OBJECTIVES: To examine the association between depression and/or anxiety and cognitive function in the elderly general population. SUBJECTS: Non-demented participants from the general population (n = 1,930) aged 72-74 years. METHODS: Symptoms and caseness of depression and anxiety disorder were assessed using the Hospital Anxiety and Depression Scale (HADS). Cognitive function was assessed by the Digit Symbol Test (modified version), the Kendrick Object Learning Test, and the 'S'-task from the Controlled Oral Word Association Test. RESULTS: There was a significant association between depression and reduced cognitive function. The inverse association between anxiety and reduced cognitive performance was explained by adjustment for co-morbid depression. The inverse association between depressive symptoms and cognitive function was found to be close to linear, and was also present in the sub-clinical symptom range. Males were more affected cognitively by depressive symptoms than females. CONCLUSION: The inverse association between depression and cognitive function is not only a finding restricted to severely ill patient samples, but it can also be found in the elderly general population.
This study investigated the relationship between patients' self-reported illness, daily afflictions, and the frequency of home nursing care, and whether patients' coping resources influenced the allocation of care. DESIGN, SAMPLE AND MEASUREMENTS: A cross-sectional survey was adopted. Two hundred and forty-two people aged 75 years and above receiving home nursing care participated in the study. Binary logistic regression model was used to test the effects of the independent variables on home nursing care.
Poor capacity to perform activities of daily living and high level of education were directly associated with a high frequency of home nursing care. Lack of perceived social support affected the amount of home nursing care allocated only when feelings of loneliness were connected with poor activities of daily living functioning. Interaction effects revealed that perceived social support influenced the amount of home nursing care in persons with higher education, in persons with low education, no such association were found. No associations were found between coping resources and home nursing care.
Impaired capacity to perform activities of daily living was the main reason for care allocation. Education was associated with more formal care. Patients with low perceived social support combined with a low education level was a particularly vulnerable group.
Naturalistic trials are needed to evaluate whether the results obtained in randomised trials of cholinesterase inhibitors (CEI) can be generalised to clinical practice. We conducted two studies in Norway to address this issue.
We included patients with dementia from 16 centres in Norway who had received treatment with a CEI until November 2001 (study 1, n = 1,167, retrospective case review) or who came to the first evaluation after onset of treatment (study 2; n = 252; prospective enrollment). Adverse events, global effectiveness, and Mini-Mental State Exam scores were recorded.
In study 1, 56% of the patients were rated as mildly or markedly improved two to four months after onset of treatment. Side effects were recorded in 23%; 8% discontinued treatment due to side effects. In study 2, 49% were rated as mildly or markedly improved on at least one of the items cognition, psychiatric symptoms, activities of daily living or behaviour. Treatment was discontinued due to lack of effectiveness in 12%.
CEI were found to be useful in clinical practice in Norway. The open and uncontrolled design of the study limits the generalisability of the study.
To assess renal function in various groups of elderly persons, and to determine the proportion of patients with clinically important renal impairment.
Three geriatric populations aged 70 years and over, representing increasing levels of care/treatment: community-dwelling elderly referred to a geriatric outpatient department, inpatients on a geriatric ward, and nursing home patients.
Cockroft and Gault's formula was applied to calculate glomerular filtration rate (GFR). Differences in GFR between age groups and between care levels were explored.
Altogether 288 elderly persons were included in the study. We observed a general age-related decline of renal function. Only 2% of the participants had normal renal function (GFR >90 ml/min), 13% had light (GFR 60-89 ml/min), 68% moderate (GFR 30-59 ml/min), and 17% severe (GFR 15-29 ml/min) impairment in GFR. Moderate or severely decreased GFR was observed in 75% of the outpatients, 78% of the patients from the geriatric ward, and 91% of the nursing home patients. Altogether 99% of patients aged 85+ had renal impairment necessitating dosing adjustment for drugs that are mainly eliminated through renal excretion.
Clinically important renal impairment is common in old age, especially in the frailest elderly living in nursing homes. This finding underlines the necessity for close supervision of drug treatment based on renal function in old age.
To investigate the cross-sectional relation between metabolic markers of vitamin B(12) status and cognitive performance, and possible effect modification by the presence of depression and apolipoprotein E (ApoE) e4.
This is a population-based study of 1935 participants, aged 71 to 74 years, from Norway. Participants were administered a cognitive test battery, and vitamin B(12) status was assessed by measurements of plasma vitamin B(12), holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine.
The geometric mean (95% confidence interval) for vitamin B(12) was 348 pM (341-354), whereas 5.9% of participants had vitamin B(12) levels lower than 200 pM. In linear regression analyses, holoTC (p = .039) and the holoTC/vitamin B(12) ratio (p = .013) were positively related, whereas MMA (p = .010) was inversely related, to global cognition, after adjustment for sex, education, ApoE status, plasma creatinine, and history of diabetes, cardiovascular disease, hypertension, and depression. Among those positive for ApoE e4, but not among those without the e4 allele, plasma vitamin B(12) was positively associated with global cognition (p = .015), whereas MMA was inversely related to global cognition (p = .036) and executive function (p = .014). In participants with depression, MMA was inversely associated with global cognition (p
Fruits and vegetables are among the most nutritious and healthy of foods, and are related to the prevention of many chronic diseases. The aim of the study was to examine the relationship between intake of different plant foods and cognitive performance in elderly individuals in a cross-sectional study. Two thousand and thirty-one elderly subjects (aged 70-74 years; 55 % women) recruited from the general population in Western Norway underwent extensive cognitive testing and completed a comprehensive FFQ. The cognitive test battery covered several domains (Kendrick Object Learning Test, Trail Making Test - part A, modified versions of the Digit Symbol Test, Block Design, Mini-Mental State Examination and Controlled Oral Word Association Test). A validated and self-reported FFQ was used to assess habitual food intake. Subjects with intakes of>10th percentile of fruits, vegetables, grain products and mushrooms performed significantly better in cognitive tests than those with very low or no intake. The associations were strongest between cognition and the combined intake of fruits and vegetables, with a marked dose-dependent relationship up to about 500 g/d. The dose-related increase of intakes of grain products and potatoes reached a plateau at about 100-150 g/d, levelling off or decreasing thereafter, whereas the associations were linear for mushrooms. For individual plant foods, the positive cognitive associations of carrots, cruciferous vegetables, citrus fruits and high-fibre bread were most pronounced. The only negative cognitive association was with increased intake of white bread. In the elderly, a diet rich in plant foods is associated with better performance in several cognitive abilities in a dose-dependent manner.
Effect of antipsychotic withdrawal on behavior and sleep/wake activity in nursing home residents with dementia: a randomized, placebo-controlled, double-blinded study. The Bergen District Nursing Home Study.
Thirty patients (mean age 83.5) taking haloperidol, risperidone, or olanzapine for nonpsychotic symptoms.
Study participants were randomly assigned to withdrawal (intervention group) or continued treatment with antipsychotic medications (reference group) for 4 consecutive weeks.
Behavioral rating using the Neuropsychiatric Inventory Questionnaire (NPI-Q) and actigraphy.
After antipsychotic withdrawal, behavioral scores remained stable or improved in 11 of 15 patients, whereas four had worsening scores. Actigraphy revealed decreased sleep efficiency after drug discontinuation and increased 24-hour and night activity in both groups. Actigraphy records of nighttime and daytime activity indicated sleep problems and restlessness, in terms of the NPI-Q. One patient was restarted on antipsychotics.
Antipsychotic drug withdrawal affected activity and sleep efficiency over the short term. Increases in total activity and impaired sleep quality after drug discontinuation should be monitored, because the long-term effect of these changes is not known. The NPI-Q and actigraphy are feasible tools that disclose relevant changes occurring during antipsychotic withdrawal in NH patients with dementia. Their use in clinical practice should be substantiated by larger studies.
Knowledge of the factors determining the performance of bronchodilator reversibility testing in a general population is lacking. Random samples of all adults aged 47-48 and 71-73 years living in Bergen, Norway, were invited to a cross-sectional study. Altogether 3506 subjects attended (69%). Test quality predictors were examined through multiple logistic regression analyses including gender, age, body mass, educational level, smoking history, respiratory symptoms, and in the elderly cohort cognitive level. Among the participants, 1.6% refused to inhale salbutamol, 2.5% failed the initial spirometry according to the ATS guidelines, and 1.3% failed the post-bronchodilator spirometry. Old age and body mass index > 30 kg/m2 were independent risk factors for an unsuccessful initial spirometry, and never smoking and respiratory symptoms were risk factors for failing the post-bronchodilator spirometry. Cognitive impairment in the elderly was a risk factor for failing both the initial- and post-bronchodilator spirometry. The median number of forced expirations was 7 in subjects obtaining an acceptable reversibility test. One third of these participants needed > or = 8 attempts, with independent predicting factors being old age, Little formal education and never smoking. Although reversibility testing becomes increasingly difficult with age, reliable data are obtained in a vast majority (94%) of subjects in our community study.
OBJECTIVE: To establish dementia diagnoses in patients recently admitted to a nursing home by a geriatrician, and to compare the agreement with diagnoses recorded in the nursing home's medical records and with short screening instruments. DESIGN: Descriptive study. Geriatric work-up of the individual patient, information obtained from the medical records of nursing homes, structured interviews with nurses and a short cognitive test. SETTING: Nursing homes in Bergen, Norway, with 123 long-term care patients. MAIN OUTCOME MEASURES: Dementia diagnosis according to the International Classification of Diseases (ICD-10), Clinical Dementia Rating and the Short Portable Mental Status Questionnaire. RESULTS: Fifty-nine percent of the patients were diagnosed as demented according to the ICD-10. One-third of cases were not formerly diagnosed according to nursing home medical records. Clinical Dementia Rating and the Short Portable Mental Status Questionnaire detected "dementia/non-dementia" cases correctly in 93% and 94%, respectively. CONCLUSION: Geriatric work-up indicates under-diagnosing of dementia among recently admitted nursing home patients. This may have serious consequences for the treatment. Dementia diagnostics in primary health care must be improved. The knowledge of the attending nurses should be better incorporated in the medical work-up of nursing home patients.
The use of psychotropic drugs in nursing homes is generally considered to be inappropriately high. The aim of the present survey was to compare psychotropic drug use in nursing homes (NHs) in 1985 relative to 1996/97, and to explore predictors for this drug use.
Cross-sectional study. Mental capacity was assessed by means of the Clinical Dementia Rating scale (CDR), and behavior registered by trained nurses. Scheduled, daily use of psychotropic drugs among long-term care residents in 1985 (N=1247) and 1996/97 (N=1035) was recorded. Bivariate analyses and logistic regression analyses were applied to establish predictors for psychoactive drug use.
From 1985 to 1996/97, the proportion of residents using any psychotropic drug increased from 52 to 57%. Antipsychotic drug use decreased from 33 to 22%, while anxiolytics increased from 11 to 16%, hypnotics from 11 to 14%, and antidepressants from 12 to 31%. Psychotropic drug use was predominantly associated with behavioral symptoms and not with mental impairment. Concurrent use of two or more psychotropic drugs increased from 23 to 32% of all psychotropic users.
During the study period, a substantial decline in the use of antipsychotics was observed, but a generally increased overall use of psychotropic drugs, particularly antidepressants. Psychotropic drug treatment was mainly associated with behavioral symptoms.