognitive impairment. CIND were also less educated, more likely to be unmarried and to have lower socioeconomic status (SES). SCI individuals differed from persons with CIND as they were older, more educated, more likely to be married, and to have higher SES. Co-twin control analysis, which corrects for common genetic and shared environmental background, confirmed the association of low education with CIND. Probandwise concordance for SCI and CIND was 63% and 52% in monozygotic twins, 63% and 50% in dizygotic same-sex twins, and 42% and 29% in dizygotic unlike-sex twins. Tetrachoric correlations showed no significant differences between monozygotic and dizygotic same-sex twins. We conclude that subjective and objective cognitive impairment are both highly prevalent among nondemented elderly yet have distinct sociodemographic profiles. Shared environmental influences rather than genetic background play a role in the occurrence of SCI and CIND.

  • 92.
    Caracciolo, Barbara
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Collins, Stephen
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Cognitive decline, dietary factors and gut-brain interactions2014In: Mechanisms of Ageing and Development, ISSN 0047-6374, E-ISSN 1872-6216, Vol. 136, p. 59-69Article in journal (Refereed)
    Abstract [en]

    Cognitive decline in elderly people often derives from the interaction between aging-related changes and age-related diseases and covers a large spectrum of clinical manifestations, from intact cognition through mild cognitive impairment and dementia. Epidemiological evidence supports the hypothesis that modifiable lifestyle-related factors are associated with cognitive decline, opening new avenues for prevention. Diet in particular has become the object of intense research in relation to cognitive aging and neurodegenerative disease. We reviewed the most recent findings in this rapidly expanding field. Some nutrients, such as vitamins and fatty acids, have been studied longer than others, but strong scientific evidence of an association is lacking even for these compounds. Specific dietary patterns, like the Mediterranean diet, may be more beneficial than a high consumption of single nutrients or specific food items. A strong link between vascular risk factors and dementia has been shown, and the association of diet with several vascular and metabolic diseases is well known. Other plausible mechanisms underlying the relationship between diet and cognitive decline, such as inflammation and oxidative stress, have been established. In addition to the traditional etiological pathways, new hypotheses, such as the role of the intestinal microbiome in cognitive function, have been suggested and warrant further investigation.

  • 93. Carfi, A.
    et al.
    Liperoti, R.
    Fusco, D.
    Giovannini, S.
    Brandi, V.
    Vetrano, Davide Liborio
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of the Sacred Heart, Italy.
    Meloni, E.
    Mascia, D.
    Villani, E. R.
    Gravina, E. Manes
    Bernabei, R.
    Onder, G.
    Bone mineral density in adults with Down syndrome2017In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 28, no 10, p. 2929-2934Article in journal (Refereed)
    Abstract [en]

    Summary

    This study analyzed data of bone mineral density (BMD) from a large cohort of adults with Down syndrome (DS). BMD was found to decrease with age more rapidly in these subjects than in the general population, exposing adults with DS to an increased risk of osteoporosis and bone fracture.

    Introduction

    Down syndrome (DS) in adulthood presents with a high prevalence of osteoporosis. However, in DS, bone mineral density (BMD) can be underestimated due to short stature. Furthermore, the rate of age-related decline in BMD and its association with gender in DS has been rarely evaluated or compared with the general population. The present study is aimed at assessing the variation of BMD with age and gender in a sample of adults with DS and to compare these data with those of the general population, after adjusting for anthropometric differences.

    Methods

    Adults with DS, aged 18 or older, were assessed dual-energy-X-ray-absorptiometry (DXA) at the femoral neck and at the lumbar spine. They were compared with the general population enrolled in the National Health and Nutrition Examination Survey (NHANES) 2009-2010 dataset. Bone mineral apparent density (BMAD) was calculated for each individual.

    Results

    DXA was evaluated in 234 subjects with DS (mean age 36.93 +/- 11.83 years, ranging from 20 to 69 years; 50.4% females). In the lumbar spine both mean BMD (DS 0.880 +/- 0.141 vs. NHANES 1.062 +/- 0.167, p < 0.001) and BMAD (DS 0.138 +/- 0.020 vs. NHANES 0.152 +/- 0.020, p < 0.001) were significantly lower in the DS sample than in the NAHNES cohort. The same trend was observed at the femoral neck in both BMD (DS 0.658 +/- 0.128 vs. NHANES 0.835 +/- 0.137, p < 0.001) and BMAD (DS 0.151 +/- 0.030 vs. NHANES 0.159 +/- 0.028, p < 0.001). Age was associated with lower femoral neck BMAD in both samples; importantly, this association was significantly stronger in the DS sample. In the lumbar spine region, no significant association between BMAD and age could be observed in both samples.

    Conclusions

    Adults with DS have lower bone mineral density compared to the general population and they experience a steeper decline with age. Early screening programs are needed in DS population.

  • 94. Cavallin, Lena
    et al.
    Bronge, Lena
    Zhang, Yi
    Oksengård, Anne-Rita
    Wahlund, Lars-Olof
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Axelsson, Rimma
    Comparison between visual assessment of MTA and hippocampal volumes in an elderly, non-demented population2012In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 53, no 5, p. 573-579Article in journal (Refereed)
    Abstract [en]

    Background It is important to have a replicable easy method for monitoring atrophy progression in Alzheimer's disease. Volumetric methods for calculating hippocampal volume are time-consuming and commonly used in research. Visual assessments of medial temporal lobe atrophy (vaMTA) is a rapid method for clinical use. This method has not been tested in a large non-demented population in comparison with volumetry mesurements. Since hippocampal volume decreases with time even in normal aging there is also a need to study the normal age differences of medial temporal lobe atrophy.                     

    Purpose To compare visual assessment of medial temporal lobe atrophy (vaMTA) with hippocampal volume in a healthy, non-demented elderly population. To describe normal ageing using vaMTA.                     

    Material and Methods Non-demented individuals aged 60, 66, 72, 78, 81, 84, and ≥87 years old were recruited from the Swedish National study on Ageing and Care in Kungsholmen (SNAC-K), Sweden. Standard magnetic resonance imaging (MRI) scans, vaMTA, and calculations of hippocampal volumes were performed in 544 subjects.                     

    Results Significant correlation (rs = −0.32, P < 0.001, sin; and rs = −0.26, P < 0.001, dx) was found between hippocampal volume measurements and vaMTA. In normal ageing, almost 95% of ≤66-year-olds had a medial temporal lobe atrophy (MTA) score ≤1, with possible scores ranging from 0 to 4. Subjects aged 72, 78, and 81 years scored ≤2, while the two oldest age groups had scores ≤3.                     

    Conclusion There was a highly significant correlation between volumetric measurements of the hippocampus and MTA scoring. In normal ageing, there is increasing MTA score. For non-demented elderly individuals ≤70 years, an MTA score of 0–1 may be considered normal, compared with MTA ≤2 for 70–80-years and MTA 3 for >80-year-old individuals.

  • 95. Celeste, R. K.
    et al.
    Eyjolfsdottir, Harpa S.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Lennartsson, Carin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fritzell, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Socioeconomic Life Course Models and Oral Health: A Longitudinal Analysis2020In: Journal of Dental Research, ISSN 0022-0345, E-ISSN 1544-0591, Vol. 99, no 3, p. 257-263Article in journal (Refereed)
    Abstract [en]

    We compared socioeconomic life course models to decompose the direct and mediated effects of socioeconomic status (SES) in different periods of life on late-life oral health. We used data from 2 longitudinal Swedish studies: the Level of Living Survey and the Swedish Panel Study of Living Conditions of the Oldest Old. Two birth cohorts (older, 1925 to 1934; younger, 1944 to 1953) were followed between 1968 and 2011 with 6 waves. SES was measured with 4 indicators of SES and modeled as a latent variable. Self-reported oral health was based on a tooth conditions question. Variables in the younger and older cohorts were grouped into 4 periods: childhood, young/mid-adulthood, mid /late adulthood, late adulthood/life. We used structural equation modeling to fit the following into lagged-effects life course models: 1) chain of risk, 2) sensitive period with late-life effect, 3) sensitive period with early- and late-life effects, 4) accumulation of risks with cross-sectional effects, and 5) accumulation of risks. Chain of risk was incorporated into all models and combined with accumulation, with cross-sectional effects yielding the best fit (older cohort: comparative fit index = 0.98, Tucker-Lewis index = 0.98, root mean square error of approximation = 0.04, weighted root mean square residual = 1.51). For the older cohort, the chain of SES from childhood -> mid-adulthood -> late adulthood -> late life showed the following respective standardized coefficients: 053, 0.92, and 0.97. The total effect of childhood SES on late-life tooth loss (standardized coefficient: -0.23 for older cohort, -0.17 for younger cohort) was mediated by previous tooth loss and SES. Cross-sectional effects of SES on tooth loss were observed throughout the life course, but the strongest coefficients were at young/mid-adulthood (standardized coefficient: -0.41 for older cohort, -0.45 for younger cohort). SES affects oral health cumulatively over the life course and through a chain of risks. Actions to improve socioeconomic conditions in early life might have long-lasting effects on health if they help prevent people from becoming trapped in a chain of risks.

  • 96. Cermakova, Pavla
    et al.
    Fereshtehnejad, Seyed-Mohammad
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Winblad, Bengt
    Eriksdotter, Maria
    Religa, Dorota
    Cardiovascular medication burden in dementia disorders: a nationwide study of 19,743 dementia patients in the Swedish Dementia Registry2014In: Alzheimer's research & therapy, ISSN 1758-9193, Vol. 6, no 3, p. 34-Article in journal (Refereed)
    Abstract [en]

    Introduction: Administration of several cardiovascular drugs has an effect on dementia. We aimed to investigate whether there are differences in the use of cardiovascular medication between different dementia disorders. Methods: We obtained information about dementia patients from the Swedish Dementia Registry. Patients were diagnosed with one of these dementia disorders: Alzheimer's disease (n = 8,139), mixed dementia (n = 5,203), vascular dementia (n = 4,982), Lewy body dementia (n = 605), frontotemporal dementia (n = 409) and Parkinson's disease dementia (n = 405). Multivariate logistic regression analysis was performed to investigate the association between use of cardiovascular medication and dementia disorders, after adjustment for age, gender, living alone, cognitive status and total number of drugs (a proxy for overall co-morbidity). Results: Seventy percent of all the dementia patients used cardiovascular medication. Use of cardiovascular drugs is common in patients with vascular and mixed dementia. Male gender, higher age, slightly better cognitive status and living with another person was associated with use of cardiovascular medication. Conclusions: Cardiovascular medication is used extensively across dementia disorders and particularly in vascular and mixed dementia. Future research should investigate the tolerability and effectiveness of these drugs in the different dementia disorders.

  • 97. Cermakova, Pavla
    et al.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Garcia-Ptacek, Sara
    Lund, Lars H.
    Winblad, Bengt
    Eriksdotter, Maria
    Religa, Dorota
    Cardiovascular Diseases in similar to 30,000 Patients in the Swedish Dementia Registry2015In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 48, no 4, p. 949-958Article in journal (Refereed)
    Abstract [en]

    Background: Cardiovascular diseases are leading causes of death and patients with dementia are often affected by them. Objective: Investigate associations of cardiovascular diseases with different dementia disorders and determine their impact on mortality. Methods: This study included 29,630 patients from the Swedish Dementia Registry (mean age 79 years, 59% women) diagnosed with Alzheimer's disease (AD), mixed dementia, vascular dementia, dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), frontotemporal dementia (FTD), or unspecified dementia. Records of cardiovascular diseases come from the Swedish National Patient Register. Multinomial logistic regression and cox proportional hazard models were applied. Results: Compared to AD, we found a higher burden of all cardiovascular diseases in mixed and vascular dementia. Cerebrovascular diseases were more associated with DLB than with AD. Diabetes mellitus was less associated with PDD and DLB than with AD. Ischemic heart disease was less associated with PDD and FTD than AD. All cardiovascular diseases predicted death in patients with AD, mixed, and vascular dementia. Only ischemic heart disease significantly predicted death in DLB patients (HR = 1.72; 95% CI = 1.16-2.55). In PDD patients, heart failure and diabetes mellitus were associated with a higher risk of death (HR = 3.06; 95% CI = 1.74-5.41 and HR = 3.44; 95% CI = 1.31-9.03). In FTD patients, ischemic heart disease and atrial fibrillation or flutter significantly predicted death (HR = 2.11; 95% CI = 1.08-4.14 and HR= 3.15; 95% CI = 1.60-6.22, respectively). Conclusion: Our study highlights differences in the occurrence and prognostic significance of cardiovascular diseases in several dementia disorders. This has implications for the care and treatment of the different dementia disorders.

  • 98. Cermakova, Pavla
    et al.
    Lund, Lars H.
    Fereshtehnejad, Seyed-Mohammad
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Winblad, Bengt
    Dahlstrom, Ulf
    Eriksdotter, Maria
    Religa, Dorota
    Heart failure and dementia: survival in relation to types of heart failure and different dementia disorders2015In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 17, no 6, p. 612-619Article in journal (Refereed)
    Abstract [en]

    AimsHeart failure (HF) and dementia frequently coexist, but little is known about their types, relationships to each other and prognosis. The aims were to (i) describe patients with HF and dementia, assess (ii) the proportion of specific dementia disorders in types of HF based on ejection fraction and (iii) the prognostic role of types of HF and dementia disorders. Methods and resultsThe Swedish Heart Failure Registry (RiksSvikt) and The Swedish Dementia Registry (SveDem) were record-linked. Associations between dementia disorders and HF types were assessed with multinomial logistic regression and survival was investigated with Kaplan-Meier analysis and multivariable Cox regression. We studied 775 patients found in both registries (55% men, mean age 82years). Ejection fraction was preserved in 38% of patients, reduced in 34%, and missing in 28%. The proportions of dementia disorders were similar across HF types. Vascular dementia was the most common dementia disorder (36%), followed by other dementias (28%), mixed dementia (20%), and Alzheimer disease (16%). Over a mean follow-up of 1.5years, 76% of patients survived 1year. We observed no significant differences in survival with regard to HF type (P=0.2) or dementia disorder (P=0.5). After adjustment for baseline covariates, neither HF types nor dementia disorders were independently associated with survival. ConclusionsHeart failure with preserved ejection fraction was the most common HF type and vascular dementia was the most common dementia disorder. The proportions of dementia disorders were similar across HF types. Neither HF types nor specific dementia disorders were associated with survival.

  • 99. Cermakova, Pavla
    et al.
    Szummer, Karolina
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Winblad, Bengt
    Eriksdotter, Maria
    Religa, Dorota
    Management of Acute Myocardial Infarction in Patients With Dementia: Data From SveDem, the Swedish Dementia Registry2017In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 18, no 1, p. 19-23Article in journal (Refereed)
    Abstract [en]

    Objectives: We aimed to (1) study factors that determine the use of invasive procedures in the management of acute myocardial infarction (AMI) in patients with dementia and (2) determine whether the use of invasive procedures was associated with their better survival. Design: Cohort study based on patients registered in the Swedish Dementia Registry (SveDem), 20072012. Median follow-up time was 228 days. Setting: Patients diagnosed with dementia in specialist memory clinics and primary care units in Sweden. Participants: A total of 525 patients with dementia who suffered AMI (mean age 89 years, 54% women). Measurements: Information on AMI and use of invasive procedures (coronary angiography and percutaneous coronary intervention) was obtained from Swedish national health registers. Binary logistic regression was applied to study associations of patients characteristics with the use of invasive procedures; odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Survival was analyzed with Kaplan-Meier curves; log-rank test was used to compare survival of patients who received an invasive procedure versus those who did not receive it. Cox regression was applied to study association of the invasive procedures with all-cause mortality; hazard ratios (HRs) with 95% CIs were calculated. Results: One hundred ten patients (21%) with dementia received an invasive procedure in the management of AMI. After multivariate adjustment, lower age and higher global cognitive status were associated with the use of invasive procedures. The invasively managed patients survived longer (P = .001). The use of invasive procedures was associated with a lower risk of all-cause mortality, adjusting for type of AMI and dementia disorder, age, gender, registration unit, history of AMI and comorbidity score (HR 0.35, 95% CI 0.21-0.59), or total number of drugs (HR 0.34, 95% CI 0.20-0.58). Conclusion: Age and cognitive status determine the use of invasive procedures in patients with dementia. This study suggests that the invasive management of AMI has a benefit for survival of patients with dementia. (C) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

  • 100. Cesaroni, Giulia
    et al.
    Forastiere, Francesco
    Stafoggia, Massimo
    Andersen, Zorana J.
    Badaloni, Chiara
    Beelen, Rob
    Caracciolo, Barbara
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    de Faire, Ulf
    Erbel, Raimund
    Eriksen, Kirsten T.
    Fratiglioni, Laura
    Galassi, Claudia
    Hampel, Regina
    Heier, Margit
    Hennig, Frauke
    Hilding, Agneta
    Hoffmann, Barbara
    Houthuijs, Danny
    Joeckel, Karl-Heinz
    Korek, Michal
    Lanki, Timo
    Leander, Karin
    Magnusson, Patrik K. E.
    Migliore, Enrica
    Östenson, Caes-Göran
    Overvad, Kim
    Pedersen, Nancy L.
    Pekkanen, Juha J.
    Penell, Johanna
    Pershagen, Göran
    Pyko, Andrei
    Raaschou-Nielsen, Ole
    Ranzi, Andrea
    Ricceri, Fulvio
    Sacerdote, Carlotta
    Salomaa, Veikko
    Swart, Wim
    Turunen, Anu W.
    Vineis, Paolo
    Weinmayr, Gudrun
    Wolf, Kathrin
    de Hoogh, Kees
    Hoek, Gerard
    Brunekreef, Bert
    Peters, Annette
    Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project2014In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 348, p. f7412-Article in journal (Refereed)
    Abstract [en]

    Objectives To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE). Design Prospective cohort studies and meta-analysis of the results. Setting Cohorts in Finland, Sweden, Denmark, Germany, and Italy. Participants 100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline. Main outcome measures Modelled concentrations of particulate matter <2.5 mu m (PM2.5), 2.5-10 mu m (PMcoarse), and <10 mu m (PM10) in aerodynamic diameter, soot (PM2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios. Results 5157 participants experienced incident events. A 5 mu g/m(3) increase in estimated annual mean PM2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 mu g/m(3) increase in estimated annual mean PM10 was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 mu g/m(3) for PM2.5 (1.18, 1.01 to 1.39, for 5 mu g/m(3) increase in PM2.5) and below 40 mu g/m(3) for PM10 (1.12, 1.00 to 1.27, for 10 mu g/m(3) increase in PM10). Positive but non-significant associations were found with other pollutants. Conclusions Long term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values.

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