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  • 1.
    Alassaad, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Improving the Quality and Safety of Drug Use in Hospitalized Elderly: Assessing the Effects of Clinical Pharmacist Interventions and Identifying Patients at Risk of Drug-related Morbidity and Mortality2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Older people admitted to hospital are at high risk of rehospitalization and medication errors. We have demonstrated, in a randomized controlled trial, that a clinical pharmacist intervention reduces the incidence of revisits to hospital for patients aged 80 years or older admitted to an acute internal medicine ward. The aims of this thesis were to further study the effects of the intervention and to investigate possibilities of targeting the intervention by identifying predictors of treatment response or adverse health outcomes.

    The effect of the pharmacist intervention on the appropriateness of prescribing was assessed, by using three validated tools. This study showed that the quality of prescribing was improved for the patients in the intervention group but not for those in the control group. However, no association between the appropriateness of prescribing at discharge and revisits to hospital was observed.

    Subgroup analyses explored whether the clinical pharmacist intervention was equally effective in preventing emergency department visits in patients with few or many prescribed drugs and in those with different levels of inappropriate prescribing on admission. The intervention appeared to be most effective in patients taking fewer drugs, but the treatment effect was not altered by appropriateness of prescribing.

    The most relevant risk factors for rehospitalization and mortality were identified for the same study population, and a score for risk-estimation was constructed and internally validated (the 80+ score). Seven variables were selected. Impaired renal function, pulmonary disease, malignant disease, living in a nursing home, being prescribed an opioid and being prescribed a drug for peptic ulcer or gastroesophageal reflux disease were associated with an increased risk, while being prescribed an antidepressant drug (tricyclic antidepressants not included) was linked with a lower risk. These variables made up the components of the 80+ score. Pending external validation, this score has potential to aid identification of high-risk patients.

    The last study investigated the occurrence of prescription errors when patients with multi-dose dispensed (MDD) drugs were discharged from hospital. Twenty-five percent of the MDD orders contained at least one medication prescription error. Almost half of the errors were of moderate or major severity, with potential to cause increased health-care utilization. 

    List of papers
    1. Effects of Pharmacists' Interventions on Appropriateness of Prescribing and Evaluation of the Instruments' (MAI, STOPP and STARTs') Ability to Predict Hospitalization-Analyses from a Randomized Controlled Trial
    Open this publication in new window or tab >>Effects of Pharmacists' Interventions on Appropriateness of Prescribing and Evaluation of the Instruments' (MAI, STOPP and STARTs') Ability to Predict Hospitalization-Analyses from a Randomized Controlled Trial
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    2013 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 8, no 5, p. e62401-Article in journal (Refereed) Published
    Abstract [en]

    Background: Appropriateness of prescribing can be assessed by various measures and screening instruments. The aims of this study were to investigate the effects of pharmacists' interventions on appropriateness of prescribing in elderly patients, and to explore the relationship between these results and hospital care utilization during a 12-month follow-up period. Methods: The study population from a previous randomized controlled study, in which the effects of a comprehensive pharmacist intervention on re-hospitalization was investigated, was used. The criteria from the instruments MAI, STOPP and START were applied retrospectively to the 368 study patients (intervention group (I) n = 182, control group (C) n = 186). The assessments were done on admission and at discharge to detect differences over time and between the groups. Hospital care consumption was recorded and the association between scores for appropriateness, and hospitalization was analysed. Results: The number of Potentially Inappropriate Medicines (PIMs) per patient as identified by STOPP was reduced for I but not for C (1.42 to 0.93 vs. 1.46 to 1.66 respectively, p<0.01). The number of Potential Prescription Omissions (PPOs) per patient as identified by START was reduced for I but not for C (0.36 to 0.09 vs. 0.42 to 0.45 respectively, p<0.001). The summated score for MAI was reduced for I but not for C (8.5 to 5.0 and 8.7 to 10.0 respectively, p<0.001). There was a positive association between scores for MAI and STOPP and drug-related readmissions (RR 8-9% and 30-34% respectively). No association was detected between the scores of the tools and total re-visits to hospital. Conclusion: The interventions significantly improved the appropriateness of prescribing for patients in the intervention group as evaluated by the instruments MAI, STOPP and START. High scores in MAI and STOPP were associated with a higher number of drug-related readmissions.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-203295 (URN)10.1371/journal.pone.0062401 (DOI)000319107900008 ()
    Available from: 2013-07-08 Created: 2013-07-08 Last updated: 2022-01-28Bibliographically approved
    2. The effects of pharmacist intervention on emergency department visits in patients 80 years and older: subgroup analyses by number of prescribed drugs and appropriate prescribing
    Open this publication in new window or tab >>The effects of pharmacist intervention on emergency department visits in patients 80 years and older: subgroup analyses by number of prescribed drugs and appropriate prescribing
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    2014 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 9, no 11, p. e111797-Article in journal (Refereed) Published
    Abstract [en]

    Background: Clinical pharmacist interventions have been shown to have positive effect on occurrence of drug-related issues as well as on clinical outcomes. However, evidence about which patients benefiting most from the interventions is limited. We aimed to explore whether pharmacist intervention is equally effective in preventing emergency department (ED) visits in patients with few or many prescribed drugs and in those with different levels of inappropriate prescribing. Methods: Patient and outcome data from a randomized controlled trial exploring the clinical effects of a ward-based pharmacist intervention in patients, 80 years and older, were used. The patients were divided into subgroups according to the number of prescribed drugs (< 5 or >= 5 drugs) and the level of inappropriate prescribing [using the Screening Tool Of Older People's potentially inappropriate Prescriptions (STOPP) and the Screening Tool to Alert doctors to Right Treatment (START) with a score of >= 2 (STOPP) and >= 1 (START) as cutoff points]. The effect of the intervention on the number of times the different subgroups visited the ED was analyzed. Results: The pharmacist intervention was more effective with respect to the number of subsequent ED visits in patients taking < 5 drugs on admission than in those taking >= 5 drugs. The rate ratio (RR) for a subsequent ED visit was 0.22 [95% confidence interval (CI) 0.09-0.52] for,5 drugs and 0.70 (95% CI 0.47-1.04) for >= 5 drugs (p = 0.02 for the interaction). The effect of intervention did not differ between patients with high or low STOPP or START scores. Conclusion: In this exploratory study, the pharmacist intervention appeared to be more effective in preventing visits to the ED for patients who were taking fewer drugs before the intervention. Our analysis of STOPP and START scores indicated that the level of inappropriate prescribing on admission had no effect on the outcomes of intervention with respect to ED visits.

    Keywords
    clinical pharmacy, medication review, inappropriate prescribing, polypharmacy, geriatrics
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:uu:diva-234485 (URN)10.1371/journal.pone.0111797 (DOI)000345558100122 ()25364817 (PubMedID)
    Available from: 2014-10-20 Created: 2014-10-20 Last updated: 2022-01-28Bibliographically approved
    3. A tool for prediction of risk of rehospitalization and mortality in hospitalized elderly
    Open this publication in new window or tab >>A tool for prediction of risk of rehospitalization and mortality in hospitalized elderly
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    (English)Article in journal (Refereed) Submitted
    Abstract [en]

    Importance: Older patients with multiple co-morbidities and multi-drug use are at high risk of revisits to hospital and mortality, which poses an increasing health economic burden.

    Objective: To construct and internally validate a risk score, the “80+ score”, for revisits to hospital and mortality for older patients, incorporating aspects of pharmacotherapy. Our secondary aim was to compare the discriminatory ability of the score with that of three validated tools for measuring inappropriate prescribing: Screening Tool of Older Person’s Prescriptions (STOPP), Screening Tool to Alert doctors to Right Treatment (START) and Medication Appropriateness Index (MAI).

    Design: Secondary use of data from a randomized controlled trial investigating effects of a comprehensive pharmacist intervention, conducted in 2005-2006.

    Setting: Two acute internal medicine wards at Uppsala University hospital.

    Participants: Data from 368 patients, 80 years and older, admitted to one of the study wards.

    Main outcomes and measures: Time to rehospitalization or death during the year after discharge from hospital. Candidate variables were selected among a large number of clinical and drug-specific variables. After a selection process, a score for risk-estimation was constructed.  The score was internally validated, and the discriminatory ability of the new score and of STOPP, START and MAI was assessed using C-statistics.

    Results: Seven variables were selected for the 80+ score. Impaired renal function, pulmonary disease (chronic obstructive pulmonary disease [COPD or asthma]), malignant disease (past or present), living in nursing home, being prescribed an opioid or being prescribed a drug for peptic ulcer or gastroesophageal reflux disease was associated with an increased risk, while being prescribed an antidepressant drug (tricyclic antidepressants not included) was linked to a lower risk of the outcome. These variables made up the components of the 80+ score. The C-statistics were 0.71 (80+ score), 0.57 (STOPP), 0.54 (START) and 0.63 (MAI).

    Conclusion and Relevance: We developed and internally validated a score for prediction of risk of rehospitalization and mortality in hospitalized older people. The score discriminated risk considerably better than available tools for inappropriate prescribing. Pending external validation, this score can aid in clinical identification of high-risk patients and targeting of interventions. 

    Keywords
    Geriatrics, drugs, risk-estimation, polypharmacy, pharmacotherapy
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:uu:diva-234487 (URN)
    Available from: 2014-10-20 Created: 2014-10-20 Last updated: 2015-02-03Bibliographically approved
    4. Prescription and transcription errors in multidose-dispensed medications on discharge from hospital: an observationaland interventional study
    Open this publication in new window or tab >>Prescription and transcription errors in multidose-dispensed medications on discharge from hospital: an observationaland interventional study
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    2013 (English)In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 19, no 1, p. 185-191Article in journal (Refereed) Published
    Abstract [en]

    Background 

    Medication errors frequently occur when patients are transferred between health care settings. The main objective of this study was to investigate the frequency, type and severity of prescribing and transcribing errors for drugs dispensed in multidose plastic packs when patients are discharged from the hospital. The secondary objective was to correct identified errors and suggest measures to promote safe prescribing.

    Methods 

    The drugs on the patients' multidose drug dispensing (MDD) order sheets and the medication administration records were reconciled prior to the MDD orders being sent to the pharmacy for dispensing. Discrepancies were recorded and the prescribing physician was notified and given the opportunity to change the order. Discrepancies categorized as unintentional and related to the discharge process were subject to further analysis.

    Results 

    Seventy-two (25%) of the 290 reviewed MDD orders had at least one discharge error. In total, 120 discharge errors were identified, of which 49 (41%) were assessed as being of moderate and three (3%) of major severity. Orders with a higher number of medications and orders from the orthopaedic wards had a significantly higher error rate.

    Conclusion 

    The main purpose of the MDD system is to increase patient safety by reducing medication errors. However, this study shows that prescribing and transcribing errors frequently occur when patients are hospitalized. Because the population enrolled in the MDD system is an elderly, physically vulnerable group with a high number of prescribed drugs, preventive measures to ensure safe prescribing of MDD drugs are warranted.

    Keywords
    medication error, medication reconciliation, multi-dose dispensed medications, patient safety, prescription error, transition of care
    National Category
    Social and Clinical Pharmacy
    Research subject
    Pharmaceutical Science; Pharmacokinetics and Drug Therapy
    Identifiers
    urn:nbn:se:uu:diva-167137 (URN)10.1111/j.1365-2753.2011.01798.x (DOI)000314114400026 ()
    Available from: 2012-01-22 Created: 2012-01-22 Last updated: 2018-01-12
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  • 2.
    Alehagen, Urban
    et al.
    Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85 Linköping, Sweden.
    Alexander, Jan
    Norwegian Institute of Public Health, 0213 Oslo, Norway.
    Aaseth, Jan O.
    Department of Research, Innlandet Hospital Trust, 2382 Brumunddal, Norway;Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, 2624 Lillehammer, Norway.
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Svensson, Erland
    Swedish Defence Research Agency, 164 40 Stockholm, Sweden (Ret.).
    Opstad, Trine B.
    Centre for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, 0450 Oslo, Norway;Faculty of Medicine, University of Oslo, 0313 Oslo, Norway.
    Effects of an Intervention with Selenium and Coenzyme Q10 on Five Selected Age-Related Biomarkers in Elderly Swedes Low in Selenium: Results That Point to an Anti-Ageing Effect—A Sub-Analysis of a Previous Prospective Double-Blind Placebo-Controlled Randomised Clinical Trial2023In: Cells, E-ISSN 2073-4409, Vol. 12, no 13, article id 1773Article in journal (Refereed)
    Abstract [en]

    Background: Ageing is associated with cardiovascular disease (CVD). As no single biomarker reflects the full ageing process, we aimed to investigate five CVD- and age-related markers and the effects of selenium and coenzyme Q10 intervention to elucidate the mechanisms that may influence the course of ageing. Methods: This is a sub-study of a previous prospective double-blind placebo-controlled randomized clinical trial that included 441 subjects low in selenium (mean age 77, 49% women). The active treatment group (n = 220) received 200 µg/day of selenium and 200 mg/day of coenzyme Q10, combined. Blood samples were collected at inclusion and after 48 months for measurements of the intercellular adhesion molecule (ICAM-1), adiponectin, leptin, stem cell factor (SCF) and osteoprotegerin (OPG), using ELISAs. Repeated measures of variance and ANCOVA evaluations were used to compare the two groups. In order to better understand and reduce the complexity of the relationship between the biomarkers and age, factor analyses and structural equation modelling (SEM) were performed, and a structural model is presented. Results: Correlation analyses of biomarker values at inclusion in relation to age, and relevant markers related to inflammation, endothelial dysfunction and fibrosis, demonstrated the biomarkers’ association with these pathological processes; however, only ICAM1 and adiponectin were directly correlated with age. SEM analyses showed, however, that the biomarkers ICAM-1, adiponectin, SCF and OPG, but not leptin, all had significant associations with age and formed two independent structural factors, both significantly related to age. While no difference was observed at inclusion, the biomarkers were differently changed in the active treatment and placebo groups (decreasing and increasing levels, respectively) at 48 months (p ≤ 0.02 in all, adjusted), and in the SEM model, they showed an anti-ageing impact. Conclusions: Supplementation with selenium/Q10 influenced the analysed biomarkers in ways indicating an anti-ageing effect, and by applying SEM methodology, the interrelationships between two independent structural factors and age were validated.

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  • 3.
    Alehagen, Urban
    et al.
    Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden..
    Opstad, Trine B
    Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevål, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway..
    Alexander, Jan
    Norwegian Institute of Public Health, P.O. Box 222 Skøyen, N-0213 Oslo, Norway..
    Larsson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Aaseth, Jan
    Department of Research, Innlandet Hospital Trust, P.O. Box 104, N-2381 Brumunddal, Norway..
    Impact of Selenium on Biomarkers and Clinical Aspects Related to Ageing: A Review2021In: Biomolecules, E-ISSN 2218-273X, Vol. 11, no 10, article id 1478Article in journal (Refereed)
    Abstract [en]

    Selenium (Se) is an essential dietary trace element that plays an important role in the prevention of inflammation, cardiovascular diseases, infections, and cancer. Selenoproteins contain selenocysteine in the active center and include, i.a., the enzymes thioredoxin reductases (TXNRD1-3), glutathione peroxidases (GPX1-4 and GPX6) and methionine sulfoxide reductase, involved in immune functions, metabolic homeostasis, and antioxidant defense. Ageing is an inevitable process, which, i.a., involves an imbalance between antioxidative defense and reactive oxygen species (ROS), changes in protein and mitochondrial renewal, telomere attrition, cellular senescence, epigenetic alterations, and stem cell exhaustion. These conditions are associated with mild to moderate inflammation, which always accompanies the process of ageing and age-related diseases. In older individuals, Se, by being a component in protective enzymes, operates by decreasing ROS-mediated inflammation, removing misfolded proteins, decreasing DNA damage, and promoting telomere length. Se-dependent GPX1-4 and TXNRD1-3 directly suppress oxidative stress. Selenoprotein H in the cell nucleus protects DNA, and selenoproteins residing in the endoplasmic reticulum (ER) assist in the removal of misfolded proteins and protection against ER stress. In this review, we highlight the role of adequate Se status for human ageing and prevention of age-related diseases, and further its proposed role in preservation of telomere length in middle-aged and elderly individuals.

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  • 4.
    Almandoz-Gil, Leire
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Lindström, Veronica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Sigvardson, Jessica
    BioArctic, Stockholm, Sweden.
    Kahle, Philipp J.
    Univ Tubingen, Hertie Inst Clin Brain Res, Dept Neurodegenerat, Lab Funct Neurogenet, Tubingen, Germany.;German Ctr Neurodegenerat Dis, Tubingen, Germany..
    Lannfelt, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Ingelsson, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Bergström, Joakim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Mapping of Surface-Exposed Epitopes of In Vitro and In Vivo Aggregated Species of Alpha-Synuclein2017In: Cellular and molecular neurobiology, ISSN 0272-4340, E-ISSN 1573-6830, Vol. 37, no 7, p. 1217-1226Article in journal (Refereed)
    Abstract [en]

    Aggregated alpha-synuclein is the main component of Lewy bodies, intraneuronal deposits observed in Parkinson's disease and dementia with Lewy bodies. The objective of the study was to identify surface-exposed epitopes of alpha-synuclein in vitro and in vivo formed aggregates. Polyclonal immunoglobulin Y antibodies were raised against short linear peptides of the alpha-synuclein molecule. An epitope in the N-terminal region (1-10) and all C-terminal epitopes (90-140) were found to be exposed in an indirect enzyme-linked immunosorbent assay (ELISA) using recombinant monomeric, oligomeric, and fibrillar alpha-synuclein. In a phospholipid ELISA, the N-terminus and mid-region of alpha-synuclein (i.e., 1-90) were associated with phosphatidylserine and thus occluded from antibody binding. The antibodies that reacted most strongly with epitopes in the in vitro aggregates (i.e., 1-10 and epitopes between positions 90-140) also labeled alpha-synuclein inclusions in brains from transgenic (Thy-1)-h[A30P] alpha-synuclein mice and Lewy bodies and Lewy neurites in brains of patients with alpha-synucleinopathies. However, differences in reactivity were observed with the C-terminal antibodies when brain tissue from human and transgenic mice was compared. Taken together, the study shows that although similar epitopes are exposed in both in vitro and in vivo formed alpha-synuclein inclusions, structural heterogeneity can be observed between different molecular species.

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  • 5.
    Almkvist, Ove
    et al.
    Karolinska Inst, Ctr Alzheimer Res, Dept Neurobiol Care Sci & Soc, Div Translat Alzheimer Neurobiol, Stockholm, Sweden.;Karolinska Univ Hosp Huddinge, Dept Geriatr Med, Stockholm, Sweden.;Stockholm Univ, Dept Psychol, Stockholm, Sweden..
    Rodriguez-Vieitez, Elena
    Karolinska Inst, Ctr Alzheimer Res, Dept Neurobiol Care Sci & Soc, Div Translat Alzheimer Neurobiol, Stockholm, Sweden..
    Thordardottir, Steinunn
    Karolinska Univ Hosp Huddinge, Dept Geriatr Med, Stockholm, Sweden.;Karolinska Inst, Div Neurogeriatr, Dept Neurobiol Care Sci & Soc, Ctr Alzheimer Res, Stockholm, Sweden..
    Amberla, Kaarina
    Karolinska Univ Hosp Huddinge, Dept Geriatr Med, Stockholm, Sweden..
    Axelman, Karin
    Karolinska Univ Hosp Huddinge, Dept Geriatr Med, Stockholm, Sweden..
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Kinhult-Stahlbom, Anne
    Karolinska Univ Hosp Huddinge, Dept Geriatr Med, Stockholm, Sweden.;Karolinska Inst, Div Neurogeriatr, Dept Neurobiol Care Sci & Soc, Ctr Alzheimer Res, Stockholm, Sweden..
    Lilius, Lena
    Karolinska Univ Hosp Huddinge, Dept Geriatr Med, Stockholm, Sweden..
    Remes, Anne
    Univ Eastern Finland, Inst Clin Med Neurol, Dept Neurol, Kuopio, Finland..
    Wahlund, Lars-Olof
    Karolinska Univ Hosp Huddinge, Dept Geriatr Med, Stockholm, Sweden.;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Ctr Alzheimer Res, Stockholm, Sweden..
    Viitanen, Matti
    Karolinska Univ Hosp Huddinge, Dept Geriatr Med, Stockholm, Sweden.;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Ctr Alzheimer Res, Stockholm, Sweden.;Turku City Hosp, Dept Geriatr, Turku, Finland.;Univ Turku, Turku, Finland..
    Lannfelt, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Graff, Caroline
    Karolinska Univ Hosp Huddinge, Dept Geriatr Med, Stockholm, Sweden.;Karolinska Inst, Div Neurogeriatr, Dept Neurobiol Care Sci & Soc, Ctr Alzheimer Res, Stockholm, Sweden..
    Predicting Cognitive Decline across Four Decades in Mutation Carriers and Non-carriers in Autosomal-Dominant Alzheimer's Disease2017In: Journal of the International Neuropsychological Society, ISSN 1355-6177, E-ISSN 1469-7661, Vol. 23, no 3, p. 195-203Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to investigate cognitive performance including preclinical and clinical disease course in carriers and non-carriers of autosomal-dominant Alzheimer's disease (adAD) in relation to multiple predictors, that is, linear and non-linear estimates of years to expected clinical onset of disease, years of education and age. Methods: Participants from five families with early-onset autosomal-dominant mutations (Swedish and Arctic APP, PSEN1 M146V, H163Y, and I143T) included 35 carriers (28 without dementia and 7 with) and 44 non-carriers. All participants underwent a comprehensive clinical evaluation, including neuropsychological assessment at the Memory Clinic, Karolinska University Hospital at Huddinge, Stockholm, Sweden. The time span of disease course covered four decades of the preclinical and clinical stages of dementia. Neuropsychological tests were used to assess premorbid and current global cognition, verbal and visuospatial functions, short-term and episodic memory, attention, and executive function. Results: In carriers, the time-related curvilinear trajectory of cognitive function across disease stages was best fitted to a formulae with three predictors: years to expected clinical onset (linear and curvilinear components), and years of education. In non-carriers, the change was minimal and best predicted by two predictors: education and age. The trajectories for carriers and non-carriers began to diverge approximately 10 years before the expected clinical onset in episodic memory, executive function, and visuospatial function. Conclusions: The curvilinear trajectory of cognitive functions across disease stages was mimicked by three predictors in carriers. In episodic memory, executive and visuospatial functions, the point of diverging trajectories occurred approximately 10 years ahead of the clinical onset compared to non-carriers.

  • 6.
    Almkvist, Ove
    et al.
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Clin Geriatr, SE-14157 Stockholm, Sweden.
    Rodriguez-Vieitez, Elena
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Clin Geriatr, SE-14157 Stockholm, Sweden.
    Thordardottir, Steinunn
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurogeriatr, Stockholm, Sweden.
    Nordberg, Agneta
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Clin Geriatr, SE-14157 Stockholm, Sweden.
    Viitanen, Matti
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Clin Geriatr, SE-14157 Stockholm, Sweden.
    Lannfelt, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Graff, Caroline
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Neurogeriatr, Stockholm, Sweden.
    Longitudinal cognitive decline in autosomal-dominant Alzheimer's disease varies with mutations in APP and PSEN1 genes2019In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 82, p. 40-47Article in journal (Refereed)
    Abstract [en]

    The purpose was to compare longitudinal cognitive changes in APP and PSEN1 gene mutation carriers and noncarriers from four autosomal-dominant Alzheimer's disease (ADAD) families across preclinical and early clinical stages of disease. Carriers (n = 34) with four different mutations (PSEN1(M146V), PSEN1(H163Y), APP(SWE), and APP(ARC)) and noncarriers (n = 41) were followed up longitudinally with repeated cognitive assessments starting many years before the expected clinical onset. The relationship between cognition and years to expected clinical onset, education, age, and type of mutation was analyzed using mixed-effects models. Results showed an education-dependent and time-related cognitive decline with linear and quadratic predictors in mutation carriers. Cognitive decline began close to the expected clinical onset and was relatively rapid afterward in PSEN1 mutation carriers, whereas decline was slower and started earlier than 10 years before expected clinical onset in APP mutation carriers. In noncarriers, the decline was minimal across time in accordance with normal aging. These results suggest that phenotypes for onset and rate of cognitive decline vary with PSEN1 and APP genes, suggesting a behavioral heterogeneity in ADAD. (C) 2019 Elsevier Inc. All rights reserved.

  • 7.
    Andersson, Christin
    et al.
    Karolinska Inst, Dept Clin Neurosci, Nobels Vag 9, SE-17165 Stockholm, Sweden.;KaaDepartment of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden;Division of Medical Psychology, Karolinska University Hospital, Stockholm, Sweden.
    Marklund, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Walles, Håkan
    Department of Aging, Karolinska University Hospital, Stockholm, Sweden.
    Hagman, Göran
    Department of Aging, Karolinska University Hospital, Stockholm, Sweden;Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Miley-Akerstedt, Anna
    Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden;Department of Aging, Karolinska University Hospital, Stockholm, Sweden.
    Lifestyle Factors and Subjective Cognitive Impairment in Patients Seeking Help at a Memory Disorder Clinic: The Role of Negative Life Events2019In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 48, no 3-4, p. 196-206Article in journal (Refereed)
    Abstract [en]

    Background/Aims: A large proportion of patients at memory disorders clinics are classified as having subjective cognitive impairment (SCI). Previous research has investigated whether particular lifestyle factors known to affect cognition can be useful in differentiating patients who do not show objective evidence of memory decline. There may also exist subgroups of patients with respect to lifestyle factors that could help clinicians to understand the patient group that presents to memory clinics. These may differ in diagnostic outcome. Very little is known about potential subgroups; however, but such information may help guide interventions and potentially eliminate unnecessary diagnostic procedures. The current study investigated patterns of lifestyle-related variables, including stress, sleep, sensory sensitivity, depression, and negative life events in patients presenting to a memory disorders clinic. The aim was to determine whether subgroups existed and whether it was possible to distinguish those with objectively impaired cognition. Methods: One hundred and seventy-eight patients (mean age 58 years) from a University Hospital Memory Disorders Clinic. Results: Cluster analysis identified three groups of lifestyle-related variables. Strong determinants of clusters were negative life events and age. Patients with a high number of negative life events also tended to have highest self-reported memory complaint, higher levels of stress, depression, and sensory sensitivity. However, they did not perform the worst on memory testing. In contrast, individuals who performed the worst on memory tests were older, tended to have the least memory complaints, and less negative lifestyle factors; this group also included the highest proportion of patients with mild cognitive impairment and had the lowest median amyloid A-beta 42 (A beta <sub>42</sub>). The group with the best cognitive performance were younger, included the highest proportion of patients with SCI and the highest median A beta <sub>42</sub>. On lifestyle variables, their ratings fell in between the other groups. Conclusions: Lifestyle subgroups of patients were determined by stress, emotional problems, and age. The groups were significantly associated with A beta <sub>42</sub> and diagnostic outcome. This pattern may confound the differentiation between objective and subjective memory problems. Asking about lifestyle variables, in conjunction with neuropsychological testing, could potentially identify individuals who are not likely to have objective memory impairment and guide interventions.

  • 8. Antonios, Gregory
    et al.
    Saiepour, Nasrin
    Bouter, Yvonne
    Richard, Bernhard C
    Paetau, Anders
    Verkkoniemi-Ahola, Auli
    Lannfelt, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Ingelsson, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Kovacs, Gabor G
    Pillot, Thierry
    Wirths, Oliver
    Bayer, Thomas A
    N-truncated Abeta starting with position four: early intraneuronal accumulation and rescue of toxicity using NT4X-167, a novel monoclonal antibody2013In: Acta neuropathologica communications, ISSN 2051-5960, Vol. 1, no 1, p. 56-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The amyloid hypothesis in Alzheimer disease (AD) considers amyloid β peptide (Aβ) deposition causative in triggering down-stream events like neurofibrillary tangles, cell loss, vascular damage and memory decline. In the past years N-truncated Aβ peptides especially N-truncated pyroglutamate AβpE3-42 have been extensively studied. Together with full-length Aβ1-42 and Aβ1-40, N-truncated AβpE3-42 and Aβ4-42 are major variants in AD brain. Although Aβ4-42 has been known for a much longer time, there is a lack of studies addressing the question whether AβpE3-42 or Aβ4-42 may precede the other in Alzheimer's disease pathology.

    RESULTS: Using different Aβ antibodies specific for the different N-termini of N-truncated Aβ, we discovered that Aβ4-x preceded AβpE3-x intraneuronal accumulation in a transgenic mouse model for AD prior to plaque formation. The novel Aβ4-x immunoreactive antibody NT4X-167 detected high molecular weight aggregates derived from N-truncated Aβ species. While NT4X-167 significantly rescued Aβ4-42 toxicity in vitro no beneficial effect was observed against Aβ1-42 or AβpE3-42 toxicity. Phenylalanine at position four of Aβ was imperative for antibody binding, because its replacement with alanine or proline completely prevented binding. Although amyloid plaques were observed using NT4X-167 in 5XFAD transgenic mice, it barely reacted with plaques in the brain of sporadic AD patients and familial cases with the Arctic, Swedish and the presenilin-1 PS1Δ9 mutation. A consistent staining was observed in blood vessels in all AD cases with cerebral amyloid angiopathy. There was no cross-reactivity with other aggregates typical for other common neurodegenerative diseases showing that NT4X-167 staining is specific for AD.

    CONCLUSIONS: Aβ4-x precedes AβpE3-x in the well accepted 5XFAD AD mouse model underlining the significance of N-truncated species in AD pathology. NT4X-167 therefore is the first antibody reacting with Aβ4-x and represents a novel tool in Alzheimer research.

  • 9. Arkkukangas, Marina
    et al.
    Söderlund, Anne
    Eriksson, Staffan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Johansson, Ann-Christin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Fall Preventive Exercise With or Without Behavior Change Support for Community-Dwelling Older Adults: A Randomized Controlled Trial With Short-Term Follow-up2019In: Journal of Geriatric Physical Therapy, ISSN 1539-8412, E-ISSN 2152-0895, Vol. 42, no 1, p. 9-17Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: In Western countries, falls and fall-related injuries are a well-known threat to health in the aging population. Studies indicate that regular exercise improves strength and balance and can therefore decrease the incidence of falls and fall-related injuries. The challenge, however, is to provide exercise programs that are safe, effective, and attractive to the older population. The aim of this study was to investigate the short-term effect of a home-based exercise program with or without motivational interviewing (MI) compared with standard care on physical performance, fall self-efficacy, balance, activity level, handgrip strength, adherence to the exercise, and fall frequency.

    METHOD: A total of 175 older adults participated in this randomized controlled study. They were randomly allocated for the Otago Exercise Program (OEP) (n = 61), OEP combined with MI (n = 58), or a control group (n = 56). The participants' mean age was 83 years. The recruitment period was from October 2012 to May 2015. Measurements of physical performance, fall self-efficacy, balance, activity level, handgrip strength, adherence to the exercise, and fall frequency were done before and 12 weeks after randomization.

    RESULTS AND DISCUSSION: A total of 161 participants were followed up, and there were no significant differences between groups after a period of 12 weeks of regular exercise. Within the OEP + MI group, physical performance, fall self-efficacy, physical activity level, and handgrip strength improved significantly; likewise, improved physical performance and fall self-efficacy were found in the control group. A corresponding difference did not occur in the OEP group. Adherence to the exercise was generally high in both exercise groups.

    CONCLUSION: In the short-term perspective, there were no benefits of an exercise program with or without MI regarding physical performance, fall self-efficacy, activity level, handgrip strength, adherence to the exercise, and fall frequency in comparison to a control group. However, some small effects occurred within the OEP + MI group, indicating that there may be some possible value in behavioral change support combined with exercise in older adults that requires further evaluation in both short- and long-term studies.

  • 10.
    Arkkukangas, Marina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Tuvemo Johnson, Susanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Hellström, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Anens, Elisabeth
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Åsenlöf: Physiotheraphy.
    Tonkonogi, Michail
    Larsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Fall Prevention Exercises With or Without Behavior Change Support for Community-Dwelling Older Adults: A 2-Year Follow-Up of a Randomized Controlled Trial2020In: Journal of Aging and Physical Activity, ISSN 1063-8652, E-ISSN 1543-267X, Vol. 28, no 1, p. 34-41Article in journal (Refereed)
    Abstract [en]

    This study investigates the effectiveness of two fall prevention exercise interventions targeting physical performance, activity level, fall-related self-efficacy, health-related quality of life, and falls: the Otago Exercise Programme (OEP) with and the OEP without behavior change support. In this randomized controlled trial (RCT), 175 participants were randomised into two intervention groups and one control group. A total of 124 community-dwelling older adults over the age of 75 who needed walking aids or home support participated in the two-year follow-up. The OEP with and the OEP without support for behavior change displayed no long-term benefits on physical performance, fall-related self-efficacy, health-related quality of life, and falls compared to a control group. Although no significant differences were detected between the groups, the results implied the control group's physical activity level decreased compared to the intervention groups at two-year follow up.

  • 11.
    Artzi-Medvedik, Rada
    et al.
    Ben Gurion Univ Negev, Recanati Sch Community Hlth Profess, Fac Hlth Sci, Dept Nursing, Beer Sheva, Israel.;Ben Gurion Univ Negev, Recanati Sch Community Hlth Profess, Fac Hlth Sci, Dept Phys Therapy, Beer Sheva, Israel..
    Kob, Robert
    Friedrich Alexander Univ Erlangen Nurnberg, Dept Internal Med Geriatr, Inst Biomed Aging, Krankenhaus Barmherzige Bruder, Koberger Str 60, D-90408 Nurnberg, Germany..
    Fabbietti, Paolo
    Italian Natl Res Ctr Aging IRCCS INRCA, Ancona, Italy.;Italian Natl Res Ctr Aging IRCCS INRCA, Fermo, Italy.;Italian Natl Res Ctr Aging IRCCS INRCA, Cosenza, Italy.;IRCCS INRCA, Lab Geriatr Pharmacoepidemiol & Biostat, Via S Margherita 5, I-60124 Ancona, Italy..
    Lattanzio, Fabrizia
    Italian Natl Res Ctr Aging IRCCS INRCA, Ancona, Italy.;Italian Natl Res Ctr Aging IRCCS INRCA, Fermo, Italy.;Italian Natl Res Ctr Aging IRCCS INRCA, Cosenza, Italy..
    Corsonello, Andrea
    Italian Natl Res Ctr Aging IRCCS INRCA, Ancona, Italy.;Italian Natl Res Ctr Aging IRCCS INRCA, Fermo, Italy.;Italian Natl Res Ctr Aging IRCCS INRCA, Cosenza, Italy..
    Melzer, Yehudit
    Ben Gurion Univ Negev, Recanati Sch Community Hlth Profess, Fac Hlth Sci, Dept Phys Therapy, Beer Sheva, Israel.;Maccabi Hlth Org, Tel Aviv, Israel..
    Roller-Wirnsberger, Regina
    Med Univ Graz, Dept Internal Med, Graz, Austria..
    Wirnsberger, Gerhard
    Med Univ Graz, Div Nephrol, Dept Internal Med, Graz, Austria..
    Mattace-Raso, Francesco
    Erasmus MC, Univ Med Ctr Rotterdam, Geriatr Med Sect, Dept Internal Med, Rotterdam, Netherlands..
    Tap, Lisanne
    Erasmus MC, Univ Med Ctr Rotterdam, Geriatr Med Sect, Dept Internal Med, Rotterdam, Netherlands..
    Gil, Pedro
    Hosp Clin San Carlos, Dept Geriatr Med, Madrid, Spain..
    Martinez, Sara Lainez
    Hosp Clin San Carlos, Dept Geriatr Med, Madrid, Spain..
    Formiga, Francesc
    Bellvitge Univ Hosp, IDIBELL, Dept Internal Med, Geriatr Unit, Barcelona, Spain..
    Moreno-Gonzalez, Rafael
    Bellvitge Univ Hosp, IDIBELL, Dept Internal Med, Geriatr Unit, Barcelona, Spain..
    Kostka, Tomasz
    Med Univ Lodz, Hlth Ageing Res Ctr, Dept Geriatr, Lodz, Poland..
    Guligowska, Agnieszka
    Med Univ Lodz, Hlth Ageing Res Ctr, Dept Geriatr, Lodz, Poland..
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Huddinge, Sweden..
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med, Huddinge, Sweden..
    Freiberger, Ellen
    Friedrich Alexander Univ Erlangen Nurnberg, Dept Internal Med Geriatr, Inst Biomed Aging, Krankenhaus Barmherzige Bruder, Koberger Str 60, D-90408 Nurnberg, Germany..
    Melzer, Itshak
    Ben Gurion Univ Negev, Recanati Sch Community Hlth Profess, Fac Hlth Sci, Dept Phys Therapy, Beer Sheva, Israel..
    Impaired kidney function is associated with lower quality of life among community-dwelling older adults The screening for CKD among older people across Europe (SCOPE) study2020In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, article id 340Article in journal (Refereed)
    Abstract [en]

    Background Quality of life (QoL) refers to the physical, psychological, social and medical aspects of life that are influenced by health status and function. The purpose of this study was to measure the self-perceived health status among the elderly population across Europe in different stages of Chronic Kidney Disease (CKD). Methods Our series consisted of 2255 community-dwelling older adults enrolled in the Screening for Chronic Kidney Disease (CKD) among Older People across Europe (SCOPE) study. All patients underwent a comprehensive geriatric assessment (CGA), including included demographics, clinical and physical assessment, number of medications taken, family arrangement, Geriatric Depression Scale (GDS), Cumulative Illness Rating Scale, History of falls, Lower urinary tract symptoms, and Short Physical Performance Battery (SPPB). Estimated glomerular filtration rate (eGFR) was calculated by Berlin Initiative Study (BIS) equation. Quality of life was assessed by Euro Qol questionnaire (Euro-Qol 5D) and EQ-Visual Analogue Scale (EQ-VAS). The association between CKD (eGFR < 60, < 45 ml or < 30 ml/min/1.73m(2)) and low EQoL-VAS was investigated by multivariable logistic regression models. Results CKD was found to be significantly associated with low EQoL-VAS in crude analysis (OR = 1.47, 95%CI = 1.16-1.85 for eGFR< 60; OR = 1.38, 95%CI = 1.08-1.77 for eGFR< 45; OR = 1.57, 95%CI = 1.01-2.44). Such association was no longer significant only when adjusting for SPPB (OR = 1.20, 95%CI = 0.93-1.56 for eGFR< 60; OR = 0.87, 95%CI = 0.64-1.18 for eGFR< 45; OR = 0.84, 95%CI = 0.50-1.42), CIRS and polypharmacy (OR = 1.16, 95%CI = 0.90-1.50 for eGFR< 60; OR = 0.86, 95%CI = 0.64-1.16 for eGFR< 45; OR = 1.11, 95%CI = 0.69-1.80) or diabetes, hypertension and chronic obstructive pulmonary disease (OR = 1.28, 95%CI = 0.99-1.64 for eGFR< 60; OR = 1.16, 95%CI = 0.88-1.52 for eGFR< 45; OR = 1.47, 95%CI = 0.92-2.34). The association between CKD and low EQoL-VAS was confirmed in all remaining multivariable models. Conclusions CKD may significantly affect QoL in community-dwelling older adults. Physical performance, polypharmacy, diabetes, hypertension and COPD may affect such association, which suggests that the impact of CKD on QoL is likely multifactorial and partly mediated by co-occurrent conditions/risk factors.

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  • 12.
    Ascencao, Raquel
    et al.
    Univ Lisbon, Fac Med, Lab Farmacol Clin & Terapeut, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Nogueira, Paulo
    Univ Nova Lisboa, Escola Nacl Saude Publ, Lisbon, Portugal..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Henriques, Adriana
    Nursing Res Innovat & Dev Ctr Lisbon CIDNUR, Nursing Sch Lisbon, Lisbon, Portugal..
    Costa, Andreia
    Univ Lisbon, Fac Med, Inst Saude Ambiental ISAMB, Lisbon, Portugal..
    Adverse drug reactions in hospitals: population estimates for Portugal and the ICD-9-CM to ICD-10-CM crosswalk2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1222Article in journal (Refereed)
    Abstract [en]

    BackgroundAdverse drug reactions (ADR), both preventable and non-preventable, are frequent and pose a significant burden. This study aimed to produce up-to-date estimates for ADR rates in hospitals, in Portugal, from 2010 to 2018. In addition, it explores possible pitfalls when crosswalking between ICD-9-CM and ICD-10-CM code sets for ADR identification.MethodsThe Portuguese Hospital Morbidity Database was used to identify hospital episodes (outpatient or inpatient) with at least one ICD code of ADR. Since the study period spanned from 2010 to 2018, both ICD-9-CM and ICD-10-CM codes based on previously published studies were used to define episodes. This was an exploratory study, and descriptive statistics were used to provide ADR rates and summarise episode features for the full period (2010-2018) as well as for the ICD-9-CM (2010-2016) and ICD -10-CM (2017-2018) eras.ResultsBetween 2010 and 2018, ADR occurred in 162,985 hospital episodes, corresponding to 1.00% of the total number of episodes during the same period. Higher rates were seen in the oldest age groups. In the same period, the mean annual rate of episodes related to ADR was 174.2/100,000 population. The episode rate (per 100,000 population) was generally higher in males, except in young adults (aged '15-20', '25-30' and '30-35' years), although the overall frequency of ADR in hospital episodes was higher in females.ConclusionsDespite the ICD-10-CM transition, administrative health data in Portugal remain a feasible source for producing up-to-date estimates on ADR in hospitals. There is a need for future research to identify target recipients for preventive interventions and improve medication safety practices in Portugal.

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  • 13.
    Barazzoni, Rocco
    et al.
    Univ Trieste, Dept Med Surg & Hlth Sci, Internal Med, Trieste, Italy.;Azienda Sanit Univ Integrata Trieste ASUITS, Trieste, Italy.;Univ Trieste, Dept Med Surg & Hlth Sci, Str Fiume 447, I-34149 Trieste, Italy..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Stockholm, Sweden..
    Zanetti, Michela
    Univ Trieste, Dept Med Surg & Hlth Sci, Internal Med, Trieste, Italy.;Azienda Sanit Univ Integrata Trieste ASUITS, Trieste, Italy..
    Cappellari, Gianluca Gortan
    Univ Trieste, Dept Med Surg & Hlth Sci, Internal Med, Trieste, Italy.;Azienda Sanit Univ Integrata Trieste ASUITS, Trieste, Italy..
    Defining and diagnosing sarcopenia: Is the glass now half full?2023In: Metabolism: Clinical and Experimental, ISSN 0026-0495, E-ISSN 1532-8600, Vol. 143, article id 155558Article, review/survey (Refereed)
    Abstract [en]

    Low muscle mass and function exert a substantial negative impact on quality of life, health and ultimately survival, but their definition, identification and combination to define sarcopenia have suffered from lack of universal consensus. Methodological issues have also contributed to incomplete agreement, as different approaches, techniques and potential surrogate measures inevitably lead to partly different conclusions. As a consequence: 1) awareness of sarcopenia and implementation of diagnostic procedures in clinical practice have been limited; 2) patient identification and evaluation of therapeutic strategies is largely incomplete. Significant progress has however recently occurred after major diagnostic algorithms have been developed, with common features and promising perspectives for growing consensus. At the same time, the need for further refinement of the sarcopenia concept has emerged, to address its increasingly recognized clinical heterogeneity. This includes potential differential underlying mechanisms and clinical features for age-and disease-driven sarcopenia, and the emerging challenge of sarcopenia in persons with obesity. Here, we will review existing algorithms to diagnose sarcopenia, and major open methodological issues to assess skeletal muscle mass and function under different clinical conditions, in order to highlight similarities and differences. Potential for consensus on sarcopenia diagnosis as well as emerging new challenges will be discussed.

  • 14.
    Bask, Miia
    Department of Sociology, University of Bergen, Bergen, Norway.
    Patterns of Psycho-Social Distress Among Ageing Swedes2015In: Journal of Population Ageing, ISSN 1874-7884, E-ISSN 1874-7876, Vol. 8, no 4, p. 261-278Article in journal (Refereed)
    Abstract [en]

    This paper examines psycho-social distress among middle-aged and elderly Swedes. We analysed data on 3221 individuals who were 55 to 99 years old. Based on a latent class analysis, we identified four latent classes. Two classes were associated with higher levels of psycho-social problem accumulation. The class with the lowest level of problem accumulation contained the greatest number of individuals, whereas the classes with the highest level of psycho-social distress contained the least number of individuals. The analysis showed that being a man, being married, being a native Swede, or having several hobbies was associated with a low likelihood of belonging to a latent class that was characterised by psycho-social distress. Moreover, being a woman, being between 55 and 65 years of age, or being a widow was associated with a high likelihood of belonging to a latent class that was characterised by the highest levels of problem accumulation.

  • 15.
    Bask, Miia
    Department of Sociology, University of Bergen, Bergen, Norway.
    Patterns of Psycho-Social Distress among Middle-Aged and Elderly Swedes2015Conference paper (Refereed)
  • 16.
    Bauer, Juergen M.
    et al.
    Carl von Ossietzky Univ Oldenburg, Dept Geriatr Med, D-26133 Oldenburg, Germany..
    Verlaan, Sjors
    Nutricia Adv Med Nutr, Nutricia Res, Utrecht, Netherlands.;Vrije Univ Amsterdam, Med Ctr, Dept Internal Med, Sect Gerontol & Geriatr, Amsterdam, Netherlands..
    Bautmans, Ivan
    Vrije Univ Brussel, Frailty Ageing Res Grp FRIA, Brussels, Belgium..
    Brandt, Kirsten
    Newcastle Univ, Inst Ageing, Sch Agr Food & Rural Dev, Human Nutr Res Ctr, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England..
    Donini, Lorenzo M.
    Univ Roma La Sapienza, Sect Med Pathophysiol Endocrinol & Human Nutr, Dept Expt Med, I-00185 Rome, Italy..
    Maggio, Marcello
    Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Movement Disorders & Prevent Disabil, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Food Sci Unit, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Endocrinol Aging Unit, I-43100 Parma, Italy..
    McMurdo, Marion E. T.
    Univ Dundee, Ninewells Hosp & Med Sch, Ninewells Hosp, Ageing & Hlth, Dundee DD1 9SY, Scotland..
    Mets, Tony
    Vrije Univ Brussel, Frailty Ageing Res Grp FRIA, Brussels, Belgium..
    Seal, Chris
    Newcastle Univ, Inst Ageing, Sch Agr Food & Rural Dev, Human Nutr Res Ctr, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England..
    Wijers, Sander L.
    Nutricia Adv Med Nutr, Nutricia Res, Utrecht, Netherlands..
    Ceda, Gian Paolo
    Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Movement Disorders & Prevent Disabil, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Food Sci Unit, I-43100 Parma, Italy.;Univ Parma, Univ Hosp, Dept Clin & Expt Med, Sect Geriatr,Endocrinol Aging Unit, I-43100 Parma, Italy..
    De Vito, Giuseppe
    Univ Coll Dublin, Inst Sport & Hlth, Dublin 2, Ireland..
    Donders, Gilbert
    Femicare, Clin Res Women, Tienen, Belgium..
    Drey, Michael
    Klinikum Univ Munchen LMU, Schwerpunkt Akutgeriatrie, Med Klin & Poliklin 4, Munich, Germany..
    Greig, Carolyn
    Univ Birmingham, Sch Sport Exercise & Rehabil Sci, Birmingham, W Midlands, England.;Univ Birmingham, Ctr Musculoskeletal Ageing Res, Birmingham, W Midlands, England..
    Holmbäck, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Narici, Marco
    Univ Nottingham, Royal Derby Hosp, MRC ARUK Ctr Musculoskeletal Ageing Res, Fac Med, Derby, England..
    McPhee, Jamie
    Manchester Metropolitan Univ, Sch Healthcare Sci, All Saints, Manchester M15 6BH, Lancs, England..
    Poggiogalle, Eleonora
    Univ Roma La Sapienza, Sect Med Pathophysiol Endocrinol & Human Nutr, Dept Expt Med, I-00185 Rome, Italy..
    Power, Dermot
    Mater Misericordiae Univ Hosp, Dept Med Older Persons, Dublin, Ireland.;Univ Coll Dublin, Dublin 2, Ireland..
    Scafoglieri, Aldo
    Vrije Univ Brussel, Frailty Ageing Res Grp FRIA, Brussels, Belgium..
    Schultz, Ralf
    St Marien Hosp, Clin Geriatr, Cologne, Germany..
    Sieber, Cornel C.
    Univ Erlangen Nurnberg, Inst Biomed Ageing, Nurnberg, Germany..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Effects of a Vitamin D and Leucine-Enriched Whey Protein Nutritional Supplement on Measures of Sarcopenia in Older Adults, the PROVIDE Study: A Randomized, Double-Blind, Placebo-Controlled Trial2015In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 16, no 9, p. 740-747Article in journal (Refereed)
    Abstract [en]

    Background: Age-related losses of muscle mass, strength, and function (sarcopenia) pose significant threats to physical performance, independence, and quality of life. Nutritional supplementation could positively influence aspects of sarcopenia and thereby prevent mobility disability. Objective: To test the hypothesis that a specific oral nutritional supplement can result in improvements in measures of sarcopenia. Design: A multicenter, randomized, controlled, double-blind, 2 parallel-group trial among 380 sarcopenic primarily independent-living older adults with Short Physical Performance Battery (SPPB; 0-12) scores between 4 and 9, and a low skeletal muscle mass index. The active group (n = 184) received a vitamin D and leucine-enriched whey protein nutritional supplement to consume twice daily for 13 weeks. The control group (n = 196) received an iso-caloric control product to consume twice daily for 13 weeks. Primary outcomes of handgrip strength and SPPB score, and secondary outcomes of chair-stand test, gait speed, balance score, and appendicular muscle mass (by DXA) were measured at baseline, week 7, and week 13 of the intervention. Results: Handgrip strength and SPPB improved in both groups without significant between-group differences. The active group improved more in the chair-stand test compared with the control group, between-group effect (95% confidence interval): -1.01 seconds (-1.77 to -0.19), P = .018. The active group gained more appendicular muscle mass than the control group, between-group effect: 0.17 kg (0.004-0.338), P = .045. Conclusions: This 13-week intervention of a vitamin D and leucine-enriched whey protein oral nutritional supplement resulted in improvements in muscle mass and lower-extremity function among sarcopenic older adults. This study shows proof-of-principle that specific nutritional supplementation alone might benefit geriatric patients, especially relevant for those who are unable to exercise. These results warrant further investigations into the role of a specific nutritional supplement as part of a multimodal approach to prevent adverse outcomes among older adults at risk for disability.

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  • 17.
    Benedict, Christian
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Jacobsson, Josefin A
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Rönnemaa, Elina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Sällman Almén, Markus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Brooks, Samantha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Schultes, Bernd
    Interdisciplinary Obesity Center, Kantonsspital St. Gallen.
    Fredriksson, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Lannfelt, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Kilander, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Schiöth, Helgi B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    The fat mass and obesity gene is linked to reduced verbal fluency in overweight and obese elderly men2011In: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 32, no 6, p. 1159.e1-1159.e5Article in journal (Refereed)
    Abstract [en]

    Humans carrying the prevalent rs9939609 A allele of the fat mass and obesity-associated (FTO) gene are more susceptible to developing obesity than noncarries. Recently, polymorphisms in the FTO gene of elderly subjects have also been linked to a reduced volume in the frontal lobe as well as increased risk for incident Alzheimer disease. However, so far there is no evidence directly linking the FTO gene to functional cognitive processes. Here we examined whether the FTO rs9939609 A allele is associated with verbal fluency performance in 355 elderly men at the age of 82 years who have no clinically apparent cognitive impairment. Retrieval of verbal memory is a good surrogate measure reflecting frontal lobe functioning. Here we found that obese and overweight but not normal weight FTO A allele carriers showed a lower performance on verbal fluency than non-carriers (homozygous for rs9939609 T allele). This effect was not observed for a measure of general cognitive performance (i.e., Mini-Mental State Examination score), thereby indicating that the FTO gene primarily affects frontal lobe-dependent cognitive processes in elderly men.

  • 18.
    Benetou, V.
    et al.
    Univ Athens, WHO Collaborating Ctr Nutr & Hlth, Unit Nutr Epidemiol & Nutr Publ Hlth, Dept Hyg Epidemiol & Med Stat,Sch Med, 75 Mikras Asias St, Athens 11527, Greece.
    Orfanos, P.
    Hellen Hlth Fdn, Athens, Greece;Univ Athens, WHO Collaborating Ctr Nutr & Hlth, Unit Nutr Epidemiol & Nutr Publ Hlth, Dept Hyg Epidemiol & Med Stat,Sch Med, 75 Mikras Asias St, Athens 11527, Greece.
    Feskanich, D.
    Harvard Med Sch, Boston, MA USA;Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Pettersson-Kymmer, U.
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden;Umea Univ, Dept Publ Hlth & Clin Med, Umea, Sweden.
    Byberg, Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Eriksson, S.
    Umea Univ, Dept Community Med, Umea, Sweden.
    Grodstein, F.
    Harvard Med Sch, Boston, MA USA;Brigham & Womens Hosp, Dept Med, Channing Div Network Med, 75 Francis St, Boston, MA 02115 USA.
    Wolk, Alicja
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Karolinska Inst, Inst Environm Med, Div Nutr Epidemiol, Stockholm, Sweden.
    Jankovic, N.
    Wageningen Univ, Div Human Nutr, Wageningen, Netherlands;Univ Duisburg Essen, Inst Med Informat Biometry & Epidemiol, Ctr Clin Epidemiol, Fac Med, Essen, Germany.
    de Groot, L. C. P. G. M.
    Wageningen Univ, Div Human Nutr, Wageningen, Netherlands.
    Boffetta, P.
    Icahn Sch Med Mt Sinai, Inst Translat Epidemiol, New York, NY 10029 USA;Icahn Sch Med Mt Sinai, Tisch Canc Inst, New York, NY 10029 USA.
    Trichopoulou, A.
    Hellen Hlth Fdn, Athens, Greece.
    Mediterranean diet and hip fracture incidence among older adults: the CHANCES project2018In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, no 7, p. 1591-1599Article in journal (Refereed)
    Abstract [en]

    The association between adherence to Mediterranean diet (MD) and hip fracture incidence is not yet established. In a diverse population of elderly, increased adherence to MD was associated with lower hip fracture incidence. Except preventing major chronic diseases, adhering to MD might have additional benefits in lowering hip fracture risk. Hip fractures constitute a major public health problem among older adults. Latest evidence links adherence to Mediterranean diet (MD) with reduced hip fracture risk, but still more research is needed to elucidate this relationship. The potential association of adherence to MD with hip fracture incidence was explored among older adults. A total of 140,775 adults (116,176 women, 24,599 men) 60 years and older, from five cohorts from Europe and the USA, were followed-up for 1,896,219 person-years experiencing 5454 hip fractures. Diet was assessed at baseline by validated, cohort-specific, food-frequency questionnaires, and hip fractures were ascertained through patient registers or telephone interviews/questionnaires. Adherence to MD was evaluated by a scoring system on a 10-point scale modified to be applied also to non-Mediterranean populations. In order to evaluate the association between MD and hip fracture incidence, cohort-specific hazard ratios (HR), adjusted for potential confounders, were estimated using Cox proportional-hazards regression and pooled estimates were subsequently derived implementing random-effects meta-analysis. A two-point increase in the score was associated with a significant 4% decrease in hip fracture risk (pooled adjusted HR 0.96; 95% confidence interval (95% CI) 0.92-0.99, p(heterogeneity) = 0.446). In categorical analyses, hip fracture risk was lower among men and women with moderate (HR 0.93; 95% CI 0.87-0.99) and high (HR 0.94; 95% CI 0.87-1.01) adherence to the score compared with those with low adherence. In this large sample of older adults from Europe and the USA, increased adherence to MD was associated with lower hip fracture incidence.

  • 19.
    Berglund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Measurement Variability Related to Insulin Secretion and Sensitivity: Assessment and Implications in Epidemiological Studies2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    There is a growing interest in random measurement variability of biological variables. In regression models, such variability of the predictors yields biased estimators of coefficients (regression dilution bias). The objectives of this thesis were to develop an efficient method to correct for such bias, to reveal the relative importance of insulin sensitivity and insulin secretion, corrected for regression dilution bias, on glucose tolerance, and to explore the seasonal nature of the variability of insulin sensitivity.

    A reliability study is often designed to randomly select subjects from the main study. Our idea was to collect replicates for subjects with extreme values on their first measurement. The extreme selection design, in combination with maximum likelihood estimation, resulted in an efficient estimator of a corrected regression coefficient in a simple linear regression model. Results were presented theoretically and with an application: The relation between insulin sensitivity and fasting insulin in Uppsala Longitudinal Study of Adult Men (ULSAM) where the extreme selection design decreased the standard error of the estimated regression coefficient with 28 per cent compared with the random sampling design.

    We estimated the partial longitudinal effects of the predictors insulin sensitivity and insulin secretion, corrected for regression dilution bias, on glucose tolerance in ULSAM. The effects of the predictors, when corrected, were similar.

    Insulin sensitivity in ULSAM increased during summer and decreased during winter and insulin secretion exposed opposite variation keeping glucose homeostasis nearly constant. Insulin sensitivity was related to outdoor temperature.

    In summary, we developed a cost-efficient reliability design for correction for regression dilution bias. Insulin sensitivity and insulin secretion had similar longitudinal effects on glucose tolerance, which implies that interventions aimed at these targets are equally important. Further, we revealed the seasonal nature of variations of insulin sensitivity and insulin secretion. This result has implications on glycaemic control in diabetic patients.

    List of papers
    1. Correction for regression dilution bias using replicates from subjects with extreme first measurements
    Open this publication in new window or tab >>Correction for regression dilution bias using replicates from subjects with extreme first measurements
    2007 (English)In: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 26, no 10, p. 2246-2257Article in journal (Refereed) Published
    Abstract [en]

    The least squares estimator of the slope in a simple linear regression model will be biased towards zero when the predictor is measured with random error, i.e. intra-individual variation or technical measurement error. A correction factor can be estimated from a reliability study where one replicate is available on a subset of subjects from the main study. Previous work in this field has assumed that the reliability study constitutes a random subsample from the main study.We propose that a more efficient design is to collect replicates for subjects with extreme values on their first measurement. A variance formula for this estimator of the correction factor is presented. The variance for the corrected estimated regression coefficient for the extreme selection technique is also derived and compared with random subsampling. Results show that variances for corrected regression coefficients can be markedly reduced with extreme selection. The variance gain can be estimated from the main study data. The results are illustrated using Monte Carlo simulations and an application on the relation between insulin sensitivity and fasting insulin using data from the population-based ULSAM study.In conclusion, an investigator faced with the planning of a reliability study may wish to consider an extreme selection design in order to improve precision at a given number of subjects or alternatively decrease the number of subjects at a given precision.

    Keywords
    regression dilution bias, reliability study, extreme selection, corrected regression coefficient, insulin sensitivity
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-10991 (URN)10.1002/sim.2698 (DOI)000245965200008 ()16969892 (PubMedID)
    Available from: 2007-05-08 Created: 2007-05-08 Last updated: 2017-12-11Bibliographically approved
    2. Maximum likelihood estimation of correction for dilution bias in simple linear regression using replicates from subjects with extreme first measurements
    Open this publication in new window or tab >>Maximum likelihood estimation of correction for dilution bias in simple linear regression using replicates from subjects with extreme first measurements
    Show others...
    2008 (English)In: Statistics in Medicine, ISSN 0277-6715, E-ISSN 1097-0258, Vol. 27, no 22, p. 4397-4407Article in journal (Refereed) Published
    Abstract [en]

    The least-squares estimator of the slope in a simple linear regression model is biased towards zero when the predictor is measured with random error. A corrected slope may be estimated by adding data from a reliability study, which comprises a subset of subjects from the main study. The precision of this corrected slope depends on the design of the reliability study and estimator choice.Previous work has assumed that the reliability study constitutes a random sample from the main study. A more efficient design is to use subjects with extreme values on their first measurement. Previously, we published a variance formula for the corrected slope, when the correction factor is the slope in the regression of the second measurement on the first. In this paper we show that both designs improve by maximum likelihood estimation (MLE). The precision gain is explained by the inclusion of data from all subjects for estimation of the predictor's variance and by the use of the second measurement for estimation of the covariance between response and predictor. The gain of MLE enhances with stronger true relationship between response and predictor and with lower precision in the predictor measurements. We present a real data example on the relationship between fasting insulin, a surrogate market, and true insulin sensitivity measured by a gold-standard euglycaemic insulin clamp, and simulations, where the behavior of profile-likelihood-based confidence intervals is examined. MLE was shown to be a robust estimator for non-normal distributions and efficient for small sample situations.

    Keywords
    regression dilution bias, maximum likelihood estimation, reliability study, extreme selection, corrected regression coefficient
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-17699 (URN)10.1002/sim.3312 (DOI)000259550200002 ()18618419 (PubMedID)
    Available from: 2008-08-15 Created: 2008-08-15 Last updated: 2017-12-08Bibliographically approved
    3. Early Insulin Response and Insulin Sensitivity are Equally Important as Predictors of Glucose Tolerance after Correction for Measurement Errors
    Open this publication in new window or tab >>Early Insulin Response and Insulin Sensitivity are Equally Important as Predictors of Glucose Tolerance after Correction for Measurement Errors
    Show others...
    2009 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 86, no 3, p. 219-224Article in journal (Refereed) Published
    Abstract [en]

    Aims: We estimated measurement error (ME) corrected effects of   insulin sensitivity (M/I), from euglycaemic insulin clamp, and insulin   secretion, measured as early insulin response (EIR) from oral glucose   tolerance test (OGTT), on fasting plasma glucose, HbA1c and type 2   diabetes longitudinally and cross-sectional.   Methods: : In a population-based study (n = 1128 men) 17 men made   replicate measurements to estimate ME at age 71 years. Effect of 1 SD   decrease of predictors M/I and EIR on longitudinal response variables   fasting plasma glucose (FPG) and HbA1c at follow-ups up to 11 years,   were estimated using uncorrected and ME-corrected (with the regression   calibration method) regression models.   Results: : Uncorrected effect on FPG at age 77 years was larger for M/I   than for EIR (effect difference 0.10 mmol/l, 95% CI 0.00;0.21), while   ME-corrected effects were similar (0.02 mmol/l, 95% CI -0.13;0.15   mmol/l). EIR had greater ME-corrected impact than M/I on HbA1c at age   82 years (-0.11%, -0.28; -0.01%).   Conclusions: : Due to higher ME effect of EIR on glycaemia is   underestimated as compared with M/I. By correcting for ME valid   estimates of relative contributions of insulin secretion and insulin   sensitivity on glycaemia are obtained.

    National Category
    Medical and Health Sciences
    Research subject
    Geriatrics
    Identifiers
    urn:nbn:se:uu:diva-99497 (URN)10.1016/j.diabres.2009.09.016 (DOI)000272521800010 ()19811847 (PubMedID)
    Available from: 2009-03-18 Created: 2009-03-15 Last updated: 2022-01-28Bibliographically approved
    4. Seasonal variations of insulin sensitivity from a euglycemic insulin clamp in elderly men
    Open this publication in new window or tab >>Seasonal variations of insulin sensitivity from a euglycemic insulin clamp in elderly men
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    2012 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 1, p. 35-40Article in journal (Refereed) Published
    Abstract [en]

    Introduction

    Seasonal variations in hemoglobin-A1c have been reported in diabetic patients, but the underlying mechanisms have not been elucidated.

    Aims

    To study if insulin sensitivity, insulin secretion, and fasting plasma glucose showed seasonal variations in a Swedish population-based cohort of elderly men.

    Methods

    Altogether 1117 men were investigated with a euglycemic insulin clamp and measurements of fasting plasma glucose and insulin secretion after an oral glucose tolerance test. Values were analyzed in linear regression models with an indicator variable for winter/summer season and outdoor temperature as predictors.

    Results

     During winter, insulin sensitivity (M/I, unit = 100 × mg × min-1 × kg-1/(mU × L-1)) was 11.0% lower (4.84 versus 5.44, P = 0.0003), incremental area under the insulin curve was 16.4% higher (1167 versus 1003 mU/L, P = 0.007). Fasting plasma glucose was, however, not statistically significantly different (5.80 versus 5.71 mmol/L, P = 0.28) compared to the summer season. There was an association between outdoor temperature and M/I (0.57 units increase (95% CI 0.29–0.82, P < 0.0001) per 10°C increase of outdoor temperature) independent of winter/summer season. Adjustment for life-style factors, type 2 diabetes, and medication did not alter these results.Read More:http://informahealthcare.com/doi/abs/10.3109/03009734.2011.628422

    Conclusions

    Insulin sensitivity showed seasonal variations with lower values during the winter and higher during the summer season. Inverse compensatory variations of insulin secretion resulted in only minor variations of fasting plasma glucose. Insulin sensitivity was associated with outdoor temperature. These phenomena should be further investigated in diabetic patients.

    Keywords
    Seasonal variations, insulin sensitivity, clamp, insulin secretion, temperature
    National Category
    Endocrinology and Diabetes Geriatrics
    Identifiers
    urn:nbn:se:uu:diva-165044 (URN)10.3109/03009734.2011.628422 (DOI)000300304000006 ()22066936 (PubMedID)
    Available from: 2012-01-02 Created: 2012-01-02 Last updated: 2017-12-08Bibliographically approved
    Download full text (pdf)
    FULLTEXT01
  • 20.
    Berglund, Lars
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Berne, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Svärdsudd, Kurt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology.
    Garmo, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Zethelius, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Seasonal variations of insulin sensitivity from a euglycemic insulin clamp in elderly men2012In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 117, no 1, p. 35-40Article in journal (Refereed)
    Abstract [en]

    Introduction

    Seasonal variations in hemoglobin-A1c have been reported in diabetic patients, but the underlying mechanisms have not been elucidated.

    Aims

    To study if insulin sensitivity, insulin secretion, and fasting plasma glucose showed seasonal variations in a Swedish population-based cohort of elderly men.

    Methods

    Altogether 1117 men were investigated with a euglycemic insulin clamp and measurements of fasting plasma glucose and insulin secretion after an oral glucose tolerance test. Values were analyzed in linear regression models with an indicator variable for winter/summer season and outdoor temperature as predictors.

    Results

     During winter, insulin sensitivity (M/I, unit = 100 × mg × min-1 × kg-1/(mU × L-1)) was 11.0% lower (4.84 versus 5.44, P = 0.0003), incremental area under the insulin curve was 16.4% higher (1167 versus 1003 mU/L, P = 0.007). Fasting plasma glucose was, however, not statistically significantly different (5.80 versus 5.71 mmol/L, P = 0.28) compared to the summer season. There was an association between outdoor temperature and M/I (0.57 units increase (95% CI 0.29–0.82, P < 0.0001) per 10°C increase of outdoor temperature) independent of winter/summer season. Adjustment for life-style factors, type 2 diabetes, and medication did not alter these results.Read More:http://informahealthcare.com/doi/abs/10.3109/03009734.2011.628422

    Conclusions

    Insulin sensitivity showed seasonal variations with lower values during the winter and higher during the summer season. Inverse compensatory variations of insulin secretion resulted in only minor variations of fasting plasma glucose. Insulin sensitivity was associated with outdoor temperature. These phenomena should be further investigated in diabetic patients.

  • 21.
    Björk, Anne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism.
    Ribom, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Scragg, R.
    Univ Auckland, Sch Populat Hlth, Sect Epidemiol & Biostat, Auckland, New Zealand.
    Mellstrom, D.
    Univ Gothenburg, Inst Med, Dept Internal Med & Clin, Geriatr Med,Nutr, Gothenburg, Sweden.
    Grundberg, E.
    McGill Univ, Dept Human Genet, Montreal, PQ, Canada;McGill Univ, Genome Quebec Innovat Ctr, Montreal, PQ, Canada.
    Ohlsson, C.
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Ctr Bone & Arthrit Res, Gothenburg, Sweden.
    Karlsson, M.
    Lund Univ, Skane Univ Hosp, Dept Clin Sci & Orthoped Surg, Malmo, Sweden.
    Ljunggren, Östen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism.
    Kindmark, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism.
    Variations in the vitamin D receptor gene are not associated with measures of muscle strength, physical performance, or falls in elderly men: Data from MrOS Sweden2019In: Journal of Steroid Biochemistry and Molecular Biology, ISSN 0960-0760, E-ISSN 1879-1220, Vol. 187, p. 160-165Article in journal (Refereed)
    Abstract [en]

    The vitamin D receptor (VDR) has been proposed as a candidate gene for several musculoskeletal phenotypes. However, previous results on the associations between genetic variants of the VDR with muscle strength and falls have been contradictory. The MrOS Sweden survey, a prospective population-based cohort study of 3014 elderly men (mean age 75 years, range 69-81) offered the opportunity to further investigate these associations. At baseline, data were collected on muscle strength and also the prevalence of falls during the previous 12 months. Genetic association analysis was performed for 7 Single Nucleotide Polymorphisms (SNPs), covering the genetic region surrounding the VDR gene in 2924 men with available samples of DNA. Genetic variations in the VDR were not associated with five different measurements of muscle strength or physical performance (hand grip strength right and left, 6 m walking test (easy and narrow) and timed-stands test). However, one of the 7 SNPs of the gene for the VDR receptor, rs7136534, was associated with prevalence of falls (33.6% of the AA, 14.6% of the AG and 16.5% of the GG allele). In conclusion, VDR genetic variants are not related to muscle strength or physical performance in elderly Swedish men. The role of the rs7136534 SNP for the occurrence of falls is not clear.

  • 22.
    Blom, Elin
    Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Genetic Studies of Alzheimer's Disease2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Patients with Alzheimer's disease (AD) often have a family history of the disease, implicating genetics as a major risk factor. Three genes are currently known to cause familial early-onset AD (<65 years): the amyloid precursor protein (APP) and the presenilins (PSEN1 and PSEN2). For the much more common late-onset disease (>65 years), only the APOE gene has repeatedly been associated to AD, where the ε4 allele increases disease risk and decreases age at onset. As APOE ε4 only explains part of the total estimated disease risk, more genes are expected to contribute to AD.

    This thesis has focused on the study of genetic risk factors involved in AD. In the first study, we conducted a linkage analysis of six chromosomes previously implicated in AD in a collection of affected relative pairs from Sweden, the UK and the USA. An earlier described linkage peak on chromosome 10q21 could not be replicated in the current sample, while significant linkage was demonstrated to chromosome 19q13 where the APOE gene is located. The linkage to 19q13 was further analyzed in the second study, demonstrating no significant evidence of genes other than APOE contributing to this peak.

    In the third study, the prevalence of APP duplications, a recently reported cause of early-onset AD, was investigated. No APP duplications were identified in 141 Swedish and Finnish early-onset AD patients, implying that this is not a common disease mechanism in the Scandinavian population.

    In the fourth study, genes with altered mRNA levels in the brain of a transgenic AD mouse model (tgAPP-ArcSwe) were identified using microarray analysis. Differentially expressed genes were further analyzed in AD brain. Two genes from the Wnt signaling pathway, TCF7L2 and MYC, had significantly increased mRNA levels in both transgenic mice and in AD brains, implicating cell differentiation and possibly neurogenesis in AD.

    List of papers
    1. Further analysis of previously implicated linkage regions for Alzheimer’s disease in affected relative pairs
    Open this publication in new window or tab >>Further analysis of previously implicated linkage regions for Alzheimer’s disease in affected relative pairs
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    2009 (English)In: BMC Medical Genetics, E-ISSN 1471-2350, Vol. 10, p. 122-Article in journal (Refereed) Published
    Abstract [en]

    Background: Genome-wide linkage studies for Alzheimer's disease have implicated several chromosomal regions as potential loci for susceptibility genes. Methods: In the present study, we have combined a selection of affected relative pairs (ARPs) from the UK and the USA included in a previous linkage study by Myers et al. (Am J Med Genet, 2002), with ARPs from Sweden and Washington University. In this total sample collection of 397 ARPs, we have analyzed linkage to chromosomes 1, 9, 10, 12, 19 and 21, implicated in the previous scan. Results: The analysis revealed that linkage to chromosome 19q13 close to the APOE locus increased considerably as compared to the earlier scan. However, linkage to chromosome 10q21, which provided the strongest linkage in the previous scan could not be detected. Conclusion: The present investigation provides yet further evidence that 19q13 is the only chromosomal region consistently linked to Alzheimer's disease.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97803 (URN)10.1186/1471-2350-10-122 (DOI)000272822700001 ()19951422 (PubMedID)
    Available from: 2008-11-21 Created: 2008-11-21 Last updated: 2024-01-17Bibliographically approved
    2. Does APOE explain the linkage of Alzheimer’s disease to chromosome 19q13?
    Open this publication in new window or tab >>Does APOE explain the linkage of Alzheimer’s disease to chromosome 19q13?
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    2008 (English)In: American Journal of Medical Genetics Part B: Neuropsychiatric Genetics American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, ISSN 1552-485X, Vol. 147B, no 6, p. 778-83Article in journal (Refereed) Published
    Abstract [en]

    We have studied the impact of the apolipoprotein E gene (APOE) on the chromosome 19 linkage peak from an analysis of sib-pairs affected by Alzheimer's disease. We genotyped 417 affected sib-pairs (ASPs) collected in Sweden and Norway (SWE), the UK and the USA for 10 microsatellite markers on chromosome 19. The highest Zlr (3.28, chromosome-wide P-value 0.036) from the multi-point linkage analysis was located approximately 1 Mb from APOE, at marker D19S178. The linkage to chromosome 19 was well explained by APOE in the whole sample as well as in the UK and USA subsamples, as identity by descent (IBD) increased with the number of epsilon 4 alleles in ASPs. There was a suggestion from the SWE subsample that linkage was higher than would be expected from APOE alone, although the test for this did not reach formal statistical significance. There was also a significant age at onset (aao) effect on linkage to chromosome 19q13 in the whole sample, which manifested itself as increased IBD sharing in relative pairs with lower mean aao. This effect was partially, although not completely, explained by APOE. The aao effect varied considerably between the different subsamples, with most of the effect coming from the UK sample. The other samples showed smaller effects in the same direction, but these were not significant.

    Keywords
    Alzheimer's disease, APOE, linkage, age at onset, apolipoprotein E
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97804 (URN)10.1002/ajmg.b.30681 (DOI)000259050100016 ()18161859 (PubMedID)
    Available from: 2008-11-21 Created: 2008-11-21 Last updated: 2022-01-28Bibliographically approved
    3. Low prevalence of APP duplications in Swedish and Finnish patients with early onset Alzheimer's disease
    Open this publication in new window or tab >>Low prevalence of APP duplications in Swedish and Finnish patients with early onset Alzheimer's disease
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    2008 (English)In: European Journal of Human Genetics, ISSN 1018-4813, E-ISSN 1476-5438, Vol. 16, no 2, p. 171-5Article in journal (Refereed) Published
    Abstract [en]

    Familial early-onset Alzheimer's disease with cerebral amyloid angiopathy (EOAD/CAA) was recently associated with duplications of the gene for the amyloid-beta precursor protein (APP). In this study, we have screened for duplications of APP in patients with EOAD from Sweden and Finland. Seventy-five individuals from families with EOAD and 66 individuals with EOAD without known familial inheritance were screened by quantitative PCR. On the basis of the initial results, a portion of the samples was also investigated with quantitative multiplex PCR. No duplications of APP were identified, whereby we conclude that this is not a common cause of EOAD in the Swedish and Finnish populations, at least not in our collection of families and cases.

    Keywords
    early-onset Alzheimer's disease, amyloid beta precursor protein, gene dose, APP, duplication
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-97805 (URN)10.1038/sj.ejhg.5201966 (DOI)000252426500007 ()18043715 (PubMedID)
    Available from: 2008-11-21 Created: 2008-11-21 Last updated: 2022-01-28Bibliographically approved
    4. Increased mRNA levels of TCF7L2 and MYC of the Wnt pathway in tgAPP-ArcSwe mice and Alzheimer's disease brain
    Open this publication in new window or tab >>Increased mRNA levels of TCF7L2 and MYC of the Wnt pathway in tgAPP-ArcSwe mice and Alzheimer's disease brain
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    Manuscript (Other academic)
    Identifiers
    urn:nbn:se:uu:diva-97806 (URN)
    Available from: 2008-11-21 Created: 2008-11-21 Last updated: 2010-01-13Bibliographically approved
    Download full text (pdf)
    FULLTEXT01
  • 23.
    Blom, Kim
    et al.
    Publ Hlth Agcy Sweden, Östersund, Sweden..
    Fjällström, Peter
    Umeå Univ, Dept Clin Microbiol, Umeå, Sweden..
    Molnár, Christian
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Familjelakarna AB, Stockholm, Sweden..
    Åberg, Mikael
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Chemistry.
    Vikström, Linnea
    Umeå Univ, Dept Clin Microbiol, Umeå, Sweden..
    Wigren-Byström, Julia
    Umeå Univ, Dept Clin Microbiol, Umeå, Sweden..
    Bennet, Louise
    Skane Univ Hosp, Forum South, Clin Studies Sweden, Lund, Sweden..
    Widerström, Micael
    Umeå Univ, Dept Clin Microbiol, Umeå, Sweden..
    Rasmussen, Gunlög
    Örebro Univ, Sch Med Sci, Örebro, Sweden.;Lund Univ, Dept Clin Sci, Lund, Sweden..
    Klingström, Jonas
    Linköping Univ, Dept Biomed & Clin Sci, Linköping, Sweden..
    Forsell, Mattias N. E.
    Umeå Univ, Dept Clin Microbiol, Umeå, Sweden..
    Johansson, Anders F.
    Umeå Univ, Dept Clin Microbiol, Umeå, Sweden..
    SARS-CoV-2-related mortality decrease in nursing home residents given multiple COVID-19 boosters2023In: The Lancet - Infectious diseases, ISSN 1473-3099, E-ISSN 1474-4457, Vol. 23, no 10, p. E393-E394Article in journal (Other academic)
  • 24.
    Blomqvist, Sven
    et al.
    Univ Gävle, Fac Hlth & Occupat Studies, Gävle, Sweden..
    Seipel, Stefan
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Automatic control. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala Univ, Dept Informat Technol, Uppsala, Sweden.;Univ Gävle, Fac Engn & Sustainable Dev, Gävle, Sweden..
    Engstrom, Maria
    Univ Gävle, Fac Hlth & Occupat Studies, Gävle, Sweden..
    Using augmented reality technology for balance training in the older adults: a feasibility pilot study2021In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 21, no 1, article id 144Article in journal (Refereed)
    Abstract [en]

    BackgroundImpaired balance leading to falls is common in the older adults, and there is strong evidence that balance training reduces falls and increases independence. Reduced resources in health care will result in fewer people getting help with rehabilitation training. In this regard, the new technology augmented reality (AR) could be helpful. With AR, the older adults can receive help with instructions and get feedback on their progression in balance training. The purpose of this pilot study was to examine the feasibility of using AR-based visual-interactive tools in balance training of the older adults.MethodsSeven older adults (66-88years old) with impaired balance trained under supervision of a physiotherapist twice a week for six weeks using AR-based visual-interactive guidance, which was facilitated through a Microsoft HoloLens holographic display. Afterwards, participants and physiotherapists were interviewed about the new technology and their experience of the training. Also, fear of falling and balance ability were measured before and after training.ResultsFive participants experienced the new technology as positive in terms of increased motivation and feedback. Experiences were mixed regarding the physical and technical aspects of the HoloLens and the design of the HoloLens application. Participants also described issues that needed to be further improved, for example, the training program was difficult and monotonous. Further, the HoloLens hardware was felt to be heavy, the application's menu was difficult to control with different hand manoeuvres, and the calibration took a long time. Suggestions for improvements were described. Results of the balance tests and self-assessment instruments indicated no improvements in balance performance after AR training.ConclusionsThe study showed that training with the new technology is, to some extent, feasible for the older adults, but needs further development. Also, the technology seemed to stimulate increased motivation, which is a prerequisite for adherence to training. However, the new technology and training requires further development and testing in a larger context.

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  • 25. Bogo, Renata
    et al.
    Farah, Ahmed
    Johnson, Ann-Christin
    Karlsson, Kjell K.
    Pedersen, Nancy L.
    Svartengren, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Skjonsberg, Asa
    The Role of Genetic Factors for Hearing Deterioration Across 20 Years: A Twin Study2015In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 70, no 5, p. 647-653Article in journal (Refereed)
    Abstract [en]

    Background. Hearing deterioration at advanced ages is associated with environmental exposures (eg, to noise and solvents) and genetic influences may also be important. Little is known about the role of genetic influences on hearing when evaluated longitudinally. We sought to investigate longitudinal hearing loss in a cohort of adult male twins to evaluate the importance of genetic and environmental factors for hearing deterioration over time. Methods. Hearing using conventional clinical audiometry was assessed in 583 male twins (128 monozygotic twin pairs and 111 dizygotic twin pairs) aged 34-79 at baseline and again two decades later. The hearing thresholds at two time points were compared at each frequency and in two different frequency regions. Genetic analyses were based on structural equation models. Bivariate Cholesky decomposition was used for longitudinal analysis. Results. The prevalence of hearing loss increased over time in better and worse ear. The hearing threshold shift was more pronounced in the high-frequency region, especially at 8000 Hz. Genetic influences were moderate (heritability: 53%-65%) for pure-tone averages at both lower and higher frequencies, and were of equal magnitude at baseline and follow-up. In contrast, environmental influences were of substantial importance (55%-88%) for rate of change of the hearing threshold over the 18-year period. Conclusions. Genetic factors are of considerable importance for level of hearing acuity, but environmental factors are more important for rate of change over an 18-year period.

  • 26.
    Borda, Miguel German
    et al.
    Stavanger Univ Hosp, Ctr Age Related Med SESAM, N-4011 Stavanger, Norway.;Pontificia Univ Javeriana, Ageing Inst, Med Sch, Semillero Neurociencias & Envejecimiento, Bogota 110231, Colombia.;Karolinska Inst, Div Clin Geriatr, Ctr Alzheimer Res, Dept Neurobiol Care Sci & Soc, S-14186 Stockholm, Sweden..
    Samuelsson, Jessica
    Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, S-41345 Gothenburg, Sweden..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Inflammat & Aging, S-14186 Stockholm, Sweden..
    Baldera, Jonathan Patricio
    Stavanger Univ Hosp, Ctr Age Related Med SESAM, N-4011 Stavanger, Norway.;Univ Autonoma Santo Domingo, Escuela Estadist, Santo Domingo 10103, Dominican Rep..
    Perez-Zepeda, Mario Ulises
    Inst Nacl Geriatria, Direcc Invest, Mexico City 10200, Mexico.;Univ Anahuac Mexico Campus Norte, Fac Ciencias Salud, Ctr Invest Ciencias Salud CICSA, Huixquilucan 52786, Mexico..
    Barreto, George E.
    Univ Limerick, Dept Biol Sci, Limerick V94PH61, Ireland..
    Zettergren, Anna
    Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, S-41345 Gothenburg, Sweden..
    Kern, Silke
    Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, S-41345 Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Psychiat Cognit & Old Age Psychiat, SE-43141 Mölndal, Sweden..
    Ryden, Lina
    Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, S-41345 Gothenburg, Sweden.;Uppsala Univ, Dept Publ Hlth & Caring Sci Clin Nutr & Metab, S-62167 Uppsala, Sweden.;Karolinska Univ Hosp, Theme Inflammat & Aging, S-14186 Stockholm, Sweden..
    Gonzalez-Lara, Mariana
    Dalhousie Univ, Fac Hlth, Halifax, NS B3H 4R2, Canada..
    Salazar-Londono, Salomon
    Pontificia Univ Javeriana, Ageing Inst, Med Sch, Semillero Neurociencias & Envejecimiento, Bogota 110231, Colombia..
    Duque, Gustavo
    McGill Univ, Dr Joseph Kaufmann Chair Geriatr Med, Dept Med, Montreal, PQ H3A 2B4, Canada.;McGill Univ, Bone Muscle & Gerosci Grp, Res Inst, Hlth Ctr, Montreal, PQ H4A 3J1, Canada..
    Skoog, Ingmar
    Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, S-41345 Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Psychiat Cognit & Old Age Psychiat, SE-43141 Mölndal, Sweden..
    Aarsland, Dag
    Stavanger Univ Hosp, Ctr Age Related Med SESAM, N-4011 Stavanger, Norway.;Kings Coll London, Dept Old Age Psychiat, Inst Psychiat Psychol & Neurosci, London SE1 9RT, England..
    Nutrient Intake and Its Association with Appendicular Total Lean Mass and Muscle Function and Strength in Older Adults: A Population-Based Study2024In: Nutrients, E-ISSN 2072-6643, Vol. 16, no 4, article id 568Article in journal (Refereed)
    Abstract [en]

    Treatment options for sarcopenia are currently limited, and primarily rely on two main therapeutic approaches: resistance-based physical activity and dietary interventions. However, details about specific nutrients in the diet or supplementation are unclear. We aim to investigate the relationship between nutrient intake and lean mass, function, and strength. Data were derived from the Gothenburg H70 birth cohort study in Sweden, including 719,70-year-olds born in 1944 (54.1% females). For independent variables, the diet history method (face-to-face interviews) was used to estimate habitual food intake during the preceding three months. Dependent variables were gait speed (muscle performance), hand grip strength (muscle strength), and the appendicular lean soft tissue index (ALSTI). Linear regression analyses were performed to analyze the relationship between the dependent variables and each of the covariates. Several nutrients were positively associated with ALSTI, such as polyunsaturated fatty acids (DHA, EPA), selenium, zinc, riboflavin, niacin equivalent, vitamin B12, vitamin D, iron, and protein. After correction for multiple comparisons, there were no remaining correlations with handgrip and gait speed. Findings of positive correlations for some nutrients with lean mass suggest a role for these nutrients in maintaining muscle volume. These results can be used to inform clinical trials to expand the preventive strategies and treatment options for individuals at risk of muscle loss and sarcopenia.

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  • 27.
    Britting, Sabine
    et al.
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging IBA, Dept Internal Med Geriatr, Erlangen, Germany..
    Artzi-Medvedik, Rada
    Ben Gurion Univ Negev, Recanati Sch Community Hlth Profess, Dept Nursing, Fac Hlth Sci, Beer Sheva, Israel..
    Fabbietti, Paolo
    Italian Natl Res Ctr Aging IRCCS INRCA, Ancona, Italy.;IRCCS INRCA, Lab Geriatr Pharmacoepidemiol & Biostat, Via S Margherita 5, I-60124 Ancona, Italy..
    Tap, Lisanne
    Erasmus MC, Dept Internal Med, Geriatr Med Sect, Rotterdam, Netherlands..
    Mattace-Raso, Francesco
    Erasmus MC, Dept Internal Med, Geriatr Med Sect, Rotterdam, Netherlands..
    Corsonello, Andrea
    Italian Natl Res Ctr Aging IRCCS INRCA, Ancona, Italy..
    Lattanzio, Fabrizia
    Italian Natl Res Ctr Aging IRCCS INRCA, Ancona, Italy..
    Ärnlöv, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
    Carlsson, Axel C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden..
    Roller-Wirnsberger, Regina
    Med Univ Graz, Dept Internal Med Geriatr, Graz, Austria..
    Wirnsberger, Gerhard
    Med Univ Graz, Dept Internal Med, Div Nephrol, Graz, Austria..
    Kostka, Tomasz
    Med Univ Lodz, Dept Geriatr, Hlth Ageing Res Ctr, Lodz, Poland..
    Guligowska, Agnieszka
    Med Univ Lodz, Dept Geriatr, Hlth Ageing Res Ctr, Lodz, Poland..
    Formiga, Francesc
    Bellvitge Univ Hosp, IDIBELL, Geriatr Unit, Dept Internal Med, Barcelona, Spain..
    Moreno-Gonzalez, Rafael
    Bellvitge Univ Hosp, IDIBELL, Geriatr Unit, Dept Internal Med, Barcelona, Spain..
    Gil, Pedro
    Hosp Clin San Carlos, Geriatr Dept, Martin Lagos S-N, Madrid 28040, Spain..
    Martinez, Sara Lainez
    Hosp Clin San Carlos, Geriatr Dept, Martin Lagos S-N, Madrid 28040, Spain..
    Kob, Robert
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging IBA, Dept Internal Med Geriatr, Erlangen, Germany..
    Melzer, Itshak
    Ben Gurion Univ Negev, Dept Phys Therapy, Recanati Sch Community Hlth Profess, Fac Hlth Sci, Beer Sheva, Israel..
    Freiberger, Ellen
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging IBA, Dept Internal Med Geriatr, Erlangen, Germany..
    Kidney function and other factors and their association with falls updates The screening for CKD among older people across Europe (SCOPE) study2020In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 20, article id 320Article in journal (Refereed)
    Abstract [en]

    Background: Reduced kidney function has become a major public health concern, especially among older people, as Chronic Kidney Disease (CKD) is associated with increased risk of end stage renal disease and mortality. Falls are a serious negative health outcome in older persons with one third of people aged 65 years experiencing a fall per year and increasing fall rates with increasing age. The impact of CKD on falls in older community-dwelling persons is not well investigated. Additionally, lower urinary tract symptoms (LUTS) may also increase the risk of falls. Therefore, our aim was to investigate the impact of CKD and LUTS on falls as well as on injurious falls. Methods: The SCOPE study is an observational, multinational, multicenter, prospective cohort study involving communitydwelling older persons aged 75 years and more recruited from August 2016 to March 2018 in seven European countries. The main outcomes of the present study were any falls and any injurious falls during the 12 months before enrolment The cross-sectional association of estimated glomerular filtration rate (eGFR) and LUIS with study outcomes was investigated by logistic regression analysis adjusted for baseline characteristics of enrolled subjects. Results: Our series consisted of 2256 SCOPE participants (median age = 795 years, 55.7% female). Of them, 746 participants experienced a fall and 484 reported an injurious fall in the 12 months prior to baseline assessment CKD was not significantly associated with falls (OR = 0.95, 95%CI = 0.79-1.14 for eGFR< 60; OR = 1.02, 95%CI = 0.81-128 for eGFR< 45; OR = 1.08, 95%CI = 0.74-1.57 for eGFR< 30) or injurious falls (OR = 0.91, 95%CI = 0.67-124 for eGFR< 60; OR = 0.93, 95%CI = 0.63-137 for eGFR< 45; OR = 1.19, 95%CI = 0.62-2.29 for eGFR< 30). LUTS were found significantly associated with both falls (OR = 156, 95960 =129-1.89) and injurious falls (OR = 158, 95%0 =1.14-2.19), and such associations were confirmed in all multivariable models. Conclusions: Cross-sectional data suggest that CKD may not be associated with history of falls or injurious falls, whereas LUTS is significantly associated with the outcomes.

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  • 28.
    Bromseth, Janne H.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Arts, Centre for Gender Research.
    Re-Working Norms In Geriatric Care: Exploring An LGBTQ-Sensitive And Intersectional Approach2015In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 55, p. 437-437Article in journal (Other academic)
  • 29.
    Byberg, Liisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Gedeborg, Rolf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Cars, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Berglund, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Kilander, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Melhus, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Prediction of fracture risk in men: A cohort study2012In: Journal of Bone and Mineral Research, ISSN 0884-0431, E-ISSN 1523-4681, Vol. 27, no 4, p. 797-807Article in journal (Refereed)
    Abstract [en]

    FRAX is a tool that identifies individuals with high fracture risk who will benefit from pharmacological treatment of osteoporosis. However, a majority of fractures among elderly occur in people without osteoporosis and most occur after a fall. Our aim was to accurately identify men with a high future risk of fracture, independent of cause. In the population-based Uppsala Longitudinal Study of Adult Men (ULSAM) and using survival analysis we studied different models' prognostic values (R(2) ) for any fracture and hip fracture within 10 years from age 50 (n = 2322), 60 (n = 1852), 71 (n = 1221), and 82 (n = 526). During the total follow-up period from age 50, 897 fractures occurred in 585 individuals. Of these, 281 were hip fractures occurring in 189 individuals. The rates of any fracture were 5.7/1000 person-years at risk from age 50 and 25.9/1000 person-years at risk from age 82. Corresponding hip fractures rates were 2.9 and 11.7/1000 person-years at risk. The FRAX model included all variables in FRAX except bone mineral density. The full model combining FRAX variables, comorbidity, medications, and behavioral factors explained 25-45% of all fractures and 80-92% of hip fractures, depending on age. The corresponding prognostic values of the FRAX model were 7-17% for all fractures and 41-60% for hip fractures. Net reclassification improvement (NRI) comparing the full model with the FRAX model ranged between 40 and 53% for any fracture and between 40 and 87% for hip fracture. Within the highest quintile of predicted fracture risk with the full model, 1/3 of the men will have a fracture within 10 years after age 71 years and 2/3 after age 82 years. We conclude that the addition of comorbidity, medication and behavioral factors to the clinical components of FRAX can substantially improve the ability to identify men at high risk of fracture, especially hip fracture. 

  • 30.
    Carstensen, Gunilla
    et al.
    DalarnaUniv, Sch Technol & Business Studies, Falun, Sweden.
    Rosberg, Birgitta
    Uppsala Univ Hosp, Akad Sjukhuset, Dept Rehabil Med, Uppsala, Sweden.
    Mc Kee, Kevin J.
    Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, Sweden.
    Åberg, Anna Cristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, Sweden.
    Before evening falls: Perspectives of a good old age and healthy ageing among oldest-old Swedish men2019In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 82, p. 35-44Article in journal (Refereed)
    Abstract [en]

    The late life experiences of men in the oldest-old age group have been under-researched, and their perspectives on ageing successfully neglected. This study explored the perspectives of oldest-old Swedish men on what a 'good old age' and ageing successfully meant to them. A purposive sample of 17 men, aged 85-90 years, was drawn from the Uppsala Longitudinal Study of Adult Men. An interview guide explored participants' perspectives on their ageing experiences and how they viewed ageing successfully. Participants were interviewed twice, with 1-2 weeks between interviews, and both interviews were recorded and transcribed. Content analysis identified four themes: i) Adaptation, concerning the ability to adapt to growing old with increasing limitations; ii) Sustaining Independence, related to financial resources and good health as the foundation for independence; iii) Belongingness, representing close relationships, established friendships, and the significance of the spouse; and iv) Perspectives of Time, also a common thread in all themes, in which past life experiences create an existential link between the past, the present and the future, establishing continuity of the self and enhancing life satisfaction. The participants presented themselves as active agents involved in maintaining meaning and achieving life satisfaction; a process related to the ability to manage changes in life. Our findings have resonance with models of healthy or successful ageing, but also diverge in important ways, since such models do not consider the significance of an individual's life history for their present well-being, and primarily conceptualise health as an outcome, rather than as a resource.

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  • 31.
    Cawthon, Peggy M.
    et al.
    Calif Pacific Med Ctr, Res Inst, San Francisco, CA USA.;Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA USA..
    Manini, Todd
    Univ Florida, Gainesville, FL USA..
    Patel, Sheena M.
    Calif Pacific Med Ctr, Res Inst, San Francisco, CA USA..
    Newman, Anne
    Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA..
    Travison, Thomas
    Beth Israel Deaconess Med Ctr, Dept Med, Marcus Inst Aging Res, Hebrew SeniorLife, Boston, MA 02215 USA.;Harvard Med Sch, Boston, MA 02115 USA..
    Kiel, Douglas P.
    Beth Israel Deaconess Med Ctr, Dept Med, Marcus Inst Aging Res, Hebrew SeniorLife, Boston, MA 02215 USA.;Harvard Med Sch, Boston, MA 02115 USA..
    Santanasto, Adam J.
    Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA..
    Ensrud, Kristine E.
    Minneapolis VA Hlth Care Syst, Ctr Chron Dis Outcomes Res, Minneapolis, MN USA.;Univ Minnesota, Div Epidemiol & Community Hlth, Minneapolis, MN USA.;Univ Minnesota, Dept Med, Box 736 UMHC, Minneapolis, MN 55455 USA..
    Xue, Qian-Li
    Johns Hopkins Med Inst, Div Geriatr Med & Gerontol, Baltimore, MD 21205 USA.;Johns Hopkins Med Inst, Ctr Aging & Hlth, Baltimore, MD 21205 USA..
    Shardell, Michelle
    NIA, Longitudinal Studies Sect, Baltimore, MD 21224 USA..
    Duchowny, Kate
    Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA USA..
    Erlandson, Kristine M.
    Univ Colorado Denver Anschutz Med Campus, Aurora, CO USA..
    Pencina, Karol M.
    Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15261 USA..
    Fielding, Roger A.
    Tufts Univ, Jean Mayer US Dept Agr Human Nutr Res Ctr Aging, Nutr Exercise Physiol & Sarcopenia Lab, Boston, MA 02111 USA..
    Magaziner, Jay
    Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA..
    Kwok, Timothy
    Chinese Univ Hong Kong, Dept Med & Therapeut, Fac Med, Shatin, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Sch Publ Hlth, Fac Med, Shatin, Hong Kong, Peoples R China..
    Karlsson, Magnus
    Lund Univ, Dept Clin Sci Malmo, Malmo, Sweden..
    Ohlsson, Claes
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res, Dept Internal Med & Clin Nutr,Inst Med, Gothenburg, Sweden..
    Mellstrom, Dan
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res, Dept Internal Med & Clin Nutr,Inst Med, Gothenburg, Sweden..
    Hirani, Vasant
    Univ Sydney, Charles Perkins Ctr, Sydney, NSW, Australia..
    Ribom, Eva L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Correa-de-Araujo, Rosaly
    NIA, Bethesda, MD 20892 USA..
    Bhasin, Shalender
    Harvard Med Sch, Boston Claude D Pepper Older Americans Independen, Brigham & Womens Hosp, Boston, MA 02115 USA..
    Putative Cut-Points in Sarcopenia Components and Incident Adverse Health Outcomes: AnSDOCAnalysis2020In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 68, no 7, p. 1429-1437Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES Analyses performed by the Sarcopenia Definitions and Outcomes Consortium (SDOC) identified cut-points in several metrics of grip strength for consideration in a definition of sarcopenia. We describe the associations between the SDOC-identified metrics of low grip strength (absolute or standardized to body size/composition); low dual-energy x-ray absorptiometry (DXA) lean mass as previously defined in the literature (appendicular lean mass [ALM]/ht(2)); and slowness (walking speed <.8 m/s) with subsequent adverse outcomes (falls, hip fractures, mobility limitation, and mortality). DESIGN Individual-level, sex-stratified pooled analysis. We calculated odds ratios (ORs) or hazard ratios (HRs) for incident falls, mobility limitation, hip fractures, and mortality. Follow-up time ranged from 1 year for falls to 8.8 +/- 2.3 years for mortality. SETTING Eight prospective observational cohort studies. PARTICIPANTS A total of 13,421 community-dwelling men and 4,828 community-dwelling women. MEASUREMENTS Grip strength by hand dynamometry, gait speed, and lean mass by DXA. RESULTS Low grip strength (absolute or standardized to body size/composition) was associated with incident outcomes, usually independently of slowness, in both men and women. ORs and HRs generally ranged from 1.2 to 3.0 for those below vs above the cut-point. DXA lean mass was not consistently associated with these outcomes. When considered together, those who had both muscle weakness by absolute grip strength (<35.5 kg in men and <20 kg in women) and slowness were consistently more likely to have a fall, hip fracture, mobility limitation, or die than those without either slowness or muscle weakness. CONCLUSION Older men and women with both muscle weakness and slowness have a higher likelihood of adverse health outcomes. These results support the inclusion of grip strength and walking speed as components in a summary definition of sarcopenia.

  • 32.
    Cawthon, Peggy M.
    et al.
    Calif Pacific Med Ctr Res Inst, 550 16th St,2nd Floor,Box 0560, San Francisco, CA 94143 USA.;Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA..
    Patel, Sheena M.
    Calif Pacific Med Ctr Res Inst, 550 16th St,2nd Floor,Box 0560, San Francisco, CA 94143 USA..
    Kritchevsky, Stephen B.
    Wake Forest Sch Med, Sticht Ctr Hlth Aging & Alzheimers Prevent, Winston Salem, NC 27101 USA..
    Newman, Anne B.
    Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15260 USA..
    Santanasto, Adam
    Univ Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15260 USA..
    Kiel, Douglas P.
    Beth Israel Deaconess Med Ctr, Dept Med, Hebrew SeniorLife, Marcus Inst Aging Res, Boston, MA 02215 USA.;Harvard Med Sch, Boston, MA 02115 USA..
    Travison, Thomas G.
    Beth Israel Deaconess Med Ctr, Dept Med, Hebrew SeniorLife, Marcus Inst Aging Res, Boston, MA 02215 USA.;Harvard Med Sch, Boston, MA 02115 USA..
    Lane, Nancy
    Univ Calif Davis, Med Ctr, Ctr Musculoskeletal Hlth, Sacramento, CA 95817 USA.;Univ Calif Davis, Med Ctr, Dept Internal Med, Sacramento, CA 95817 USA..
    Cummings, Steven R.
    Calif Pacific Med Ctr Res Inst, 550 16th St,2nd Floor,Box 0560, San Francisco, CA 94143 USA.;Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA..
    Orwoll, Eric S.
    Oregon Hlth & Sci Univ, Bone & Mineral Unit, Portland, OR 97201 USA..
    Duchowny, Kate A.
    Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA..
    Kwok, Timothy
    Chinese Univ Hong Kong, Fac Med, Dept Med & Therapeut, Shatin, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Fac Med, Sch Publ Hlth, Shatin, Hong Kong, Peoples R China..
    Hirani, Vasant
    Univ Sydney, Charles Perkins Ctr, Sydney, NSW, Australia..
    Schousboe, John
    HealthPartners Inst, Bloomington, MN USA.;Univ Minnesota, Div Hlth Policy & Management, Minneapolis, MN USA..
    Karlsson, Magnus K.
    Lund Univ, Skane Univ Hosp, Dept Orthoped & Clin Sci Malmö, Clin & Mol Osteoporosis Res Unit, Lund, Sweden..
    Mellstrom, Dan
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res, Inst Med,Dept Internal Med & Clin Nutr, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Drug Treatment, Reg Vastra Gotaland, Gothenburg, Sweden..
    Ohlsson, Claes
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res, Inst Med,Dept Internal Med & Clin Nutr, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Drug Treatment, Reg Vastra Gotaland, Gothenburg, Sweden..
    Ljunggren, Östen
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Endocrinology and mineral metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Uppsala Clinical Research Center (UCR).
    Xue, Qian-Li
    Johns Hopkins Med Inst, Div Geriatr Med & Gerontol, Baltimore, MD 21205 USA.;Johns Hopkins Med Inst, Ctr Aging & Hlth, Baltimore, MD 21205 USA..
    Shardell, Michelle
    Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA..
    Jordan, Joanne M.
    Univ N Carolina, Thurston Arthrit Res Ctr, Sch Med, Chapel Hill, NC 27515 USA..
    Pencina, Karol M.
    Beth Israel Deaconess Med Ctr, Dept Med, Hebrew SeniorLife, Marcus Inst Aging Res, Boston, MA 02215 USA.;Harvard Med Sch, Boston, MA 02115 USA..
    Fielding, Roger A.
    Tufts Univ, Jean Mayer US Dept Agr Human Nutr, Nutr Exercise Physiol & Sarcopenia Lab, Res Ctr Aging, Boston, MA 02111 USA..
    Magaziner, Jay
    Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA..
    Correa-de-Araujo, Rosaly
    NIA, Bethesda, MD 20892 USA..
    Bhasin, Shalender
    Harvard Med Sch, Brigham & Womens Hosp, Boston Claude D Pepper Older Amer Independence Ct, Boston, MA 02115 USA..
    Manini, Todd M.
    Univ Florida, Gainesville, FL USA..
    What Cut-Point in Gait Speed Best Discriminates Community-Dwelling Older Adults With Mobility Complaints From Those Without?: A Pooled Analysis From the Sarcopenia Definitions and Outcomes Consortium2021In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 76, no 10, p. E321-E327Article in journal (Refereed)
    Abstract [en]

    Background: Cut-points to define slow walking speed have largely been derived from expert opinion. Methods: Study participants (13 589 men and 5043 women aged >= 65years) had walking speed (m/s) measured over 4-6 m (mean +/- SD: 1.20 +/- 0.27 m/s in men and 0.94 +/- 0.24 m/s in women.) Mobility limitation was defined as any self-reported difficulty with walking approximately 1/4 mile (prevalence: 12.6% men, 26.4% women). Sex-stratified classification and regression tree (CART) models with 10-fold cross-validation identified walking speed cut-points that optimally discriminated those who reported mobility limitation from those who did not. Results: Among 5043 women, CART analysis identified 2 cut-points, classifying 4144 (82.2%) with walking speed >= 0.75 m/s, which we labeled as "fast"; 478 (9.5%) as "intermediate" (walking speed >= 0.62 m/s but <0.75 m/s); and 421 (8.3%) as "slow" (walking speed <0.62 m/s). Among 13 589 men, CART analysis identified 3 cut-points, classifying 10 001 (73.6%) with walking speed >= 1.00m/s ("very fast"); 2901 (21.3%) as "fast" (walking speed >= 0.74 m/s but <1.00 m/s); 497 (3.7%) as "intermediate" (walking speed >= 0.57 m/s but <0.74 m/s); and 190 (1.4%) as "slow" (walking speed <0.57 m/s). Prevalence of self-reported mobility limitation was lowest in the "fast" or "very fast" (11% for men and 19% for women) and highest in the "slow" (60.5% in men and 71.0% in women). Rounding the 2 slower cut-points to 0.60 m/s and 0.75 m/s reclassified very few participants. Conclusions: Cut-points in walking speed of approximately 0.60 m/s and 0.75 m/s discriminate those with self-reported mobility limitation from those without.

  • 33.
    Cawthon, Peggy M.
    et al.
    Calif Pacific Med Ctr, Res Inst, 550 16th St,Second Floor, San Francisco, CA 94143 USA.;Univ Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA USA..
    Visser, Marjolein
    Vrije Univ Amsterdam, Fac Sci, Dept Hlth Sci, Amsterdam, Netherlands.;Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands..
    Arai, Hidenori
    Natl Ctr Geriatr & Gerontol, Obu, Aichi, Japan..
    Avila-Funes, Jose A.
    Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Dept Geriatr, Mexico City, DF, Mexico..
    Barazzoni, Rocco
    Univ Trieste, Dept Med Surg & Hlth Sci, Trieste, Italy..
    Bhasin, Shalender
    Harvard Med Sch, Bostin Claude D Pepper Older Amer Independence Ct, Brigham & Womens Hosp, Boston, MA 02115 USA..
    Binder, Ellen
    Barnes Jewish Hosp, Siteman Canc Ctr, St Louis, MO 63110 USA.;Washington Univ, Sch Med, Div Geriatr & Nutr Sci, St Louis, MO USA..
    Bruyère, Olivier
    Univ Liege, World Hlth Org Collaborating Ctr Publ Hlth Aspect, Div Publ Hlth Epidemiol & Hlth Econ, Liege, Belgium..
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Inflammat & Ageing, Stockholm, Sweden.
    Chen, Liang-Kung
    Natl Yang Ming Chiao Tung Univ, Ctr Hlth Longev & Aging Sci, Taipei, Taiwan.;Taipei Vet Generfranal Hosp, Ctr Geriatr & Gerontol, Taipei, Taiwan.;Taipei Municipal Gan Dau Hosp, Taipei Vet Gen Hosp, Taipei, Taiwan..
    Cooper, Cyrus
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England.;Univ Oxford, Dept Epidemiol, Oxford, England..
    Duque, Gustavo
    McGill Univ Hlth Ctr, Res Inst, Montreal, PQ, Canada.;McGill Univ, Dept Med, Div Geriatr Med, Montreal, PQ, Canada..
    Fielding, Roger A.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer US Dept Agr Human Nutr, Res Ctr Aging, Boston, MA 02111 USA..
    Guralnik, Jack
    Univ Maryland, Sch Med, Dept Epidemiol & Publ Hlth, Baltimore, MD 21201 USA..
    Kiel, Douglas P.
    Beth Israel Deaconess Med Ctr, Dept Med, Hinda & Arthur Marcus Inst Aging Res, Hebrew SeniorLife, Boston, MA 02215 USA.;Harvard Med Sch, Boston, MA 02115 USA..
    Kirk, Ben
    Univ Melbourne, Australian Inst Musculoskeletal Sci AIMSS, St Albans, Vic, Australia.;Western Hlth, St Albans, Vic, Australia.;Univ Melbourne, Dept Med, Western Hlth, St Albans, Vic, Australia..
    Landi, Francesco
    Fdn Policlin Univ Agostino Gemelli IRCCS, I-00168 Rome, Italy..
    Sayer, Avan A.
    Newcastle Upon Tyne Hosp NHS Fdn Trust, AGE Res Grp, NIHR Newcastle Biomed Res Ctr, Newcastle Upon Tyne, Tyne & Wear, England.;Newcastle Univ, Fac Med Sci, Newcastle Upon Tyne, Tyne & Wear, England..
    Von Haehling, Stephan
    Univ Med Gottingen UMG, Dept Cardiol & Pneumol, Gottingen, Germany.;German Ctr Cardiovasc Res DZHK, Partner Site Gottingen, Gottingen, Germany..
    Woo, Jean
    Chinese Univ Hong Kong, Fac Med, Dept Med & Therapeut, Hong Kong, Peoples R China.;Chinese Univ Hong Kong, Fac Med, Ctr Nutr Studies, Hong Kong, Peoples R China..
    Cruz-Jentoft, Alfonso J.
    Hosp Univ Ramon y Cajal IRYCIS, Serv Geriatria, Madrid, Spain..
    Defining terms commonly used in sarcopenia research: a glossary proposed by the Global Leadership in Sarcopenia (GLIS) Steering Committee2022In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 13, no 6, p. 1239-1244Article in journal (Refereed)
    Abstract [en]

    Methods

    The aim of this paper is to define terms commonly related to sarcopenia to enable standardization of these terms in research and clinical settings. The Global Leadership Initiative in Sarcopenia (GLIS) aims to bring together leading investigators in sarcopenia research to develop a single definition that can be utilized worldwide; work on a global definition of sarcopenia is ongoing. The first step of GLIS is to develop the common terminology, or a glossary, that will facilitate agreement on a global definition of sarcopenia as well as interpretation of clinical and research findings.

    Results

    Several terms that are commonly used in sarcopenia research are defined, including self-reported measures of function and ability; objective physical performance tests; and measures related to muscle function and size.

    Conclusion

    As new methods and technologies are developed, these definitions may be expanded or refined over time. Our goal is to promote this common language to describe sarcopenia and its components in clinical and research settings in order to increase clinical awareness and research interest in this important condition. We hope that the use of common terminology in sarcopenia research will increase understanding of the concept and improve communication around this important age-related condition.

    Key summary points

    Aim

    The aim of this paper is to define terms commonly related to sarcopenia to enable standardization of these terms in research and clinical settings.

    Findings

    This paper provides definitions for commonly used terminology in sarcopenia in both clinical and research settings. As new methods and technologies are developed, this terminology may be expanded or refined over time.

    Message

    We hope that the use of common terminology in sarcopenia research will increase understanding of the concept and improve communication around this important age-related condition. 

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  • 34.
    Cederbom, Sara
    et al.
    OsloMet Oslo Metropolitan Univ, Fac Hlth Sci, Dept Physiotherapy, Postboks 4,St Olays Plass, N-0130 Oslo, Norway.
    Arkkukangas, Marina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Impact of the fall prevention Otago Exercise Programme on pain among community-dwelling older adults: a short- and long-term follow-up study2019In: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 14, p. 721-726Article in journal (Refereed)
    Abstract [en]

    Background: Pain is a major public health issue among community-dwelling older adults, with a prevalence of 45-80%. In addition to being strongly associated with reduced physical function, loss of independence, psychological distress, lower quality of life, and risk of earlier death. Recent research has also found that pain in older adults is associated with a higher risk of falls, which itself is another major health concern. Long-term and high-intensity pain are predictors of chronic pain and pain-related disability. Therefore, establishing an evidence-based intervention that can reduce both pain and falls in older adults is of high importance.

    Purpose: This study aimed to investigate whether a home-based fall-preventive exercise-program can reduce pain in the target population over both the short and long term.

    Patients and methods: This was a quasi-experimental study with a 1-group pretest-posttest design. We included 119 participants who had participated in a recent 2-year fall prevention intervention in a randomized controlled trial. The intervention included exercises based on the Otago Exercise Programme (OEP), an individually tailored and prescribed program that involves home-based exercises supervised by a physiotherapist. Pain was measured using an item from the EuroQol-5D questionnaire.

    Results: Pain was significantly reduced from baseline (n=119) at 3 (n=105, p=0.003), 12 (n=96, p=0.041), and 24 (n=80, p=0.028) months following the commencement of OEP-based exercises.

    Conclusions: These results indicate that the OEP could be a suitable evidence-based program for both pain management and fall prevention among community-dwelling older people who live with pain and are at a higher risk of falling. Our study highlights an effective technique for better pain management and fall prevention in older adults.

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  • 35.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Sarkopeni: ett "nytt" begrepp med klinisk betydelse för den äldre2008In: Nordisk Geriatrik, Vol. 11, no 1, p. 30-32Article in journal (Refereed)
  • 36.
    Cederholm, Tommy
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics. Karolinska Univ Hosp, Theme Inflammat & Aging, Stockholm, Sweden.
    Rothenberg, E.
    Kristianstad Univ, Facutly Hlth Sci, Kristianstad, Sweden.
    Barazzoni, R.
    Univ Trieste, Dept Med Surg & Hlth Sci, Trieste, Italy.
    A Clinically Relevant Diagnosis Code for "Malnutrition in Adults" Is Needed in ICD-112022In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 26, no 4, p. 314-315Article in journal (Other academic)
  • 37.
    Chalermsri, Chalobol
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Understanding food choices and practices among older people in Thailand – an exploratory study2019Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background: Food choice and practice of older people is very significant for their health and well-being. Earlier studies have focused on the choices made by older people in developed countries. Therefore, this study aimed to explore food choices and practices among older people in Thailand from the perspectives of older people themselves and their caregivers. Methodology: The study was performed in Samut Sakhon, Thailand. Six Focused Group Discussions and six semi-structured interviews were conducted with older people and their caregivers. The discussions and interviews explored individual food practices and the factors influencing the type and quantity of food selected. Data were transcribed using the denaturalized and verbatim approach, and analysis followed an inductive thematic approach. Results: Both older people and caregivers shared that price and convenience were two common food choice values. Some also mentioned nutritional value as a determining factor. Older people worried about unhygienic food and food which contained chemicals or was contaminated. They were concerned about food preparation process, dirt from pollution of the locality etc. Culture affected the way old people ate with their families, and what they chose to eat. Furthermore, the national Fishery law had a negative impact upon their food selection habits. Conclusion: Older people’s food choice was the outcome from their personal mental processes that weighted, balanced, and prioritized each food choice value such as affordability, convenience, availability or nutritional benefits. To encourage healthy eating habits among older people, individual needs and opinions should be taken into consideration.

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  • 38.
    Chalermsri, Chalobol
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition. Mahidol Univ, Fac Med Siriraj Hosp, Dept Prevent & Social Med, Div Geriatr Med, Bangkok, Thailand..
    Aekplakorn, Wichai
    Mahidol Univ, Fac Med Ramathibodi Hosp, Dept Community Med, Bangkok, Thailand..
    Srinonprasert, Varalak
    Mahidol Univ, Fac Med Siriraj Hosp, Dept Med, Div Geriatr Med, Bangkok, Thailand.;Mahidol Univ, Fac Med Siriraj Hosp, Siriraj Hlth Policy Unit, Bangkok, Thailand..
    Body Mass Index Combined With Possible Sarcopenia Status Is Better Than BMI or Possible Sarcopenia Status Alone for Predicting All-Cause Mortality Among Asian Community-Dwelling Older Adults2022In: Frontiers in Nutrition, E-ISSN 2296-861X, Vol. 9, article id 881121Article in journal (Refereed)
    Abstract [en]

    BackgroundBody mass index (BMI) and sarcopenia are common indicators of nutritional status. Possible sarcopenia, defined as low muscle strength or performance, was recently introduced by the Asian Working Group for Sarcopenia (AWGS) in 2019. We investigated for association between all-cause mortality and BMI combined with possible sarcopenia severity in Asian older adults. MethodsThis study included a subpopulation (8,195 participants aged >= 60 years; male gender: 49.4%; mean age: 69.2 +/- 6.8 years) from the Fourth Thai National Health Examination Survey (NHES-IV). BMI was classified using Asia-Pacific cut-offs. Possible sarcopenia was defined using quadriceps strength based on AWGS 2019 criteria, and possible sarcopenia severity was determined using study population quartile cut-offs. All-cause mortality data was derived from the national vital registry in 2020. ResultsThe prevalence of underweight status and possible sarcopenia was 11.8 and 38.9%, respectively. Multivariate analysis showed underweight individuals with severe possible sarcopenia to be at highest risk for increased mortality [adjusted hazard ratio (aHR): 3.98, 95% confidence interval (CI): 2.89-5.48], and higher risk was found in men compared to women (aHR: 5.35, 95% CI: 1.19-8.97). Obese status without possible sarcopenia was an independent protective factor (aHR: 0.61, 95% CI: 0.38-0.97). ConclusionBMI combined with possible sarcopenia severity is a better predictor of mortality risk than either parameter alone.

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  • 39.
    Chalermsri, Chalobol
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition. Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
    Moshfiqur Rahman, Syed
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition.
    Ekström, Eva-Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition.
    Ziaei, Shirin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition.
    Aekplakorn, Wichai
    Department of Community Medicine, Ramathobodi Hospital, Mahidol University.
    Satheannopakao, Warapone
    Department of Nutrition, Faculty of Public Health, Mahidol University.
    Muangpaisan, Weerasak
    Division of Geriatric Medicine, Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University.
    Dietary diversity predicts the mortality among older people: Data from the fifth Thai national health examination survey2023In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 110, article id 104986Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the association between dietary diversity (DD) and mortality among Thai older people and to investigate whether age, sex, and nutritional status modify this association.

    Methods: The national survey conducted from 2013 to 2015 recruited 5631 people aged > 60 years. Dietary diversity score (DDS) was assessed for the consumption of eight food groups using food frequency questionnaires. The Vital Statistics System provided the data on mortality in 2021. The association between DDS and mortality was analyzed by Cox proportional hazard model and adjusted for the complex survey design. Interaction terms between DDS and age, sex, and BMI were also tested.

    Results: The DDS was inversely associated with mortality (HR adj 0.98, 95%CI: 0.96–1.00). This association was stronger in people aged > 70 years (HR adj 0.93, 95%CI: 0.90–0.96 for aged 70–79 years, and HR adj 0.92, 95%CI: 0.88–0.95 for aged > 80 years). Inverse association between DDS and mortality was also found in the underweight older population (HR adj 0.95, 95%CI: 0.90–0.99). A positive association was found between DDS and mortality in the overweight/obese group (HR adj 1.03, 95%CI: 1.00–1.05). However, the interaction between the DDS with sex to mortality was not statistically significant.

    Conclusion:Increasing DD reduces mortality among Thai older people, especially in those above 70, and underweight. In contrast, an increase in DD also meant an increase in mortality among the overweight/obese group. Focus should be placed on the nutritional interventions aimed to improve DD for those 70 and over and underweight to reduce mortality.

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  • 40. Cho, Karl
    et al.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Lökk, Johan
    Calcium intake in elderly patients with hip fractures2008In: Food & nutrition research, ISSN 1654-6628, Vol. 52, p. 1654-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dietary calcium intake is assumed important in the prevention and treatment of osteoporosis. However, people in countries with a high calcium intake from commodities such as milk and milk products have a high incidence of hip fracture. The effect and influence of calcium intake in the prevention of osteoporotic fracture vary from different studies. OBJECTIVE: To investigate premorbid daily calcium intake in patients with low energy hip fractures during four consecutive years. DESIGN: In total 120 patients (mean age 78+/-8.5 (SD) years) were included between 2002 and 2005. The patients answered a structured food frequency questionnaire (FFQ) and interviews on patients' daily calcium intake from food and supplements took place during a 6-month period before the fracture. Dual energy X-ray absorptiometry (DEXA) was performed in a subgroup of 15 patients. RESULTS: The mean daily calcium intake from food and supplementation was 970+/-500 mg. However, 38% of patients had an intake below the recommended 800 mg/day. There was no significant relationship between calcium intake and age, gender, bone mineral density, serum calcium or albumin, type of fracture or body mass index. The mean free plasma calcium concentration was 2.3+/-0.1, i.e. within the reference limit. In 2005, 80% of the patients who underwent DEXA had manifest osteoporosis. There was a trend towards decreased calcium intake over the observation period, with a mean calcium intake below 800 mg/day in 2005. CONCLUSIONS: Hip fracture patients had a mean calcium intake above the recommended daily intake, as assessed by a FFQ. However, more than one-third of patients had an intake below the recommended 800 mg/day. The intake appeared to decrease over the investigated years. The relationship between calcium intake and fracture susceptibility is complex.

  • 41.
    Choudhary, Anita
    et al.
    RD Gardi Med Coll, Dept Physiol, Ujjain 456006, Madhya Pradesh, India.
    Pathak, Ashish
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India;Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden.
    Manickam, Ponnaiah
    Indian Council Med Res, Natl Inst Epidemiol, Chennai 600077, Tamil Nadu, India.
    Purohit, Manju
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden;RD Gardi Med Coll, Dept Pathol, Ujjain 456006, Madhya Pradesh, India.
    Rajasekhar, Thomas Daniel
    Indian Council Med Res, Natl Inst Epidemiol, Chennai 600077, Tamil Nadu, India.
    Dhoble, Parag
    RD Gardi Med Coll, Dept Psychiat, Ujjain 456006, Madhya Pradesh, India.
    Sharma, Ashish
    RD Gardi Med Coll, Dept Med, Ujjain 456006, Madhya Pradesh, India.
    Suliya, Juhi
    Indian Inst Publ Hlth Gandhinagar, Gandhinagar 382042, Gujarat, India.
    Apsingekar, Dhanashree
    Indian Inst Publ Hlth Gandhinagar, Gandhinagar 382042, Gujarat, India.
    Patil, Vandana
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Jaiswal, Ashish
    RD Gardi Coll Physiotherapy, Ujjain 456006, Madhya Pradesh, India.
    Gwarikar, Sudhir
    RD Gardi Med Coll, Dept Med, Ujjain 456006, Madhya Pradesh, India.
    Östh, Josefine
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden.
    Jirwe, Maria
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden;Sophiahemmet Univ, Dept Hlth Promoting Sci, SE-11486 Stockholm, Sweden.
    Diwan, Vinod Kumar
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden.
    Hallgren, Mats
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden.
    Mahadik, Vijay
    RD Gardi Med Coll, Dept Pediat, Ujjain 456006, Madhya Pradesh, India.
    Diwan, Vishal
    Karolinska Inst, Dept Publ Hlth Sci, SE-17176 Stockholm, Sweden;RD Gardi Med Coll, Dept Publ Hlth & Environm, Ujjain 456006, Madhya Pradesh, India;Ujjain Charitable Trust Hosp, Int Ctr Hlth Res, Res Ctr, Ujjain 456006, Madhya Pradesh, India.
    Effect of Yoga versus Light Exercise to Improve Well-Being and Promote Healthy Aging among Older Adults in Central India: A Study Protocol for a Randomized Controlled Trial2019In: GERIATRICS, ISSN 2308-3417, Vol. 4, no 4, article id 64Article in journal (Refereed)
    Abstract [en]

    Background: Aging is a natural process associated with many functional and structural changes. These changes may include impaired self-regulation, changes in tissues and organs. Aging also affects mood, physical status and social activity. There are adverse changes in cognitive behavior, perceived sensation and thinking processes. Regular physical activity can alleviate many health problems; yet, many older adults are inactive. Yoga is one of the scientific and popular lifestyle practice considered as the integration of mind, body and soul. Results of previous studies reported positive effects of yoga on multiple health outcomes in elderly. However, there is scarcity of scientific information where yoga's effect is examined on over well-being and on multiple health outcomes simultaneously in elderly. This protocol describes methods for a 12-week yoga-based intervention exploring the effects of yoga on well-being in physically inactive elderly living in community.

    Methods and analysis: This two group parallel single blind randomized controlled trial that will be conducted at a designated facility of R.D. Gardi Medical College, Ujjain, Madhya Pradesh, Central India. A 12-week 60-min yoga intervention three times weekly is designed. Comparison group participants will undergo a 60-min program comprising light exercise focusing on conventional stretching to improve mobility. After screening, 144 participants aged 60-80 years will be recruited. The primary outcome is subjective well-being. Secondary outcomes include mobility, fall risk, cognition, anxiety and depression, mood and stress, sleep quality, pain, physical activity/sedentary behavior and cardio-metabolic risk factors. Assessments will be conducted at baseline (0 week), after the intervention (12+1 week) and at follow-up (36+1 week). Intention-to-treat analyses with mixed linear modeling will be applied.

    Discussion: Through this trial, we aim to determine whether elderly people in the intervention group practicing yoga show more favorable primary (well-being) and secondary outcomes than those in the light exercise focusing on conventional stretching group. We assume that yoga may be practiced to maintain health, reduce particular symptoms commonly associated with skeletal pain, assist in pain relief and enhance well-being. We anticipate that practicing yoga will improve well-being and mental health and may lead to significant improvement in depression, pain and sleep quality.

    Ethics and dissemination: This study is approved by the Institutional Ethics Committee of R.D. Gardi Medical College, Ujjain, IEC Ref No. 09/2018. All participants would be provided with written and verbal information about the purpose of the project and would be free to withdraw from the study at any time. Refusal to participate in the study would not have any negative consequences. Confidentiality of the information of each participant would be ensured. Knowledge obtained would be disseminated to stakeholders through workshops, meetings and relevant scientific conferences.

    Trial Registration: The trial is prospectively registered with the Indian Council of Medical Research Trial Registry CTRI/2018/07/015051.

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  • 42. Crinelli, Raffaella
    et al.
    Östberg, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Logopedi.
    Folstein's Mini-Mental State Examination: fat chance or slim hope?2008In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 56, no 1, p. 171-172Article in journal (Other academic)
  • 43.
    Cruz-Jentoft, Alfonso J.
    et al.
    Hosp Univ Ramon y Cajal IRYCIS, Serv Geriatr, Madrid, Spain.
    Bahat, Gülistan
    Istanbul Univ, Istanbul Med Sch, Div Geriatr, Dept Internal Med, Istanbul, Turkey.
    Bauer, Jürgen
    Heidelberg Univ, Ctr Geriatr Med, Agaples Bethanien Krankenhaus, Heidelberg, Germany.
    Boirie, Yves
    CHU Clermont Ferrand, Res Dept, Clermont Ferrand, France.
    Bruyere, Olivier
    Univ Liege, Dept Publ Hlth Epidemiol & Hlth Econ, Liege, Belgium.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism. Karolinska Univ Hosp, Theme Ageing, Stockholm, Sweden.
    Cooper, Cyrus
    Univ Southampton, MRC Lifecourse Epidemiol Unit, Southampton, Hants, England;Univ Oxford, Dept Epidemiol, Ox, England.
    Landi, Francesco
    Univ Cattolica Sacro Cuore, Inst Med Interna & Geriatria, Rome, Italy.
    Rolland, Yves
    Hosp & Univ Toulouse, Dept Geriatr, Toulouse, France.
    Sayer, Avan Aihie
    Newcastle Upon Tyne Hosp NHS Fdn Trust, NIHR Newcastle Biomed Res Ctr, Newcastle, England;Newcastle Univ, Fac Med Sci, Newcastle, England.
    Schneider, Stephane M.
    Univ Cote Azur, CHU Nice, Dept Gastroenterol & Clin Nutr, Nice, France.
    Sieber, Cornel C.
    Friedrich Alexander Univ, Inst Biomed & Ageing, Dept Internal Med Geriatr, Erlangen, Germany.
    Topinkova, Eva
    Charles Univ Prague, Fac Med 1, Dept Geriatr, Prague, Czech Republic;Gen Fac Hosp, Prague, Czech Republic.
    Vandewoude, Maurits
    Univ Antwerp, Dept Geriatr, Ziekenhuisnetwerk Antwerpen ZNA, Antwerp, Belgium.
    Visser, Marjolein
    Vrije Univ Amsterdam, Fac Sci, Dept Hlth Sci, Amsterdam, Netherlands;Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands.
    Zamboni, Mauro
    Univ Verona, Geriatr Sect, Dept Med, Verona, Italy.
    Sarcopenia: revised European consensus on definition and diagnosis2019In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 48, no 1, p. 16-31Article in journal (Refereed)
    Abstract [en]

    Background: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings.

    Objectives: To increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia.

    Recommendations: Sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia.

    Conclusions; EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

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  • 44. Cruz-Jentoft, Alfonso J
    et al.
    Landi, Francesco
    Schneider, Stéphane M
    Zúñiga, Clemente
    Arai, Hidenori
    Boirie, Yves
    Chen, Liang-Kung
    Fielding, Roger A
    Martin, Finbarr C
    Michel, Jean-Pierre
    Sieber, Cornel
    Stout, Jeffrey R
    Studenski, Stephanie A
    Vellas, Bruno
    Woo, Jean
    Zamboni, Mauro
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
    Prevalence of and interventions for sarcopenia in ageing adults : a systematic review: Report of the International Sarcopenia Initiative (EWGSOP and IWGS)2014In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 43, no 6, p. 748-759Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: to examine the clinical evidence reporting the prevalence of sarcopenia and the effect of nutrition and exercise interventions from studies using the consensus definition of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP).

    METHODS: PubMed and Dialog databases were searched (January 2000-October 2013) using pre-defined search terms. Prevalence studies and intervention studies investigating muscle mass plus strength or function outcome measures using the EWGSOP definition of sarcopenia, in well-defined populations of adults aged ≥50 years were selected.

    RESULTS: prevalence of sarcopenia was, with regional and age-related variations, 1-29% in community-dwelling populations, 14-33% in long-term care populations and 10% in the only acute hospital-care population examined. Moderate quality evidence suggests that exercise interventions improve muscle strength and physical performance. The results of nutrition interventions are equivocal due to the low number of studies and heterogeneous study design. Essential amino acid (EAA) supplements, including ∼2.5 g of leucine, and β-hydroxy β-methylbutyric acid (HMB) supplements, show some effects in improving muscle mass and function parameters. Protein supplements have not shown consistent benefits on muscle mass and function.

    CONCLUSION: prevalence of sarcopenia is substantial in most geriatric settings. Well-designed, standardised studies evaluating exercise or nutrition interventions are needed before treatment guidelines can be developed. Physicians should screen for sarcopenia in both community and geriatric settings, with diagnosis based on muscle mass and function. Supervised resistance exercise is recommended for individuals with sarcopenia. EAA (with leucine) and HMB may improve muscle outcomes.

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  • 45.
    Cöster, Marcus E.
    et al.
    Lund Univ, Skåne Univ Hosp, Dept Orthoped & Clin Sci, Clin & Mol Osteoporosis Res Unit, Lund, Sweden.
    Karlsson, Magnus
    Lund Univ, Skåne Univ Hosp, Dept Orthoped & Clin Sci, Clin & Mol Osteoporosis Res Unit, Lund, Sweden.
    Ohlsson, Claes
    Univ Gothenburg, Sahlgrenska Acad, Ctr Bone & Arthrit Res, Inst Med, Dept Internal Med & Clin Nutr, Gothenburg, Sweden.
    Mellström, Dan
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Geriatr Med, Gothenburg, Sweden.
    Lorentzon, Mattias
    Univ Gothenburg, Sahlgrenska Acad, Inst Med, Geriatr Med, Gothenburg, Sweden.
    Ribom, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Rosengren, Björn
    Lund Univ, Skåne Univ Hosp, Dept Orthoped & Clin Sci, Clin & Mol Osteoporosis Res Unit, Lund, Sweden.
    Physical function tests predict incident falls: A prospective study of 2969 men in the Swedish Osteoporotic Fractures in Men study2020In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 48, no 4, p. 436-441Article in journal (Refereed)
    Abstract [en]

    Aims: Falls are common in the elderly population, and fall-related injuries are a major health issue. We investigated the ability of simple physical tests to predict incident falls.

    Methods: The Swedish Osteoporotic Fractures in Men (MrOS) study includes 3014 population-based men aged 69-81 years at the start of the study. These men performed five different physical tests at baseline: right-hand grip strength, left-hand grip strength, timed stand test, 6 m walking test (time and steps) and narrow walking test. During the first study year, we asked participants to fill out questionnaires regarding falls 4, 8 and 12 months after baseline. A total of 2969 men completed at least one questionnaire and were included in this study. We used generalised estimating equations and logarithmic regression models to estimate odds ratios for fallers and recurrent fallers (more than one fall during the one-year examination period) in each quartile of men for each physical test.

    Results: The proportions of fallers and recurrent fallers were higher in the lowest quartile of the physical tests than in the other three quartiles combined for all physical tests. A reduction of one standard deviation in respective physical test resulted in a 13-21% higher risk of becoming a faller and a 13-31% higher risk of becoming a recurrent faller.

    Conclusions: Low results on simple physical tests is a risk factor for incident falls in elderly Swedish men and may facilitate identification of high-risk individuals suitable for fall-intervention programs.

  • 46.
    Dahlkvist, Eva
    et al.
    Department of Public Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Engström, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Department of Public Health and Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden;Nursing Department, Medicine and Health College, Lishui University, Lishui, China.
    Nilsson, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Residents' use and perceptions of residential care facility gardens: A behaviour mapping and conversation study2020In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 15, no 1, article id e12283Article in journal (Refereed)
    Abstract [en]

    AIM: To describe the gardens and their use by individuals living at residential care facilities (RCFs) with high ratings on restorative values.

    BACKGROUND: Being outdoors has been described as important to older people's well-being. Use of outdoor gardens may increase residents' well-being through experiences of restorative qualities such as being away and fascination. Thus far, there has been little research on restorative experiences of gardens in the care of older people.

    DESIGN: A descriptive design using behaviour mapping observations integrated with qualitative field notes and recorded conversations.

    METHODS: A criterion sampling of two gardens (out of a total of 87) was made based on residents' ratings of restorative values; the two with the highest values were chosen. Eleven residents at the two RCFs took part. Data were collected through behaviour mapping observations, field notes and conversations on five occasions in the respective facilities during residents' visits to the garden.

    RESULTS: The observations revealed that the main uses of the gardens were to socialise and relax. The conversations also showed that the garden stimulated residents' senses and evoked memories from the past. These restorative values were interpreted as a sense of being away and fascination. Not having opportunities for outdoor visits was reported to result in disappointment and reduced well-being.

    CONCLUSIONS: The findings showed that two basic gardens with different characteristics and views could stimulate residents' senses and evoke memories from the past; this supports the call for residents to be able to spend time in gardens to promote their well-being.

    IMPLICATIONS FOR PRACTICE: First-line managers, nurses and healthcare staff in the care of older people should consider that regular opportunities to spend time outdoors may promote older people's well-being through feelings of being away and fascination.

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  • 47.
    de Souto Barreto, P.
    et al.
    Univ Toulouse, Inst Vieillissement, Gerontopole Toulouse, Ctr Hosp, Toulouse, France.;Univ Toulouse, UPS, CERPOP, Inserm 1295, Toulouse, France.
    Cesari, M.
    Univ Milan, IRCCS, Ist Clin Sci Maugeri, Milan, Italy.
    Morley, J. E.
    St Louis Univ, Div Geriatr, Sch Med, St Louis, MO USA.
    Roberts, S.
    Jean Mayer USDA Human Nutr Res Ctr Aging, Energy Metab Lab, Boston, MA USA.
    Landi, F.
    Fdn Policlin Univ Agostino Gemelli IRCCS, Rome, Italy.
    Cederholm, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Rolland, Y.
    Univ Toulouse, Inst Vieillissement, Gerontopole Toulouse, Ctr Hosp, Toulouse, France.;Univ Toulouse, UPS, CERPOP, Inserm 1295, Toulouse, France.
    Vellas, B.
    Univ Toulouse, Inst Vieillissement, Gerontopole Toulouse, Ctr Hosp, Toulouse, France.;Univ Toulouse, UPS, CERPOP, Inserm 1295, Toulouse, France.
    Fielding, R.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA USA.
    Appetite Loss and Anorexia of Aging in Clinical Care: An ICFSR Task Force Report2022In: Journal of Frailty & Aging, ISSN 2260-1341, E-ISSN 2273-4309, Vol. 11, no 2, p. 129-134Article in journal (Refereed)
    Abstract [en]

    Appetite lossianorexia of aging is a highly prevalent and burdensome geriatric syndrome that strongly impairs the quality of life of older adults. Loss of appetite is associated with several clinical conditions, including comorbidities and other geriatric syndromes, such as frailty. Despite its importance, appetite loss has been under-evaluated and, consequently, under-diagnosed and under-treated in routine clinical care. The International Conference on Frailty and Sarcopenia Research (ICFSR) Task Force met virtually on September 27th 2021 to debate issues related to appetite loss/anorexia of aging. In particular, topics related to the implementation and management of appetite loss in at-risk older adult populations, energy balance during aging, and the design of future clinical trials on this topic were discussed. Future actions in this field should focus on the systematic assessment of appetite in the care pathway of older people, such as the Integrated Care for Older People (ICOPE) program recommended by the World Health Organization. Moreover, clinical care should move from the assessment to the treatment of appetite loss/anorexia. Researchers continue to pursue their efforts to find out effective pharmacologic and non-pharmacologic interventions with a favorable risk/benefit ratio.

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  • 48.
    Degerman Gunnarsson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Biomarkers as Monitors of Drug Effect, Diagnostic Tools and Predictors of Deterioration Rate in Alzheimer’s Disease2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Decreased amyloid-ß42 (Aß42), increased total tau (t-tau) and phosphorylated tau (p-tau) in cerebrospinal fluid (CSF) reflect histopathological core changes in the most common dementia disorder, Alzheimer’s disease (AD). They discriminate AD from healthy controls and predict conversion to AD with a relatively high accuracy. Memantine, an uncompetitive NMDA-receptor antagonist, is indicated for symptomatic treatment of AD. The first aim of this thesis was to investigate effects of memantine on CSF concentrations of Aβ42, tau and p-tau. Secondly, the aim was to explore the relation between these CSF biomarkers and retention of the amyloid biomarker Pittsburgh compound B using positron emission tomography (PIB PET), regional glucose metabolism measured with 18Fluoro-2-deoxy-d-glucose (FDG) PET and neuropsychological test performance. The third aim was to investigate their possible utility as predictors of future rate of AD dementia deterioration. All patients in the studies were recruited from the Memory Clinic, Uppsala University Hospital. In study I CSF p-tau concentrations in 11 AD patients were reduced after twelve months treatment with memantine, indicating that this compound may affect a key pathological process in AD. Results from study II showed that the concentrations of CSF Aß42 are lower in PIB+ patients than in PIB- patients, and that the PIB retention was stable during 12 months. In study III 10 patients with the diagnoses AD (6 PIB+/4 PIB-) and 8 subjects (1 PIB+/7 PIB-) with frontotemporal dementia were included. PIB+ patients had lower psychomotor speed measured by performance on the Trail Making Test A and impaired visual episodic memory compared to the PIB- patients. The initial clinical diagnoses were changed in 33% of the patients (6/18) during follow-up. Study IV is the first-ever report of an association between high CSF tau and dying in severe dementia. These 196 AD patients were followed up to nine years after baseline lumbar puncture. Moreover, CSF t-tau concentrations above median was associated with an increased risk of rapid cognitive decline (OR 3.31 (95% CI 1.53-7.16), independently of baseline functional stage. Thus, a clear association between high levels of CSF t-tau and p-tau and a more aggressive course of the disease was shown.

    List of papers
    1. Reduction of Phosphorylated Tau during Memantine Treatment of Alzheimer's Disease
    Open this publication in new window or tab >>Reduction of Phosphorylated Tau during Memantine Treatment of Alzheimer's Disease
    2007 (English)In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 24, no 4, p. 247-252Article in journal (Refereed) Published
    Abstract [en]

    Background: Memantine is a moderate affinity N-methyl-D-aspartate receptor antagonist approved for treatment of Alzheimer's disease (AD). In AD, tau is abnormally hyperphosphorylated. However, no significant changes of phosphorylated tau levels in CSF are found at follow-up in studies with AD patients. It has been shown in vitro that memantine reverse induced abnormal hyperphosphorylation of tau in hippocampal neurons of rats. Methods: Eleven AD patients were examined with cognitive tests and interviews of relatives. CSF analyses were performed before starting treatment with memantine as well as after 1 year. Results: A statistically significant reduction of CSF phosphorylated tau at the 1-year follow-up was seen, from median 126 (interquartile range 107-153) to 108 (88-133) ng/l (p = 0.018). No statistically significant differences of total tau or A42 were found. Conclusion: The results may reflect effects of memantine on a key pathological feature in AD in line with previous in vitro findings.

    Keywords
    Alzheimer's disease, Memantine, Phosphorylated tau, Cerebrospinal fluid
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-11724 (URN)10.1159/000107099 (DOI)000249536700002 ()17700020 (PubMedID)
    Available from: 2007-10-15 Created: 2007-10-15 Last updated: 2017-12-11Bibliographically approved
    2. Pittsburgh compound-B and Alzheimer's disease biomarkers in CSF, plasma and urine: An exploratory study
    Open this publication in new window or tab >>Pittsburgh compound-B and Alzheimer's disease biomarkers in CSF, plasma and urine: An exploratory study
    Show others...
    2010 (English)In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 29, no 3, p. 204-212Article in journal (Refereed) Published
    Abstract [en]

    Background:

    The positron emission tomography (PET) radiotracer Pittsburgh Compound-B (PIB) is an in vivo ligand for measuring β-amyloid (Aβ) load. Associations between PET PIB and cerebrospinal fluid (CSF) Aβ1–42 and apolipoprotein E ε4 (APOE ε4) have been observed in several studies, but the relations between PIB uptake and other biomarkers of Alzheimer’s disease (AD) are less investigated.

    Method:

    PET PIB, PET 18Fluoro-2-deoxy-D-glucose and different AD biomarkers were measured twice in CSF, plasma and urine 12 months apart in 10 patients with a clinical diagnosis of mild to moderate AD.

    Results:

    PIB retention was constant over 1 year, inversely related to low CSF Aβ1–42 (p = 0.01) and correlated positively to the numbers of the APOE ε4 allele (0, 1 or 2) (p = 0.02). There was a relation between mean PIB retention and CSF ApoE protein (r = –0.59, p = 0.07), and plasma cystatin C (r = –0.56, p = 0.09).

    Conclusion:

    PIB retention is strongly related to CSF Aβ1–42, and to the numbers of the APOE ε4 allele.

    National Category
    Medical and Health Sciences Geriatrics
    Identifiers
    urn:nbn:se:uu:diva-132548 (URN)10.1159/000281832 (DOI)000276783100003 ()20332638 (PubMedID)
    Available from: 2010-10-21 Created: 2010-10-21 Last updated: 2022-01-28Bibliographically approved
    3. Re-evaluation of clinical dementia diagnoses with PET-PIB
    Open this publication in new window or tab >>Re-evaluation of clinical dementia diagnoses with PET-PIB
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Objectives: There is an overlap regarding Pittsburgh Compound-B (PIB) retention in patients clinically diagnosed as Alzheimer’s disease (AD) and non-AD dementia.  The aim of the present study was to investigate whether there are any differences between PIB+ and PIB PIB- patients in a mixed cohort of patients with neurodegenerative dementia of mild severity regarding neuropsychological test performance and regional cerebral glucose metabolism measured with 18 Fluoro-2-deoxy-d-glucose (FDG) PET.

    Methods: Eighteen patients clinically diagnosed as probable AD or frontotemporal dementia were examined with  PIB PET, FDG PET and neuropsychological tests and followed for 5-9 years in a clinical setting.

    Results:  The PIB+ patients (7/18) had slower psychomotor speed and more impaired visual episodic memory than the PIB- patients, otherwise performance did not differ between groups. The initial clinical diagnoses were changed in one third of the patients (6/18) during follow-up.  

    Conclusions: The subtle differences in neuropsychological performance, the overlap of hypometabolic patterns and clinical features between AD and non-AD dementia highlight the need of amyloid biomarkers and readiness to re-evaluate the initial diagnosis.

    Keywords
    Alzheimer’s disease, PIB PET, Dementia with Lewy Bodies, Frontotemporal dementia, ß-amyloid, amyloid biomarker, FDG PET, neuropsychological tests, TMT A, episodic memory
    National Category
    Medical and Health Sciences
    Research subject
    Medical Science
    Identifiers
    urn:nbn:se:uu:diva-196962 (URN)
    Available from: 2013-03-15 Created: 2013-03-15 Last updated: 2013-08-30
    4. High Tau Levels in Cerebrospinal Fluid Predict Rapid Decline and Increased Dementia Mortality in Alzheimer's Disease
    Open this publication in new window or tab >>High Tau Levels in Cerebrospinal Fluid Predict Rapid Decline and Increased Dementia Mortality in Alzheimer's Disease
    Show others...
    2014 (English)In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 37, no 3-4, p. 196-206Article in journal (Refereed) Published
    Abstract [en]

    Objective: Cerebrospinal fluid (CSF) amyloid beta(42) (A beta(42)), total tau (t-tau) and phosphorylated tau (p-tau) are useful as predictors of conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia. However, results are contradictory as to whether these biomarkers reflect the future rate of clinical decline. Methods: This is a retrospective study on 196 patients with AD [mild/moderate AD (n = 72) or AD-MCI (n = 124) at baseline] with a follow-up period of 2-9 years' duration (median 6 years). Lumbar punctures were performed at baseline as a part of the diagnostic procedure. Results: We found an increased risk of rapid cognitive decline defined as a drop in the Mini-Mental State Examination score of = 4 points/year in patients with CSF t-tau concentrations above the median (OR 3.31, 95% CI 1.53-7.16) and CSF p-tau above the median (OR 2.53, 95% CI 1.21-5.26). Patients with CSF t-tau in the highest quartile had a higher risk of dying in severe dementia (HR 4.67, 95% CI 1.16-18.82). Conclusions: In this large AD cohort, we found an association between high levels of CSF t-tau and p-tau and a more aggressive course of the disease, measured as a rapid cognitive decline and a higher risk of dying in severe dementia.

    Keywords
    Alzheimer’s disease, tau, p-tau, beta-amyloid, CSF, rapid cognitive decline, dying in severe dementia, mortality
    National Category
    Geriatrics Gerontology, specialising in Medical and Health Sciences
    Research subject
    Medical Science
    Identifiers
    urn:nbn:se:uu:diva-196964 (URN)10.1159/000355556 (DOI)000335227300006 ()
    Available from: 2013-03-15 Created: 2013-03-15 Last updated: 2018-01-11Bibliographically approved
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  • 49.
    Degerman Gunnarsson, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Lannfelt, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Ingelsson, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Kilander, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    High Tau Levels in Cerebrospinal Fluid Predict Rapid Decline and Increased Dementia Mortality in Alzheimer's Disease2014In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 37, no 3-4, p. 196-206Article in journal (Refereed)
    Abstract [en]

    Objective: Cerebrospinal fluid (CSF) amyloid beta(42) (A beta(42)), total tau (t-tau) and phosphorylated tau (p-tau) are useful as predictors of conversion from mild cognitive impairment (MCI) to Alzheimer's disease (AD) dementia. However, results are contradictory as to whether these biomarkers reflect the future rate of clinical decline. Methods: This is a retrospective study on 196 patients with AD [mild/moderate AD (n = 72) or AD-MCI (n = 124) at baseline] with a follow-up period of 2-9 years' duration (median 6 years). Lumbar punctures were performed at baseline as a part of the diagnostic procedure. Results: We found an increased risk of rapid cognitive decline defined as a drop in the Mini-Mental State Examination score of = 4 points/year in patients with CSF t-tau concentrations above the median (OR 3.31, 95% CI 1.53-7.16) and CSF p-tau above the median (OR 2.53, 95% CI 1.21-5.26). Patients with CSF t-tau in the highest quartile had a higher risk of dying in severe dementia (HR 4.67, 95% CI 1.16-18.82). Conclusions: In this large AD cohort, we found an association between high levels of CSF t-tau and p-tau and a more aggressive course of the disease, measured as a rapid cognitive decline and a higher risk of dying in severe dementia.

  • 50.
    Degerman Gunnarsson, Malin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Lindau, M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Santillo, A F
    Wall, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Section of Nuclear Medicine and PET.
    Engler, H
    Lannfelt, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Basun, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Kilander, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Re-evaluation of clinical dementia diagnoses with pittsburgh compound B positron emission tomography2013In: Dementia and Geriatric Cognitive Disorders Extra, E-ISSN 1664-5464, Vol. 3, no 1, p. 472-481Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    There is an overlap regarding Pittsburgh compound B (PIB) retention in patients clinically diagnosed as Alzheimer's disease (AD) and non-AD dementia. The aim of the present study was to investigate whether there are any differences between PIB-positive and PIB-negative patients in a mixed cohort of patients with neurodegenerative dementia of mild severity regarding neuropsychological test performance and regional cerebral glucose metabolism measured with [(18)F]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET).

    METHODS:

    Eighteen patients clinically diagnosed as probable AD or frontotemporal dementia were examined with PIB PET, FDG PET and neuropsychological tests and followed for 5-9 years in a clinical setting.

    RESULTS:

    The PIB-positive patients (7 out of 18) had slower psychomotor speed and more impaired visual episodic memory than the PIB-negative patients; otherwise performance did not differ between the groups. The initial clinical diagnoses were changed in one third of the patients (6 out of 18) during follow-up.

    CONCLUSIONS:

    The subtle differences in neuropsychological performance, the overlap of hypometabolic patterns and clinical features between AD and non-AD dementia highlight the need for amyloid biomarkers and a readiness to re-evaluate the initial diagnosis.

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