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  • 51.
    Franzon, Kristin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Byberg, Liisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Sjögren, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. Med Prod Agcy, Uppsala, Sweden.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Kilander, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Predictors of Independent Aging and Survival: A 16-Year Follow-Up Report in Octogenarian Men2017Ingår i: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 65, nr 9, s. 1953-1960Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To examine the longitudinal associations between aging with preserved functionality, i.e. independent aging and survival, and lifestyle variables, dietary pattern and cardiovascular risk factors.

    DESIGN: Cohort study.

    SETTING: Uppsala Longitudinal Study of Adult Men, Sweden.

    PARTICIPANTS: Swedish men (n = 1,104) at a mean age of 71 (range 69.4-74.1) were investigated, 369 of whom were evaluated for independent aging 16 years later, at a mean age of 87 (range 84.8-88.9).

    MEASUREMENTS: A questionnaire was used to obtain information on lifestyle, including education, living conditions, and physical activity. Adherence to a Mediterranean-like diet was assessed according to a modified Mediterranean Diet Score derived from 7-day food records. Cardiovascular risk factors were measured. Independent aging at a mean age of 87 was defined as lack of diagnosed dementia, a Mini-Mental State Examination score of 25 or greater, not institutionalized, independence in personal activities of daily living, and ability to walk outdoors alone. Complete survival data at age 85 were obtained from the Swedish Cause of Death Register.

    RESULTS: Fifty-seven percent of the men survived to age 85, and 75% of the participants at a mean age of 87 displayed independent aging. Independent aging was associated with never smoking (vs current) (odds ratio (OR) = 2.20, 95% confidence interval (CI) = 1.05-4.60) and high (vs low) adherence to a Mediterranean-like diet (OR = 2.69, 95% CI = 1.14-6.80). Normal weight or overweight and waist circumference of 102 cm or less were also associated with independent aging. Similar associations were observed with survival.

    CONCLUSION: Lifestyle factors such as never smoking, maintaining a healthy diet, and not being obese at age 71 were associated with survival and independent aging at age 85 and older in men.

  • 52.
    Franzon, Kristin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Zethelius, Bjorn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Kilander, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Modifiable Midlife Risk Factors, Independent Aging, and Survival in Older Men: Report on Long-Term Follow-Up of the Uppsala Longitudinal Study of Adult Men Cohort2015Ingår i: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 63, nr 5, s. 877-885Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    ObjectivesTo examine relationships between modifiable midlife factors, aging, and physical and cognitive function (independent aging) and survival in very old age. DesignProspective cohort. SettingUppsala Longitudinal Study of Adult Men, Uppsala, Sweden. ParticipantsSwedish men investigated in 1970-74 (aged 48.6-51.1) and followed up for four decades (N=2,293). MeasurementsConventional cardiovascular risk factors, body mass index (BMI), and dietary biomarkers were measured, and a questionnaire was used to gather information on lifestyle variables at age 50. Four hundred seventy-two men were reinvestigated in 2008-09 (aged 84.8-88.9). Independent aging was defined as survival to age 85, Mini-Mental State Examination score of 25 or greater, not living in an institution, independent in personal care and hygiene, able to walk outdoors without personal help, and no diagnosis of dementia. The National Swedish Death Registry provided survival data. ResultsThirty-eight percent of the cohort survived to age 85. Seventy-four percent of the participants in 2008-09 were aging independently. In univariable analyses, high leisure-time physical activity predicted survival but not independent aging. Low work-time physical activity was associated more strongly with independent aging (odds ratio (OR)=1.84, 95% confidence interval (CI)=1.18-2.88) than with survival (OR=1.27, 95% CI=1.05-1.52). In multivariable analyses, midlife BMI was negatively associated (OR=0.80/SD, 95% CI=0.65-0.99/SD), and never or former smoking was positively associated (OR=1.66, 95% CI=1.07-2.59), with independent aging. As expected, conventional cardiovascular and lifestyle risk factors were associated with mortality. ConclusionA normal midlife BMI and not smoking were associated with independent aging close to four decades later, indicating that normal weight at midlife has the potential not only to increase survival, but also to preserve independence with aging.

  • 53.
    Franzon, Kristin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Zethelius, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Kilander, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    The impact of muscle function, muscle mass and sarcopenia on independent ageing in very old Swedish men2019Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, artikel-id 153Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Preserved functions of daily life and cognition are cornerstones of independent aging, which is crucial for maintaining a high quality of life. The aim of this study was to examine the impact of sarcopenia, and its underlying components, on independent ageing in a cohort study of very old men.

    Methods The presence of sarcopenia and independent ageing at a mean age of 87 was investigated in 287 men from the Uppsala Longitudinal Study of Adult Men. Five years later 127 men were re-evaluated for independent ageing. Sarcopenia was defined by two different definitions from the European Working Group on Sarcopenia in Older People. In the first definition sarcopenia was defined as skeletal muscle index < 7.26 kg/m2 and either gait speed ≤0.8 m/s or hand grip strength < 30 kg. In the later up-dated definition, HGS < 27 kg and/or chair stand test > 15 s defines probable sarcopenia, which is confirmed by SMI < 7.0 kg/m2. Independent ageing was defined as a Mini-Mental State Examination score of ≥25 points, absence of diagnosed dementia, community-dwelling, independency in personal care and ability to walk outdoors alone.

    Results Sarcopenia at baseline was observed in 21% (60/287) and 20% (58/287), respectively, due to definition. The prevalence of independent ageing was 83% (239/288) at baseline and 69% (87/127) five years later. None of the sarcopenia diagnoses were associated with independent ageing. In contrast, gait speed was both in cross-sectional (odds ratio (OR) per one standard deviation increase 2.15, 95% confidence interval (CI) 1.47–3.15), and in longitudinal multivariate analyses (OR 1.84, 95% CI 1.19–2.82). In the cross-sectional analysis also higher hand grip strength was associated with independent ageing (OR 1.58, 95% CI 1.12–2.22), while a slower chair stand test was inversely associated (OR 0.61, 95% CI 0.43–0.86). Muscle mass; i.e. skeletal muscle index, was not associated with independent ageing.

    Conclusions For very old men, especially a higher gait speed, but also a higher hand grip strength and a faster chair stand test, were associated with independent ageing, while skeletal muscle index alone, and the composite sarcopenia phenotype measured with two different definitions, were not.

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  • 54.
    Giannakopoulos, Panteleimon
    et al.
    Univ Geneva, Dept Psychiat, Geneva, Switzerland.;Geneva Univ Hosp, Med Direct, Geneva, Switzerland..
    Rodriguez, Cristelle
    Univ Geneva, Dept Psychiat, Geneva, Switzerland.;Geneva Univ Hosp, Med Direct, Geneva, Switzerland..
    Montandon, Marie-Louise
    Univ Geneva, Dept Psychiat, Geneva, Switzerland.;Geneva Univ Hosp, Med Direct, Geneva, Switzerland.;Geneva Univ Hosp, Dept Rehabil & Geriatr, Geneva, Switzerland.;Univ Geneva, Geneva, Switzerland..
    Garibotto, Valentina
    Geneva Univ Hosp, Diagnost Dept, Div Nucl Med & Mol Imaging, Geneva, Switzerland.;Univ Geneva, Fac Med, Geneva, Switzerland..
    Haller, Sven
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi. Univ Geneva, Fac Med, Geneva, Switzerland.;CIRD, Geneva, Switzerland.
    Herrmann, Francois R.
    Geneva Univ Hosp, Dept Rehabil & Geriatr, Geneva, Switzerland.;Univ Geneva, Geneva, Switzerland..
    Less agreeable, better preserved?: A PET amyloid and MRI study in a community-based cohort2020Ingår i: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 89, s. 24-31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The relationship between personality profiles and brain integrity in old age is still a matter of debate. We examined the association between Big Five factor and facet scores and MRI brain volume changes on a 54-month follow-up in 65 elderly controls with 3 neurocognitive assessments (baseline, 18 months, and 54 months), structural brain MRI (baseline and 54 months), brain amyloid PET during follow-up, and APOE genotyping. Personality was assessed with the Neuroticism Extraversion Openness Personality Inventory-Revised. Regression models were used to identify predictors of volume loss including time, age, sex, personality, amyloid load, presence of APOE epsilon 4 allele, and cognitive evolution. Lower agreeableness factor scores (and 4 of its facets) were associated with lower volume loss in the hippocampus, entorhinal cortex, amygdala, mesial temporal lobe, and precuneus bilaterally. Higher openness factor scores (and 2 of its facets) were also associated with lower volume loss in the left hippocampus. Our findings persisted when adjusting for confounders in multivariable models. These data suggest that the combination of low agreeableness and high openness is an independent predictor of better preservation of brain volume in areas vulnerable to neurodegeneration. (C) 2020 Elsevier Inc. All rights reserved.

  • 55. Giron, Maria Stella T
    et al.
    Forsell, Yvonne
    Bernsten, Cecilia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälso- och sjukvårdsforskning.
    Thorslund, Mats
    Winblad, Bengt
    Fastbom, Johan
    Sleep problems in a very old population: drug use and clinical correlates2002Ingår i: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 57, nr 4, s. M236-40Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. Complaints of disturbed or dissatisfied sleep are common among older people. This study aimed to evaluate the prevalence of sleep problems in very old persons and its relation to physical and mental health and drug use.

    Methods. This is a cross-sectional analysis of sleep problems in a population of old persons living in Stockholm, Sweden. There were 641 subjects aged 81+ years; 77.8% were women, 91.4% were noninstitutionalized, and 68.6% lived alone. All persons underwent a comprehensive medical and psychiatric interview and examination. Sleep problems were assessed using the Clinical Psychopathological Rating Scale (CPRS). Covariates included chronic medical conditions, depression, dementia, pain, self-rated health, activities of daily living, use of hypnotics-sedatives, use of other psychotropic drugs, and use of nonpsychotropic drugs.

    Results. More than one third of subjects were identified with sleep problems. They were more common among women and persons using a higher number of drugs. Poor self-rated health, depression, and pain were related to the presence of sleep problems. Among persons with sleep problems and depression, only 19.2% used antidepressants, and 46.2% used hypnotics-sedatives. Among persons with sleep problems and pain, 63.2% used analgesics, and 47.0% used hypnotics-sedatives. One or more chronic diseases, use of hypnotics-sedatives, use of other psychotropic drugs, and use of nonpsychotropic drugs were also related to sleep problems. After multivariate analysis, factors significantly related to sleep problems were female gender, depression, pain, and hypnotic-sedative use.

    Conclusions. Sleep problems were common in this very old population. These results suggest the importance of carefully assessing an older person's complaints to accurately diagnose and effectively treat sleep problems.

  • 56.
    Grosicki, Gregory J.
    et al.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA;Georgia Southern Univ, Dept Hlth Sci & Kinesiol, Biodynam & Human Performance Ctr, Armstrong Campus,11935 Abercorn St, Savannah, GA 31419 USA.
    Barrett, B. B.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Englund, D. A.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Liu, C.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Travison, T. G.
    Hebrew SeniorLife, Marcus Inst Aging Res, Boston, MA USA;Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02115 USA.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Koochek, Afsaneh
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    von Berens, Åsa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Gustafsson, T.
    Karolinska Inst, Dept Lab Med, Div Clin Physiol, Stockholm, Sweden.
    Benard, T.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Reid, K. F.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Fielding, R. A.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.
    Circulating Interleukin-6 is Associated with Skeletal Muscle Strength, Quality, and Functional Adaptation with Exercise Training in Mobility-Limited Older Adults2020Ingår i: JOURNAL OF FRAILTY & AGING, ISSN 2260-1341, Vol. 9, nr 1, s. 57-63Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Human aging is characterized by a chronic, low-grade inflammation suspected to contribute to reductions in skeletal muscle size, strength, and function. Inflammatory cytokines, such as interleukin-6 (IL-6), may play a role in the reduced skeletal muscle adaptive response seen in older individuals.

    Objectives: To investigate relationships between circulating IL-6, skeletal muscle health and exercise adaptation in mobility-limited older adults.

    Design: Randomized controlled trial.

    Setting: Exercise laboratory on the Health Sciences campus of an urban university.

    Participants: 99 mobility-limited (Short Physical Performance Battery (SPPB) <= 9) older adults.

    Intervention: 6-month structured physical activity with or without a protein and vitamin D nutritional supplement.

    Measurements: Circulating IL-6, skeletal muscle size, composition (percent normal density muscle tissue), strength, power, and specific force (strength/CSA) as well as physical function (gait speed, stair climb time, SPPB-score) were measured pre- and post-intervention.

    Results: At baseline, Spearman's correlations demonstrated an inverse relationship (P<0.05) between circulating IL-6 and thigh muscle composition (r = -0.201), strength (r = -0.311), power (r = -0.210), and specific force (r = -0.248), and positive association between IL-6 and stair climb time (r = 0.256; P<0.05). Although the training program did not affect circulating IL-6 levels (P=0.69), reductions in IL-6 were associated with gait speed improvements (r = -0.487; P<0.05) in "higher" IL-6 individuals (>1.36 pg/ml). Moreover, baseline IL-6 was inversely associated (P<0.05) with gains in appendicular lean mass and improvements in SPPB score (r = -0.211 and -0.237, respectively).

    Conclusions: These findings implicate age-related increases in circulating IL-6 as an important contributor to declines in skeletal muscle strength, quality, function, and training-mediated adaptation. Given the pervasive nature of inflammation among older adults, novel therapeutic strategies to reduce IL-6 as a means of preserving skeletal muscle health are enticing.

  • 57.
    Grönstedt, Helena
    et al.
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Univ Hosp, Allied Hlth Profess, Funct Area Occupat Therapy & Physiotherapy, Stockholm, Sweden.
    Vikström, Sofia
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Occupat Therapy, Stockholm, Sweden.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism. Uppsala Univ Hosp, Dept Geriatr Med, Uppsala, Sweden;Karolinska Univ Hosp, Theme Aging, Stockholm, Sweden.
    Franzen, Erika
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Univ Hosp, Allied Hlth Profess, Funct Area Occupat Therapy & Physiotherapy, Stockholm, Sweden;Karolinska Inst, Div Physiotherapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Seiger, Åke
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Wimo, Anders
    Karolinska Inst, Div Neurogeriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Faxen-Irving, Gerd
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Inst, Div Clin Geriatr, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden;Karolinska Univ Hosp, Funct Area Clin Nutr, Allied Hlth Professionals, Stockholm, Sweden.
    Boström, Anne-Marie
    Stockholms Sjukhem R&D Unit, Stockholm, Sweden;Karolinska Univ Hosp, Theme Aging, Stockholm, Sweden;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden;Western Norway Univ Appl Sci, Haugesund, Norway.
    A study protocol of Older Person's Exercise and Nutrition Study (OPEN) - a sit-to-stand activity combined with oral protein supplement - effects on physical function and independence: a cluster randomized clinical trial2018Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, artikel-id 138Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Poor nutrition and age per see add to the development of sarcopenia, i.e. loss of muscle mass and strength, which contributes to increased risk of impaired activities of daily living (ADL) and reduced independence. Protein deficiency plays an important role in the development of sarcopenia. In order to increase the muscle mass protein intake should be combined with physical exercise. A daily physical activity, the sit-to-stand exercise, has been proven to decrease older persons' dependence in ADL. Our study aims to evaluate the effects of the sit-to-stand exercise in combination with a protein-rich nutritional supplement, on physical function and independence in frail nursing home residents. The resident's perceptions and experiences of the intervention and the staff's experiences of supporting the resident to complete the intervention will also be explored.

    Methods: The study is a two-arm cluster-randomized controlled trial which will be performed in nursing homes at two municipalities in Sweden. We will recruit 120 residents, age 75 or older and able to stand up from a seated position. Residents (n = 60) randomized to the intervention group will perform the sit-to-stand exercise at four occasions daily and will be offered a protein-rich oral supplement, twice a day. The intervention period will last for 12 weeks and measures of physical function, nutritional status, quality of life and health economy will be performed at baseline and at 12-weeks follow-up. The primary outcome will be the number of chair rises performed in 30 s. The control group will receive standard care. Data will be analysed by intention-to-treat analysis and with mixed effect models. During the last part of the intervention period individual interviews with the residents, on the topic of feasibility with the OPEN concept will be held. Likewise, focus-group-interviews with staff will be performed.

    Discussion: The residents' physical and mental health could be expected to improve. Even the work situation for staff could be positively affected. One innovative feature of the OPEN study is the simple intervention consisting of a basic daily activity that can be performed by several nursing home residents with the support of existing staff and available resources.

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  • 58.
    Gunnarsson, Anna-Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Gunningberg, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Larsson, Sune
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Jonsson, Kenneth B.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Cranberry juice concentrate does not significantly decrease the incidence of acquired bacteriuria in female hip-fracture patients receiving urine catheter: a double-blind randomised trial2017Ingår i: Clinical Interventions in Aging, ISSN 1176-9092, E-ISSN 1178-1998, Vol. 12, s. 137-143Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Urinary tract infection (UTI) is a common complication among patients with hip fractures. Receiving an indwelling urinary catheter is a risk factor for developing UTIs. Treatment of symptomatic UTIs with antibiotics is expensive and can result in the development of antimicrobial resistance. Cranberries (lat. Vaccinium macrocarpon Ait.)  are thought to prevent UTI. There is no previous research on this potential effect in patients with hip fracture who receive urinary catheters.

    Aim

    To investigate whether cranberry capsules given pre- and postoperatively are useful in preventing hospital-acquired UTIs in female patients with hip fracture and urinary catheter.

    Design

    Randomised, placebo-controlled double-blind trial.

    Method

    Female patients, age 60 years and older, with hip fracture were recruited (n=227). The patients were randomised to receive cranberry (n=113) or placebo (n=114) capsules daily, from admission to the ward, until five days postoperatively. Urine cultures were obtained at admission and at five and 14 days postoperatively. In addition, EQ-5D assessments were performed and patients were screened for UTI symptoms.

    Result

    There was no difference between the groups in the proportion of patients with postoperative positive urine cultures. When excluding patients with positive cultures at admission, patients with antibiotic treatment during follow-up, and patients that did not adhere to the protocol, there was a trend towards a protective effect of cranberry treatment against hospital-acquired UTIs ; e.g. 36% (n=33) in the control group vs. 22%  (n=41) in cranberry group (p=0.17) at 5 days postoperatively.

    Conclusion

    Cranberry concentrate does not seem to have an effect in preventing UTI in female patients with hip fracture and indwelling urinary catheter.

     

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  • 59.
    Gunnarsson, Malin Degerman
    et al.
    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.
    Blennow, Kaj
    Univ Gothenburg, Sahlgrenska Univ Hosp, Inst Neurosci & Physiol, Clin Neurochem Lab, SE-43180 Molndal, Sweden..
    Basun, Hans
    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.
    Kilander, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    High tau levels in cerebrospinal fluid predict nursing home placement and rapid progression in Alzheimer's disease2016Ingår i: Alzheimer's Research & Therapy, E-ISSN 1758-9193, Vol. 8, artikel-id 22Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Increased concentrations of cerebrospinal fluid (CSF) total tau (t-tau) and phosphorylated tau, as well as decreased amyloid-beta 42 peptide, are biomarkers of Alzheimer's disease (AD) pathology, but few studies have shown an association with AD progression rate. We hypothesized that high CSF tau, as a marker of ongoing neurodegeneration, would predict a more aggressive course of AD, using time to nursing home placement (NHP) as the main outcome. Methods: Our sample inlcuded 234 patients with mild cognitive impairment (MCI) due to AD (n = 134) or mild to moderate AD (n = 100) who underwent lumbar puncture at a memory clinic and were followed for 2-11 years (median 4.9 years). Results: Individuals with CSF t-tau in the highest quartile (>= 900 ng/L) had a higher ratio of NHP, both in the total cohort and in patients with MCI only (adjusted HR 2.17 [95 % CI 1.24-3.80]; HR 2.37 [95 % CI 1.10-5.09], respectively), than the lowest quartile. The association between high t-tau levels and future steep deterioration was confirmed in analyses with conversion to moderate dementia (HR 1.66; 95 % CI 1.08-2.56), rapid decline in Mini Mental State Examination score (>= 4-point drop/12 months), and dying in severe dementia as outcomes. Conclusions: To our knowledge, this is the first study to show that high CSF t-tau levels predict early NHP and conversion to moderate dementia in an AD cohort. Selecting patients with high CSF t-tau, indicating more aggressive neurodegeneration and steeper decline, for AD immunotherapy trials might increase the possibility of showing contrast between active treatment and placebo.

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  • 60.
    Gustafsson, Gabriel
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Eriksson, Fredrik
    BioArctic Neurosci AB, Stockholm, Sweden..
    Möller, Christer
    BioArctic Neurosci AB, Stockholm, Sweden..
    da Fonseca, Tomas Lopes
    Univ Med Ctr Gottingen, Dept Neurodegenerat & Restorat Res, Gottingen, Germany..
    Outeiro, Tiago F.
    Univ Med Ctr Gottingen, Dept Neurodegenerat & Restorat Res, Gottingen, Germany.;Max Plank Inst Expt Med, Gottingen, Germany..
    Lannfelt, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Bergström, Joakim
    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.
    Cellular Uptake of alpha-Synuclein Oligomer-Selective Antibodies is Enhanced by the Extracellular Presence of alpha-Synuclein and Mediated via Fc gamma Receptors2017Ingår i: Cellular and molecular neurobiology, ISSN 0272-4340, E-ISSN 1573-6830, Vol. 37, nr 1, s. 121-131Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Immunotherapy targeting aggregated alpha-synuclein has emerged as a potential treatment strategy against Parkinson's disease and other alpha-synucleinopathies. We have developed alpha-synuclein oligomer/protofibril selective antibodies that reduce toxic alpha-synuclein in a human cell line and, upon intraperitoneal administration, in spinal cord of transgenic mice. Here, we investigated under which conditions and by which mechanisms such antibodies can be internalized by cells. For this purpose, human neuroglioma H4 cells were treated with either monoclonal oligomer/protofibril selective alpha-synuclein antibodies, linear epitope monoclonal alpha-synuclein antibodies, or with a control antibody. The oligomer/protofibril selective antibody mAb47 displayed the highest cellular uptake and was therefore chosen for additional analyses. Next, alpha-synuclein overexpressing cells were incubated with mAb47, which resulted in increased antibody internalization as compared to non-transfected cells. Similarly, regular cells exposed to mAb47 together with media containing alpha-synuclein displayed a higher uptake as compared to cells incubated with regular media. Finally, different Fc gamma receptors were targeted and we then found that blockage of Fc gamma RI and Fc gamma RIIB/C resulted in reduced antibody internalization. Our data thus indicate that the robust uptake of the oligomer/protofibril selective antibody mAb47 by human CNS-derived cells is enhanced by extracellular alpha-synuclein and mediated via Fc gamma receptors. Altogether, our finding lend further support to the belief that alpha-synuclein pathology can be modified by monoclonal antibodies and that these can target toxic alpha-synuclein species in the extracellular milieu. In the context of immunotherapy, antibody binding of alpha-synuclein would then not only block further aggregation but also mediate internalization and subsequent degradation of antigen-antibody complexes.

  • 61.
    Gustafsson, Gabriel
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Lindström, Veronica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Rostami, Jinar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Nordström, Eva
    BioArct AB, Stockholm.
    Lannfelt, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Bergström, Joakim
    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.
    Erlandsson, Anna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Alpha-synuclein oligomer-selective antibodies reduce intracellular accumulation and mitochondrial impairment in alpha-synuclein exposed astrocytes2017Ingår i: Journal of Neuroinflammation, ISSN 1742-2094, E-ISSN 1742-2094, Vol. 14, artikel-id 241Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Due to its neurotoxic properties, oligomeric alpha-synuclein (α-syn) has been suggested as an attractive target for passive immunization against Parkinson’s disease (PD). In mouse models of PD, antibody treatment has been shown to lower the levels of pathogenic α-syn species, including oligomers, although the mechanisms of action remain unknown. We have previously shown that astrocytes rapidly engulf α-syn oligomers that are intracellularly stored, rather than degraded, resulting in impaired mitochondria.

    Methods: The aim of the present study was to investigate if the accumulation of α-syn in astrocytes can be affected by α-syn oligomer-selective antibodies. Co-cultures of astrocytes, neurons, and oligodendrocytes were derived from embryonic mouse cortex and exposed to α-syn oligomers or oligomers pre-incubated with oligomer-selective antibodies.

    Results: In the presence of antibodies, the astrocytes displayed an increased clearance of the exogenously added α-syn, and consequently, the α-syn accumulation in the culture was markedly reduced. Moreover, the addition of antibodies rescued the astrocytes from the oligomer-induced mitochondrial impairment.

    Conclusions: Our results demonstrate that oligomer-selective antibodies can prevent α-syn accumulation and mitochondrial dysfunction in cultured astrocytes.

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  • 62. Guzman, Erika Avendano
    et al.
    Bouter, Yvonne
    Richard, Bernhard C.
    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.
    Paetau, Anders
    Verkkoniemi-Ahola, Auli
    Wirths, Oliver
    Bayer, Thomas A.
    Abundance of A beta(5-x) x like immunoreactivity in transgenic 5XFAD, APP/PS1KI and 3xTG mice, sporadic and familial Alzheimer's disease2014Ingår i: Molecular Neurodegeneration, ISSN 1750-1326, E-ISSN 1750-1326, Vol. 9, s. 13-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: According to the modified amyloid hypothesis the main event in the pathogenesis of Alzheimer's disease (AD) is the deposition of neurotoxic amyloid beta-peptide (A beta) within neurons. Additionally to full-length peptides, a great diversity of N-truncated A beta variants is derived from the larger amyloid precursor protein (APP). Vast evidence suggests that A beta(x-42) isoforms play an important role triggering neurodegeneration due to its high abundance, amyloidogenic propensity and toxicity. Although N-truncated and A beta(x-42) species have been pointed as crucial players in AD etiology, the A beta(5-x) isoforms have not received much attention. Results: The present study is the first to show immunohistochemical evidence of A beta(5-x) in familial cases of AD (FAD) and its distribution in APP/PS1KI, 5XFAD and 3xTG transgenic mouse models. In order to probe A beta(5-x) peptides we generated the AB5-3 antibody. Positive plaques and congophilic amyloid angiopathy (CAA) were observed among all the FAD cases tested carrying either APP or presenilin 1 (PS1) mutations and most of the sporadic cases of AD (SAD). Different patterns of A beta(5-x) distribution were found in the mouse models carrying different combinations of autosomal mutations in the APP, PS1 and Tau genes. All of them showed extracellular A beta deposits but none CAA. Additionally, they were all affected by a severe amyloid pathology in the hippocampus among other areas. Interestingly, neither 5XFAD nor APP/PS1KI showed any evidence for intraneuronal A beta(5-x). Conclusions: Different degrees of A beta(5-x) accumulations can be found in the transgenic AD mouse models and human cases expressing the sporadic or the familial form of the disease. Due to the lack of intracellular A beta(5-x), these isoforms might not be contributing to early mechanisms in the cascade of events triggering AD pathology. Brain sections obtained from SAD cases showed higher A beta(5-x)-immunoreactivity in vascular deposits than in extracellular plaques, while both are equally important in the FAD cases. The difference may rely on alternative mechanisms involving A beta(5-x) peptides and operating in a divergent way in the late and early onset forms of the disease.

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  • 63.
    Hansson, Oskar
    et al.
    Lund Univ, Dept Clin Sci Malmo, Clin Memory Res Unit, Malmo, Sweden;Skane Univ Hosp, Memory Clin, Malmo, Sweden.
    Svensson, Martina
    Lund Univ, Dept Expt Med Sci, Expt Neuroinflammat Lab, S-22184 Lund, Sweden.
    Gustaysson, Anna-Marta
    Lund Univ, Dept Clin Sci Malmo, Clin Memory Res Unit, Malmo, Sweden;Skane Univ Hosp, Memory Clin, Malmo, Sweden.
    Andersson, Emelie
    Lund Univ, Dept Clin Sci Malmo, Clin Memory Res Unit, Malmo, Sweden.
    Yang, Yiyi
    Lund Univ, Dept Expt Med Sci, Expt Neuroinflammat Lab, S-22184 Lund, Sweden.
    Nagga, Katarina
    Lund Univ, Dept Clin Sci Malmo, Clin Memory Res Unit, Malmo, Sweden;Linkoping Univ, Dept Acute Internal Med & Geriatr, Linkoping, Sweden.
    Hållmarker, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    James, Stefan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi.
    Deierborg, Tomas
    Lund Univ, Dept Expt Med Sci, Expt Neuroinflammat Lab, S-22184 Lund, Sweden.
    Midlife physical activity is associated with lower incidence of vascular dementia but not Alzheimer's disease2019Ingår i: Alzheimer's Research & Therapy, E-ISSN 1758-9193, Vol. 11, artikel-id 87Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Physical activity might reduce the risk of developing dementia. However, it is still unclear whether the protective effect differs depending on the subtype of dementia. We aimed to investigate if midlife physical activity affects the development of vascular dementia (VaD) and Alzheimer's disease (AD) differently in two large study populations with different designs.

    Methods: Using a prospective observational design, we studied whether long-distance skiers of the Swedish Vasaloppet (n = 197,685) exhibited reduced incidence of VaD or AD compared to matched individuals from the general population (n = 197,684) during 21 years of follow-up (median 10, interquartile range (IQR) 5-15 years). Next, we studied the association between self-reported physical activity, stated twice 5 years apart, and incident VaD and AD in 20,639 participants in the Swedish population-based Malmo Diet and Cancer Study during 18 years of follow-up (median 15, IQR 14-17 years). Finally, we used a mouse model of AD and studied brain levels of amyloid-beta, synaptic proteins, and cognitive function following 6 months of voluntary wheel running.

    Results Vasaloppet skiers (median age 36.0 years [IQR 29.0-46.0], 38% women) had lower incidence of all-cause dementia (adjusted hazard ratio (HR) 0.63, 95% CI 0.52-0.75) and VaD (adjusted HR 0.49, 95% CI 0.33-0.73), but not AD, compared to non-skiers. Further, faster skiers exhibited a reduced incidence of VaD (adjusted HR 0.38, 95% CI 0.16-0.95), but not AD or all-cause dementia compared to slower skiers. In the Malmo Diet and Cancer Study (median age 57.5 years [IQR 51.0-63.8], 60% women), higher physical activity was associated with reduced incidence of VaD (adjusted HR 0.65, 95% CI 0.49-0.87), but not AD nor all-cause dementia. These findings were also independent of APOE-epsilon 4 genotype. In AD mice, voluntary running did not improve memory, amyloid-beta, or synaptic proteins.

    Conclusions: Our results indicate that physical activity in midlife is associated with lower incidence of VaD. Using three different study designs, we found no significant association between physical activity and subsequent development of AD.

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  • 64.
    Hasan, Birgyul
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Comparison of reducing high fall risk related medication in General Medical Unit at Alfred Hospital (with intervention) versus in Aged Care Unit at Caulfield Hospital (without intervention)2014Självständigt arbete på avancerad nivå (masterexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
    Abstract [en]

    Introduction: Falls are one of the major adverse events and a public challenge for countries with ageing population. Alfred Health implemented a strategy to minimise falls and fall related injuries, specifically targeting medications associated with an increased risk of falls. This ongoing project was implemented in The Alfred Hospital’s general medical unit. Aim: To compare the incidence of prescribing high falls risk medicines in a cohort of older patients (≥65 years of age); firstly, at the point of discharge or transfer from the Alfred General Medical Unit and secondly, at the point of discharge from Aged Care Unit at Caulfield Hospital in 2013 and 2014. Methodology: The study was performed at the Alfred’s General Medical Unit and Aged Care Unit at Caulfield Hospital in Melbourne, Australia. Fall risk related medication was collected retrospectively in two study groups (the Alfred’s General Medical Unit and Aged Care Unit at Caulfield Hospital) and also, in Aged Care Unit in 2013 versus 2014. Results: A total of 1077 inpatient from the Alfred’s General Medical Unit and 360 inpatients from Aged Care Unit at Caulfield Hospital were included. Number of high fall risk medication in Aged Care Unit at Caulfield Hospital that were ceased or dose reduced was higher in Aged Care Unit at Caulfield (median (interquartile range) 0.33(0.67) than the Alfred’s General Medical Unit 0.00(0.00) (p<0.0001). Conclusion: Aged Care Unit at Caulfield Hospital had significant reduction of prescribing of fall risk medication at the point of discharge in comparison to the Alfred’s General Medical Unit. No significant reduction had been shown of high fall risk medication in the cohort from 2013 versus 2014 in Aged Care Unit at Caulfield Hospital.  

  • 65.
    Hedman, Sanna
    et al.
    Department of Clinical Nutrition and dietetics, Karolinska University Hospital, Stockholm, Sweden.
    Nydahl, Margaretha
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Faxén-Irving, Gerd
    Division of Clinical Geriatrics, department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
    Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients2016Ingår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, nr 3, s. 692-698Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background & aims

    Malnutrition is a well-recognized problem in geriatric patients. Individually prescribed diet is fundamental to optimize nutritional treatment in geriatric patients. The objective of this study was to investigate routines regarding dietary prescriptions and monitoring of food intake in geriatric patients and to see how well the prescribed diet conforms to the patients' nutritional status and ability to eat. A further aim was to identify the most common reasons and factors interacting with patients not finishing a complete meal.

    Methods

    This study combines two methods using both qualitative and quantitative analysis. Patients (n = 43; 82.5 ± 7.5 yrs; 60% females) at four geriatric wards performed a two-day dietary record, assisted by a dietician. Nurses and assistant nurses at each ward participated in a semi-structured interview regarding prescription of diets and portion size for the patients.

    Results

    The prescribed diet differed significantly (P < 0.01) from a diet based upon the patient's nutritional status and ability to eat. Only 30% of the patients were prescribed an energy-enriched diet in contrast to 60% that was in need of it. The most common reason for not finishing the meal was lack of appetite. Diet prescription for the patient was based upon information about eating difficulties identified in the Mini Nutritional Assessment-Short Form (MNA-SF) at admission and the type of diet that was prescribed on a previous ward. Monitoring of the patients' food intake was described as a continuous process discussed daily between the staff.

    Conclusion

    Patients' nutritional status and to what extent they were able to eat a complete meal was not routinely considered when prescribing food and monitoring food intake in this study. By making use of this information the diet could be tailored to the patients' needs, thereby improving their nutritional treatment.

  • 66.
    Hellgren Matsdotter, Ingela
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    "Vi kunde ha haft det så bra... ":  Upplevelser hos den äldre kvarboende när partnern flyttar till ett särskilt boende.2011Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
    Abstract [sv]

    SAMMANFATTNING

     

    Syfte; Att beskriva den kvarboendes upplevelser i samband med att partnern flyttar till ett särskilt boende.

    Metodbeskrivning; Kvalitativ deskriptiv studie med intervjuer av sex kvarboende makar. En modifierad kvalitativ innehållsanalys gjordes, inspirerad av Sandbergs ”Flyttningsprocessen”.  

    Huvudresultat; I samband med beslutet om flytten beskrivs upplevelser av sorg/förlust, förståelse inför situationen samt behov av information och stöd. Vid genomförandet av flytten beskrivs olika grad av delaktighet. Anpassningen efter genomförd flytt beskrivs utifrån olika grad av kontroll över partnerns liv, påverkan på relationer/eget liv, och i ett senare skede förändrad roll, förändrad relation till partnern och förändrat liv. Att vara delaktig genom hela processen är viktigt för att den kvarboende ska kunna ha viss kontroll över situationen. Den kvarboende får uppleva nya och förändrade relationer i omgivningen. Livsförändringen skapar ensamhet även om familj och vänner finns i omgivningen.

    Slutsats; Flytten av partnern kan ses som en process för den kvarboende. Processen är mycket individuell och tar olika lång tid. Det finns ett stort behov av information och stöd från vårdgivare och personal på boenden, inför och genom det nya förhållandet. Personalen behöver vara medveten om de olika reaktioner som den kvarboende kan hamna i och stötta dessa.

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  • 67.
    Hultqvist, Greta
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Syvänen, Stina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Fang, Xiaotian T.
    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.
    Sehlin, Dag
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Bivalent Brain Shuttle Increases Antibody Uptake by Monovalent Binding to the Transferrin Receptor2017Ingår i: Theranostics, ISSN 1838-7640, E-ISSN 1838-7640, Vol. 7, nr 2, s. 308-318Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The blood-brain barrier (BBB) is an obstacle for antibody passage into the brain, impeding the development of immunotherapy and antibody-based diagnostics for brain disorders. In the present study, we have developed a brain shuttle for active transport of antibodies across the BBB by receptor-mediated transcytosis. We have thus recombinantly fused two single-chain variable fragments (scFv) of the transferrin receptor (TfR) antibody 8D3 to the light chains of mAb158, an antibody selectively binding to A beta protofibrils, which are involved in the pathogenesis of Alzheimer's disease (AD). Despite the two TfR binders, a monovalent interaction with TfR was achieved due to the short linkers that sterically hinder bivalent binding to the TfR dimer. The design enabled efficient receptor-mediated brain uptake of the fusion protein. Two hours after administration, brain concentrations were 2-3% of the injected dose per gram brain, comparable to small molecular drugs and 80-fold higher than unmodified mAb158. After three days, fusion protein concentrations in AD transgenic mouse brains were 9-fold higher than in wild type mice, demonstrating high in vivo specificity. Thus, our innovative recombinant design markedly increases mAb158 brain uptake, which makes it a strong candidate for improved Aa immunotherapy and as a PET radioligand for early diagnosis and evaluation of treatment effect in AD. Moreover, this approach could be applied to any target within the brain.

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  • 68.
    Hägglund, Patricia
    et al.
    Umea Univ, Fac Med, Dept Odontol, Oral & Maxillofacial Radiol, SE-90187 Umea, Sweden..
    Olai, Lena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Dalarna Univ, Sch Educ Hlth & Social Sci, Falun, Sweden..
    Ståhlnacke, Katri
    Publ Dent Hlth Serv, Orebro Cty Reg, Orebro, Sweden.;Orebro Univ, Fac Hlth & Med, Orebro, Sweden..
    Persenius, Mona
    Karlstad Univ, Fac Hlth Sci & Technol, Dept Hlth Sci, Karlstad, Sweden..
    Hägg, Mary
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Cty Council Gavleborg, Hudiksvall Hosp, Speech & Swallowing Ctr, Dept Otorhinolaryngol, Hudiksvall, Sweden..
    Andersson, Maria
    Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden..
    Koistinen, Susanne
    Dalarna Univ, Sch Educ Hlth & Social Sci, Falun, Sweden.;Orebro Univ, Fac Hlth & Med, Sch Hlth Sci, Orebro, Sweden..
    Carlsson, Eva
    Rebro Univ, Fac Hlth & Med, Univ Hlth Care Res Ctr, Orebro, Sweden..
    Study protocol for the SOFIA project: Swallowing function, Oral health, and Food Intake in old Age: a descriptive study with a cluster randomized trial2017Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 17, artikel-id 78Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Extensive studies have shown that older people are negatively impacted by impaired eating and nutrition. The abilities to eat, enjoy food, and participate in social activities associated with meals are important aspects of health-related quality of life (HRQoL) and recovery after illness. This project aims to (i) describe and analyze relationships between oral health and oral HRQoL, swallowing ability, eating ability, and nutritional risk among older individuals admitted to short-term care; (ii) compare the perceptions that older individuals and staff report on care quality related to oral hygiene and eating; and (iii) study the feasibility and effects of a training program for people with impaired swallowing (i.e., dysphagia). Methods/Design: This project consists of two parts, which will be performed in five Swedish counties. It will include approximately 400 older individuals and 200 healthcare professionals. Part 1 is a cross-sectional, descriptive study of older people admitted to short-term care. Subjects will be assessed by trained professionals regarding oral health status, oral HRQoL, eating and nutritional risk, and swallowing ability. Swallowing ability will be measured with a teaspoon test and a swallowing capacity test (SCT). Furthermore, subjects and staff will complete a questionnaire regarding their perceptions of care quality. Part 2 is a cluster randomized intervention trial with controls. Older participants with dysphagia (i.e., SCT < 10 ml/s, measured in part 1) will be recruited consecutively to either the intervention or control group, depending on where they were admitted for short-term care. At baseline, all subjects will be assessed for oral health status, oral HRQoL, eating and nutritional risk, swallowing ability, and swallowing-related QoL. Then, the intervention group will receive 5 weeks of training with an oral screen for neuromuscular training focused on orofacial and pharyngeal muscles. After completing the intervention, and at six months post-intervention, all assessments will be repeated in both study groups. Discussion: The results will make important contributions to rehabilitation knowledge, including approaches for improving swallowing function, oral health, and food intake and for improving the quality of oral care for older people.

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  • 69.
    Jonsson, Ulf
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri. Karolinska Inst, Div Insurance Med, Dept Clin Neurosci, Stockholm, Sweden.;Natl Board Hlth & Welf, Stockholm, Sweden..
    Bertilsson, Goran
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden..
    Allard, Per
    Umea Univ, Div Psychiat, Dept Clin Sci, Umea, Sweden..
    Gyllensvard, Harald
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden.;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden..
    Soderlund, Anne
    Malardalen Univ, Sch Hlth Care & Social Welf, Physiotherapy, Malardalen, Vasteras, Sweden..
    Tham, Anne
    Karolinska Inst, Psychiat Sect, Dept Clin Neurosci, Stockholm, Sweden..
    Andersson, Gerhard
    Karolinska Inst, Psychiat Sect, Dept Clin Neurosci, Stockholm, Sweden.;Linkoping Univ, Dept Behav Sci & Learning, Linkoping, Sweden..
    Psychological Treatment of Depression in People Aged 65 Years and Over: A Systematic Review of Efficacy, Safety, and Cost-Effectiveness2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 8, artikel-id e0160859Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objectives Depression in elderly people is a major public health concern. As response to antidepressants is often unsatisfactory in this age group, there is a need for evidence-based non-pharmacological treatment options. Our objectives were twofold: firstly, to synthesize published trials evaluating efficacy, safety and cost-effectiveness of psychological treatment of depression in the elderly and secondly, to assess the quality of evidence. Method The electronic databases PubMed, EMBASE, Cochrane Library, CINAL, Scopus, and Psyc-INFO were searched up to 23 May 2016 for randomized controlled trials (RCTs) of psychological treatment for depressive disorders or depressive symptoms in people aged 65 years and over. Two reviewers independently assessed relevant studies for risk of bias. Where appropriate, the results were synthesized in meta-analyses. The quality of the evidence was graded according to GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results Twenty-two relevant RCTs were identified, eight of which were excluded from the synthesis due to a high risk of bias. Of the remaining trials, six evaluated problem-solving therapy (PST), five evaluated other forms of cognitive behavioural therapy (CBT), and three evaluated life review/reminiscence therapy. In frail elderly with depressive symptoms, the evidence supported the efficacy of PST, with large but heterogeneous effect sizes compared with treatment as usual. The results for life-review/reminiscence therapy and CBT were also promising, but because of the limited number of trials the quality of evidence was rated as very low. Safety data were not reported in any included trial. The only identified cost-effectiveness study estimated an incremental cost per additional point reduction in Beck Depression Inventory II score for CBT compared with talking control and treatment as usual. Conclusion Psychological treatment is a feasible option for frail elderly with depressive symptoms. However, important questions about efficacy, generalizability, safety and cost-effectiveness remain.

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  • 70.
    Kania-Lundholm, Magdalena
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Torres, Sandra
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    The Divide That Older People Make: Age, Digital Technologies And Meaning Among Older Internet Users2014Ingår i: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 54, nr S2, s. 116-116Artikel i tidskrift (Övrigt vetenskapligt)
  • 71.
    Karmali, Kunal N.
    et al.
    Northwestern Univ, Dept Med, Chicago, IL 60611 USA..
    Lloyd-Jones, Donald M.
    Northwestern Univ, Dept Med, Chicago, IL 60611 USA..
    van der Leeuw, Joep
    Univ Med Ctr Utrecht, Dept Vasc Med, Utrecht, Netherlands..
    Goff, David C., Jr.
    NHLBI, Div Cardiovasc Sci, Bldg 10, Bethesda, MD 20892 USA..
    Yusuf, Salim
    McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada..
    Zanchetti, Alberto
    Ist Auxol Italiano, Milan, Italy..
    Glasziou, Paul
    Bond Univ, Ctr Res Evidence Based Practice, Robina, Australia..
    Jackson, Rodney
    Univ Auckland, Sch Populat Hlth, Fac Med & Hlth Sci, Auckland, New Zealand..
    Woodward, Mark
    Univ Oxford, George Inst Global Hlth, Oxford, England.;George Inst Global Hlth, Sydney, NSW, Australia..
    Rodgers, Anthony
    George Inst Global Hlth, Sydney, NSW, Australia..
    Neal, Bruce C.
    George Inst Global Hlth, Sydney, NSW, Australia..
    Berge, Eivind
    Oslo Univ Hosp, Dept Cardiol, Oslo, Norway..
    Teo, Koon
    McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada..
    Davis, Barry R.
    Univ Texas Dallas, Sch Publ Hlth, Dallas, TX USA..
    Chalmers, John
    George Inst Global Hlth, Sydney, NSW, Australia..
    Pepine, Carl
    Univ Florida, Div Cardiovasc Med, Gainesville, FL USA..
    Rahimi, Kazem
    Univ Oxford, George Inst Global Hlth, Oxford, England..
    Sundström, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Kardiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Uppsala kliniska forskningscentrum (UCR).
    Blood pressure-lowering treatment strategies based on cardiovascular risk versus blood pressure: A meta-analysis of individual participant data2018Ingår i: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 15, nr 3, artikel-id e1002538Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Clinical practice guidelines have traditionally recommended blood pressure treatment based primarily on blood pressure thresholds. In contrast, using predicted cardiovascular risk has been advocated as a more effective strategy to guide treatment decisions for cardiovascular disease (CVD) prevention. We aimed to compare outcomes from a blood pressure-lowering treatment strategy based on predicted cardiovascular risk with one based on systolic blood pressure (SBP) level.

    Methods and findings: We used individual participant data from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) from 1995 to 2013. Trials randomly assigned participants to either blood pressure-lowering drugs versus placebo or more intensive versus less intensive blood pressure-lowering regimens. We estimated 5-y risk of CVD events using a multivariable Weibull model previously developed in this dataset. We compared the two strategies at specific SBP thresholds and across the spectrum of risk and blood pressure levels studied in BPLTTC trials. The primary outcome was number of CVD events avoided per persons treated. We included data from 11 trials (47,872 participants). During a median of 4.0 y of follow-up, 3,566 participants (7.5%) experienced a major cardiovascular event. Areas under the curve comparing the two treatment strategies throughout the range of possible thresholds for CVD risk and SBP demonstrated that, on average, a greater number of CVD events would be avoided for a given number of persons treated with the CVD risk strategy compared with the SBP strategy (area under the curve 0.71 [95% confidence interval (CI) 0.70-0.72] for the CVD risk strategy versus 0.54 [95% CI 0.53-0.55] for the SBP strategy). Compared with treating everyone with SBP >= 150 mmHg, a CVD risk strategy would require treatment of 29% (95% CI 26%-31%) fewer persons to prevent the same number of events or would prevent 16% (95% CI 14%-18%) more events for the same number of persons treated. Compared with treating everyone with SBP >= 140 mmHg, a CVD risk strategy would require treatment of 3.8% (95% CI 12.5% fewer to 7.2% more) fewer persons to prevent the same number of events or would prevent 3.1% (95% CI 1.5%-5.0%) more events for the same number of persons treated, although the former estimate was not statistically significant. In subgroup analyses, the CVD risk strategy did not appear to be more beneficial than the SBP strategy in patients with diabetes mellitus or established CVD.

    Conclusions: A blood pressure-lowering treatment strategy based on predicted cardiovascular risk is more effective than one based on blood pressure levels alone across a range of thresholds. These results support using cardiovascular risk assessment to guide blood pressure treatment decision-making in moderate- to high-risk individuals, particularly for primary prevention.

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  • 72.
    Kaya, Ibrahim
    et al.
    Univ Gothenburg, Sahlgrenska Acad, Dept Psychiat & Neurochem, S-43180 Molndal, Sweden..
    Brinet, Dimitri
    Univ Gothenburg, Sahlgrenska Acad, Dept Psychiat & Neurochem, S-43180 Molndal, Sweden.;Univ Gothenburg, Dept Chem & Mol Biol, S-41296 Gothenburg, Sweden..
    Michno, Wojciech
    Univ Gothenburg, Sahlgrenska Acad, Dept Psychiat & Neurochem, S-43180 Molndal, Sweden..
    Syvänen, Stina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Sehlin, Dag
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Zetterberg, Henrik
    Univ Gothenburg, Sahlgrenska Acad, Dept Psychiat & Neurochem, S-43180 Molndal, Sweden.;Sahlgrens Univ Hosp, Clin Neurochem Lab, S-43180 Molndal, Sweden.;UCL, Inst Neurol, Dept Mol Neurosci, London WC1N 3BG, England..
    Blennow, Kaj
    Univ Gothenburg, Sahlgrenska Acad, Dept Psychiat & Neurochem, S-43180 Molndal, Sweden.;Sahlgrens Univ Hosp, Clin Neurochem Lab, S-43180 Molndal, Sweden..
    Hanrieder, Jorg
    Univ Gothenburg, Sahlgrenska Acad, Dept Psychiat & Neurochem, S-43180 Molndal, Sweden.;UCL, Inst Neurol, Dept Mol Neurosci, London WC1N 3BG, England.;Chalmers, Dept Chem & Chem Engn, S-41296 Gothenburg, Sweden..
    Delineating Amyloid Plaque Associated Neuronal Sphingolipids in Transgenic Alzheimer's Disease Mice (tgArcSwe) Using MALDI Imaging Mass Spectrometry2017Ingår i: ACS Chemical Neuroscience, ISSN 1948-7193, E-ISSN 1948-7193, Vol. 8, nr 2, s. 347-355Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The major pathological hallmarks of Alzheimer's disease (AD) are the progressive aggregation and accumulation of beta-amyloid (A beta) and hyperphosphorylated tau protein into neurotoxic deposits. A beta aggregation has been suggested as the critical early inducer, driving the disease progression. However, the factors that promote neurotoxic A beta aggregation remain elusive. Imaging mass spectrometry (IMS) is a powerful technique to comprehensively elucidate the spatial distribution patterns of lipids, peptides, and proteins in biological tissue sections. In the present study, matrix-assisted laser desorption/ionization (MALDI) mass spectrometry (MS)-based imaging was used on transgenic Alzheimer's disease mouse (tgArcSwe) brain tissue to investigate the sphingolipid microenvironment of individual A beta plaques and elucidate plaque-associated sphingolipid alterations. Multivariate data analysis was used to interrogate the IMS data for identifying pathologically relevant, anatomical features based on their lipid chemical profile. This approach revealed sphingolipid species that distinctly located to cortical and hippocampal deposits, whose A beta identity was further verified using fluorescent amyloid staining and immunohistochemistry. Subsequent multivariate statistical analysis of the spectral data revealed significant localization of gangliosides and ceramides species to A beta positive plaques, which was accompanied by distinct local reduction of sulfatides. These plaque-associated changes in sphingolipid levels implicate a functional role of sphingolipid metabolism in A beta plaque pathology and AD pathogenesis. Taken together, the presented data highlight the potential of imaging mass spectrometry as a powerful approach for probing A beta plaque-associated lipid changes underlying AD pathology.

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  • 73.
    Kherad, Mehrsa
    et al.
    Lund Univ, Skane Univ Hosp, Dept Orthoped Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden.;Lund Univ, Skane Univ Hosp, Dept Clin Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden..
    Rosengren, Bjorn E.
    Lund Univ, Skane Univ Hosp, Dept Orthoped Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden.;Lund Univ, Skane Univ Hosp, Dept Clin Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden..
    Hasserius, Ralph
    Lund Univ, Skane Univ Hosp, Dept Orthoped Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden.;Lund Univ, Skane Univ Hosp, Dept Clin Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden..
    Nilsson, Jan-Ake
    Lund Univ, Skane Univ Hosp, Dept Orthoped Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden.;Lund Univ, Skane Univ Hosp, Dept Clin Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden..
    Redlund-Johnell, Inga
    Lund Univ, Skane Univ Hosp, Dept Orthoped Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden.;Lund Univ, Skane Univ Hosp, Dept Clin Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden..
    Ohlsson, Claes
    Gothenburg Univ, Sahlgrenska Univ Hosp, Inst Med, Ctr Bone & Arthrit Res, Gothenburg, Sweden..
    Mellstrom, Dan
    Gothenburg Univ, Sahlgrenska Univ Hosp, Inst Med, Geriatr Med, Gothenburg, Sweden..
    Lorentzon, Mattiaz
    Gothenburg Univ, Sahlgrenska Univ Hosp, Inst Med, Geriatr Med, Gothenburg, Sweden..
    Ljunggren, Östen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Endokrinologi och mineralmetabolism.
    Karlsson, Magnus K.
    Lund Univ, Skane Univ Hosp, Dept Orthoped Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden.;Lund Univ, Skane Univ Hosp, Dept Clin Sci, Clin & Mol Osteoporosis Res Unit, Malmo, Sweden..
    Risk factors for low back pain and sciatica in elderly men-the MrOS Sweden study2017Ingår i: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 46, nr 1, s. 64-71Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: the aim of this study was to identify whether factors beyond anatomical abnormalities are associated with low back pain (LBP) and LBP with sciatica (SCI) in older men. Material and methods: Mister Osteoporosis Sweden includes 3,014 men aged 69-81 years. They answered questionnaires on lifestyle and whether they had experienced LBP and SCI during the preceding 12 months. About 3,007 men answered the back pain (BP) questions, 258 reported BP without specified region. We identified 1,388 with no BP, 1,361 with any LBP (regardless of SCI), 1,074 of those with LBP also indicated if they had experienced LBP (n = 615), LBP+ SCI (n = 459). Results: about 49% of those with LBP and 54% of those with LBP+ SCI rated their health as poor/very poor (P < 0.001). Men with any LBP to a greater extent than those without BP had poor self-estimated health, depressive symptoms, dizziness, fall tendency, serious comorbidity (diabetes, stroke, coronary heart disease, pulmonary disease and/or cancer) (all P < 0.001), foreign background, were smokers (all P < 0.01), had low physical activity and used walking aids (all P < 0.05). Men with LBP+ SCI to a greater extent than those with LBP had lower education, lower self-estimated health, comorbidity, dizziness and used walking aids (all P < 0.001). Conclusions: in older men with LBP and SCI, anatomical abnormalities such as vertebral fractures, metastases, central or lateral spinal stenosis or degenerative conditions may only in part explain prevalent symptoms and disability. Social and lifestyle factors must also be evaluated since they are associated not only with unspecific LBP but also with LBP with SCI.

  • 74.
    Kirn, Dylan R.
    et al.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA..
    Koochek, Afsaneh
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Reid, Kieran F.
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA..
    von Berens, Asa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Travison, Thomas G.
    Hebrew SeniorLife, Inst Aging Res, Boston, MA USA.;Harvard Univ, Sch Med, Boston, MA USA.;Beth Israel Deaconess Med Ctr, Div Gerontol, Boston, MA 02215 USA..
    Folta, Sara
    Tufts Univ, Friedman Sch Nutr Sci & Policy, Boston, MA 02111 USA..
    Sacheck, Jennifer
    Tufts Univ, Friedman Sch Nutr Sci & Policy, Boston, MA 02111 USA..
    Nelson, Miriam
    Tufts Univ, Friedman Sch Nutr Sci & Policy, Boston, MA 02111 USA.;Tufts Univ, Jonathan M Tisch Coll Citizenship & Publ Serv, Medford, MA 02155 USA..
    Liu, Christine
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap. Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA..
    Phillips, Edward
    Tufts Univ, Nutr Exercise Physiol & Sarcopenia Lab, Jean Mayer USDA Human Nutr Res Ctr Aging, Boston, MA 02111 USA.;Harvard Univ, Sch Med, Boston, MA USA.;Spaulding Rehabil Hosp, Boston, MA USA..
    Åberg, Anna Cristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Nydahl, Margaretha
    Boston Univ, Sch Med, Sect Geriatr, Boston, MA 02118 USA..
    Gustafsson, Thomas
    Karolinska Inst, Dept Lab Med, Stockholm, Sweden..
    Cederholm, Tommy
    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..
    The Vitality, Independence, and Vigor in the Elderly 2 Study (VIVE2): Design and methods2015Ingår i: Contemporary Clinical Trials, ISSN 1551-7144, E-ISSN 1559-2030, Vol. 43, s. 164-171Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Nutritional supplementation may potentiate the increase in skeletal muscle protein synthesis following exercise in healthy older individuals. Whether exercise and nutrition act synergistically to produce sustained changes in physical functioning and body composition has not been well studied, particularly in mobility-limited older adults. Methods: The VIVE2 study was a multi-center, randomized controlled trial, conducted in the United States and Sweden. This study was designed to compare the effects of a 6-month intervention with a once daily, experimental, 4 fl. oz. liquid nutritional supplement providing 150 kcal, whey protein (20 g), and vitamin D (800 IU) (Nestle Health Science, Vevey, Switzerland), to a low calorie placebo drink (30 kcal, non-nutritive; identical format) when combined with group-based exercise in 150 community-dwelling, mobility-limited older adults. All participants participated in a structured exercise program (3 sessions/week for 6 months), which included aerobic, strength, flexibility, and balance exercises. Results: The primary outcome was 6-month change in 400 m walk performance (m/s) between supplement and placebo groups. Secondary outcomes included 6 month change in: body composition, muscle cross-sectional area, leg strength, grip strength, stair climb time, quality of life, physical performance, mood/depressive symptoms and nutritional status. These outcomes were selected based on their applicability to the health and wellbeing of older adults. Conclusions: The results of this study will further define the role of nutritional supplementation on physical functioning and restoration of skeletal muscle mass in older adults. Additionally, these results will help refine the current physical activity and nutritional recommendations for mobility-limited older adults.

  • 75.
    Kirsebom, Marie
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Hedström, Mariann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Wadensten, Barbro
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Pöder, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    The frequency of and reasons for acute hospital transfers of older nursing home residents2013Ingår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 58, nr 1, s. 115-120Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The purpose of the study was to examine the frequency of and reason for transfer from nursing homes to the emergency department (ED), whether these transfers led to admission to a hospital ward, and whether the transfer rate differs as a function of type of nursing home provider and to identify the frequency of avoidable hospitalizations as defined by the Swedish Association of Local Authorities and Regions (SALAR). The design was retrospective, descriptive. Data were collected in a Swedish municipality where 30,000 inhabitants are 65 years or older. Structured reviews of the electronic healthcare records were performed. Included were residents living in a nursing home age 65+, with healthcare records including documented transfers to the ED during a 9-month period in 2010. The transfer rate to the ED was 594 among a total of 431 residents (M = 1.37 each). 63% resulted in hospitalization (M = 7.12 days). Nursing home's transfer rate differed between 0.00 and 1.03 transfers/ bed and was higher for the private for-profit providers than for public/private non-profit providers. One- fourth of the transfers were caused by falls and/or injuries, including fractures. The frequency of avoidable hospitalizations was 16% among the 375 hospitalizations. The proportion of transfers to the ED ranged widely between nursing homes. The reasons for this finding ought to be explored.

     

  • 76. Lagerin, Annica
    et al.
    Carlsson, Axel C.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Nilsson, Gunnar
    Westman, Jeanette
    Tornkvist, Lena
    District nurses' preventive home visits to 75-year-olds: An opportunity to identify factors related to unsafe medication management2014Ingår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, nr 8, s. 786-794Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: To investigate factors related to unsafe medication management among 75-year-olds during preventive home visits, and to describe the interventions district nurses used. Methods: An explorative study. During a 9- to 12-month period, 36 DNs used the Safe Medication Assessment (SMA) tool during preventive home visits to 75-year-olds who used at least one drug (n=113). Results: One or more factors related to unsafe medication management were identified in 84% of the 75-year-olds. More than 40% used five or more drugs, and 34.5% reported symptoms potentially indicative of adverse effects of their drugs. Nearly 30% had prescribers from more than two medical units, and 7.1% of the older persons were appraised as having reduced cognitive ability. DNs intervened in more than two-thirds of the cases and used a variety of nursing care interventions to improve the safety of medication management. Conclusions: Preventive home visits seem to provide a unique opportunity to promote safe medication management. Several factors related to unsafe medication management were identified, and several different nursing care interventions were carried out to ensure safe medication management. Use of the SMA tool in preventive home visits seems to be advantageous in improving the safety of medication management among older persons.

  • 77.
    Langenskiöld, Sophie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Hälsoekonomi.
    Evidensbaserad vård även för de allra äldsta, tack!2015Ingår i: Svensk Geriatrik, nr 1, s. 16-20Artikel, forskningsöversikt (Övrigt vetenskapligt)
  • 78.
    Lannfelt, Lars
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Moller, Christer
    Basun, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Osswald, Gunilla
    Sehlin, Dag
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Satlin, Andrew
    Logovinsky, Veronika
    Gellerfors, Par
    Perspectives on future Alzheimer therapies: amyloid-beta protofibrils - a new target for immunotherapy with BAN2401 in Alzheimer's disease2014Ingår i: ALZHEIMERS RES THER, ISSN 1758-9193, Vol. 6, nr 2, s. 16-Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    The symptomatic drugs currently on the market for Alzheimer's disease (AD) have no effect on disease progression, and this creates a large unmet medical need. The type of drug that has developed most rapidly in the last decade is immunotherapy: vaccines and, especially, passive vaccination with monoclonal antibodies. Antibodies are attractive drugs as they can be made highly specific for their target and often with few side effects. Data from recent clinical AD trials indicate that a treatment effect by immunotherapy is possible, providing hope for a new generation of drugs. The first anti-amyloid-beta (anti-A beta) vaccine developed by Elan, AN1792, was halted in phase 2 because of aseptic meningoencephalitis. However, in a follow-up study, patients with antibody response to the vaccine demonstrated reduced cognitive decline, supporting the hypothesis that A beta immunotherapy may have clinically relevant effects. Bapineuzumab (Elan/Pfizer Inc./Johnson & Johnson), a monoclonal antibody targeting fibrillar A beta, was stopped because the desired clinical effect was not seen. Solanezumab (Eli Lilly and Company) was developed to target soluble, monomeric A beta. In two phase 3 studies, Solanezumab did not meet primary endpoints. When data from the two studies were pooled, a positive pattern emerged, revealing a significant slowing of cognitive decline in the subgroup of mild AD. The Arctic mutation has been shown to specifically increase the formation of soluble A beta protofibrils, an A beta species shown to be toxic to neurons and likely to be present in all cases of AD. A monoclonal antibody, mAb158, was developed to target A beta protofibrils with high selectivity. It has at least a 1,000-fold higher selectivity for protofibrils as compared with monomers of A beta, thus targeting the toxic species of the peptide. A humanized version of mAb158, BAN2401, has now entered a clinical phase 2b trial in a collaboration between BioArctic Neuroscience and Eisai without the safety concerns seen in previous phase 1 and 2a trials. Experiences from the field indicate the importance of initiating treatment early in the course of the disease and of enriching the trial population by improving the diagnostic accuracy. BAN2401 is a promising candidate for A beta immunotherapy in early AD. Other encouraging efforts in immunotherapy as well as in the small-molecule field offer hope for new innovative therapies for AD in the future.

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  • 79.
    Lannfelt, Lars
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Relkin, N. R.
    Siemers, E. R.
    Amyloid-beta-directed immunotherapy for Alzheimer's disease2014Ingår i: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 275, nr 3, s. 284-295Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Current treatment options for Alzheimer's disease (AD) are limited to medications that reduce dementia symptoms. Given the rapidly ageing populations in most areas of the world, new therapeutic interventions for AD are urgently needed. In recent years, a number of drug candidates targeting the amyloid-ss (A ss) peptide have advanced into clinical trials; however, most have failed because of safety issues or lack of efficacy. The A ss peptide is central to the pathogenesis, and immunotherapy against A ss has attracted considerable interest. It offers the possibility to reach the target with highly specific drugs. Active immunization and passive immunization have been the most widely studied approaches to immunotherapy of AD. A favourable aspect of active immunization is the capacity for a small number of vaccinations to generate a prolonged antibody response. A potential disadvantage is the variability in the antibody response across patients. The potential advantages of passive immunotherapy include the reproducible delivery of a known amount of therapeutic antibodies to the patient and rapid clearance of those antibodies if side effects develop. A disadvantage is the requirement for repeated infusions of antibodies over time. After more than a decade of research, anti-amyloid immunotherapy remains one of the most promising emerging strategies for developing disease-modifying treatments for AD. In this review, we examine the presently ongoing A ss-directed immunotherapies that have passed clinical development Phase IIa.

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  • 80.
    Larsson, Susanna C.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Markus, Hugh S
    Does Treating Vascular Risk Factors Prevent Dementia and Alzheimer's Disease? A Systematic Review and Meta-Analysis.2018Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 64, nr 2, s. 657-668Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Epidemiological evidence has associated Alzheimer's disease (AD) with vascular risk factors (VRFs), but whether treatment of VRFs reduces the incidence of dementia and AD is uncertain.

    OBJECTIVE: To conduct a systematic review and meta-analysis to summarize available data on the impact of treatment of VRFs on dementia and AD incidence.

    METHODS: Pertinent studies published until 1 January 2018 were identified from PubMed. Both randomized controlled trials (RCT) and prospective studies that investigated the impact of treatment of VRFs on dementia or AD incidence were included.

    RESULTS: Eight RCTs and 52 prospective studies were identified. Antihypertensive treatment was associated with a non-significant reduced risk of dementia in RCTs (n = 5; relative risk [RR], 0.84; 95% confidence interval [CI], 0.69-1.02) and prospective studies (n = 3; RR, 0.77; 95% CI, 0.58-1.01) and with reduced AD risk in prospective studies (n = 5; RR = 0.78; 95% CI, 0.66-0.91). In prospective studies, treatment of hyperlipidemia with statins, but not nonstatin lipid-lowering agents, was associated with reduced risk of dementia (n = 17; RR, 0.77; 95% CI, 0.63-0.95) and AD (n = 13; RR, 0.86; 95% CI, 0.80-0.92). The single RCT on statins and dementia incidence showed no association. Data from one RCT and six prospective studies did not support a beneficial impact of antidiabetic drugs or insulin therapy on dementia risk.

    CONCLUSION: Current evidence indicates that antihypertensives and statins might reduce the incidence of dementia and AD. Further trials to determine the effect of VRF on AD are needed.

  • 81.
    Larsson, Susanna C.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi.
    Orsini, Nicola
    Coffee Consumption and Risk of Dementia and Alzheimer's Disease: A Dose-Response Meta-Analysis of Prospective Studies.2018Ingår i: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 10, nr 10, artikel-id E1501Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Coffee consumption is associated with a reduced risk of several diseases but uncertainty remains about the influence of coffee consumption on the risk of dementia. We performed a dose-response meta-analysis to summarize the prospective data on coffee consumption and associated risk of dementia and Alzheimer's disease. We identified studies by searching PubMed (from January 1966) and Web of Science (from January 1945) through 4 October 2018 and by scrutinizing the reference lists of pertinent publications. Two researchers independently reviewed the literature. Results were combined using a restricted cubic spline random-effects dose-response meta-analysis based on a one-stage approach. Eight relevant prospective studies were identified. These studies included 7486 dementia cases diagnosed among 328,885 individuals during an average follow-up of 4.9⁻25 years. Meta-analysis of all eight studies indicated no statistically significant association between coffee consumption and the risk of dementia and no deviations from a linear trend (p = 0.08). The relative risk of dementia per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval (CI) 0.98⁻1.05; p = 0.37). Meta-analysis of five studies that focused on Alzheimer's disease revealed no association between coffee consumption and Alzheimer's disease and no deviations from a linear trend (p = 0.79). The relative risk of Alzheimer's disease per 1 cup/day increment of coffee consumption was 1.01 (95% confidence interval 0.95⁻1.07; p = 0.80). These results do not support an association between coffee consumption and an increased risk of overall dementia or Alzheimer's disease specifically, but further research on the association of coffee consumption with dementia risk is needed.

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  • 82.
    Larsson, Susanna C.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol, Stockholm, Sweden.
    Wolk, Alicja
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Ortopedi. Karolinska Inst, Inst Environm Med, Unit Nutr Epidemiol, Stockholm, Sweden.
    Sedentary leisure-time in relation to mortality and survival time2019Ingår i: Journal of Science and Medicine in Sport, ISSN 1440-2440, E-ISSN 1878-1861, Vol. 22, nr 5, s. 562-567Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To examine the association between sedentary leisure-time and all-cause mortality and differences in survival time.

    Design: Prospective cohort study.

    Methods: Information on sedentary leisure-time, defined as TV viewing and/or sitting reading, was collected from 72 003 Swedish adults who were 45-83 (median 60) years of age and completed a self-administered questionnaire at baseline and were followed up for 17 years through linkage with the Swedish Death Register.

    Results: The association between sedentary leisure-time and all-cause mortality was modified by age with a more pronounced association in middle-aged (<60 years of age) than in older adults (>= 60 years of age) (p-interaction <0.001). During follow-up, 3358 and 15 217 deaths occurred in the middle-aged and older age group, respectively. The multivariable-adjusted hazard ratios for the highest (>6 h/day) versus lowest category (<1 h/day) of sedentary leisure-time were 1.72 (95% confidence interval [CI] 1.29-2.30) in middle-aged adults and 1.19 (95% CI 1.05-1.36) in older adults. This corresponded to a difference in survival time of respectively 2.4 (95% CI -4.1 to -0.8) years and 1.5 (95% CI -2.2 to -0.7) years.

    Conclusions: Prolonged sedentary leisure-time was associated with a significantly decreased survival time up to 2.4 years in middle-aged adults. 

  • 83.
    Lemoine, Laetitia
    et al.
    Karolinska Inst, Stockholm, Sweden..
    Ingelsson, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Nennesmo, Inger
    Karolinska Inst, Stockholm, Sweden..
    Gillberg, Per-Goran
    Karolinska Inst, Stockholm, Sweden..
    Nordberg, Agneta
    Karolinska Inst, Stockholm, Sweden..
    In Vitro Characterization Of Fibrillar Amyloid, Tau Deposits, And Activated Astrocytes In Arctic App And Sporadic Alzheimer's Disease Brain Using, 3H-Pib And 3H-Thk5117 And 3H-Deprenyl In Comparison To Immunostaining2016Ingår i: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 39, s. S15-S15Artikel i tidskrift (Övrigt vetenskapligt)
  • 84.
    Liberman, Keliane
    et al.
    VUB, Frailty Ageing Res Grp FRIA, Laarbeeklaan 103, B-1090 Brussels, Belgium.
    Njemini, Rose
    VUB, Frailty Ageing Res Grp FRIA, Laarbeeklaan 103, B-1090 Brussels, Belgium.
    Luiking, Yvette
    Nutricia Res, Nutricia Adv Med Nutr, Utrecht, Netherlands.
    Forti, Louis N.
    VUB, Frailty Ageing Res Grp FRIA, Laarbeeklaan 103, B-1090 Brussels, Belgium.
    Verlaan, Sjors
    Vrije Univ Amsterdam, Med Ctr, Sect Gerontol & Geriatr, Dept Internal Med, Amsterdam, Netherlands.
    Bauer, Juergen M.
    Heidelberg Univ, Ctr Geriatr Med, Heidelberg, Germany.
    Memelink, Robert
    VUB, Frailty Ageing Res Grp FRIA, Laarbeeklaan 103, B-1090 Brussels, Belgium;Amsterdam Univ Appl Sci, Fac Sports & Nutr, Amsterdam, Netherlands.
    Brandt, Kirsten
    Newcastle Univ, Inst Cellular Med, Human Nutr Res Ctr, Newcastle Upon Tyne, Tyne & Wear, England.
    Donini, Lorenzo M.
    Sapienza Univ Rome, Sect Med Pathophysiol Endocrinol & Human Nutr, Dept Expt Med, Rome, Italy.
    Maggio, Marcello
    Univ Parma, Sect Geriatr, Dept Med & Surg, Parma, Italy.
    Mets, Tony
    VUB, Frailty Ageing Res Grp FRIA, Laarbeeklaan 103, B-1090 Brussels, Belgium.
    Wijers, Sander L. J.
    Nutricia Res, Nutricia Adv Med Nutr, Utrecht, Netherlands.
    Sieber, Cornel
    Friedrich Alexander Univ Erlangen Nurnberg, Erlangen, Germany.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik.
    Bautmans, Ivan
    VUB, Frailty Ageing Res Grp FRIA, Laarbeeklaan 103, B-1090 Brussels, Belgium.
    Thirteen weeks of supplementation of vitamin D and leucine-enriched whey protein nutritional supplement attenuates chronic low-grade inflammation in sarcopenic older adults: the PROVIDE study2019Ingår i: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 31, nr 6, s. 845-854Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background A chronic low-grade infammatory profle (CLIP) is associated with sarcopenia in older adults. Protein and Vitamin (Vit)D have immune-modulatory potential, but evidence for efects of nutritional supplementation on CLIP is limited. Aim To investigate whether 13 weeks of nutritional supplementation of VitD and leucine-enriched whey protein afected CLIP in subjects enrolled in the PROVIDE-study, as a secondary analysis. Methods Sarcopenic adults (low skeletal muscle mass) aged ≥ 65 years with mobility limitations (Short Physical Performance Battery 4–9) and a body mass index of 20–30 kg/m2 were randomly allocated to two daily servings of active (n=137, including 20 g of whey protein, 3 g of leucine and 800 IU VitD) or isocaloric control product (n=151) for a double-blind period of 13 weeks. At baseline and after 13 weeks, circulating interleukin (IL)-8, IL-1 receptor antagonist (RA), soluble tumor-necrosis-factor receptor (sTNFR)1, IL-6, high-sensitivity C-reactive protein, pre-albumin and 25-hydroxyvitamin(OH) D were measured. Data-analysis included repeated measures analysis of covariance (corrected for dietary VitD intake) and linear regression. Results IL-6 and IL-1Ra serum levels showed overall increases after 13 weeks (p=0.006 and p<0.001, respectively). For IL-6 a signifcant time × treatment interaction (p=0.046) was observed, with no signifcant change over time in the active group (p=0.155) compared to control (signifcant increase p=0.012). IL-8 showed an overall signifcant decrease (p=0.03). The change in pre-albumin was a signifcant predictor for changes in IL-6 after 13 weeks. Conclusions We conclude that 13 weeks of nutritional supplementation with VitD and leucine-enriched whey protein may attenuate the progression of CLIP in older sarcopenic persons with mobility limitations.

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  • 85.
    Lindberg, Terese
    et al.
    Blekinge Inst Technol, Karlskrona, Sweden;Blekinge Ctr Competence, Karlskrona, Sweden;Lund Univ, Lund, Sweden.
    Wimo, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Gävleborg. Karolinska Inst, Stockholm, Sweden;Stockholm Univ, Stockholm, Sweden.
    Elmstahl, Solve
    Lund Univ, Lund, Sweden.
    Qiu, Chengxuan
    Karolinska Inst, Stockholm, Sweden;Stockholm Univ, Stockholm, Sweden.
    Bohman, Doris M.
    Blekinge Inst Technol, Karlskrona, Sweden.
    Berglund, Johan Sanmartin
    Blekinge Inst Technol, Karlskrona, Sweden;Blekinge Ctr Competence, Karlskrona, Sweden.
    Prevalence and Incidence of Atrial Fibrillation and Other Arrhythmias in the General Older Population: Findings From the Swedish National Study on Aging and Care2019Ingår i: Gerontology and geriatric medicine, E-ISSN 2333-7214, Vol. 5, s. 1-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To study the prevalence and cumulative incidence of arrhythmias in the general population of adults aged 60 and older over a 6-year period. Study Design and Setting: Data were taken from the Swedish National Study on Aging and Care (SNAC), a national, longitudinal, multidisciplinary study of the general elderly population (defined as 60 years of age or older). A 12-lead resting electrocardiography (ECG) was performed at baseline and 6-year follow-up. Results: The baseline prevalence of atrial fibrillation (AF) was 4.9% (95% confidence interval [CI] = [4.5%, 5.5%]), and other arrhythmias including ventricular premature complexes (VPCs), supraventricular tachycardia (SVT), and supraventricular extrasystole (SVES) were seen in 8.4% (7.7%, 9.0%) of the population. A first- or second-degree atrioventricular (AV) block was found in 7.1% of the population (95% CI = [6.5%, 7.7%]), and there were no significant differences between men and women in baseline arrhythmia prevalence. The 6-year cumulative incidence of AF was 4.1% (95% CI = [3.5%, 4.9%]), or 6.9/1,000 person-years (py; 95% CI = [5.7, 8.0]). The incidence of AF, other arrhythmias, AV block, and pacemaker-induced rhythm was significantly higher in men in all cohorts except for the oldest. Conclusion: Our data highlight the prevalence and incidence of arrhythmias, which rapidly increase with advancing age in the general population.

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  • 86.
    Lindskog, Magnus
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Cancerfarmakologi och beräkningsmedicin.
    Karvestedt, Lars
    Furst, Carl Johan
    Glycaemic control in end-of-life care: fundamental or futile?2014Ingår i: Current Opinion in Supportive and Palliative Care, ISSN 1751-4258, Vol. 8, nr 4, s. 378-382Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Purpose of review Diabetes mellitus is one of the most common comorbidities in palliative care. Yet, the optimal handling of diabetes mellitus in dying patients is debated. This review aims to discuss comprehensively the scientific basis as of today for diabetes mellitus management decisions in end-of-life (EOL) care. Recent findings Glycaemic control provides prognostic information in EOL care of diabetes mellitus patients. Original data on how to manage dying patients with type 2 diabetes mellitus are scarce. Findings in elderly type 2 diabetes mellitus patients and expert opinions support that glycaemic control should be relaxed in dying patients with type 2 diabetes mellitus, in the absence of risk factors for true insulin dependence, to avoid symptomatic hypoglycaemia. For terminal but conscious type 1 diabetes mellitus patients, regular blood glucose measurements and continued insulin therapy is the mainstay, with some discrepancy in preferred management between palliative care physicians and diabetes consultants. No randomized controlled trials are available. Improvement is clearly needed with regard to communication about diabetes mellitus in EOL and documentation of decisions. Corticosteroid-induced diabetes mellitus is a significant problem in palliative care, but predictors exist. Summary In the absence of large observational studies or randomized controlled trials, the current body of knowledge is based on expert opinions, surveys and retrospective studies. Nevertheless, some clinically meaningful recommendations can be made. Prospective studies need to be performed in order to improve our understanding about diabetes mellitus management in EOL. The palliative care community has a joint responsibility to address these questions.

  • 87. Liu, Yao
    et al.
    Atkinson, Rachel A. K.
    Fernandez-Martos, Carmen M.
    Kirkcaldie, Matthew T. K.
    Cui, Hao
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk biokemi och mikrobiologi.
    Vickers, James C.
    King, Anna E.
    Changes in TDP-43 expression in development, aging, and in the neurofilament light protein knockout mouse2015Ingår i: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 36, nr 2, s. 1151-1159Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The transactive response DNA-binding protein 43 (TDP-43) has been identified as a neurofilament light (NF-L) messenger RNA (mRNA)-binding protein. Abnormally increased levels of TDP-43 are detected in patients with amyotrophic lateral sclerosis and a downregulation of NF-L mRNA. However, links between NF-L and TDP-43 expressions are unclear. In this study, we investigated whether the deficiency of NF-L protein can result in alterations in TDP-43 localization or protein expression and whether this is altered with aging. There was a significant increase in TDP-43 protein levels in the cortex and lumbar spinal cord in 12-month-old NF-L knockout (NF-L KO) mice, compared with wild-type (WT) C57BL/6 mice. However, there was no difference in either the phosphorylation of TDP-43 between WT and NF-L KO mice or the abnormal mislocalization of TDP-43 to the cytoplasm in NF-L KO animals. Our findings suggest that NF-L protein or mRNA may negatively affect the expression of TDP-43 in the central nervous system. However, altered phosphorylation of TDP-43 may be more highly associated with aging than the levels of TDP-43 expression.

  • 88.
    Logovinsky, Veronika
    et al.
    Eisai Inc, 100 Tice Blvd, Woodcliff Lake, NJ 07677 USA..
    Satlin, Andrew
    Eisai Inc, 100 Tice Blvd, Woodcliff Lake, NJ 07677 USA..
    Lai, Robert
    Eisai Inc, 100 Tice Blvd, Woodcliff Lake, NJ 07677 USA..
    Swanson, Chad
    Eisai Inc, 100 Tice Blvd, Woodcliff Lake, NJ 07677 USA..
    Kaplow, June
    Eisai Inc, 100 Tice Blvd, Woodcliff Lake, NJ 07677 USA..
    Osswald, Gunilla
    BioArctic Neurosci AB, Warfvinges Vag 35, S-11251 Stockholm, Sweden..
    Basun, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. BioArctic Neurosci AB, Warfvinges Vag 35, S-11251 Stockholm, Sweden..
    Lannfelt, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. BioArctic Neurosci AB, Warfvinges Vag 35, S-11251 Stockholm, Sweden..
    Safety and tolerability of BAN2401 - a clinical study in Alzheimer's disease with a protofibril selective A beta antibody2016Ingår i: Alzheimer's Research & Therapy, E-ISSN 1758-9193, Vol. 8, artikel-id 14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Several monoclonal antibodies for the treatment of Alzheimer's disease (AD) have been in development over the last decade. BAN2401 is a monoclonal antibody that selectively binds soluble amyloid beta (A beta) protofibrils.

    Methods: Here we describe the first clinical study with BAN2401. Safety and tolerability were investigated in mild to moderate AD. A study design was used with staggered parallel single and multiple ascending doses, from 0.1 mg/kg as a single dose to 10 mg/kg biweekly for four months. The presence of amyloid related imaging abnormalities (ARIA, E for edema, H for hemorrhage) was assessed with magnetic resonance imaging (MRI). Cerebrospinal fluid (CSF) and plasma samples were analyzed to investigate pharmacokinetics (PK) and effects on biomarkers.

    Results: The incidence of ARIA-E/H on MRI was comparable to that of placebo. BAN2401 exposure was approximately dose proportional, with a serum terminal elimination half-life of similar to 7 days. Only a slight increase of plasma A beta((1-40)) was observed but there were no measurable effects of BAN2401 on CSF biomarkers. On the basis of these findings Phase 2b efficacy study has been initiated in early AD.

    Conclusions: BAN2401 was well-tolerated across all doses. The PK profile has guided us for selecting dose and dose regimens in the ongoing phase 2b study. There was no clear guidance for an effective dose based on biomarkers.

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  • 89. Looi Chee Leong, Jeffrey
    et al.
    Lindberg, Olof
    Zandbelt, Bram
    Östberg, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Andersen, Christian
    Botes, Lisa
    Svensson, Leif
    Wahlund, Lars-Olof
    Caudate nucleus volumes in frontotemporal lobar degeneration: differential atrophy in subtypes2008Ingår i: American Journal of Neuroradiology, ISSN 0195-6108, E-ISSN 1936-959X, Vol. 29, nr 8, s. 1537-1543Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND PURPOSE: Frontostriatal circuits involving the caudate nucleus have been implicated in frontotemporal lobar degeneration (FTLD). We assessed caudate nucleus volumetrics in FTLD and subtypes: frontotemporal dementia (FTD, n = 12), semantic dementia (SD, n = 13), and progressive nonfluent aphasia (PNFA, n = 9) in comparison with healthy controls (n = 27) and subjects with Alzheimer disease (AD, n = 19).

    MATERIALS AND METHODS: Diagnoses were based on accepted clinical criteria. Manual volume measurement of the head and body of the caudate, excluding the tail, was conducted on T1-weighted brain MR imaging scans, using a published protocol, by a single analyst blinded to the diagnosis.

    RESULTS: Paired t tests (P < .05) showed that the right caudate nucleus volume was significantly larger than the left in controls and PNFA. No hemispheric asymmetry was found in AD, ETD, and SD. Across the groups, there was a positive partial correlation between the left caudate nucleus volume and Mini-Mental State Examination (MMSE) scores (r = 0.393, n = 76, P = .001) with higher left caudate volumes associated with higher MMSE scores. Multivariate analysis of covariance was used to assess the statistical significance between the subject groups (AD, ETD, SD, PNFA, and controls) as independent variables and raw right/left caudate volumes at the within-subject level (covariates: age and intracranial volume; P < .05). Control volume was largest, followed by AD (93% of control volume), SD (92%), PNFA (79%), and ETD (75%).

    CONCLUSIONS: Volume of the head and body of the caudate nucleus differs in subtypes of FTLD, due to differential frontostriatal dysfunction in subtypes being reflected in structural change in the caudate, and is correlated with cognition

  • 90. Looi, JC
    et al.
    Svensson, L
    Lindberg, O
    Zandbelt, BB
    Östberg, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Örndahl, E
    Wahlund, L-O
    Putaminal volume in frontotemporal lobar degeneration and Alzheimer disease: differential volumes in dementia subtypes and controls2009Ingår i: American Journal of Neuroradiology, ISSN 0195-6108, E-ISSN 1936-959X, Vol. 30, nr 8, s. 1552-1560Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND AND PURPOSE: Frontostriatal (including the putamen) circuit-mediated cognitive dysfunction has been implicated in frontotemporal lobar degeneration (FTLD), but not in Alzheimer disease (AD) or healthy aging. We sought to assess putaminal volume as a measure of the structural basis of relative frontostriatal dysfunction in these groups. MATERIALS AND METHODS: We measured putaminal volume in FTLD subtypes: frontotemporal dementia (FTD, n = 12), semantic dementia (SD, n = 13), and progressive nonfluent aphasia (PNFA, n = 9) in comparison with healthy controls (n = 25) and patients with AD (n = 18). Diagnoses were based on accepted clinical criteria. We conducted manual volume measurement of the putamen blinded to the diagnosis on T1 brain MR imaging by using a standardized protocol. RESULTS: Paired t tests (P < .05) showed that the left putaminal volume was significantly larger than the right in all groups combined. Multivariate analysis of covariance with a Bonferroni correction was used to assess statistical significance among the subject groups (AD, FTD, SD, PNFA, and controls) as independent variables and right/left putaminal volumes as dependent variables (covariates, age and intracranial volume; P < .05). The right putamen in FTD was significantly smaller than in AD and controls; whereas in SD, it was smaller compared with controls with a trend toward being smaller than in AD. There was also a trend toward the putamen in the PNFA being smaller than that in controls and in patients with AD. Across the groups, there was a positive partial correlation between putaminal volume and Mini-Mental State Examination (MMSE). CONCLUSIONS: Right putaminal volume was significantly smaller in FTD, the FTLD subtype with the greatest expected frontostriatal dysfunction; whereas in SD and PNFA, it showed a trend towards being smaller, consistent with expectation, compared to controls and AD; and in SD, compared with AD and controls. Putaminal volume weakly correlated with MMSE.

  • 91. Looi, Jefferey Chee Leong
    et al.
    Walterfang, Mark
    Styner, Martin
    Svensson, Leif
    Lindberg, Olof
    Karolinska institutet.
    Östberg, Per
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Logopedi.
    Botes, Lisa
    Örndahl, Eeva
    Chua, Phyllis
    Kumar, Rajeev
    Velakoulis, Dennis
    Wahlund, Lars-Olof
    Shape analysis of the neostriatum in frontotemporal lobar degeneration, Alzheimer's disease, and controls2010Ingår i: NeuroImage, ISSN 1053-8119, E-ISSN 1095-9572, Vol. 51, nr 3, s. 970-986Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and purpose: Frontostriatal circuit mediated cognitive dysfunction has been implicated in frontotemporal lobar degeneration (FTLD), but not Alzheimer's disease, or healthy aging. We measured the neostriatum (caudate nucleus and putamen) volume in FTLD (n=34), in comparison with controls (n=27) and Alzheimer's disease (AD, n=19) subjects.

    Methods: Diagnoses were based on international consensus criteria. Manual bilateral segmentation of the caudate nucleus and putamen was conducted blind to diagnosis by a single analyst, on MRI scans using a standardized protocol. Intra-cranial volume was calculated via a stereological point counting technique and was used for scaling the shape analysis. The manual segmentation binaries were analyzed using UNC Shape Analysis tools (University of North Carolina) to perform comparisons among FTLD, AD, and controls for global shape, local p-value significance maps, and mean magnitude of shape displacement.

    Results: Shape analysis revealed that there was significant shape difference between FTLD, AD, and controls, consistent with the predicted frontostriatal dysfunction and of significant magnitude, as measured by displacement maps. There was a lateralized difference in shape for the left caudate for FTLD compared to AD; non-specific global atrophy in AD compared to controls; while FTLD showed a more specific pattern in regions relaying fronto- and corticostriatal circuits.

    Conclusions: Shape analysis shows regional specificity of atrophy, manifest as shape deflation, with implications for frontostriatal and corticostriatal motoric circuits, in FTLD, AD, and controls.

  • 92.
    Lövheim, Hugo
    et al.
    Umeå Univ, Dept Community Med & Rehabil, Geriatr Med, Umeå, Sweden.
    Norman, Tove
    Umeå Univ, Dept Community Med & Rehabil, Geriatr Med, Umeå, Sweden.
    Weidung, Bodil
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Geriatrik. Umeå Univ, Dept Community Med & Rehabil, Geriatr Med, Umeå, Sweden.
    Olsson, Jan
    Umeå Univ, Dept Clin Microbiol, Virol, Umeå, Sweden.
    Josefsson, Maria
    Umeå Univ, Ctr Demog & Ageing Res, Umeå, Sweden; Umeå Univ, Umeci Ctr Funct Brain Imaging, Umeå, Sweden.
    Adolfsson, Rolf
    Umeå Univ, Dept Clin Sci, Psychiat, Umeå, Sweden.
    Nyberg, Lars
    Umeå Univ, Umeci Ctr Funct Brain Imaging, Umeå, Sweden; Umeå Univ, Dept Radiat Sci, Umeå, Sweden; Umeå Univ, Dept Integrat Med Biol, Umeå, Sweden.
    Elgh, Fredrik
    Umeå Univ, Dept Clin Microbiol, Virol, Umeå, Sweden.
    Herpes Simplex Virus, APOEɛ4, and Cognitive Decline in Old Age: Results from the Betula Cohort Study2019Ingår i: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 67, nr 1, s. 211-220Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Herpes simplex virus (HSV) has been suggested to play a role in Alzheimer’s disease (AD) development.

    Objective: The aim of the present study was to investigate the early AD-related symptom episodic memory decline in relation to HSV and carriage of allele 4 of the apolipoprotein E gene (APOE ɛ4) in a large population-based cohort with a long follow-up time.

    Methods: The study included 3,413 persons, with longitudinal data available for 1,293 persons with a mean follow-up time of 11.6 years. The associations between HSV carriage, APOE ɛ4 carriage, and episodic memory was investigated at baseline, as well as in longitudinal analyses where individuals with and without HSV antibodies (HSV1/2 non-specific) were matched and episodic memory decline compared.

    Results: Cross-sectional analyses revealed an age-dependent association of HSV carriage with lower episodic memory function, particularly among APOE ɛ4 carriers (p = 0.008). Longitudinal analyses showed an increased risk of episodic memory decline in HSV carriers (≥65 years: p < 0.001, all ages: non-significant), and a significant interaction between HSV and APOE ɛ4 for episodic memory decline (p < 0.001).

    Conclusion: In this large population-based cohort study, both cross-sectional and longitudinal results support an association between HSV carriage and declining episodic memory function, especially among APOE ɛ4 carriers. The results strengthen the hypothesis that HSV is associated with AD development.

  • 93.
    Madeira, Teresa
    et al.
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Inst Saude Ambiental, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Peixoto-Placido, Catarina
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Inst Saude Ambiental, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Goulao, Beatriz
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Aberdeen, Hlth Serv Res Unit, Foresterhill, Aberdeen AB25 2ZD, Scotland..
    Mendonca, Nuno
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Newcastle Univ, Inst Ageing, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England..
    Alarcao, Violeta
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Inst Saude Ambiental, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Santos, Nuno
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Inst Saude Ambiental, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    de Oliveira, Rita Machado
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Inst Saude Ambiental, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Yngve, Agneta
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för kostvetenskap.
    Bye, Asta
    Oslo & Akershus Univ, Coll Appl Sci, Pilestredet 46, N-0167 Oslo, Norway.;Oslo Univ Hosp, Reg Advisory Unit Palliat Care, Box 4965Nydalen, N-0424 Oslo, Norway..
    Bergland, Astrid
    Oslo & Akershus Univ, Coll Appl Sci, Pilestredet 46, N-0167 Oslo, Norway..
    Lopes, Carla
    Univ Porto, EPIUnit Inst Publ Hlth, Rua Taipas 135, P-4050600 Oporto, Portugal.;Univ Porto, Fac Med, P-4200319 Oporto, Portugal..
    Nicola, Paulo
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Inst Saude Ambiental, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Santos, Osvaldo
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Inst Saude Ambiental, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    Clara, Joao Gorjao
    Univ Lisbon, Fac Med, Inst Med Prevent & Saude Publ, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Inst Saude Ambiental, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal.;Univ Lisbon, Fac Med, Ave Prof Egas Moniz, P-1649028 Lisbon, Portugal..
    National survey of the Portuguese elderly nutritional status: study protocol2016Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 16, artikel-id 139Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Worldwide we are facing a serious demographic challenge due to the dramatic growth of the population over 60 years. It is expected that the proportion of this population will nearly double from 12 to 22 %, between 2015 and 2050. This demographic shift comes with major health and socio-economic concerns. Nutrition is a fundamental determinant of both health and disease and its role in extending a healthy lifespan is the object of considerable research. Notably, malnutrition is one of the main threats to health and quality of life among the elderly. Therefore, knowledge about nutritional status among the elderly is essential for the promotion and maintenance of healthy ageing and to support the development of health protection policies and equity in elderly health care. Methods: This is a nationwide nutrition survey of the Portuguese population over 65 years old, with data collection through face-to-face interviews. A representative and random sample of community dwelling elderly and nursing homes residents will be obtained by multistage sampling stratified per main Portuguese regions, sex and age groups. Minimum sample size was estimated to be 2077 elderly (979 in the community and 1098 in nursing homes). Data will be collected on food habits and eating patterns, nutritional status, food insecurity, lifestyle, self-rated general health status and self-reported diseases, functionality, loneliness, cognitive function, emotional status and demographic and socio-economic characterization. Discussion: This is the first national survey to evaluate the prevalence of nutritional risk and malnutrition of the Portuguese population above 65 years old, including those living in nursing homes. It will allow the identification of population subgroups of elderly with increased odds of malnutrition and nutritional risk. In addition, this survey will contribute to the identification of psychosocial and clinical predictors of malnutrition among elderly, which is an important risk factor for other devastating medical conditions.

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  • 94.
    Marcusson, Jan
    et al.
    Linköpings universitet.
    Nord, Magnus
    Linköpings universitet.
    Johannsson, Maria
    Linköpings universitet.
    Alwin, Jenny
    Linköpings universitet.
    Levin, Lars-Åke
    Linköpings universitet.
    Dannapfel, Petra
    Thomas, Kristin
    Poksinska, Bonnie
    Sverker, Annette
    Olaison, Anna
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen, Centrum för socialt arbete - CESAR.
    Cedersund, Elisabet
    Kelfve, Susanne
    Motel-Klingebiel, Andreas
    Hellström, Ingrid
    Kullberg, Agneta
    Böttiger, Ylva
    Dong, Huan-Ji
    Peolsson, Anneli
    Wass, Malin
    Lyth, Johan
    Andersson, Agneta
    Proactive healthcare for frail elderly persons: study protocol for a prospective controlled primary care intervention in Sweden2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 5, artikel-id e027847Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

  • 95.
    Marvig, Camilla L.
    et al.
    Univ Copenhagen, Dept Drug Design & Pharmacol, Fac Hlth & Med Sci, Copenhagen, Denmark..
    Verhoef, Talitha I.
    Univ Utrecht, Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands..
    de Boer, Anthonius
    Univ Utrecht, Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands..
    Kamali, Farhad
    Newcastle Univ, Sch Med, Inst Cellular Med, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England..
    Redekop, Ken
    Erasmus Univ, Inst Med Technol Assessment, Rotterdam, Netherlands..
    Pirmohamed, Munir
    Univ Liverpool, Wolfson Ctr Personalised Med, Inst Translat Med, Liverpool L69 3BX, Merseyside, England..
    Daly, Ann K.
    Newcastle Univ, Sch Med, Inst Cellular Med, Newcastle Upon Tyne NE2 4HH, Tyne & Wear, England..
    Manolopoulos, Vangelis G.
    Democritus Univ Thrace, Sch Med, Pharmacol Lab, Alexandroupolis, Greece..
    Wadelius, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Bouvy, Marcel
    Univ Utrecht, Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands..
    Maitland-van der Zee, Anke H.
    Univ Utrecht, Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands..
    Quality of life in patients with venous thromboembolism and atrial fibrillation treated with coumarin anticoagulants2015Ingår i: Thrombosis Research, ISSN 0049-3848, E-ISSN 1879-2472, Vol. 136, nr 1, s. 69-75Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Little is known about the overall quality of life (QOL) in patients newly diagnosed with venous thromboembolism (VTE) and atrial fibrillation (AF). We studied QOL in patients with VTE and AF immediately after the start of anticoagulant therapy, and after three months of treatment. Furthermore we identified whether QOL was affected by age, gender and nationality. Materials and Methods: The European pharmacogenetics of anticoagulant therapy (EU-PACT) study was a multicentre, randomized controlled trial of patients aged > 18 years diagnosed with VTE or AF. QOL was assessed using EuroQol 5 dimensions (EQ-5D) questionnaires. Results: The EQ-5D questionnaires were completed by 187 patients with VTE and 660 patients with AF. The QOL in patients diagnosed with VTE or AF was significantly impaired, however, during a 3 months treatment period, patients experienced an improvement (p < 0.05). The QOL in patients diagnosed with VTE improved with increasing age, with similar effects seen in men and women. Men and women diagnosed with AF differed in QOL (respectively 0.84 and 0.74, p < 0.05), and QOL decreased with age. Comparison between countries showed significant differences in the EQ-Index score at follow-up of patients with VTE, and in both EQ-Index score and EQ-VAS of patients with AF. Conclusions: The QOL in patients with VTE and AF is strongly reduced directly after the start of anticoagulant treatment, but improves within 3 months. Moreover, QOL is influenced by demographic and disease-specific variables. These findings provide useful information for future cost-effectiveness studies.

  • 96.
    McAleese, Kirsty E.
    et al.
    Newcastle Univ, Inst Neurosci, Newcastle Upon Tyne, Tyne & Wear, England..
    Alafuzoff, Irina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för immunologi, genetik och patologi.
    Charidimou, Andreas
    Harvard Med Sch, Massachusetts Gen Hosp Stroke Res Ctr, Dept Neurol, Hemorrhag Stroke Res Program, Boston, MA USA..
    De Reuck, Jacques
    Univ Hosp Lille, Stroke Res Team, Lille, France..
    Grinberg, Lea T.
    Univ Calif San Francisco, Dept Neurol, San Francisco, CA USA.;Univ Calif San Francisco, Dept Pathol, San Francisco, CA 94140 USA.;Univ Sao Paulo, Sch Med, Dept Pathol LIM 22, Sao Paulo, Brazil..
    Hainsworth, Atticus H.
    St Georges Univ London, Inst Cardiovasc & Cell Sci, London, England..
    Hortobagyi, Tibor
    Univ Debrecen, Dept Neuropathol, Debrecen, Hungary..
    Ince, Paul
    Sheffield Inst Translat Neurosci, Sheffield, S Yorkshire, England..
    Jellinger, Kurt
    Inst Clin Neurobiol, Vienna, Austria..
    Gao, Jing
    Beijing Union Med Coll Hosp, Dept Neurol, Beijing, Peoples R China..
    Kalaria, Raj N.
    Newcastle Univ, Inst Neurosci, Newcastle Upon Tyne, Tyne & Wear, England..
    Kovacs, Gabor G.
    Med Univ Vienna, Inst Neurol, Vienna, Austria..
    Kovari, Eniko
    Univ Geneva, Dept Mental Hlth & Psychiat, Geneva, Switzerland..
    Love, Seth
    Univ Bristol, Clin Neurosci, Bristol, Avon, England..
    Popovic, Mara
    Univ Ljubljana, Inst Pathol, Fac Med, Ljubljana, Slovenia..
    Skrobot, Olivia
    Univ Bristol, Clin Neurosci, Bristol, Avon, England..
    Taipa, Ricardo
    Univ Porto, Ctr Hosp Porto, Unit Neuropathol, Oporto, Portugal..
    Thal, Dietmar R.
    Katholieke Univ Leuven, Dept Neurosci, Leuven, Belgium.;UZ Leuven, Dept Pathol, Leuven, Belgium..
    Werring, David
    UCL, Inst Neurol, London, England..
    Wharton, Stephen B.
    Sheffield Inst Translat Neurosci, Sheffield, S Yorkshire, England..
    Attems, Johannes
    Newcastle Univ, Inst Neurosci, Newcastle Upon Tyne, Tyne & Wear, England..
    Post-mortem assessment in vascular dementia: advances and aspirations2016Ingår i: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 14, artikel-id 129Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Cerebrovascular lesions are a frequent finding in the elderly population. However, the impact of these lesions on cognitive performance, the prevalence of vascular dementia, and the pathophysiology behind characteristic in vivo imaging findings are subject to controversy. Moreover, there are no standardised criteria for the neuropathological assessment of cerebrovascular disease or its related lesions in human post-mortem brains, and conventional histological techniques may indeed be insufficient to fully reflect the consequences of cerebrovascular disease. Discussion: Here, we review and discuss both the neuropathological and in vivo imaging characteristics of cerebrovascular disease, prevalence rates of vascular dementia, and clinico-pathological correlations. We also discuss the frequent comorbidity of cerebrovascular pathology and Alzheimer's disease pathology, as well as the difficult and controversial issue of clinically differentiating between Alzheimer's disease, vascular dementia and mixed Alzheimer's disease/vascular dementia. Finally, we consider additional novel approaches to complement and enhance current post-mortem assessment of cerebral human tissue. Conclusion: Elucidation of the pathophysiology of cerebrovascular disease, clarification of characteristic findings of in vivo imaging and knowledge about the impact of combined pathologies are needed to improve the diagnostic accuracy of clinical diagnoses.

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  • 97.
    McIntosh, Jennifer
    et al.
    Departament de Recerca i Innovació, Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain .
    Alonso, Albert
    Departament de Recerca i Innovació, Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain .
    MacLure, Katie
    School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland .
    Stewart, Derek
    School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland .
    Kempen, Thomas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk farmakogenomik och osteoporos.
    Mair, Alpana
    Effective prescribing and therapeutics, Health and social care directorate, Scottish Government, Edinburgh, Scotland .
    Castel-Branco, Margarida
    Laboratory of Pharmacology and Pharmaceutical Care, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal .
    Codina, Carles
    Servei de Farmàcia, Hospital Clínic de Barcelona, Barcelona, Spain .
    Fernandez-Llimos, Fernando
    Institute for Medicines Research, Department of Social Pharmacy, Faculty of Pharmacy, University of Lisbon, Lisboa, Portugal .
    Fleming, Glenda
    Pharmacy Department and Regional Medicines Optimisation Innovation Centre(MOIC) Northern Health and Social Care Trust, Antrim, Northern Ireland .
    Gennimata, Dimitra
    Department of Social and Education Policy, University of Peloponnese, Korinthos, Greece, eHealth Innovation Unit, 1st Regional Health Authority of Attica, Athens, Greece .
    Gillespie, Ulrika
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Harrison, Cathy
    Department of Health, Belfast, Northern Ireland .
    Illario, Maddalena
    Federico II University Hospital, Naples, Italy .
    Junius-Walker, Ulrike
    Institute of General Practice, Hannover Medical School, Hannover, Germany .
    Kampolis, Christos F
    Department of Social and Education Policy, University of Peloponnese, Korinthos, Greece, eHealth Innovation Unit, 1st Regional Health Authority of Attica, Athens, Greece .
    Kardas, Przemyslaw
    Department of Family Medicine, Medical University of Lodz, Lodz, Poland .
    Lewek, Pawel
    Department of Family Medicine, Medical University of Lodz, Lodz, Poland .
    Malva, João
    Institute of Biomedical Imaging and Life Sciences (IBILI) and Institute of Pharmacology and Experimental Therapeutics, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
    Menditto, Enrica
    CIRFF, Center of Pharmacoeconomics, University of Naples Federico II, Naples, Italy.
    Scullin, Claire
    Clinical & Practice Research Group, School of Pharmacy, Queen’s University, Belfast, Northern Ireland .
    Wiese, Birgitt
    Institute of General Practice, Hannover Medical School, Hannover, Germany .
    A case study of polypharmacy management in nine European countries: implications for change management and implementation2018Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, nr 4, artikel-id e0195232Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained.

    METHODS: Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases.

    RESULTS: Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation.

    CONCLUSION: Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

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  • 98. Michel, Jean-Pierre
    et al.
    Cruz-Jentoft, Alfonso J.
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Frailty, Exercise and Nutrition2015Ingår i: Clinics in Geriatric Medicine, ISSN 0749-0690, E-ISSN 1879-8853, Vol. 19, nr 3, s. 375-387Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This article first reports the spontaneous course of frailty conditions, and then focuses on randomized, controlled frailty interventions (such as physical exercise, nutrition, combined exercise plus nutrition, and multifactorial interventions) or metaanalysis in community-dwelling older adults or volunteers published in 2012, 2013, and 2014. The main take-home messages that emerge from recent literature are summarized.

  • 99.
    Miguel, Sophie
    et al.
    Mars Wrigley, 1132 W Blackhawk St, Chicago, IL 60642 USA..
    Champ, Claire
    Univ Leeds, Sch Psychol, Human Appetite Res Unit, Leeds LS2 9JT, W Yorkshire, England..
    Day, Jon
    Cerebrus Associates Ltd, White House,2 Meadrow, Godalming GU7 3HN, Surrey, England..
    Aarts, Esther
    Radboud Univ Nijmegen, Donders Inst Brain Cognit & Behav, Kapittelweg 29, NL-6525 EN Nijmegen, Netherlands..
    Bahr, Ben A.
    Univ N Carolina, Biotechnol Res & Training Ctr, Pembroke, WA USA..
    Bakker, Martijntje
    Netherlands Org Hlth Res & Dev, Laan Nieuw Oost Indie 334, NL-2593 CE The Hague, Netherlands..
    Banati, Diana
    Europe ILSI Europe, Int Life Sci Inst, E Mounier 83,Box 6, B-1200 Brussels, Belgium..
    Calabrese, Vittorio
    Univ Catania, Dept Biomed & Biotechnol Sci, Biol Tower Via Santa Sofia 97, Catania, Italy..
    Cederholm, Tommy
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk nutrition och metabolism.
    Cryan, John
    Univ Coll Cork, Anat & Neurosci, 386 Western Gateway Bldg, Cork, Ireland..
    Dye, Louise
    Univ Leeds, Sch Psychol, Human Appetite Res Unit, Leeds LS2 9JT, W Yorkshire, England..
    Farrimond, Jonathan A.
    Lucozade Ribena Suntory Ltd, Uxbridge, Middx, England..
    Korosi, Aniko
    Univ Amsterdam, Ctr Neurosci, Swammerdam Inst Life Sci, Sci Pk 904, NL-1098 XH Amsterdam, Netherlands..
    Laye, Sophie
    INRA Bordeaux Univ, Nutr & Neurobiol Integree, 146 Rue Lio Saignat, F-33076 Bordeaux, France..
    Maudsley, Stuart
    Univ Antwerp, Dept Biomed Res, Gebouw V,Campus Drie Eileen,Univ Pl 1, Antwerp, Belgium.;Univ Antwerp, VIBU Antwerp Ctr Mol Neurol, Gebouw V,Campus Drie Eileen,Univ Pl 1, Antwerp, Belgium..
    Milenkovic, Dragan
    UCA, INRA, Human Nutr Unit, F-63003 Clermont Ferrand, France.;Univ Calif Davis, Sch Med, Dept Internal Med, Div Cardiovasc Med, Davis, CA 95616 USA..
    Mohajeri, M. Hasan
    DSM Nutr Prod Ltd, Wurmisweg 576, CH-4303 Kaiseraugst, Switzerland..
    Sijben, John
    Nutr Adv Med Nutr, Nutr Res, POB 80141, NL-3508 TC Utrecht, Netherlands..
    Solomon, Alina
    Karolinska Inst, Aging Res Ctr, Gavlegatan 16, SE-11330 Stockholm, Sweden..
    Spencer, Jeremy P. E.
    Univ Reading, Hugh Sinclair Unit Human Nutr, Reading RG6 6AP, Berks, England.;Univ Reading, Inst Cardiovasc & Metab Res, Dept Food & Nutr Sci, Reading RG6 6AP, Berks, England..
    Thuret, Sandrine
    Kings Coll London, Inst Psychiat Psychol & Neurosci, Maurice Wohl Clin Neurosci Inst, 125 Coldharbour Lane, London SE5 9NU, England..
    Vanden Berghe, Wim
    Univ Antwerp, Dept Biomed Sci, PPES, Campus Drie Eileen,Univ Pl 1, B-2610 Antwerp, Belgium..
    Vauzour, David
    Univ East Anglia, Norwich Res Pk, Norwich NR4 7TJ, Norfolk, England..
    Vellas, Bruno
    CHU Toulouse, Dept Geriatr Med, Toulouse, France..
    Wesnes, Keith
    Wesnes Cognit Ltd, Little Paddock, Streatley On Thames RG8 9RD, England.;Univ Exeter, Med Sch, Exeter, Devon, England.;Northumbria Univ, Dept Psychol, Newcastle, NSW, Australia.;Swinbume Univ, Ctr Human Psychopharmacol, Melbourne, Vic, Australia.;Newcastle Univ, Med Plant Res Croup, Newcastle, NSW, Australia..
    Willatts, Peter
    Univ Dundee Nethergate, Sch Psychol, Dundee DD1 4HN, Scotland..
    Wittenberg, Raphael
    London Sch Econ & Polit Sci, Personal Social Serv, Res Unit, London, England..
    Geurts, Lucie
    Europe ILSI Europe, Int Life Sci Inst, E Mounier 83,Box 6, B-1200 Brussels, Belgium..
    Poor cognitive ageing: Vulnerabilities, mechanisms and the impact of nutritional interventions2018Ingår i: Ageing Research Reviews, ISSN 1568-1637, E-ISSN 1872-9649, Vol. 42, s. 40-55Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Ageing is a highly complex process marked by a temporal cascade of events, which promote alterations in the normal functioning of an individual organism. The triggers of normal brain ageing are not well understood, even less so the factors which initiate and steer the neuronal degeneration, which underpin disorders such as dementia. A wealth of data on how nutrients and diets may support cognitive function and preserve brain health are available, yet the molecular mechanisms underlying their biological action in both normal ageing, age-related cognitive decline, and in the development of neurodegenerative disorders have not been clearly elucidated.

    Objectives: This review aims to summarise the current state of knowledge of vulnerabilities that predispose towards dysfunctional brain ageing, highlight potential protective mechanisms, and discuss dietary interventions that may be used as therapies. A special focus of this paper is on the impact of nutrition on neuroprotection and the underlying molecular mechanisms, and this focus reflects the discussions held during the 2nd workshop ‘Nutrition for the Ageing Brain: Functional Aspects and Mechanisms’ in Copenhagen in June 2016. The present review is the most recent in a series produced by the Nutrition and Mental Performance Task Force under the auspice of the International Life Sciences Institute Europe (ILSI Europe).

    Conclusion: Coupling studies of cognitive ageing with studies investigating the effect of nutrition and dietary interventions as strategies targeting specific mechanisms, such as neurogenesis, protein clearance, inflammation, and non-coding and microRNAs is of high value. Future research on the impact of nutrition on cognitive ageing will need to adopt a longitudinal approach and multimodal nutritional interventions will likely need to be imposed in early-life to observe significant impact in older age.

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  • 100. Montandon, Marie-Louise
    et al.
    Herrmann, François R
    Garibotto, Valentina
    Rodriguez, Cristelle
    Haller, Sven
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Radiologi. CIRD - Centre d’Imagerie Rive Droite, Geneva, Switzerland;Department of Neuroradiology, Faculty of Medicine of the University of Geneva, Geneva, Switzerland.
    Giannakopoulos, Panteleimon
    Determinants of mesial temporal lobe volume loss in older individuals with preserved cognition: a longitudinal PET amyloid study2020Ingår i: Neurobiology of Aging, ISSN 0197-4580, E-ISSN 1558-1497, Vol. 87, s. 108-114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Mesial temporal lobe (MTL) is prominently affected in normal aging and associated with neurodegeneration in AD. Whether or not MTL atrophy is dependent on increasing amyloid load before the emergence of cognitive deficits is still disputed. We performed a 4.5-year longitudinal study in 75 older community dwellers (48 women, mean age: 79.3 years) including magnetic resonance imaging at baseline and follow-up, positron emission tomography amyloid during follow-up, neuropsychological assessment at 18 and 55 months, and APOE genotyping. Linear regression models were used to identify predictors of the MTL volume loss. Amyloid load was negatively associated with bilateral MTL volume at baseline explaining almost 10.5% of its variability. In multivariate models including time of follow-up and demographic variables (older age, male gender), this percentage exceeded 35%. The APOE4 allele independently contributed another 6%. Cognitive changes had a modest but still significant negative association with MTL volume loss. Our data support a multifactorial model including amyloid deposition, older age, male gender, APOE4 allele, and slight decline of cognitive abilities as independent predictors of MTL volume loss in brain aging.

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