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  • 1. Bi, Yu-Han
    et al.
    Pei, Jin-Jing
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Hao, Changfu
    Yao, Wu
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    The relationship between chronic diseases and depression in middle-aged and older adults: A 4-year follow-up study from the China Health and Retirement Longitudinal Study.2021In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 289, p. 160-166Article in journal (Refereed)
    Abstract [en]

    Background: Evidence of the association between common chronic diseases and depression is sparse.

    Methods: Totally 7819 participants aged 45+ without depression at baseline were followed-up (2011-2015) to detect incident depression. Chronic diseases and depression were defined by self-reported diagnosis and the Center for Epidemiological Studies Depression Scale (CES-D10), respectively. Cox proportional hazards model was used to explore the association between chronic diseases and depression adjusting for age, gender, education, marital/living conditions, area, smoking, drinking, economic status, BMI and health insurance.

    Results: During an average of 3.42 years follow-up, 2271 participants developed depression (85 per 1000 person-year). Chronic diseases were related to significantly higher risk of depression (HR = 1.38). A higher risk of depression was also associated with specific diseases: stomach/other digestive diseases (HR = 1.19), diabetes (HR = 1.22), arthritis/rheumatism (HR = 1.30), and kidney diseases (HR = 1.34) (P < 0.05). The risk of depression increased with increasing in the number of chronic diseases (1: HR = 1.27, 2: HR = 1.49, and 3+: HR = 1.51, P-trend < 0.001). No significant difference was observed across age, gender, education, and area.

    Limitations: Chronic diseases and depression were based on self-reported diagnosis and measurement scale, respectively, which could lead to information bias. Some unmeasured confounders might have biased the results.

    Conclusions: The occurrence of depression in people aged 45+ is associated with number of chronic diseases in a dose-response fashion. These results may provide guidance on preventing depression and improving the quality of life in middle and late adulthood.

  • 2.
    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.

  • 3.
    Dekhtyar, Serhiy
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Marseglia, Anna
    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).
    Darin-Mattsson, Alexander
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Genetic risk of dementia mitigated by cognitive reserve: A cohort study2019In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 86, no 1, p. 68-78Article in journal (Refereed)
    Abstract [en]

    Objective We investigated whether cognitive reserve modifies the risk of dementia attributable to apolipoprotein epsilon 4 (APOE-epsilon 4), a well-known genetic risk factor for dementia. Methods We followed 2,556 cognitively intact participants aged >= 60 years from the ongoing prospective community-based Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Dementia was ascertained through clinical and neuropsychological assessments and diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. Structural equation modeling was used to generate a cognitive reserve indicator from 4 previously validated contributors: early life education, midlife substantive work complexity, late life leisure activities, and late life social networks. Cox proportional hazard models estimated dementia risk in relation to cognitive reserve indicator. The interaction between the cognitive reserve indicator and APOE-epsilon 4 was assessed on multiplicative and additive scales. Results After an average of 6.3 years (range = 2.1-10.7) of follow-up, 232 dementia cases were ascertained. Relative to individuals in the lowest tertile of cognitive reserve indicator, those with moderate and high reserve were at a reduced risk of dementia. There was no multiplicative interaction between APOE-epsilon 4 status and cognitive reserve indicator (p = 0.113). Additive interaction was statistically significant. Relative to APOE-epsilon 4 carriers with low cognitive reserve, epsilon 4 carriers with high reserve had a reduced risk of dementia (hazard ratio [HR] = 0.28, 95% confidence interval [CI] = 0.13-0.59). The magnitude of risk reduction was similar in epsilon 4 noncarriers with a high cognitive reserve indicator (HR = 0.24, 95% CI = 0.15-0.40). Interpretation Lifelong engagement in reserve-enhancing activities attenuates the risk of dementia attributable to APOE-epsilon 4. Promoting cognitive reserve might be especially effective in subpopulations with high genetic risk of dementia. ANN NEUROL 2019

  • 4.
    Dekhtyar, Serhiy
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Vetrano, Davide Liborio
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Università Cattolica del Sacro Cuore, Italy; Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico “A. Gemelli”, Italy.
    Marengoni, Alessandra
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Brescia, Brescia, Italy.
    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.
    Pan, Kuan-Yu
    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).
    Calderón-Larrañaga, Amaia
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center.
    Association Between Speed of Multimorbidity Accumulation in Old Age and Life Experiences: A Cohort Study2019In: American Journal of Epidemiology, ISSN 0002-9262, E-ISSN 1476-6256, Vol. 188, no 9, p. 1627-1636Article in journal (Refereed)
    Abstract [en]

    Rapidly accumulating multiple chronic conditions (multimorbidity) during aging are associated with many adverse outcomes. We explored the association between 4 experiences throughout life-childhood socioeconomic circumstances, early-adulthood education, midlife occupational stress, and late-life social network-and the speed of chronic disease accumulation. We followed 2,589 individuals aged >= 60 years from the Swedish National Study on Aging and Care in Kungsholmen for 9 years (2001-2013). Information on life experiences was collected from detailed life-history interviews. Speed of disease accumulation was operationalized as the change in the count of chronic conditions obtained from clinical examinations, medical histories, laboratory data, drug use, and register linkages over 9 years. Linear mixed models were used to analyze the data. Speed of disease accumulation was lower in individuals with more than elementary education (for secondary, beta x time = -0.065, 95% CI: -0.126, -0.004; for university, beta x time = -0.118, 95% CI: -0.185, -0.050); for active occupations compared with high-strain jobs (beta x time = -0.078, 95% CI: -0.138, -0.017); and for richer social networks (for moderate tertile, beta x time = -0.102, 95% CI: -0.149, -0.055; for highest tertile, beta x time = -0.135, 95% CI: -0.182, -0.088). The association between childhood circumstances and speed of disease accumulation was attenuated by later-life experiences. Diverse experiences throughout life might decelerate chronic disease accumulation during aging.

  • 5. Feng, Meng-Yao
    et al.
    Bi, Yu-Han
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Pei, Jin-Jing
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Influence of chronic diseases on the occurrence of depression: A 13-year follow-up study from the Survey of Health, Ageing and Retirement in Europe2023In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 326, article id 115268Article in journal (Refereed)
    Abstract [en]

    The causal association between chronic diseases and depression remains unclear. This study aimed to explore the effects of types and number of chronic diseases on the risk of depression using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). A self-admitted questionnaire was used to obtain data on 14 predefined chronic diseases and the European-Depression Scale (EURO-D) was used to assess depression. Among the 16,080 baseline depression-free participants aged 50+, 31.29% (5032) developed depression over 13 years. Multivariate Cox regression models showed that individuals with any chronic diseases were at higher risk of new onset depression compared to disease-free participants. The risk of new onset depression increased with an increasing number of diseases among both younger (50–64) and older (65+) adults. Individuals with heart attack, stroke, diabetes, chronic lung disease, and arthritis were at increased risk of depression across age groups. However, some age-specific associations were observed, with cancer increasing depression risk among younger- and peptic ulcer, Parkinson's disease and cataracts increasing depression risk among older adults. These findings highlight the importance of managing chronic diseases, especially among those with more than two diseases, to prevent the development of depression among middle-aged and older adults.

  • 6. Feng, Meng-Yao
    et al.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Zhuo, Lai-Bao
    Yao, Wu
    Hao, Chang-Fu
    Pei, Jin-Jing
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Work-Related Stress and Occurrence of Cardiovascular Disease A 13-Year Prospective Study2022In: Journal of Occupational and Environmental Medicine, ISSN 1076-2752, E-ISSN 1536-5948, Vol. 64, no 11, p. 927-933Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study is to investigate the influence of work-related psychological and physical stresses on risk of cardiovascular disease (CVD). Methods : A total of 5651 CVD-free participants older than 50 years from the Survey of Health, Ageing and Retirement in Europe were followed up for 13 years to detect incident CVD. Work-related stress was assessed using job strain and job reward questionnaire. Cox regression model was used to estimate the association. Results: High physical demands (hazard ratio [HR], 1.30) and low reward (HR, 1.19) compared with their counterparts, as well as active physical jobs (HR, 1.41) and high physical strain (HR, 1.45) in comparison with low physical strain were associated with higher risk of incident CVD after adjusting for confounders. However, combining physically stressful jobs with low reward did not further increase the CVD risk. Conclusions: Avoiding physically stressful jobs or providing appropriate reward may reduce the occurrence of CVD.

  • 7. Han, Fei-Fei
    et al.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Wu, Jia-Jia
    Yao, Wu
    Hao, Chang-Fu
    Pei, Jin-Jing
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Depressive symptoms and cognitive impairment: A 10-year follow-up study from the Survey of Health, Ageing and Retirement in Europe2021In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 64, no 1, article id e55Article in journal (Refereed)
    Abstract [en]

    Background. Depressive symptoms and cognitive impairment often coexisted in the elderly. This study investigates the effect of late-life depressive symptoms on risk of mild cognitive impairment (MCI).

    Methods. A total of 14,231 dementia- and MCI free participants aged 60+ from the Survey of Health, Ageing, and Retirement in Europe were followed-up for 10 years to detect incident MCI. MCI was defined as 1.5 standard deviation (SD) below the mean of the standardized global cognition score. Depressive symptoms were assessed by a 12-item Europe-depression scale (EURO-D). Severity of depressive symptoms was grouped as: no/minimal (score 0–3), moderate (score 4–5), and severe (score 6–12). Significant depressive symptoms (SDSs) were defined as EURO-D score ≥ 4.

    Results. During an average of 8.2 (SD = 2.4)-year follow-up, 1,352 (9.50%) incident MCI cases were identified. SDSs were related to higher MCI risk (hazard ratio [HR] = 1.26, 95% confidence intervals [CI]: 1.10–1.44) in total population, individuals aged 70+ (HR = 1.35, 95% CI: 1.14–1.61) and women (HR = 1.28, 95% CI: 1.08–1.51) in Cox proportional hazard model adjusting for confounders. In addition, there was a dose–response association between the severity of depressive symptoms and MCI incidence in total population, people aged ≥70 years and women (p-trend <0.001).

    Conclusions. Significant depressive symptoms were associated with higher incidence of MCI in a dose–response fashion, especially among people aged 70+ years and women. Treating depressive symptoms targeting older population and women may be effective in preventing MCI.

  • 8. Islamoska, Sabrina
    et al.
    Hansen, Åse Marie
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Garde, Anne Helene
    Andersen, Per Kragh
    Garde, Ellen
    Møller Hansen, Jakob
    Waldemar, Gunhild
    Nabe-Nielsen, Kirsten
    Mid- to late-life migraine diagnoses and risk of dementia: a national register-based follow-up study2020In: Journal of Headache and Pain, ISSN 1129-2369, E-ISSN 1129-2377, Vol. 21, no 1, article id 98Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies found an association between migraine and dementia, which are two leading causes of disability. However, these studies did not differentiate between migraine types and did not investigate all prevalent dementia subtypes. The main objective of this national register-based study was to investigate whether migraine was a risk factor for dementia. Additionally, we explored potential differences in dementia risk for migraine with and without aura.

    Methods: We obtained data on birth cohorts born between 1935 and 1956 (n = 1,657,890) from Danish national registers. Individuals registered with migraine before age 59 (n = 18,135) were matched (1:5) on sex and birthdate with individuals without migraine (n = 1,378,346). Migraine was defined by International Classification of Diseases (ICD) diagnoses and dementia was defined by ICD diagnoses and anti-dementia medication. After matching, 62,578 individuals were eligible for analysis. For the statistical analyses, we used Cox regression models and adjusted for socio-demographic factors and several psychiatric and somatic morbidities.

    Results: During a median follow-up time of 6.9 (IQR: 3.6-11.2) years, 207 individuals with migraine developed dementia. Compared with individuals without migraine, we found a 50% higher rate of dementia among individuals with migraine (HR = 1.50; 95% CI: 1.28-1.76). Individuals without aura had a 19% higher rate of dementia (HR = 1.19; 95% CI: 0.84-1.70), and individuals with aura had a two times higher rate of dementia (HR = 2.11; 95% CI: 1.48-3.00).

    Conclusions: Our findings support the hypothesis that migraine is a midlife risk factor for dementia in later life. The higher rate of dementia in individuals with a hospital-based diagnosis of migraine with aura emphasizes the need for studies on pathological mechanisms and potential preventative measures. Furthermore, given that only hospital-based migraine diagnoses were included in this study, future research should also investigate migraine cases derived from the primary healthcare system to include less severe migraine cases.

  • 9. Lenart-Bugla, Marta
    et al.
    Łuc, Mateusz
    Pawłowski, Marcin
    Szcześniak, Dorota
    Seifert, Imke
    Wiegelmann, Henrik
    Gerhardus, Ansgar
    Wolf-Ostermann, Karin
    Rouwette, Etiënne A. J. A.
    Ikram, M. Arfan
    Brodaty, Henry
    Jeon, Yun-Hee
    Maddock, Jane
    Marseglia, Anna
    Melis, René J. F.
    Samtani, Suraj
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. 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). Stockholm Gerontology Research Center, Sweden.
    Vernooij-Dassen, Myrra
    Rymaszewska, Joanna
    What Do We Know about Social and Non-Social Factors Influencing the Pathway from Cognitive Health to Dementia? A Systematic Review of Reviews2022In: Brain Sciences, ISSN 2076-3425, E-ISSN 2076-3425, Vol. 12, no 9, article id 1214Article, review/survey (Refereed)
    Abstract [en]

    The heterogeneous and multi-factorial nature of dementia requires the consideration of all health aspects when predicting the risk of its development and planning strategies for its prevention. This systematic review of reviews provides a comprehensive synthesis of those factors associated with cognition in the context of dementia, identifying the role of social aspects and evidencing knowledge gaps in this area of research. Systematic reviews and meta-analyses from 2009–2021 were searched for within Medline, PsycINFO, CINAHL Complete, Cochrane, and Epistemonikos. Reviewers independently screened, reviewed, and assessed the records, following the PRISMA-2020 guidelines. From 314 included studies, 624 cognitive-related factors were identified, most of them risk factors (61.2%), mainly belonging to the group of ‘somatic comorbidities’ (cardiovascular disease and diabetes) and ‘genetic predispositions’. The protective factors (20%) were mainly related to lifestyle, pointing to the Mediterranean diet, regular physical activity, and cognitively stimulating activities. Social factors constituted 9.6% of all identified factors. Research on biological and medical factors dominates the reviewed literature. Greater social support and frequent contact may confer some protection against cognitive decline and dementia by delaying its onset or reducing the overall risk; however, overall, our findings are inconsistent. Further research is needed in the fields of lifestyle, psychology, social health, and the protective factors against cognitive decline and dementia.

  • 10. Lu, Ya-Ke
    et al.
    Qiao, Ya-Mei
    Liang, Xiao
    Yao, Wu
    Yan, Zhen
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Zhengzhou University, China.
    Pei, Jin-Jing
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Reciprocal relationship between psychosocial work stress and quality of life: the role of gender and education from the longitudinal study of the Survey of Health, Ageing and Retirement in Europe2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 6, article id e027051Article in journal (Refereed)
    Abstract [en]

    Objective To investigate the reciprocal relationship between psychosocial work stress and quality of life (QoL) and to examine whether the relationship can be moderated by gender or education. Design Longitudinal, population-based study. Setting The Survey of Health, Ageing and Retirement in Europe (SHARE). Participants The study population was derived from the SHARE, and there were 2006 participants with good QoL at baseline, 1109 with high job control and 1072 with high job reward, respectively, who were followed up for 2 years to detect incidence of poor QoL, low job control and low job reward. Main outcome measures Logistic regression models were employed to explore the reciprocal relationship between psychological work stress and QoL. Stratification analyses by gender and education were performed. Results Participants with low reward (OR= 1.53, 95% CI 1.26 to 1.88) and low control (OR= 1.40, 95% CI 1.14 to 1.71) at baseline were at higher risk of poor QoL over the 2-year follow-up. The combination of low reward and low control further increased the risk (OR= 1.90, 95% CI 1.46 to 2.48). Stratified analyses revealed that these associations were more pronounced among those who had high levels of education. Further, individuals with poor QoL were at significantly higher risk of having low reward (OR= 2.14, 95% CI 1.55 to 2.96) but not low control (OR= 1.33, 95% CI0.98 to 1.79) at the 2-year follow-up, especially among those who had medium levels of education. No gender differences were found. Conclusions There is a reciprocal relationship between psychological work stress and poor QoL. Education may play an important role in the relationship.

  • 11. Marseglia, Anna
    et al.
    Kalpouzos, Grégoria
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Laukka, Erika J.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Stockholm, Sweden.
    Maddock, Jane
    Patalay, Praveetha
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Bäckman, Lars
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Westman, Eric
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Stockolm, Sweden; Karolinska University Hospital, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden.
    Dekhtyar, Serhiy
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Social Health and Cognitive Change in Old Age: Role of Brain Reserve2023In: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 93, no 4, p. 844-855Article in journal (Refereed)
    Abstract [en]

    Objective: Individual aspects of social health (SH; eg, network, engagement, support) have been linked to cognitive health. However, their combined effect and the role of the structural properties of the brain (brain reserve [BR]) remain unclear. We investigated the interplay of SH and BR on cognitive change in older adults.

    Methods: Within the Swedish National Study on Aging and Care–Kungsholmen, 368 dementia-free adults aged ≥60 years with baseline brain magnetic resonance imaging were followed over 12 years to assess cognitive change. A measure of global cognition was computed at each of the 5 waves of assessment by averaging domain-specific Z scores for episodic memory, perceptual speed, semantic memory, and letter and category fluency. An SH composite score was computed at baseline by combining leisure activities and social network. BR was proxied by total brain tissue volume (TBTV). Linear mixed models (adjusted for sociodemographic, vascular, and genetic factors) were used to estimate cognitive trajectories in relation to SH and TBTV. Interaction analysis and stratification were used to examine the interplay between SH and TBTV.

    Results: Moderate–good SH (n = 245; vs poor, β-slope = 0.01, 95% confidence interval [CI] = 0.002–0.02, p = 0.018) and moderate-to-large TBTV (n = 245; vs small, β-slope = 0.03, 95% CI = 0.02–0.04, p < 0.001) were separately associated with slower cognitive decline. In stratified analysis, moderate–good SH was associated with higher cognitive levels (but not change) only in participants with moderate-to-large TBTV (β-intercept = 0.21, 95% CI = 0.06–0.37, p < 0.01; interaction SH * TBTV, p < 0.05).

    Interpretation: Our findings highlight the interplay between SH and BR that likely unfolds throughout the entire life course to shape old-age cognitive outcomes. ANN NEUROL 2023

  • 12.
    Marseglia, Anna
    et al.
    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.
    Rizzuto, Debora
    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.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tianjin Medical University, China.
    Participating in Mental, Social, and Physical Leisure Activities and Having a Rich Social Network Reduce the Incidence of Diabetes-Related Dementia in a Cohort of Swedish Older Adults2019In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 42, no 2, p. 232-239Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE

    The effect of a healthy lifestyle on diabetes-related dementia remains unknown. We examined whether an active lifestyle and rich social network may counteract the increased risk of dementia in people with diabetes.

    RESEARCH DESIGN AND METHODS

    Dementia-free older adults from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) (n = 2,650) were followed up for 10 years. Diabetes was ascertained on the basis of medical history, medication use, medical records, or glycated hemoglobin (HbA(1c)) 6.5% and prediabetes as HbA(1c) between 5.7 and 6.5%. Dementia was diagnosed by specialists following standard criteria. An active lifestyle was defined as a moderate to high (vs. low) level of engagement in leisure activities or a rich social network (having moderate to rich [vs. poor] social connections and support). Hazard ratios (HRs) of dementia risk were derived from Cox regression models.

    RESULTS

    There were 246 incident dementia cases during follow-up. Those with diabetes (n = 243), but not those with prediabetes (n = 921), had greater risk of dementia (adjusted HR 2.0 [95% CI 1.4-2.9]) than diabetes-free participants. Participants with diabetes but low level of engagement in leisure activities (HR 4.2 [95% CI 2.2-8.2]) or a poor social network (HR 3.4 [95% CI 1.9-6.1]) had greater dementia risk than diabetes-free participants with moderate to high levels of leisure activity engagement or a moderate to rich social network. In participants with diabetes, an active lifestyle (high level of engagement in leisure activities or a rich social network) was associated with less of a raised risk (HR 1.9 [95% CI 1.1-3.4]).

    CONCLUSIONS

    An active and socially integrated lifestyle may significantly counteract the detrimental effect of diabetes on dementia risk.

  • 13.
    Pan, Kuan-Yu
    et al.
    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).
    Mangialasche, Francesca
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Dekhtyar, Serhiy
    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.
    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.
    Working Life Psychosocial Conditions in Relation to Late-Life Cognitive Decline: A Population-Based Cohort Study2019In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 67, no 1, p. 315-325Article in journal (Refereed)
    Abstract [en]

    While the importance of working conditions on cognitive function has been tentatively suggested previously, few studies have considered cumulative effects of exposure throughout the working life. We examined the association between job demand-control status and late-life cognitive decline, taking into account exposure durations. In the population-based cohort study, Swedish National Study on Aging and Care-Kungsholmen, 2,873 dementia-free participants aged 60+ were followed up to nine years. Cognitive function was measured using the Mini-Mental State Examination. The entire working life was outlined through interview and occupations were graded with a psychosocial job-exposure matrix. Multivariate linear mixed-effects models were used. Slower cognitive decline was observed among people with high job control (beta: 0.10, 95% CI: 0.03, 0.19) and demands (beta: 0.15, 95% CI: 0.07, 0.22) in the longest-held job. Compared to active job, faster decline was shown in low strain (beta: -0.17, 95% CI: -0.26, -0.08), high strain (beta: -0.13, 95% CI: -0.24, -0.03), and passive job (beta: -0.22, 95% CI: -0.34, -0.11). Longer duration of active jobs was associated with slower cognitive decline (beta: 0.24, 95% CI: 0.16, 0.32), whereas faster decline was associated with longer durations of low strain (beta: -0.12, 95% CI: -0.19, -0.05), high strain (beta: -0.13, 95% CI: -0.21, -0.04), and passive jobs (beta: -0.12, 95% CI: -0.20, -0.04). In conclusion, not only psychologically stressful jobs, but also low-stimulating and passive jobs are associated with faster cognitive decline in later life. Duration of exposure may play a role in the psychosocial working condition-cognitive decline association.

  • 14.
    Pan, Kuan-Yu
    et al.
    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).
    Mangialasche, Francesca
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    Wang, Rui
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Dekhtyar, Serhiy
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Calderón-Larrañaga, Amaia
    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.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Psychosocial working conditions, trajectories of disability, and the mediating role of cognitive decline and chronic diseases: A population-based cohort study2019In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 16, no 9, article id e1002899Article in journal (Refereed)
    Abstract [en]

    Background Unfavorable psychosocial working conditions have been associated with cognitive decline and chronic diseases, both of which may subsequently accelerate functional dependence. This study aimed to investigate the association between job demand-control-support combinations and trajectories of disability in later life and to further explore the role of cognitive decline and the co-occurrence of chronic diseases in mediating this association. Methods and findings In this cohort study, 2,937 community dwellers aged 60+ years (mean age 73 +/- 10.6; 62.9% female) residing in the Kungsholmen District of Stockholm, Sweden, participated in the baseline survey (2001-2004) and were followed up to 12 years. Lifelong occupational history was obtained through a standardized interview; job demands, job control, and social support at work in the longest-held occupation were graded with a psychosocial job-exposure matrix. Job control, demands, and social support were dichotomized using the median values from the matrix, respectively, to further generate demand-control-support combinations. Disability was measured by summing the number of impaired basic and instrumental activities of daily living. Global cognitive function was assessed by Mini-Mental State Examination. Chronic conditions were ascertained by clinical examinations, medical history, and patient clinical records; the total number of chronic diseases was summed. Data were analyzed using linear mixed-effects models and mediation analysis. Age, sex, education, alcohol consumption, smoking, leisure activity engagement, early-life socioeconomic status, occupational characteristic and physical demands, and baseline cognitive function and number of chronic diseases were adjusted for in the analyses. Compared with active jobs (high control/high demands; n = 1,807), high strain (low control/high demands; n = 328), low strain (high control/low demands; n = 495), and passive jobs (low control/low demands; n = 307) were all associated with a faster rate of disability progression (beta = 0.07, 95% CI 0.02-0.13, p = 0.01; beta = 0.10, 95% CI 0.06-0.15, p < 0.001; beta = 0.11, 95% CI 0.05-0.18, p < 0.001). The association between high strain and disability progression was only shown in people with low social support at work (beta = 0.13, 95% CI 0.07-0.19, p < 0.001), but not in those with high social support (beta = 0.004, 95% CI -0.09 to 0.10, p = 0.93). Moreover, we estimated that the association between demand-control status and disability trajectories was mediated 38.5% by cognitive decline and 18.4% by accumulation of chronic diseases during the follow-up period. The limitations of this study include unmeasured confounding, self-reported work experience, and the reliance on a psychosocial job-exposure matrix that does not consider variabilities in individuals' perception on working conditions or job characteristics within occupations. Conclusions Our findings suggest that negative psychosocial working conditions during working life may accelerate disability progression in later life. Notably, social support at work may buffer the detrimental effect of high strain on disability progression. Cognitive decline and chronic-disease accumulation, and especially the former, partially mediate the association of psychosocial working conditions with trajectories of disability. Further studies are required to explore more mechanisms that underlie the association between psychosocial working conditions and disability trajectories. Author summaryWhy was this study done? Work is one of the activities that take up a considerable amount of time in our adult lives, thus potentially making it an important determinant of health, even in later life. Inability to independently carry out daily tasks (defined as disability) can affect older people's quality of life and pose a burden on caregivers and societies. A better understanding of the pathway between midlife working conditions and late-life disability may help the development of preventive strategies. What did the researchers do and find? We studied the association of psychosocial working conditions with the rate of disability progression over 12 years in a cohort of 2,937 individuals aged 60 years and older. We found that unfavorable psychosocial working conditions, including high-strain, low-strain, and passive jobs, were related to a faster rate of disability progression. The association of high-strain jobs with accelerated disability accumulation was only present among people with low social support at work. The decrement in cognitive function and increase in chronic-disease burden, and especially the former, partially explained the relationship between unfavorable working conditions and disability progression in later life. What do these findings mean? Unfavorable psychosocial working conditions during working life are related to the progression of disability in later life. Public health authorities, employers, and employees should all be aware of that. Social support at work is especially important in a high-strain work environment given its capacity to attenuate the impact of high-strain jobs on disability accumulation. Monitoring cognitive function and medical conditions of people with unfavorable working conditions is endorsed by the role of both dimensions, and especially of cognitive dysfunction, in accelerating disability progression in older age.

  • 15.
    Pan, K-Y.
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Xu, W.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Mangialasche, F.
    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). Stockholm Gerontology Research Center, Sweden.
    Wang, Hui Xin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Work-related psychosocial stress and the risk of type 2 diabetes in later life2017In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 281, no 6, p. 601-610Article in journal (Refereed)
    Abstract [en]

    Objectives: Although work-related psychosocial stress and type 2 diabetes mellitus (T2DM) have been investigated, the association between lifelong work stress and T2DM in later life remains unclear. This study examined whether high work stress increased the risk of T2DM risk in later life, accounting also for other sources of stress outside work, such as burden from household chores.

    Methods: From the population-based prospective study SNAC-K, 2719 diabetes-free participants aged 60 years were identified and followed up for 6 years. T2DM was ascertained by glycated haemoglobin level, self-report, hypoglycaemic medication use and clinical records. Levels of job control and demands over the whole working life were assessed by a validated matrix. Household chores load was assessed by hours spent on such chores. Multivariate logistic regression models were used to estimate the association between job strain and T2DM.

    Results: During the 6-year follow-up, 154 incident cases of T2DM were identified. High job strain was associated with T2DM occurrence amongst the 60-year-old cohort (OR = 3.14, 95% CI: 1.27-7.77), and only amongst women (OR = 6.18, 95% CI: 1.22-31.26), but not in men. When taking into account household chores load, a more pronounced risk of T2DM was associated with high job strain in combination with heavy household chores load in women aged 60 years at baseline (OR = 9.45, 95% CI: 1.17-76.53).

    Conclusion: Work-related psychosocial stress may increase the risk of T2DM only amongst women in their early 60s. The risk can be amplified by high household chores load.

  • 16. Qiao, Ya-Mei
    et al.
    Lu, Ya-Ke
    Yan, Zhen
    Yao, Wu
    Pei, Jin-Jing
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Zhengzhou University, China.
    Reciprocal associations between job strain and depression: A 2-year follow-up study from the Survey of Health, Ageing and Retirement in Europe2019In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 9, article id e01381Article in journal (Refereed)
    Abstract [en]

    Background: A growing number of people suffered from depression. This study examined the depression prevalence in workers across 10 European countries plus Israel and the reciprocal associations between job strain and depression.

    Methods: The study population consisted of 7,879 workers aged 50-63 years at baseline (2004) from the Survey of Health, Ageing, and Retirement in Europe (SHARE). Job demands (physical or psychosocial) and job control variables were derived from the Job Content Questionnaire (JCQ). Two 4-category job strains (physical and psychosocial) were obtained based on the cross-tabulation of these dichotomized demands and control variables. There were 4,284 depression-free, 3,259 high physical strain-free and 3,195 high psychosocial strain-free participants at baseline who were followed up for 2 years to detect incident depression, high physical job strain, or high psychosocial strain, respectively. The reciprocal associations between job strain and depression were analyzed by multivariate logistic regression and multivariate multilevel logistic regression adjusting for potential confounders.

    Results: The prevalence of depression varied from the lowest 12.5% in Germany to the highest 27.2% in France. Compared to individuals with low strain, a significantly higher risk of depression were found in individuals with high physical strain (OR = 1.39) and high psychosocial strain (OR = 1.55), after adjusting for potential confounders. Depression at baseline was not significantly associated with subsequent high job strain. Similar results were observed from multilevel models that took into consideration of the potential country-level influences.

    Conclusions: The prevalence of depression varies across countries in Europe. Avoiding high job strain may be an effective preventive strategy to prevent depression epidemic.

  • 17.
    Rizzuto, Debora
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Mossello, Enrico
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Santoni, Giola
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Personality and Survival in Older Age: The Role of Lifestyle Behaviors and Health Status2017In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 25, no 12, p. 1363-1372Article in journal (Refereed)
    Abstract [en]

    Objective: We intended to assess the relationship between personality and survival in an older population and to explore the role of lifestyle behaviors and health status as potential mediators. Design: Population-based cohort study. Setting: Swedish National Study of Aging and Care in Kungsholmen, Sweden. Participants: 2,298 adults aged 60 or more years, without dementia or depression, followed for 11 years. Measurements: Personality (extraversion, neuroticism, and openness) was assessed with a shortened version of the NEO-Five Factor Inventory. We tested whether personality affected mortality and examined the potential mediating effect of health status (body mass index, number of chronic diseases, impairment in instrumental activities of daily living, and C-reactive protein) and lifestyle behaviors (leisure activities, social network, smoking, and alcohol consumption). Results: Over 11 years of follow-up, higher levels of extraversion were associated with a 14% reduction in mortality. Examination of different combinations of personality traits showed that independent of levels of neuroticism and openness, high extraversion were associated with up to 65% lower mortality. Decomposing the effect of extraversion on mortality, we found that the majority (44%) of the beneficial effect was mediated by healthy lifestyle behaviors. Health status accounted for 5% of the association. Conclusions: Extroverted people, who are characterized by higher optimism and high self-efficacy, are prone to healthier behaviors and better health, which may result in longer survival. These results highlight the importance of a healthy lifestyle in survival.

  • 18.
    Shakersain, Behnaz
    et al.
    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).
    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.
    Faxén-Irving, Gerd
    Prinelli, Federica
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Institute of Biomedical Technologies - National Research Council, Italy.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tianjin Medical University, China.
    An Active Lifestyle Reinforces the Effect of a Healthy Diet on Cognitive Function: A Population-Based Longitudinal Study2018In: Nutrients, E-ISSN 2072-6643, Vol. 10, no 9, article id 1297Article in journal (Refereed)
    Abstract [en]

    The joint effect of diet and leisure activity on cognitive function remains unknown. We aimed to verify the hypothesis that an active lifestyle reinforces the effect of the Nordic Prudent Dietary Pattern (NPDP) on cognitive function. A total of 2223 dementia-free Swedish adults aged 60 with Mini-Mental State Examination (MMSE) scores 27 were followed for an average of 6 years. MMSE was tested during follow-ups. Diet was assessed by food frequency questionnaire. The NPDP index was calculated and tertiled (low, moderate, and high adherence). Participation in physical, mental and social activities was trichotomised (low, moderate, and intense). An active lifestyle was defined based on the participation in each activity. Data were analyzed using mixed-effects models. Moderate-to-high adherence to NPDP was associated with a reduced decline in the MMSE score (: 0.19, 95% Confidence Interval (CI): 0.14-0.24). This association became stronger when combined with moderate-to-intense physical (: 0.34, 95% CI: 0.2-0.45), mental (: 0.29, 95% CI: 0.21-0.37), or social (: 0.27, 95% CI: 0.19-0.34) activities. An active lifestyle strengthened the effect of NPDP on cognitive function by two times, and further lowered risk of MMSE decline by 30%. Thus, an active lifestyle reinforces the effect of a healthy diet on preserved cognitive function, and further decreases the risk of cognitive decline.

  • 19. Shang, Ying
    et al.
    Fratiglioni, Laura
    Marsegilia, Anna
    Wang, Rui
    Welmer, Anna-Karin
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Xu, Weili
    Incidence and Evolution of Prediabetes among Older Adults: A Population-Based Cohort Study2018In: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 67, no suppl 1, p. LB49-LB49, article id 177-LBArticle in journal (Refereed)
    Abstract [en]

    Objective: The incidence and evolution of prediabetes in older adults is still unclear. We aimed to estimate the incidence of prediabetes, the rates of prediabetes reverting to normoglycemia or progressing to type 2 diabetes, and to identify possible prognostic factors among older adults with prediabetes.

    Methods: In the Swedish National Study on Aging and Care-Kungsholmen Project, 3049 diabetes-free participants aged ≥60 years were examined at baseline (2001-2004), and were followed-up to 12 years (2013-2016). At each wave, type 2 diabetes was ascertained based on self-report, antidiabetic drug use, medical records, or glycated haemoglobin (HbA1c) ≥6.5% (48 mmol/mol). In diabetes-free participants, prediabetes was assessed as HbA1c ≥5.7% (39 mmol/mol), and normoglycemia was defined as HbA1c <5.7%. Data were analysed with Poisson regression and multinomial logistic regression.

    Results: During 12 years follow-up, among 1972 (64.7%) participants with normoglycemia, 505 (25.6%) developed prediabetes (incidence=4.3/100 person-years, 95% CI 3.9-4.8). Of the 1077 (35.3%) participants with prediabetes at baseline, 204 (18.9%) reverted to normoglycemia (reversion rate=3.1/100 person-years, 95% CI: 2.6-3.6) and 119 (11.0%) progressed to type 2 diabetes (progression rate=1.7/100 person-years, 95% CI: 1.3-2.1). The reversal to normoglycemia was significantly associated with lower systolic blood pressure and weight loss, while, obesity and weight gain were risk factors for progression to type 2 diabetes.

    Conclusions: The incidence of prediabetes is high (about 26%) among older adults. Around 19% of people with prediabetes may revert to normoglycemia and 11% progress to type 2 diabetes. Weight change and systolic blood pressure may play a role in such evolution.

  • 20.
    Shang, Ying
    et al.
    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.
    Marseglia, Anna
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Plym, Anna
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska University Hospital, Sweden.
    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.
    Wang, Rui
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Wisconsin School of Medicine and Public Health, USA; The Swedish School of Sport and Health Science, GIH, Sweden.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tianjin Medical University, China.
    Association of diabetes with stroke and post-stroke dementia: A population-based cohort study2020In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 16, no 7, p. 1003-1012Article in journal (Refereed)
    Abstract [en]

    Introduction: The impact of prediabetes and diabetes on stroke and the development of dementia after a stroke remain unclear.

    Methods: A total of 2655 dementia-free participants (including a stroke-free cohort and a prevalent stroke cohort) were followed-up for 12 years. Dementia and post-stroke dementia were determined by clinical examinations and national registry data. Diabetes was ascertained via medical examination, medication use, medical records, or glycated hemoglobin (HbA1c) >= 6.5%. Prediabetes was defined as H bA1c >= 5.7% in diabetes-free participants.

    Results: In the stroke-free cohort, 236 participants developed ischemic stroke, and 47 developed post-stroke dementia. Diabetes was associated with ischemic stroke (hazard ratio [HR] 1.76, 95% confidence interval [CI] 1.16 to 2.67) and post-stroke dementia (HR 2.56, 95% CI 1.04 to 6.25). In the prevalent stroke cohort, diabetes was also related to dementia risk. Prediabetes was not significantly related to stroke or post-stroke dementia.

    Discussion: Diabetes, but not prediabetes, is associated with an increased risk of ischemic stroke and post-stroke dementia.

  • 21.
    Shang, Ying
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Marseglia, Anna
    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.
    Welmer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska University Hospital, Sweden.
    Wang, Rui
    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.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tianjin Medical University, China.
    Natural history of prediabetes in older adults from a population-based longitudinal study2019In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 286, no 3, p. 326-340Article in journal (Refereed)
    Abstract [en]

    Background. The natural history of prediabetes in older adults remains unknown.

    Objectives. To assess the rate at which prediabetes progresses to diabetes, leads to death or reverts to normoglycaemia in older adults and to identify prognostic factors related to different outcomes of prediabetes.

    Methods. In the Swedish National Study on Aging and Care-Kungsholmen, 2575 diabetes-free participants aged >= 60 years were examined at baseline and followed for up to 12 years. At each wave, diabetes was diagnosed via medical examination, antidiabetic drug use, medical records or glycated haemoglobin (HbA1c) >= 6.5%. Prediabetes was defined as HbA1c >= 5.7% and normoglycaemia as HbA1c <5.7% in diabetes-free participants. Data were analysed with multinomial logistic regression.

    Results. At baseline, 918 (36%) individuals had prediabetes. Of them, 204 (22%) reverted to normoglycaemia (3.4/100 person-years, 95% CI 5.6-12.3), 119 (13%) developed diabetes (2.0/100 person-years, 95% CI 1.7-2.4) and 215 (23%) died (13.0/100 person-years, 95% CI 11.4-14.9) during the 12-year follow-up. The rates of reversion, progression and mortality were higher in the first 6-year than in the second 6-year follow-up, albeit not statistically significant. Lower systolic blood pressure (SBP), absence of heart diseases and weight loss promoted the reversion from prediabetes to normoglycaemia, whilst obesity accelerated its progression to diabetes.

    Conclusions. During a 12-year follow-up, most of older adults with prediabetes remained stable or reverted to normoglycaemia, whereas only one-third developed diabetes or died. Lower SBP, no heart diseases and weight management may promote reversion to normoglycaemia, suggesting possible strategies for achieving normoglycaemia in older adults with prediabetes.

  • 22.
    Sindi, Shireen
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; Imperial College London, United Kingdom.
    Johansson, Lena
    Skoog, Johan
    Mattsson, Alexander Darin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Sjöberg, Linnea
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden.
    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. Karolinska Institutet, Sweden.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; Stockholm Gerontology Research Center, Sweden.
    Kulmala, Jenni
    Soininen, Hilkka
    Solomon, Alina
    Johansson, Boo
    Skoog, Ingmar
    Kivipelto, Miia
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Sleep disturbances and later cognitive status: a multi-centre study2018In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 52, p. 26-33Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the associations between sleep disturbances in mid-life and late-life and late-life cognitive status. Methods: In four population-based studies (three Swedish studies: H70 study, Kungsholmen Project (KP) and The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD); and one Finnish study: Cardiovascular Risk Factors, Aging and Dementia (CAIDE)), participants provided self-reports on insomnia, nightmares and general sleep problems. Late-life cognitive status was measured by the Mini Mental State Exam (MMSE). The associations between late-life sleep disturbances and cognition 3-11 years later were investigated across all studies (n = 3210). Mean baseline ages were 70 (CAIDE, H70 and SWEOLD), and 84 years (KP). Additional analyses examined the association between midlife sleep and late-life cognition using CAIDE (21 and 31 years follow-up, n = 1306, mean age 50 years), and SWEOLD (20-24 years follow-up, n = 2068, mean age 58 years). Ordered logistic regressions, adjusted for potential baseline confounders, were used in the analyses. Results: Late-life sleep disturbances were associated with poorer cognition after 3-11 years (fully adjusted beta = -0.12, 95% CI = -0.24 to -0.01). Midlife nightmares and insomnia were also associated with lower MMSE scores (fully adjusted beta = -0.28, 95% CI = -0.49 to -0.07 and beta = -0.20, 95% CI = -0.39 to -0.01), although the latter association was attenuated after adjusting for lifestyle/health-related confounders. Midlife general sleep problems were not associated with late-life MMSE performance. Conclusions: Sleep disturbances and midlife nightmares were associated with lower MMSE scores, which suggests that sleep disturbances in earlier life stages can be associated with worse late-life cognition.

  • 23.
    Sindi, Shireen
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Karolinska Institutet, Sweden; Imperial College London, United Kingdom.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Johansson, Lena
    Skoog, Johan
    Sjöberg, Linnea
    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.
    Johansson, Boo
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Soininen, Hilkka
    Solomon, Alina
    Skoog, Ingmar
    Kivipelto, Miia
    Sleep disturbances and dementia risk: A multicenter study2018In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 14, no 10, p. 1235-1242Article in journal (Refereed)
    Abstract [en]

    Introduction

    Few longitudinal studies assessed whether sleep disturbances are associated with dementia risk.

    Methods

    Sleep disturbances were assessed in three population-based studies (H70 study and Kungsholmen Project [Sweden]; Cardiovascular Risk Factors, Aging and Dementia study [Finland]). Late-life baseline analyses (3–10 years follow-up) used all three studies (N = 1446). Baseline ages ≈ 70 years (Cardiovascular Risk Factors, Aging and Dementia, H70), and ≈84 years (Kungsholmen Project). Midlife baseline (age ≈ 50 years) analyses used Cardiovascular Risk Factors, Aging and Dementia (21 and 32 years follow-up) (N = 1407).

    Results

    Midlife insomnia (fully adjusted hazard ratio = 1.24, 95% confidence interval = 1.02–1.50) and late-life terminal insomnia (fully adjusted odds ratio = 1.94, 95% confidence interval = 1.08–3.49) were associated with a higher dementia risk. Late-life long sleep duration (>9 hours) was also associated with an increased dementia risk (adjusted odds ratio = 3.98, 95% confidence interval = 1.87–8.48).

    Discussion

    Midlife insomnia and late-life terminal insomnia or long sleep duration were associated with a higher late-life dementia risk.

  • 24. Sindi, Shireen
    et al.
    Kåreholt, Ingemar
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Jönköping University, Sweden.
    Ngandu, Tiia
    Rosenberg, Anna
    Kulmala, Jenni
    Johansson, Lena
    Wetterberg, Hanna
    Skoog, Johan
    Sjöberg, Linnea
    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, Department of Psychology, Stress Research Institute.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Skoog, Ingmar
    Kivipelto, Miia
    Sex differences in dementia and response to a lifestyle intervention: Evidence from Nordic population-based studies and a prevention trial2021In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 17, no 7, p. 1166-1178Article in journal (Refereed)
    Abstract [en]

    Introduction: Evidence on sex differences in the risk for dementia has been mixed. The goal was to assess sex differences in the development of dementia, and in the effects of a lifestyle intervention.

    Methods: Two strategies were adopted, one using combined data from three large Nordic population-based cohort studies (n = 2289), adopting dementia as outcome, and 2-year multidomain lifestyle intervention (n = 1260), adopting cognitive change as outcome.

    Results: There was higher risk for dementia after age 80 years in women. The positive effects of the lifestyle intervention on cognition did not significantly differ between men and women. Sex-specific analyses suggested that different vascular, lifestyle, and psychosocial risk factors are important for women and men in mid- and late-life.

    Conclusion: Women had higher risk for dementia among the oldest individuals. Lifestyle interventions may be effectively implemented among older men and women.

  • 25.
    Sjöberg, Linnea
    et al.
    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 (LF), Sweden.
    Lövdén, Martin
    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.
    Low Mood and Risk of Dementia: The Role of Marital Status and Living Situation2020In: The American journal of geriatric psychiatry, ISSN 1064-7481, E-ISSN 1545-7214, Vol. 28, no 1, p. 33-44Article in journal (Refereed)
    Abstract [en]

    Objective: This study aims to explore whether low mood is related to an increased dementia risk in two cohorts of older adults of different generations, and whether marital status and living situation modify this association. Methods: Participants (>= 70 years), free from dementia and living at home, were identified from two population-based studies: the Kungsholmen Project (KP; n = 1,197) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; n = 1,402). Low mood was obtained by self-report (KP and SNAC-K) at baseline in 1987-89 (KP) and 2001-04 (SNAC-K). Incident dementia cases were ascertained over 9 years, using the same diagnostic procedures and comparable criteria for the two cohorts (DSM-III-R in KP and DSM-IV-TR in SNAC-K). Hazard ratios (HR) were derived from Cox proportional hazards models. Results: Those having low mood at baseline were at higher risk of dementia in both cohorts combined (HR: 1.2, 95% confidence interval (CI): 1.0-1.4) than those without low mood. However, an increased risk was detected only in those who did not have a partner (HR: 1.5, 95% CI: 1.2-1.9), or lived alone (HR: 1.5, 95% CI: 1.2-1.9), but not among those who had a partner or lived with someone (HR: 0.8, 95% CI: 0.5-1.2). Conclusion: Marital status and living situation have the potential to buffer the detrimental effects of low mood on dementia onset. Thus, specific attention from health care should target individuals having low mood and who do not have a partner or live alone.

  • 26.
    Sjöberg, Linnea
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Karlsson, Björn
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Atti, Anna-Rita
    Skoog, Ingmar
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Prevalence of depression: Comparisons of different depression definitions in population-based samples of older adults2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 221, p. 123-131Article in journal (Refereed)
    Abstract [en]

    Background: Depression prevalence in older adults varies largely across studies, which probably reflects methodological rather than true differences. This study aims to explore whether and to what extent the prevalence of depression varies when using different diagnostic criteria and rating scales, and various samples of older adults. Methods: A population-based sample of 3353 individuals aged 60-104 years from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were examined in 2001-2004. Point prevalence of depression was estimated by: 1) diagnostic criteria, ICD-10 and DSM-IV-TR/DSM-5; 2) rating scales, MADRS and GDS-15; and 3) self-report. Depression prevalence in sub-samples by dementia status, living place, and socio-demographics were compared. Results: The prevalence of any depression (including all severity grades) was 4.2% (moderate/severe: 1.6%) for ICD-10 and 9.3% (major: 2.1%) for DSM-IV-TR; 10.6% for MADRS and 9.2% for GDS-15; and 9.1% for selfreport. Depression prevalence was lower in the dementia-free sample as compared to the total population. Furthermore, having poor physical function, or not having a partner were independently associated with higher depression prevalence, across most of the depression definitions. Limitations: The response rate was 73.3% and this may have resulted in an underestimation of depression. Conclusion: Depression prevalence was similar across all depression definitions except for ICD-10, showing much lower figures. However, independent of the definition used, depression prevalence varies greatly by dementia status, physical functioning, and marital status. These findings may be useful for clinicians when assessing depression in older adults and for researchers when exploring and comparing depression prevalence across studies.

  • 27.
    Stengård, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Virtanen, Marianna
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Do good psychosocial working conditions prolong working lives? Findings from a prospective study in Sweden2022In: European Journal of Ageing, ISSN 1613-9372, E-ISSN 1613-9380, Vol. 19, p. 677-688Article in journal (Refereed)
    Abstract [en]

    Due to an ageing population, governments in European countries are striving to keep older workers longer in the workforce. Remarkably few studies have paid attention to the influence of psychosocial working conditions on timing of retirement for older workers in and beyond normative retirement age. The aim of the present study was to examine whether good psychosocial working conditions contribute to prolonged working lives among older workers (59 years and above). A particular question was whether such conditions increase in importance with age. Seven waves (2006-2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (N = 6000, observations = 10,632). Discrete-time event history analyses showed that higher levels of job resources (decision authority [OR 1.13, 95% CI 1.06-1.22], skill use [OR 1.17, 95% CI 1.07-1.29], learning opportunities [OR 1.22, 95% CI 1.13-1.31], social support [OR 1.29 (95% CI 1.16-1.42], work-time control [OR 1.07, 95% CI 1.01-1.13], and reward [OR 1.40, 95% CI 1.24-1.57])-but not lower levels of job demands (quantitative and emotional demands or effort)-were associated with working longer (continued work two years later). Also, low effort-reward imbalance (OR 0.84 [95% CI 0.73-0.96]) was associated with working longer. In addition, skill use, work-time control, reward, and low effort-reward imbalance increased in importance with age for continued work. These results suggest that providing older workers with control over their work tasks, giving opportunities for learning and using their skills, as well as rewarding and acknowledging their achievements, may keep them in the workforce longer. Especially, job resources may grow in importance with age.

  • 28.
    Stengård, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Prolonging working life among blue-collar workers: The buffering effect of psychosocial job resources on the association between physically demanding and hazardous work and retirement timing2023In: SSM - Population Health, ISSN 2352-8273, Vol. 22, article id 101372Article in journal (Refereed)
    Abstract [en]

    The need to delay retirement timing has been acknowledged in Western countries due to demographic ageing. The aim of the present study was to examine the buffering effects of job resources (decision authority, social support, work-time control, and rewards) on the association of exposures to physically demanding work tasks and physically hazardous work environment with non-disability retirement timing. Results from discrete-time event history analyses, in a sample of blue-collar workers (n = 1741; 2792 observations) from the nationwide longitudinal Swedish Longitudinal Occupational Survey of Health (SLOSH), supported that decision authority and social support may buffer the negative impact of heavy physical demands on working longer (continuing working vs retiring). Stratified analyses by gender showed that the buffering effect of decision authority remained statistically significant for men, while that of social support remained statistically significant for women. Moreover, an age effect was displayed, such that a buffering effect of social support on the association of heavy physical demands and high physical hazards with working longer were found among older men (≥64 years), but not younger (59–63 years). The findings suggest that heavy physical demands should be reduced, however, when not feasible physical demands should be accompanied by social support at work for delaying retirement.

  • 29.
    Stengård, Johanna
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Virtanen, Marianna
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    The Implication of Physically Demanding and Hazardous Work on Retirement Timing2022In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 13, article id 8123Article in journal (Refereed)
    Abstract [en]

    The need to retain individuals longer in the workforce is acknowledged in many high-income countries. The present study therefore aimed to examine the importance of physically demanding work tasks (PDWT) and physically hazardous work environment (PHWE) in relation to retirement timing among pensionable workers (≥61 years). A particular question was whether PDWT and PHWE increased in importance with age. Six waves (2008–2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (n = 5201; 56% women and 44% men; mean age at first survey was 61.0 (SD 2.0) years). Discrete time-event history analysis, stratified by socioeconomic position and gender, showed that among blue-collar workers, PDWT and PHWE were associated with an increased likelihood of retiring within the next two years. With increasing age, high-level PHWE was associated with higher probability of retiring among blue-collar men, whereas heavy PDWT was associated with lower probability of retiring among blue-collar women. Among white-collar workers, having at least some PDWT compared to no PDWT was associated with a lower likelihood of retiring within the next two years. With increasing age, exposure to PHWE was associated with higher probability of retiring among white-collar women. These results suggest that to delay retirements, organizations could offer their older employees, especially blue-collar workers and the oldest white-collar women, alternatives to PDWT and PHWE.

  • 30.
    Tan, Edwin C. K.
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). University of Sydney, Australia; Monash University, Australia.
    Pan, Kuan-Yu
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Amsterdam University Medical Center, The Netherlands; Vrije Universiteit, The Netherlands.
    Magnusson Hanson, Linda L
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Psychosocial job strain and polypharmacy: a national cohort study2020In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 46, no 6, p. 589-598Article in journal (Refereed)
    Abstract [en]

    Objectives: Psychosocial job strain has been associated with a range of adverse health outcomes. The aim of this study was to examine the association between psychosocial job strain and prospective risk of polypharmacy (the prescription of ≥5 medications) and to evaluate whether coping strategies can modify this risk.

    Methods: Cohort study of 9703 working adults [mean age 47.5 (SD 10.8) years; 54% female] who participated in the Swedish Longitudinal Occupational Survey of Health (SLOSH) at baseline in 2006 or 2008. Psychosocial job strain was represented by job demands and control, and measured by the Swedish version of the demand–control questionnaire. The outcome was incidence of polypharmacy over an eight-year follow-up period. Information on dispensed drugs were extracted from the Swedish Prescribed Drug Register. Logistic regression was used to estimate the association of job strain status with polypharmacy, adjusted for a range of confounders.

    Results: During the follow-up, 1409 people developed polypharmacy (incident rate: 20.6/1000 person-years). In comparison to workers with low-strain jobs (high control/low demands), those with high-strain jobs (low control/high demands) had a significantly higher risk of incident polypharmacy (OR 1.40, 95% CI 1.04–1.89). The impact of high-strain jobs on developing polypharmacy remained among those with covert coping strategies (ie, directed inwards or towards others) but not among those with open coping strategies (ie, primarily directed toward the stressor).

    Conclusions: Workers in high-strain jobs may be at an increased risk of polypharmacy. Open coping strategies may reduce the negative impact of psychosocial job strain on risk of polypharmacy.

  • 31. Tan, Xiao
    et al.
    Lebedeva, Aleksandra
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Stockholm, Sweden.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Sleep Mediates the Association Between Stress at Work and Incident Dementia: Study From the Survey of Health, Ageing and Retirement in Europe2023In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 78, no 3, p. 447-453Article in journal (Refereed)
    Abstract [en]

    Background: Both psychosocial stress at work and sleep disturbance may predispose impaired cognitive function and dementia in later life. However, whether sleep plays a mediating role for the link between stress at work and subsequent dementia has yet to be investigated.

    Methods: Data from the Survey of Health, Ageing and Retirement in Europe were used for the study. A cohort of 7 799 dementia-free individuals (aged 71.1 ± 0.2 years) were followed up for a median of 4.1 years for incident dementia. Job demand and control were estimated using questions derived from the Karasek’s Job Content Questionnaire. Sleep disturbance was ascertained by a question in the EURO-Depression scale. Cox proportional hazard models adjusted for age, sex, education, cognitive test score, and other potential covariates were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of dementia in relation to different job strain levels.

    Results: An interaction between job demand and sleep disturbance regarding the risk of dementia was detected. Data suggested a protective role of high-level job demand for dementia in individuals with sleep disturbance (HR [95% CI]: 0.69 [0.47, 1.00]) compared with low job demand. A 4-category job strain model based on the combination of job demand and job control levels suggested that among individuals with sleep disturbance, passive job (low demand, low control) was associated with a higher risk of dementia (1.54 [1.01, 2.34]), compared to active job (high demand, high control).

    Conclusion: The link between work-related stress and risk of dementia is limited to individuals suffering sleep disturbance.

  • 32. Tan, Xiao
    et al.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology. Karolinska Institutet, Sweden.
    Lagerros, Ylva Trolle
    Åkerstedt, Anna Miley
    Bellocco, Rino
    Adami, Hans-Olov
    Ye, Weimin
    Pei, Jin-Jing
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm University, Faculty of Social Sciences, Department of Psychology, Biological psychology.
    Interactive association between insomnia symptoms and sleep duration for the risk of dementia: a prospective study in the Swedish National March Cohort2023In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 52, no 9, article id afad163Article in journal (Refereed)
    Abstract [en]

    Objective: Given the importance of sleep in maintaining neurocognitive health, both sleep duration and quality might be component causes of dementia. However, the possible role of insomnia symptoms as risk factors for dementia remain uncertain. Methods: We prospectively studied 22,078 participants in the Swedish National March Cohort who were free from dementia and stroke at baseline. Occurrence of dementia was documented by national registers during a median follow-up period of 19.2 years. Insomnia symptoms and sleep duration were ascertained by Karolinska Sleep Questionnaire. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: Compared to participants without insomnia at baseline, those who reported any insomnia symptom experienced a greater incidence of dementia during follow-up (HR 1.08, 95% CI: 1.03, 1.35). Difficulty initiating sleep versus non insomnia (HR 1.24, 95% CI: 1.02, 1.52), but not difficulty maintaining sleep or early morning awakening was associated with an increased risk of dementia. Short sleep duration was associated with increased risk of dementia (6 h vs. 8 h, HR 1.29, 95% CI: 1.11-1.51; 5 h vs. 8 h, HR 1.26, 95% CI: 1.00-1.57). Stratified analyses suggested that insomnia symptoms increased the risk of dementia only amongst participants with =7 h sleep (vs. non-insomnia HR 1.24, 95% CI: 1.00-1.54, P=0.05), but not amongst short sleepers (<7 h). Short sleep duration also did not further inflate the risk of dementia amongst insomniacs. Conclusion: Insomnia and short sleep duration increase the risk of dementia amongst middle-aged to older adults.

  • 33. Trevisan, Caterina
    et al.
    Rizzuto, Debora
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Maggi, Stefania
    Sergi, Giuseppe
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Weimer, Anna-Karin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden; Karolinska University Hospital, Sweden.
    Impact of Social Network on the Risk and Consequences of Injurious Falls in Older Adults2019In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 67, no 9, p. 1851-1858Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES A smaller social network is associated with worse health-related outcomes in older people. We examined the impact of social connections and social support on the risk of injurious fall and on fall-related functional decline and mortality. DESIGN Prospective study with 6-year follow-up. SETTING Community. PARTICIPANTS A total of 2630 participants (aged >= 60 years) from the Swedish National Study on Aging and Care in Kungsholmen. MEASUREMENTS Social connections (social network size and contact frequency) and social support (social resource perception and satisfaction) were assessed through validated questionnaires. Data on injurious falls (falls requiring inpatient or outpatient care) and mortality came from official registers. We defined injurious falls as severe if they caused fracture and/or intracranial injury and as multiple if two or more occurred during the 6-year follow-up. Functional decline was defined as the loss of ability to perform one or more activities of daily living during the follow-up. RESULTS During the follow-up, 322 participants experienced injurious falls. After adjusting for potential confounders, the hazard ratio of injurious falls was 1.7 (95% confidence interval [CI] = 1.1-2.4) for people with poor social connections and 1.5 (95% CI = 1.1-2.1) for people with moderate social connections (reference: rich social connections). Social support was not associated with fall risk. The odds of functional decline among those with severe/multiple falls and (1) poor social connections (odds ratio [OR] = 5.2 [95% CI = 2.1-12.9]) or (2) poor social support (OR = 4.5 [95% CI = 1.7-12.0]) was up to twice as high as among those with severe/multiple falls and (3) rich social connections (OR = 2.5 [95% CI = .9-6.6]) or (4) rich social support (OR = 2.7 [95% CI = 1.2-6.3]). Similar but more attenuated results emerged for mortality. CONCLUSIONS Social network may influence fall risk and fall-related functional decline and mortality. J Am Geriatr Soc 67:1851-1858, 2019

  • 34. Tu, Raoping
    et al.
    Pan, Kuan-Yu
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Cai, Guoxi
    Yamamoto, Taro
    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.
    The role of education in the association between self-rated health and levels of C-reactive protein: a cross-sectional study in rural areas of China2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 11, article id e027659Article in journal (Refereed)
    Abstract [en]

    Objectives This study aims to examine the association between self-rated health (SRH) and levels of C-reactive protein (CRP) among adults aged 45 to 101 years old in rural areas of China, and to explore the role of education in the association.

    Design Cross-sectional study.

    Setting The study population was derived from two databases in China: Nanping project (NP) and the China Health and Retirement Longitudinal Study (CHARLS).

    Participants There were 646 participants from a rural area of Nanping (NP) and 8555 rural participants from a national representative sample of China (CHARLS).

    Methods CRP was measured using a high sensitivity sandwich enzyme immunoassay in the NP and immunoturbidimetric assay in the GNARLS. SRH was assessed by SRH questionnaires and categorised into good and poor. Education was measured by the maximum years of schooling and dichotomised into illiterate and literate. Multivariate linear regression models were used to study the associations.

    Results Compared to people with good SRH, those with poor SRH had higher levels of CRP in NP beta=0.16, 95% CI -0.02 to 0.34) and in CHARLS (beta=0.07, 95% CI 0.02 to 0.11) after adjusting for potential confounders. Similar findings were observed in the pooled population (beta=0.08, 95% CI 0.03 to 0.12), especially in men (beta=0.13, 95% CI 0.06 to 0.20) and in literate people (beta=0.12, 95% CI 0.06 to 0.18).

    Conclusion Poor SRH may be a predicator of elevated levels of CRP among middle-aged and older people in rural areas, especially in men and literate people.

  • 35.
    Wang, Hui-Xin
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Zhengzhou University, China.
    MacDonald, Stuart W S
    Dekhtyar, Serhiy
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Stockholm Gerontology Research Center, Sweden.
    Association of lifelong exposure to cognitive reserve-enhancing factors with dementia risk: A community-based cohort study2017In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 14, no 3, article id e1002251Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Variation in the clinical manifestation of dementia has been associated with differences in cognitive reserve, although less is known about the cumulative effects of exposure to cognitive reserve factors over the life course. We examined the association of cognitive reserve-related factors over the lifespan with the risk of dementia in a community-based cohort of older adults.

    METHODS AND FINDINGS: Information on early-life education, socioeconomic status, work complexity at age 20, midlife occupation attainment, and late-life leisure activities was collected in a cohort of dementia-free community dwellers aged 75+ y residing in the Kungsholmen district of Stockholm, Sweden, in 1987-1989. The cohort was followed up to 9 y (until 1996) to detect incident dementia cases. To exclude preclinical phases of disease, participants who developed dementia at the first follow-up examination 3 y after the baseline were excluded (n = 602 after exclusions). Structural equation modelling was used to generate latent factors of cognitive reserve from three periods over the life course: early (before 20 y), adulthood (around 30-55 y), and late life (75 y and older). The correlation between early- and adult-life latent factors was strong (γ = 0.9), whereas early-late (γ = 0.27) and adult-late (γ = 0.16) latent factor correlations were weak. One hundred forty-eight participants developed dementia during follow-up, and 454 remained dementia-free. The relative risk (RR) of dementia was estimated using Cox models with life-course cognitive reserve-enhancing factors modelled separately and simultaneously to assess direct and indirect effects. The analysis was repeated among carriers and noncarriers of the apolipoprotein E (APOE) ε4 allele. A reduced risk of dementia was associated with early- (RR 0.57; 95% CI 0.36-0.90), adult- (RR 0.60; 95% CI 0.42-0.87), and late-life (RR 0.52; 95% CI 0.37-0.73) reserve-enhancing latent factors in separate multivariable Cox models. In a mutually adjusted model, which may have been imprecisely estimated because of strong correlation between early- and adult-life factors, the late-life factor preserved its association (RR 0.65; 95% CI 0.45-0.94), whereas the effect of midlife (RR 0.73; 95% CI 0.50-1.06) and early-life factors (RR 0.76; 95% CI 0.47-1.23) on the risk of dementia was attenuated. The risk declined progressively with cumulative exposure to reserve-enhancing latent factors, and having high scores on cognitive reserve-enhancing composite factors in all three periods over the life course was associated with the lowest risk of dementia (RR 0.40; 95% CI 0.20-0.81). Similar associations were detected among APOE ε4 allele carriers and noncarriers. Limitations include measurement error and nonresponse, with both biases likely favouring the null. Strong correlation between early- and adult-life latent factors may have led to a loss in precision when estimating mutually adjusted effects of all periods.

    CONCLUSIONS: In this study, cumulative exposure to reserve-enhancing factors over the lifespan was associated with reduced risk of dementia in late life, even among individuals with genetic predisposition.

  • 36.
    Wang, Rui
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). The Swedish School of Sport and Health Sciences, Sweden; University of Wisconsin School of Medicine and Public Health, USA.
    Qiu, Chengxuan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Dintica, Christina S.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Shang, Ying
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Calderón Larrañaga, Amaia
    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, Department of Psychology, Stress Research Institute.
    Xu, Weili
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tianjin Medical University, China.
    Shared risk and protective factors between Alzheimer's disease and ischemic stroke: A population-based longitudinal study2021In: Alzheimer's & Dementia: Journal of the Alzheimer's Association, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 17, no 2, p. 191-204Article in journal (Refereed)
    Abstract [en]

    Introduction: Stroke, especially ischemic stroke's (IS) link with Alzheimer's disease (AD) remains unclear.

    Methods: This prospective cohort study included 2459 AD‐ and cerebrovascular disease‐free older adults at baseline (mean age 71.9 ± 10.3 years, Stockholm, Sweden). Using Cox regressions, shared risk factors (SRFs) and shared protective factors (SPFs) between AD and IS were recognized when their hazard ratios in both AD and IS models were significant and in the same direction.

    Results: During the follow‐up period of up to 15 years, 132 AD and 260 IS mutually exclusive cases were identified. SRFs were low education, sedentary lifestyle, and heart diseases. High levels of psychological well‐being, actively engaging in leisure activities, and a rich social network were SPFs. Having ≥1 SPF reduced 47% of AD and 28% of IS risk among people with a low risk profile (<2 SRFs), and 38% of AD and 31% of IS risk with a high risk profile (≥2 SRFs). In total, 57.8% of AD/IS cases could be prevented if individuals have ≥1 SPF and no SRF.

    Discussion: AD and IS share risk/protective profiles, and SPFs seem to counteract the adverse effects of SRFs on both AD and IS.

  • 37. Wu, Jia-Jia
    et al.
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute. Zhengzhou University, China.
    Yao, Wu
    Yan, Zhen
    Pei, Jin-Jing
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Stress Research Institute.
    Late-life depression and the risk of dementia in 14 countries: a 10-year follow-up study from the Survey of Health, Ageing and Retirement in Europe2020In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 274, p. 671-677Article in journal (Refereed)
    Abstract [en]

    Background: Depression is the most common mental health problem and often co-occurs with dementia in old age. This study investigates the in fluence of late-life depression on risk of dementia.

    Methods: A total of 16210 dementia-free participants aged 60+ from the Survey of Health, Aging, and Retirement in Europe were followed up for 10 years to detect incident dementia. Depression was assessed by a 12-item Europe-depression scale, dementia was determined by physician diagnosis reported by the participants and their informants. Fine and Gray model was performed to explore the association between depression and incident dementia taking into account competing risk of death.

    Results: During an average of 8 years follow-up, 1030 (6.35%) incident dementia were identi fied. Late-life depression was related to higher subdistribution hazard ratio (sHR) of dementia (sHR=1.52, 95%CI: 1.32-1.75) after adjusting for age, gender, country, education, smoking, drinking, living arrangement, BMI, chronic disease, and physical activity. Further, the risk was only existed in those below age of 80 (sHR=1.75, 95%CI: 1.47-2.07). In addition, a dose-response association was observed between the severity of depression and dementia risk (p for trend<0.001).

    Limitation: The ascertainment of depression and dementia was based on information reported by the participants and/or their informants, which might result in information bias. The causal relationship could not be determined because limited follow-up time.

    Conclusions: Late-life depression is associated with higher incidence of dementia in a dose-response fashion. Interventions targeting depression patients aged 60-79 years and those with severe depression may be e ffective strategies to prevent dementia.

  • 38. Xiong, Ying
    et al.
    Tvedt, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Psychobiology and epidemiology.
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Psychobiology and epidemiology. Karolinska Institutet, Sweden.
    Cadar, Dorina
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Psychobiology and epidemiology.
    Impact of sleep duration and sleep disturbances on the incidence of dementia and Alzheimer's disease: A 10-year follow-up study2024In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 333, article id 115760Article in journal (Refereed)
    Abstract [en]

    The nature of the relationship between sleep problems and dementia remains unclear. This study investigated the relationship between sleep measures and dementia in older adults (≥ 65) using data from the English Longitudinal Study of Ageing (ELSA) and further investigated the causal association in Mendelian randomization (MR) analysis. In total of 7,223 individuals, 5.7 % developed dementia (1.7 % Alzheimer's disease (AD)) within an average of 8 (± 2.9) years. Cox regression models and MR were employed. Long sleep duration (>8 h) was associated with 64 % increased risk of incident dementia and 2-fold high risk of AD compared to ideal sleep duration (7–8 h). This association was particularly evident in older-older adults (≥70 years) and those who consumed alcohol. Short sleep duration (<7 h) was associated with lower risk of incident dementia among older-older but higher risk among younger-older adults. Sleep disturbances and perceived sleep quality were not associated with dementia or AD. The MR study did not reveal causal associations between sleep duration and dementia. These findings suggest that self-reported short sleep in younger-older and long sleep in older-older adults and those with frequent alcohol consumption are associated with dementia. Early detection of these sleep patterns may help identify individuals at higher dementia risk.

  • 39.
    Xu, Weili
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Tianjin Medical University, China.
    Xu, Zhongliang
    Jia, Junting
    Xie, Yun
    Wang, Hui-Xin
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Qi, Xiuying
    Detection of Prediabetes and Undiagnosed Type 2 Diabetes: A Large Population-Based Study2012In: Canadian Journal of Diabetes, ISSN 1499-2671, Vol. 36, no 3, p. 108-113Article in journal (Refereed)
    Abstract [en]

    Objective: Prediabetes and undiagnosed diabetes have been commonly ignored. We aimed to investigate the prevalence of prediabetes and undiagnosed type 2 diabetes mellitus, and to verify the hypothesis that vascular risk factors (VRFs) may indicate prediabetes and undiagnosed type 2 diabetes.

    Methods: A total of 7567 adults, who were 20 to 79 years of age, and living in Tianjin, China, participated in this study. Type 2 diabetes was assessed based on medical history, hypoglycemic drugs use, fasting plasma glucose level >= 7.0 mmol/L, or postprandial 2-hour plasma glucose level >= 11.1 mmol/L. Undiagnosed type 2 diabetes was defined among subjects with type 2 diabetes when neither a medical history of diabetes nor hypoglycemic drugs use was present. Prediabetes was ascertained as fasting plasma glucose level of 6.1 to 6.9 mmol/L, or postprandial 2-hour plasma glucose level of 7.8 to 11.0 mmol/L (WHO 1999) among diabetes-free participants. Data were analyzed using multinomial logistic regression with adjustment for potential confounders.

    Results: Of all participants, 655 (8.7%) had prediabetes, and 721 (9.5%) were patients with type 2 diabetes, including 321 (4.2%) undiagnosed type 2 diabetes accounting for 44.5% patients with diabetes. The prevalence of prediabetes and undiagnosed type 2 diabetes increased with age, and was higher in women than in men. In a fully adjusted multinomial logistic regression model, hypertension, overweight, obesity, central obesity, and family history of diabetes were significantly associated with prediabetes and undiagnosed diabetes, whereas physical inactivity was independently related to undiagnosed diabetes.

    Conclusion: The prevalence of prediabetes and undiagnosed diabetes is approximately 13%, and almost 45% of patients with diabetes are undiagnosed. VRFs, such as hypertension, high adiposity, and family history of diabetes can be indicators for detecting prediabetes and undiagnosed diabetes.

  • 40. Zhuo, Lai-Bao
    et al.