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  • 151.
    Vingare, Emme-Li
    et al.
    Department of Social Work, Faculty of Social Sciences, Linnaeus University, Vaxjo, Sweden.
    Umb-Carlsson, Öie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Forskning om funktionshinder och habilitering.
    Adaption to care dependency in community care2017Ingår i: Quality in Ageing and Older Adults, ISSN 1471-7794, Vol. 18, nr 4, s. 246-253Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The purpose of this paper is to explore the lived experiences of adapting to care dependency among adults receiving health and social care in ordinary housing.

    Design/methodology/approach: This was done by conducting a phenomenological study by interviewing ten adults, receiving home care services in ordinary housing.

    Findings: Participants not only adapted by becoming a “good patient” but they had four strategies they used: sociability, distance, competence and compliance, contributing to a sense of dignity and personal safety.

    Research limitations/implications: Further research is needed regarding how to preserve quality of care with adults with various ways of adapting to care dependency.

    Practical implications: The relationship between professionals and adults in care dependency is a dynamic process where a need for understanding different modes of adaptation is vital. Good treatment and quality care may be different things to different adults, depending on what aspects of the process of adaptation concern them the most, and depending on their individual adaptation strategy.

    Originality/value: This paper contributes to the understanding of modes of adaptation to care dependency from the perspective of adults indicating that working person centered may include respecting strategies not traditionally being associated with “the good patient.”

  • 152.
    Volkert, Dorothee
    et al.
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, D-90408 Nurnberg, Germany.
    Beck, Anne Marie
    Univ Coll Copenhagen, Dept Nutr & Hlth, DK-2200 Copenhagen, Denmark;Herlev & Gentofte Univ Hosp, DK-2703 Herlev, Denmark.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism. Karolinska Univ Hosp, Theme Ageing, S-17176 Stockholm, Sweden.
    Cereda, Emanuele
    Fdn IRCCS Policlin San Matteo, Clin Nutr & Dietet Unit, I-27100 Pavia, Italy.
    Cruz-Jentoft, Alfonso
    Hosp Univ Ramon y Cajal IRYCIS, Serv Geriatria, Madrid 28034, Spain.
    Goisser, Sabine
    Heidelberg Univ, Ctr Geriatr Med & Network Aging Res NAR, D-69126 Heidelberg, Germany.
    de Groot, Lisette
    Wageningen Univ, Div Human Nutr, NL-6708 WE Wageningen, Netherlands.
    Grosshauser, Franz
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, D-90408 Nurnberg, Germany.
    Kiesswetter, Eva
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, D-90408 Nurnberg, Germany.
    Norman, Kristina
    German Inst Human Nutr Potsdam Rehbrucke, Dept Nutr & Gerontol, D-14558 Nuthetal, Germany;Charite Univ Med Berlin, Res Grp Geriatr, D-10117 Berlin, Germany;Free Univ Berlin, D-10117 Berlin, Germany;Humboldt Univ, D-10117 Berlin, Germany;Berlin Inst Hlth, D-10117 Berlin, Germany;Univ Potsdam, Inst Nutr Sci, D-14558 Nuthetal, Germany.
    Pourhassan, Maryam
    Ruhr Univ Bochum, Marien Hosp Herne, Univ Hosp, Dept Geriatr Med, D-44625 Herne, Germany.
    Reinders, Ilse
    Vrije Univ Amsterdam, Dept Hlth Sci, Fac Sci, NL-1081 HV Amsterdam, Netherlands;Vrije Univ Amsterdam, Amsterdam Publ Hlth Res Inst, NL-1081 HV Amsterdam, Netherlands.
    Roberts, Helen C.
    Univ Southampton, Southampton Gen Hosp, Southampton NIHR Biomed Res Ctr, Southampton SO16 6YD, Hants, England.
    Rolland, Yves
    Ctr Hospitalouniv Toulouse, Gerontopole, F-31059 Toulouse, France.
    Schneider, Stephane M.
    Univ Cote dAzur, CHU Nice, Nutr Support Unit, F-06200 Nice, France.
    Sieber, Cornet C.
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, D-90408 Nurnberg, Germany;Kantonsspital Winterthur, Dept Med, CH-8401 Winterthur, Switzerland.
    Thiem, Ulrich
    Ctr Geriatr & Gerontol, Hamburg, Germany;Univ Med Ctr Eppendorf, Chair Geriatr & Gerontol, D-20246 Hamburg, Germany.
    Visser, Marjolein
    Vrije Univ Amsterdam, Dept Hlth Sci, Fac Sci, NL-1081 HV Amsterdam, Netherlands;Vrije Univ Amsterdam, Amsterdam Publ Hlth Res Inst, NL-1081 HV Amsterdam, Netherlands.
    Wijnhoven, Hanneke A. H.
    Vrije Univ Amsterdam, Dept Hlth Sci, Fac Sci, NL-1081 HV Amsterdam, Netherlands;Vrije Univ Amsterdam, Amsterdam Publ Hlth Res Inst, NL-1081 HV Amsterdam, Netherlands.
    Wirth, Rainer
    Ruhr Univ Bochum, Marien Hosp Herne, Univ Hosp, Dept Geriatr Med, D-44625 Herne, Germany.
    Management of Malnutrition in Older Patients: Current Approaches, Evidence and Open Questions2019Ingår i: JOURNAL OF CLINICAL MEDICINE, ISSN 2077-0383, Vol. 8, nr 7, artikel-id 974Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken-from the identification and elimination of potential causes to enteral and parenteral nutrition-depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies.

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  • 153.
    Volkert, Dorothee
    et al.
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, Nurnberg, Germany.
    Beck, Anne Marie
    Univ Coll Copenhagen, Herlev & Gentofte Univ Hosp, Dietet & Nutr Res Unit, Fac Hlth,Inst Nutr & Nursing, Copenhagen, Denmark.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Cruz-Jentoft, Alfonso
    Hosp Univ Ramon y Cajal IRYCIS, Serv Geriatria, Madrid, Spain.
    Goisser, Sabine
    Heidelberg Univ, NAR, Heidelberg, Germany.
    Hooper, Lee
    Univ East Anglia, Norwich Med Sch, Norwich, Norfolk, England.
    Kiesswetter, Eva
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, Nurnberg, Germany.
    Maggio, Marcello
    Univ Parma, Dept Med & Surg, Parma, Italy; Parma Univ Hosp, Geriatr Rehabil Dept, Parma, Italy.
    Raynaud-Simon, Agathe
    Hop Xavier Bichat, AP HP, Dept Geriatr, Fac Med Denis Diderot, Paris, France.
    Sieber, Cornel C.
    Friedrich Alexander Univ Erlangen Nurnberg, Inst Biomed Aging, Nurnberg, Germany; Krankenhaus Barmherzige Bruder, Regensburg, Germany.
    Sobotka, Lubos
    Charles Univ Prague, Med Fac, Dept Med, Prague, Czech Republic; Charles Univ Prague, Fac Hosp Hradec Kralove, Prague, Czech Republic.
    van Asselt, Dieneke
    Radboud Univ Nijmegen, Med Ctr, Dept Geriatr Med, Nijmegen, Netherlands.
    Wirth, Rainer
    Ruhr Univ Bochum, Marien Hosp Herne, Herne, Germany.
    Bischoff, Stephan C.
    Univ Hohenheim, Inst Nutr Med, Stuttgart, Germany.
    ESPEN guideline on clinical nutrition and hydration in geriatrics2019Ingår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, nr 1, s. 10-47Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats.

    Aim: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons.

    Methods: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process.

    Results: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach.

    Conclusion: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

  • 154.
    von Berens, Åsa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Fielding, Roger A.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Gustafsson, Thomas
    Karolinska Inst, Dept Lab Med, Stockholm, Sweden.
    Kirn, Dylan
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Laussen, Jonathan
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Nydahl, Margaretha
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Reid, Kieran
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Travison, Thomas G.
    Harvard Med Sch, Boston, MA USA;Beth Israel Deaconess Med Ctr, Div Gerontol, Boston, MA 02215 USA;Hebrew SeniorLife, Inst Aging Res, Boston, MA USA.
    Zhu, Hao
    Hebrew SeniorLife, Inst Aging Res, Boston, MA USA.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Koochek, Afsaneh
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism. Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Effect of exercise and nutritional supplementation on health-related quality of life and mood in older adults: the VIVE2 randomized controlled trial2018Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, artikel-id 286Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Health-related quality of life (HRQoL) and absence of depressive symptoms are of great importance for older people, which may be achieved through lifestyle interventions, e.g., exercise and nutrition interventions. The aim of this investigation was to analyze the effects of a physical activity program in combination with protein supplementation on HRQoL and depressive symptoms in community-dwelling, mobility-limited older adults. Methods: In the Vitality, Independence, and Vigor 2 Study (VIVE2), community-dwelling men and women with an average age of 77.55.4 years, some mobility limitations and low serum vitamin D levels (25(OH)Vit D 22.5-60 nmol/l) from two study sites (Stockholm, Sweden and Boston, USA) were randomized to receive a nutritional supplement or a placebo for 6 months. All took part in a physical activity program 2-3 times/week. The primary outcome examined in VIVE2 was 400 M walk capacity. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Health Survey (SF36), consisting of the Physical Component Summary (PCS) and Mental Component Summary (MCS), and depressive symptoms were measured using The Centre for Epidemiologic Studies Depression Scale (CES-D). In the sensitivity analyses, the sample was divided into sub-groups based on body measures and function (body mass index (BMI), appendicular lean mass index (ALMI), handgrip strength and gait speed). Results: For the whole sample, there was a significant improvement in both MCS, mean (95% CI) 2.68 (0.5, 4.9) (p 0.02), and CES-D -2.7 (-4.5, -0.9) (p 0.003) during the intervention, but no difference was detected between those who received the nutritional supplement and those who received the placebo. The results revealed no significant change in PCS or variation in effects across the sub-categories. Conclusions: This study demonstrates that a six-month intervention using a physical activity program had positive effects on mental status. No additional effects from nutritional supplementation were detected.

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  • 155.
    Vossius, Corinna
    et al.
    Stavanger Univ Hosp, Ctr Age Related Med, Stavanger, Norway;Innlandet Hosp Trust, Ctr Old Age Psychiat Res, Ottestad, Norway.
    Selbaek, Geir
    Innlandet Hosp Trust, Ctr Old Age Psychiat Res, Ottestad, Norway;Vestfold Hosp Trust, Norwegian Natl Advisory Unit Ageing & Hlth, Tonsberg, Norway;Univ Oslo, Inst Hlth & Soc, Oslo, Norway.
    Benth, Jurate Saltyte
    Innlandet Hosp Trust, Ctr Old Age Psychiat Res, Ottestad, Norway;Univ Oslo, Inst Clin Med, Oslo, Norway;Akershus Univ Hosp, Hlth Serv Res Unit, Lorenskog, Norway.
    Wimo, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Karolinska Inst, Div Neurogeriatr, Dept Neurobiol Care Sci & Soc NVS, Stockholm, Sweden.
    Bergh, Sverre
    Innlandet Hosp Trust, Ctr Old Age Psychiat Res, Ottestad, Norway;Vestfold Hosp Trust, Norwegian Natl Advisory Unit Ageing & Hlth, Tonsberg, Norway.
    The use of direct care in nursing home residents: A longitudinal cohort study over 3 years2019Ingår i: International Journal of Geriatric Psychiatry, ISSN 0885-6230, E-ISSN 1099-1166, Vol. 34, nr 2, s. 337-351Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To evaluate the trend in the use of direct care in a cohort of nursing home (NH) residents and explore its association with resident characteristics and organizational factors.

    Methods/design: A total of 696 NH residents from 47 Norwegian NHs were included at admissions at NH. In 537 residents, the use of direct care was assessed every 6 months over a course of 3 years. A multiple model was estimated to identify demographic, clinical, and organizational characteristics associated with the use of direct care time.

    Results: Six months after admission, on average, 76.2 hours of direct care were rendered to each resident per month, while this number was reduced to 50.3 hours per month at the end of the study period. Most residents (92%) showed a stable use of direct care time, while a small group of residents displayed a much higher and varying use of direct care time. Increasing dementia, neuropsychiatric symptoms, and decreasing function in activities of daily living were associated with higher use of direct care time. Direct care time constituted about 50% of the staff's working time.

    Conclusion: In Norwegian NHs, high use of direct care time was associated with younger age, more severe dementia, and severe neuropsychiatric symptoms. By identifying factors that impact on direct care time, preventive measures might be put in place to the benefit of the residents and possibly to improve resource use. Further research should explore the association between direct care time, quality of care, and the residents' quality of life.

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  • 156.
    Walfridsson, Angelica
    et al.
    Ostervala Primary Hlth Care Ctr, Ostervala, Sweden..
    Sehlberg, Maja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Gillespie, Ulrika
    Uppsala Univ Hosp Akad Sjukhuset, Uppsala, Sweden..
    Dahlkvist, Jonathan
    Uppsala Lans Landsting, Uppsala, Sweden..
    Johansson, Hans-Erik
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. Ostervala Primary Hlth Care Ctr, Ostervala, Sweden..
    Diabetes treatment and hypoglycaemic episodes in elderly patients at nursing homes in Uppsala County2016Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, nr 3, s. 179-183Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to examine the situation for elderly patients with diabetes living in nursing homes with regard to diabetes treatment, clinical variables, and vascular complications associated with diabetes. A second aim was to evaluate if the patients were at risk of hypoglycaemia. Methods: This was a cross-sectional study including diabetes patients from all 30 nursing homes in Uppsala County, Sweden. Current antidiabetic medications, HbA(1c) hypoglycaemic events, and diabetes complications were registered from the medical records. The patients were stratified into a general group and divided into three groups according to HbA(1c) (<52, 52-73, and >73 mmol/mol). Results: Of 1,350 individuals, 218 patients were identified with diabetes mellitus. The diabetes duration was 11.2 +/- 9.4 years and their serum HbA(1c) concentration 56.0 +/- 1.2 mmol/mol. Hypoglycaemic events were reported in 24% of the diabetic individuals, and 43.1% of them had HbA(1c) <52 mmol/mol (mean value 44.0 +/- 1.1 mmol/mol). Of these, 36% were taking antidiabetic drugs. Another 35.8% of the patients had HbA(1c) values between 52-73 mmol/mol (mean value 60.0 +/- 1.1 mmol/mol), and 82% of these patients were taking antidiabetic drugs. Almost 80% of the diabetic patients had either micro- or macrovascular complications, with diabetes duration as an association for both micro- or macrovascular complications and hypoglycaemic events. Conclusions: A reduction of the use of antidiabetic drugs with follow-up of HbA(1c) level should be considered, especially for multimorbid elderly patients with low HbA(1c) and hypoglycaemia.

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  • 157.
    Wallert, John
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk psykologi i hälso- och sjukvård. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Westman, Erik
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Ulinder, Johnny
    Norrlandskliniken, Umeå, Sweden.
    Annerstedt, Mathilde
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Terzis, Beata
    Capio Geriatric Hospital, Stockholm, Sweden.
    Ekman, Urban
    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Stockholms Sjukhem, Stockholm, Sweden.
    Differentiating Patients at the Memory Clinic With Simple Reaction Time Variables: A Predictive Modeling Approach Using Support Vector Machines and Bayesian Optimization2018Ingår i: Frontiers in Aging Neuroscience, ISSN 1663-4365, E-ISSN 1663-4365, Vol. 10, artikel-id 144Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Mild Cognitive Impairment (MCI) and dementia differ in important ways yet share a future of increased prevalence. Separating these conditions from each other, and from Subjective Cognitive Impairment (SCI), is important for clinical prognoses and treatment, socio-legal interventions, and family adjustments. With costly clinical investigations and an aging population comes a need for more cost-efficient differential diagnostics.

    Methods: Using supervised machine learning, we investigated nine variables extracted from simple reaction time (SRT) data with respect to their single and conjoined ability to discriminate both MCI/dementia, and SCI/MCI/dementia, compared to—and together with—established psychometric tests. One-hundred-twenty elderly patients (age range = 65–95 years) were recruited when referred to full neuropsychological assessment at a specialized memory clinic in urban Sweden. A freely available SRT task served as index test and was administered and scored objectively by a computer before diagnosis of SCI (n = 17), MCI (n = 53), or dementia (n = 50). As reference standard, diagnosis was decided through the multidisciplinary memory clinic investigation. Bonferroni-Holm corrected P-values for constructed models against the null model are provided.

    Results: Algorithmic feature selection for the two final multivariable models was performed through recursive feature elimination with 3 × 10-fold cross-validation resampling. For both models, this procedure selected seven predictors of which five were SRT variables. When used as input for a soft-margin, radial-basis support vector machine model tuned via Bayesian optimization, the leave-one-out cross-validated accuracy of the final model for MCI/dementia classification was good (Accuracy = 0.806 [0.716, INS [0].877], P < 0.001) and the final model for SCI/MCI/dementia classification held some merit (Accuracy = 0.650 [0.558, 0.735], P < 0.001). These two models are implemented in a freely available application for research and educatory use.

    Conclusions: Simple reaction time variables hold some potential in conjunction with established psychometric tests for differentiating MCI/dementia, and SCI/MCI/dementia in these difficult-to-differentiate memory clinic patients. While external validation is needed, their implementation within diagnostic support systems is promising.

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  • 158. Wandell, Per Erik
    et al.
    Carlsson, Axel Carl
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiovaskulär epidemiologi.
    Sundquist, Jan
    Johansson, Sven-Erik
    Bottai, Matteo
    Sundquist, Kristina
    Pharmacotherapy and mortality in atrial fibrillation: a cohort of men and women 75 years or older in Sweden2015Ingår i: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, nr 2, s. 232-238Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: atrial fibrillation (AF) is a common cardiovascular morbidity, not least among elderly people, and is treated with different classes of cardiovascular pharmacotherapies. Hypothesis: cardiovascular drugs may have a different impact on survival in elderly patients with AF in primary health care. Methods: a cohort of 3,020 men and 3,749 women aged a parts per thousand yen75 and diagnosed with AF were selected from 75 primary care centres in Sweden. Laplace regression was used with years to death of the first 10% of the participants as the outcome. Independent variables were prescribed cardiovascular drugs. Regression models were adjusted for a propensity score comprising age, cardiovascular co-morbidities, socio-economic factors and other cardiovascular pharmacotherapies. Results: overall, mortality was 18.2%. The main finding of this study was survival increases associated with anticoagulants versus no treatment and versus antiplatelets of 1.95 years (95% confidence interval (CI) 1.43-2.48) and 0.78 years (95% CI 0.38-1.18), respectively, and survival increases associated with thiazides and calcium channel blockers of 0.81 years (95% CI 0.43-1.18) and 0.83 years (95% CI 0.47-1.18), respectively, in men and women together (results from sex-adjusted models). Conclusion: our findings suggest that anticoagulants, thiazides and calcium channel blockers may lead to longer survival in elderly patients with AF.

  • 159. Watts, Joel C.
    et al.
    Condello, Carlo
    Stoehr, Jan
    Oehler, Abby
    Lee, Joanne
    DeArmond, Stephen J.
    Lannfelt, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Ingelsson, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Giles, Kurt
    Prusiner, Stanley B.
    Serial propagation of distinct strains of A beta prions from Alzheimer's disease patients2014Ingår i: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 111, nr 28, s. 10323-10328Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An increasing number of studies argues that self-propagating protein conformations (i.e., prions) feature in the pathogenesis of several common neurodegenerative diseases. Mounting evidence contends that aggregates of the amyloid-beta (A beta) peptide become self-propagating in Alzheimer's disease (AD) patients. An important characteristic of prions is their ability to replicate distinct strains, the biological information for which is enciphered within different conformations of protein aggregates. To investigate whether distinct strains of A beta prions can be discerned in AD patients, we performed transmission studies in susceptible transgenic mice using brain homogenates from sporadic or heritable (Arctic and Swedish) AD cases. Mice inoculated with the Arctic AD sample exhibited a pathology that could be distinguished from mice inoculated with the Swedish or sporadic AD samples, which was judged by differential accumulation of A beta isoforms and the morphology of cerebrovascular A beta deposition. Unlike Swedish AD- or sporadic AD-inoculated animals, Arctic AD-inoculated mice, like Arctic AD patients, displayed a prominent A beta 38-containing cerebral amyloid angiopathy. The divergent transmission behavior of the Arctic AD sample compared with the Swedish and sporadic AD samples was maintained during second passage in mice, showing that A beta strains are serially transmissible. We conclude that at least two distinct strains of A beta prions can be discerned in the brains of AD patients and that strain fidelity was preserved on serial passage in mice. Our results provide a potential explanation for the clinical and pathological heterogeneity observed in AD patients.

  • 160.
    Wiberg, Bernice
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Risk Factors for Stroke in Adult Men: A Population-based Study2010Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    In the last decades our knowledge concerning cardiovascular risk factors has grown rapidly through results from longitudinal studies. However, despite new treatment, in Western countries coronary heart disease remains the leading cause of death and stroke is still the leading cause of severe disability.

    The studies reported in these papers examine the relationships between stroke/transient ischaemic attack (TIA) and a number of different factors measured on two different occasions in men born in Uppsala 1920-1924 and are epidemiological in their character.

    The findings indicate that in addition to already established risk factors, indices of an unhealthy dietary fat intake and high serum lipoprotein(a) are independent predictors of stroke/TIA. Among different glucometabolic variables a low insulin sensitivity index derived from the euglycaemic insulin clamp and proinsulin carries a high predictive value for later stroke, independently of diabetes.

    Moreover, cognitive test performance measured with Trail Making Test B at age 70 is a strong and independent predictor of brain infarction, indicating that the risk is already increased in the subclinical phase of milder cognitive dysfunction. Performance at a pre-stroke Trail Making Test is also of predictive value for mortality after first-ever stroke/TIA, but none of the studied pre-stroke variables or cognitive tests was found to be related to dependency after an event.

    In summary these studies provide further knowledge about predictors of stroke and of mortality after first-ever stroke. They also indicate the possible importance of new markers of risk, such as the level of lipoprotein(a), profile of fatty acids in the diet, low insulin sensitivity derived from clamp investigations, level of proinsulin, and cognitive performance measured with Trail Making Tests.

     

    Delarbeten
    1. Metabolic risk factors for stroke and transient ischemic attacks in middle-aged men: a community-based study with long-term follow-up
    Öppna denna publikation i ny flik eller fönster >>Metabolic risk factors for stroke and transient ischemic attacks in middle-aged men: a community-based study with long-term follow-up
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    2006 (Engelska)Ingår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 37, nr 12, s. 2898-2903Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    BACKGROUND AND PURPOSE: The impact of lipometabolic and glucometabolic disturbances on stroke incidence remains to be characterized in detail. We investigated relations of a comprehensive panel of baseline lipometabolic and glucometabolic variables to incident fatal and nonfatal stroke or transient ischemic attack (TIA), and stroke subtypes. METHODS: A community-based prospective study of 2313 middle-aged men invited to a health survey at age 50. RESULTS: During a follow-up of up to 32 years, 421 developed stroke or TIA. In Cox proportional hazards analyses adjusting for treatment with cardiovascular drugs at baseline, 1-standard deviation increases in body mass index, systolic and diastolic blood pressures, serum proinsulin, and lipoprotein(a) were associated with 11 to 35% increased risk for subsequent stroke/TIA. Electrocardiographic left ventricular hypertrophy and smoking were also associated with a higher risk for stroke/TIA. Essentially the same variables were related to brain infarction/TIA. Higher proportions of palmitic (16:0), palmitoleic (16:1), and oleic acid (18:1) in cholesterol esters were associated with an increased risk, whereas a higher proportion of linoleic acid (18:2 n-6) was protective against stroke/TIA. Further adjusting all models also for hypertension, diabetes, the metabolic syndrome, serum cholesterol, atrial fibrillation, cardiovascular disease, smoking, and physical activity, essentially the same pattern was observed. CONCLUSIONS: Indices of an unhealthy dietary fat intake and a high serum lipoprotein (a) level predicted fatal and nonfatal stroke/TIA independently of established risk factors in a community-based sample of middle-aged men followed for 32 years.

    Nyckelord
    fatty acids, lipoproteins, risk factors, stroke
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-18469 (URN)10.1161/01.STR.0000249056.24657.8b (DOI)000243411500018 ()17053177 (PubMedID)
    Tillgänglig från: 2006-12-21 Skapad: 2006-12-21 Senast uppdaterad: 2017-12-08Bibliografiskt granskad
    2. Insulin sensitivity measured by the euglycaemic insulin clamp and proinsulin levels as predictors of stroke in elderly men
    Öppna denna publikation i ny flik eller fönster >>Insulin sensitivity measured by the euglycaemic insulin clamp and proinsulin levels as predictors of stroke in elderly men
    2009 (Engelska)Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 52, nr 1, s. 90-6Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIMS/HYPOTHESIS: Our aim was to investigate the predictive power of a panel of variables in glucose and insulin metabolism for the incidence of stroke or transient ischaemic attacks (TIA). We hypothesised that proinsulin and insulin resistance contributes to an increase of risk for fatal and non-fatal stroke/TIA, independently of diabetes and established risk factors. METHODS: The study is based on the Uppsala Longitudinal Study of Adult Men cohort. The examinations were performed at age 70 years. RESULTS: In 1,151 men free from stroke at baseline, 150 developed stroke or TIA during a median follow-up of 8.8 years. In unadjusted Cox proportional hazards analyses, a 1 SD increase of a predictor variable was associated with an increased risk for stroke/TIA, e.g. plasma insulin (HR 1.19, 95% CI 1.01-1.40), fasting intact proinsulin (HR 1.28, 95% CI 1.09-1.49); whereas a 1 SD increase in insulin sensitivity measured by the euglycaemic insulin clamp method decreased the risk for stroke/TIA (HR 0.81, 95% CI 0.68-0.96). The predictive values of fasting intact proinsulin and insulin sensitivity endured but not that of plasma insulin when adjusting for diabetes. In models adjusting for diabetes, hypertension, atrial fibrillation, electrocardiographic left ventricular hypertrophy, serum cholesterol and smoking, proinsulin remained as a significant predictor of later stroke/TIA (HR 1.22, 95% CI 1.00-1.48) whereas clamp insulin sensitivity did not (HR 0.87, 95% CI 0.71-1.07). CONCLUSIONS/INTERPRETATION: Fasting intact proinsulin level and insulin sensitivity at clamp predicted subsequent fatal and non-fatal stroke/TIA, independently of diabetes in elderly men whereas fasting insulin did not.

    Nyckelord
    Clamp, Insulin resistance, Proinsulin, Risk factors, Stroke
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-103482 (URN)10.1007/s00125-008-1171-0 (DOI)000261375400014 ()18949454 (PubMedID)
    Tillgänglig från: 2009-05-19 Skapad: 2009-05-19 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    3. Cognitive function and risk of stroke in elderly men
    Öppna denna publikation i ny flik eller fönster >>Cognitive function and risk of stroke in elderly men
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    2010 (Engelska)Ingår i: Neurology, ISSN 0028-3878, E-ISSN 1526-632X, Vol. 74, nr 5, s. 379-385Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: Vascular risk factors are associated with ischemic changes in the cerebral white matter. We studied the predictive value of cognitive test performance especially related to subcortico-frontal pathways, together with a cognitive screening test, for later incidence of fatal or nonfatal stroke or TIAs and stroke subtypes. METHODS: A sample of 930 70-year-old men without previous stroke/TIA from the community-based Uppsala Longitudinal Study of Adult Men was investigated at baseline using Trail Making Tests (TMT) A and B and the Mini-Mental State Examination (MMSE). RESULTS: During up to 13 years of follow-up, 166 men developed a stroke or TIA; 105 participants had a brain infarction. In Cox proportional hazards analyses adjusting for education, social group, and traditional cardiovascular risk factors, a 1-SD increase in TMT-B time was associated with a higher risk for brain infarction (hazard ratio 1.48, 95% confidence interval 1.11-1.97). The risk of brain infarction was more than threefold higher in the highest (TMT-B = 146-240 s) compared to the lowest (TMT-B = 43-84 s) TMT-B quartile. TMT-A and MMSE results were not consistently related to stroke outcomes. CONCLUSION: Impaired performance in elderly men measured by Trail Making Test B, a cognitive test especially reflecting subcortico-frontal activities, was an independent predictor of subsequent brain infarction in this community-based sample of elderly men. Our results extend previous findings of cognitive decline as an independent predictor of stroke and indicate that the risk of brain infarction is increased already in the subclinical phase of cognitive deficit.

    Nationell ämneskategori
    Medicin och hälsovetenskap
    Identifikatorer
    urn:nbn:se:uu:diva-123000 (URN)10.1212/WNL.0b013e3181ccc516 (DOI)000274154000006 ()20124202 (PubMedID)
    Tillgänglig från: 2010-04-22 Skapad: 2010-04-22 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
    4. Cognitive Function Prior to Stroke is a Risk Factor for Post-Stroke Mortality but Not Dependency
    Öppna denna publikation i ny flik eller fönster >>Cognitive Function Prior to Stroke is a Risk Factor for Post-Stroke Mortality but Not Dependency
    Visa övriga...
    (Engelska)Artikel i tidskrift (Övrigt vetenskapligt) Submitted
    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:uu:diva-120536 (URN)
    Tillgänglig från: 2010-03-12 Skapad: 2010-03-12 Senast uppdaterad: 2018-08-24
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    FULLTEXT01
  • 161.
    Willem, Michael
    et al.
    Univ Munich, Biomed Ctr BMC, D-81377 Munich, Germany..
    Tahirovic, Sabina
    German Ctr Neurodegenerat Dis DZNE Munich, D-81377 Munich, Germany..
    Busche, Marc Aurel
    Tech Univ Munich, Dept Psychiat & Psychotherapy, D-81675 Munich, Germany.;Tech Univ Munich, Inst Neurosci, D-80802 Munich, Germany.;Univ Munich, Munich Cluster Syst Neurol SyNergy, D-81377 Munich, Germany..
    Ovsepian, Saak V.
    German Ctr Neurodegenerat Dis DZNE Munich, D-81377 Munich, Germany..
    Chafai, Magda
    Univ Nice Sophia Antipolis, UMR 7275, CNRS, IPMC, F-06560 Valbonne, France..
    Kootar, Scherazad
    Univ Nice Sophia Antipolis, UMR 7275, CNRS, IPMC, F-06560 Valbonne, France..
    Hornburg, Daniel
    Max Planck Inst Biochem, D-82152 Martinsried, Germany..
    Evans, Lewis D. B.
    Univ Cambridge, Gurdon Inst, Cambridge Stem Cell Inst, Cambridge CB2 1QN, England.;Univ Cambridge, Dept Biochem, Cambridge CB2 1QN, England..
    Moore, Steven
    Univ Cambridge, Gurdon Inst, Cambridge Stem Cell Inst, Cambridge CB2 1QN, England.;Univ Cambridge, Dept Biochem, Cambridge CB2 1QN, England..
    Daria, Anna
    Univ Munich, Biomed Ctr BMC, D-81377 Munich, Germany..
    Hampel, Heike
    Univ Munich, Biomed Ctr BMC, D-81377 Munich, Germany..
    Mueller, Veronika
    Univ Munich, Biomed Ctr BMC, D-81377 Munich, Germany..
    Giudici, Camilla
    Univ Munich, Biomed Ctr BMC, D-81377 Munich, Germany..
    Nuscher, Brigitte
    Univ Munich, Biomed Ctr BMC, D-81377 Munich, Germany..
    Wenninger-Weinzierl, Andrea
    German Ctr Neurodegenerat Dis DZNE Munich, D-81377 Munich, Germany..
    Kremmer, Elisabeth
    German Ctr Neurodegenerat Dis DZNE Munich, D-81377 Munich, Germany.;Univ Munich, Munich Cluster Syst Neurol SyNergy, D-81377 Munich, Germany.;German Res Ctr Environm Hlth, Inst Mol Immunol, D-81377 Munich, Germany..
    Heneka, Michael T.
    Univ Bonn, Clin Neurosci Unit, Dept Neurol, D-53127 Bonn, Germany.;German Ctr Neurodegenerat Dis DZNE Bonn, D-53175 Bonn, Germany..
    Thal, Dietmar R.
    Univ Ulm, Inst Pathol, Neuropathol Lab, D-89081 Ulm, Germany..
    Giedraitis, Vilmantas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Lannfelt, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Mueller, Ulrike
    Heidelberg Univ, Funct Genom, Inst Pharm & Mol Biotechnol IPMB, D-69120 Heidelberg, Germany..
    Livesey, Frederick J.
    Univ Cambridge, Gurdon Inst, Cambridge Stem Cell Inst, Cambridge CB2 1QN, England.;Univ Cambridge, Dept Biochem, Cambridge CB2 1QN, England..
    Meissner, Felix
    Max Planck Inst Biochem, D-82152 Martinsried, Germany..
    Herms, Jochen
    German Ctr Neurodegenerat Dis DZNE Munich, D-81377 Munich, Germany..
    Konnerth, Arthur
    Tech Univ Munich, Inst Neurosci, D-80802 Munich, Germany.;Univ Munich, Munich Cluster Syst Neurol SyNergy, D-81377 Munich, Germany..
    Marie, Helene
    Univ Nice Sophia Antipolis, UMR 7275, CNRS, IPMC, F-06560 Valbonne, France..
    Haass, Christian
    Univ Munich, Biomed Ctr BMC, D-81377 Munich, Germany.;German Ctr Neurodegenerat Dis DZNE Munich, D-81377 Munich, Germany.;Univ Munich, Munich Cluster Syst Neurol SyNergy, D-81377 Munich, Germany..
    eta-Secretase processing of APP inhibits neuronal activity in the hippocampus2015Ingår i: Nature, ISSN 0028-0836, E-ISSN 1476-4687, Vol. 526, nr 7573, s. 443-447Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Alzheimer disease (AD) is characterized by the accumulation of amyloid plaques, which are predominantly composed of amyloid-beta peptide(1). Two principal physiological pathways either prevent or promote amyloid-beta generation from its precursor, beta-amyloid precursor protein (APP), in a competitive manne(r)1. Although APP processing has been studied in great detail, unknown proteolytic events seem to hinder stoichiometric analyses of APP metabolism in vivo(2). Here we describe a new physiological APP processing pathway, which generates proteolytic fragments capable of inhibiting neuronal activity within the hippocampus. We identify higher molecular mass carboxy-terminal fragments (CTFs) of APP, termed CTF-eta, in addition to the long-known CTF-alpha and CTF-beta fragments generated by the alpha- and beta-secretases ADAM10 (a disintegrin and metalloproteinase 10) and BACE1 (beta-site APP cleaving enzyme 1), respectively. CTF-eta generation is mediated in part by membrane-bound matrix metalloproteinases such as MT5-MMP, referred to as g-secretase activity. g-Secretase cleavage occurs primarily at amino acids 504-505 of APP(695), releasing a truncated ectodomain. After shedding of this ectodomain, CTF-eta is further processed by ADAM10 and BACE1 to release long and short A eta peptides (termed A eta-alpha and A eta-beta). CTFs produced by g-secretase are enriched in dystrophic neurites in an AD mouse model and in human AD brains. Genetic and pharmacological inhibition of BACE1 activity results in robust accumulation of CTF-eta and A eta-alpha. In mice treated with a potent BACE1 inhibitor, hippocampal long-term potentiation was reduced. Notably, when recombinant or synthetic A eta-alpha was applied on hippocampal slices ex vivo, long-term potentiation was lowered. Furthermore, in vivo single-cell two-photon calcium imaging showed that hippocampal neuronal activity was attenuated by A eta-alpha. These findings not only demonstrate a major functionally relevant APP processing pathway, but may also indicate potential translational relevance for therapeutic strategies targeting APP processing.

  • 162.
    Wimo, A
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg.
    Ballard, C
    Brayne, C
    Gauthier, S
    Handels, R
    Jones, R W
    Jonsson, L
    Khachaturian, A S
    Kramberger, M
    Health economic evaluation of treatments for Alzheimer's disease: impact of new diagnostic criteria2014Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 275, nr 3, s. 304-316Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The socio-economic impact of Alzheimer's disease (AD) and other dementias is enormous, and the potential economic challenges ahead are clear given the projected future numbers of individuals with these conditions. Because of the high prevalence and cost of dementia, it is very important to assess any intervention from a cost-effectiveness viewpoint. The diagnostic criteria for preclinical AD suggested by the National Institute on Aging and Alzheimer's Association workgroups in combination with the goal of effective disease-modifying treatment (DMT) are, however, a challenge for clinical practice and for the design of clinical trials. Key issues for future cost-effectiveness studies include the following: (i) the consequences for patients if diagnosis is shifted from AD-dementia to predementia states, (ii) bridging the gap between clinical trial populations and patients treated in clinical practice, (iii) translation of clinical trial end-points into measures that are meaningful to patients and policymakers/payers and (iv) how to measure long-term effects. To improve cost-effectiveness studies, long-term population-based data on disease progression, costs and outcomes in clinical practice are needed not only in dementia but also in predementia states. Reliable surrogate end-points in clinical trials that are sensitive to detect effects even in predementia states are also essential as well as robust and validated modelling methods from predementia states that also take into account comorbidities and age. Finally, the ethical consequences of early diagnosis should be considered.

  • 163.
    Winblad, Ulrika
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning. Brown Univ, Providence, RI 02912 USA..
    McHugh, J.
    Brown Univ, Providence, RI 02912 USA..
    Shield, R.
    Brown Univ, Providence, RI 02912 USA..
    Gadbois, E.
    Brown Univ, Providence, RI 02912 USA..
    Tyler, D. A.
    Brown Univ, Providence, RI 02912 USA..
    How Do Hospitals That Are Part Of ACOS Lower Readmission Rates?2016Konferensbidrag (Refereegranskat)
  • 164.
    Wleklik, M
    et al.
    Wroclaw Med Univ, Wroclaw, Lower Silesia, Poland.
    Uchmanowicz, I
    Wroclaw Med Univ, Wroclaw, Lower Silesia, Poland.
    Jankowska-Polańska, B
    Wroclaw Med Univ, Wroclaw, Lower Silesia, Poland.
    Andreae, Christina
    Wroclaw Med Univ, Wroclaw, Lower Silesia, Poland.
    Regulska-Ilow, B
    Wroclaw Med Univ, Wroclaw, Lower Silesia, Poland.
    The Role of Nutritional Status in Elderly Patients with Heart Failure2018Ingår i: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 22, nr 5, s. 581-588Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Evidence indicates that malnutrition very frequently co-occurs with chronic heart failure (HF) and leads to a range of negative consequences. Studies show associations between malnutrition and wound healing disorders, an increased rate of postoperative complications, and mortality. In addition, considering the increasing age of patients with HF, a specific approach to their treatment is required. Guidelines proposed by the European Society of Cardiology (ESC) for treating acute and chronic HF refer to the need to monitor and prevent malnutrition in HF patients. However, the guidelines feature no strict nutritional recommendations for HF patients, who are at high nutritional risk as a group, nor do they offer any such recommendations for the poor nutritional status subgroup, for which high morbidity and mortality rates have been observed. In the context of multidisciplinary healthcare, recommended by the ESC and proven by research to offer multifaceted benefits, nutritional status should be systematically assessed in HF patients. Malnutrition has become a challenge within healthcare systems and day-to-day clinical practice, especially in developed countries, where it affects the course of disease and patients' prognosis.

  • 165.
    Zanchi, Davide
    et al.
    Univ Basel, Dept Psychiat, Basel, Switzerland.;Univ Psychiat Clin, Dept Neuropsychiat, Basel, Switzerland..
    Giannakopoulos, Panteleimon
    Univ Geneva, Fac Med, Dept Psychiat, Geneva, Switzerland..
    Borgwardt, Stefan
    Univ Basel, Dept Psychiat, Basel, Switzerland..
    Rodriguez, Cristelle
    Univ Geneva, Fac Med, Dept Psychiat, Geneva, Switzerland..
    Haller, Sven
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi. Affidea Carouge Radiol Diagnost Ctr, Geneva, Switzerland.;Univ Hosp Freiburg, Dept Neuroradiol, Freiburg, Germany.;Univ Geneva, Fac Med, Dept Neuroradiol, Geneva, Switzerland..
    Hippocampal and Amygdala Gray Matter Loss in Elderly Controls with Subtle Cognitive Decline2017Ingår i: Frontiers in Aging Neuroscience, ISSN 1663-4365, E-ISSN 1663-4365, Vol. 9, artikel-id 50Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In contrast to the idea that hippocampal and amygdala volume loss occur in late phases of neurodegeneration, recent contributions point to the relevance of preexisting structural deficits that are associated with aging and are independent of amyloid deposition in preclinical Alzheimer disease cases. The present work explores GM hippocampal and amygdala volumes in elderly controls displaying the first signs of cognitive decline. 455 subjects (263 females), including 374 controls (228 females) and 81 middle cognitive impairment subjects (35 females), underwent two neuropsychological evaluations (baseline and 18 months follow-up) and a MRI-T1 examination (only baseline). Clinical assessment included Mini-Mental State Examination (MMSE), Clinical Dementia Rating scale, Hospitalized Anxiety and Depression scale, the Consortium to Establish a Registry for Alzheimer's Disease neuropsychological battery and RI-48 Cued Recall Test (RI-48) for episodic memory. Based on their cognitive performance, we defined the controls as stable controls (sCON) and deteriorating controls (dCONs). Analyses included volumetric assessment, shape analyses and linear regressions between GM volume loss and differences in clinical scores between baseline and follow-up. Significant GM volume decrease in hippocampus bilaterally and right amygdala was found in dCON compared to sCON (p < 0.05). Lower right amygdala volumes were measured in mild cognitive impairment (MCI) compared to sCON (p < 0.05). Shape analyses revealed that atrophy was more pronounced at the superior-posterior lateral side of the hippocampus and amygdala. Significant correlations were found between GM volume of left hippocampus and the delta of MMSE and RI-48 scores in dCON and MCI groups separately. Decreased hippocampal and right amygdala volumes precede the first signs of cognitive decline in healthy elderly controls at the pre-MCI state. Left hippocampus volume may also predict short-term changes of overall cognition in these vulnerable cases.

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    fulltext
  • 166.
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Kapitel 11: Fetma och övervikt2009Ingår i: Diabetes / [ed] Carl-David Agardh, Christian Berne, Stockholm: Liber , 2009, 4. uppl., s. 114-126Kapitel i bok, del av antologi (Övrig (populärvetenskap, debatt, mm))
  • 167.
    Åberg, Anna Cristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Gender comparisons of function-related dependence pain and insecurity in geriatric rehabilitation2006Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 38, nr 1, s. 73-79Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate possible gender differences regarding the effect of intervention in geriatric rehabilitation, expressed in terms of change in function-related dependence, pain and insecurity. DESIGN: Comparative study. PARTICIPANTS: A total of 110 women and 44 men undergoing geriatric rehabilitation. METHODS: Performance-based assessments with use of the General Motor Function assessment scale. Non-parametric statistics were mainly used. RESULTS: The women showed higher degrees of function-related dependence, pain and insecurity on admission than the men. Both women and men displayed significant improvement in all 3 variables during the rehabilitation period. However, the positive changes regarding pain and insecurity were according to the analyses of systematic group changes, at a low degree among the men, probably because of the low levels on admission. Gender comparisons of proportions with positive intervention outcome indicated that a significantly larger proportion of the women showed a positive treatment effect after intervention, with a difference in recovery of 19% in dependence, 23% in pain and 33% in insecurity (p<0.05). CONCLUSIONS: Gender differences in disability, with higher degrees of function-related dependence, pain and insecurity among women on admission for geriatric rehabilitation, can be diminished during the rehabilitation period. These promising results may have relevance for the public health of the elderly population.

  • 168.
    Åberg, Anna Cristina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Ehrenberg, Anna
    Dalarna Univ, Sch Educ Hlth & Social Studies, S-79188 Falun, Sweden.;Orebro Univ, Sch Hlth Sci, Orebro, Sweden..
    Inpatient geriatric care in Sweden-Important factors from an inter-disciplinary team perspective2017Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 72, s. 113-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care: Interactive assessment processes, A holistic care approach, and Proactive non-hierarchical interaction. Aspects of Time and Goal-Orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment - which is possibly best provided by older-friendly hospitals - appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area.

  • 169.
    Åberg, Anna Cristina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Sidenvall, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Hepworth, Mike
    O'Reilly, Karen
    Lithell, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    On loss of activity and independence, adaptation improves life satisfaction in old age: a qualitative study of patients' perceptions2005Ingår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 14, nr 4, s. 1111-1125Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose was to improve the understanding of factors are perceived by elderly people as important for their life satisfaction, during and after rehabilitation. Fifteen persons aged 80-94 years were interviewed while in hospital and on two follow-up occasions after discharge. Assessment of motor function using the General Motor Function assessment scale was used for descriptive purposes. Three themes emerged as important for life satisfaction: activity, independence and adaptation. Activity and independence were considered significant for life satisfaction. Basic activity preferences were related to care of one's own body and to social contacts. Control and influence over help and services were regarded as important. Different strategies for adaptation to the consequences of disease were used: reorganisation, interaction with caregivers, mental adaptation and mental activities (used as pastime and escape). Those with declined motor functions limited their activity preferences. A key finding was that pleasant past memories were actively recalled in an effort to achieve current life satisfaction. This adaptation strategy created a sense of life satisfaction, however with a potential risk for concealing dissatisfaction with conditions that might otherwise be correctable. Strategies for improving life satisfaction among old people in rehabilitation are suggested.

  • 170.
    Åhman, Hanna Bozkurt
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Giedraitis, Vilmantas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Cedervall, Ylva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Lennhed, Bjorn
    Falu Lasarett, Dept Geriatr & Rehabil Med, Falun, Sweden.
    Berglund, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    McKee, Kevin
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Kilander, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. Uppsala Univ, Dept Publ Hlth & Caring Sci, Box 564, SE-75122 Uppsala, Sweden.
    Rosendahl, Erik
    Umea Univ, Dept Community Med & Rehabil, Umea, Sweden.
    Ingelsson, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. Uppsala Univ, Dept Publ Hlth & Caring Sci, Box 564, SE-75122 Uppsala, Sweden.
    Åberg, Anna Cristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden.
    Dual-Task Performance and Neurodegeneration: Correlations Between Timed Up-and-Go Dual-Task Test Outcomes and Alzheimer's Disease Cerebrospinal Fluid Biomarkers2019Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 71, s. S75-S83Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Tools to identify individuals at preclinical stages of dementia disorders are needed to enable early interventions. Alterations in dual-task performance have been detected early in progressive neurodegenerative disorders. Hence, dual-task testing may have the potential to screen for cognitive impairment caused by neurodegeneration. Exploring correlations between dual-task performance and biomarkers of neurodegeneration is therefore of interest. Objective: To investigate correlations between Timed Up-and-Go dual-task (TUGdt) outcomes and Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers amyloid-beta 42 (A beta(42)), total tau (t-tau), and phosphorylated tau (p-tau). Methods: This cross-sectional cohort study included 90 participants (age range 49-84 years) undergoing memory assessment, who were subsequently diagnosed with AD, other dementia disorders, mild cognitive impairment, or subjective cognitive impairment. TUG combined with "Naming Animals" (TUGdt NA) and "Months Backwards" (TUGdt MB), respectively, were used to assess dual-task performance. The number of correct words and time taken to complete the tests were measured. The CSF biomarkers were analysed by ELISA. Spearman's rank correlation was used for analyses between TUGdt outcomes (TUGdt NA and TUGdt MB), and CSF biomarkers, adjusted for age, gender, and educational level. Results: The number of correct words, as well as the number of correct words/10 s during TUGdt NA correlated negatively to CSF t-tau and p-tau. No correlations were found between any time scores and CSF biomarkers. Conclusion: The correlations between TUGdt NA and t-tau and p-tau may indicate that neurodegeneration affects dual-task performance. Longitudinal studies are needed to further explore dual-task testing in screening for cognitive impairment due to neurodegeneration.

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