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Age, education and dementia related deaths. The Norwegian Counties Study and The Cohort of Norway.

https://arctichealth.org/en/permalink/ahliterature263219
Source
J Neurol Sci. 2014 Oct 15;345(1-2):75-82
Publication Type
Article
Date
Oct-15-2014
Author
Bjørn Heine Strand
Ellen Melbye Langballe
Tor A Rosness
Astrid Liv Mina Bergem
Knut Engedal
Per Nafstad
Grethe S Tell
Heidi Ormstad
Kristian Tambs
Espen Bjertness
Source
J Neurol Sci. 2014 Oct 15;345(1-2):75-82
Date
Oct-15-2014
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Aging
Cause of Death
Cohort Studies
Death
Dementia - epidemiology
Educational Status
Female
Humans
Male
Middle Aged
Norway - epidemiology
Regression Analysis
Risk factors
Abstract
An inverse relationship between educational level and dementia has been reported in several studies. In this study we investigated the relationship between educational level and dementia related deaths for cohorts of people all born during 1915-39. The cohorts were followed up from adulthood or old age, taking into account possible confounders and mediating paths. Our study population comprised participants in Norwegian health examination studies in the period 1974-2002; The Counties Study and Cohort of Norway (CONOR). Dementia related deaths were defined as deaths with a dementia diagnosis on the death certificate and linked using the Cause of Death Registry to year 2012. The study included 90,843 participants, 2.06 million person years and 2440 dementia related deaths. Cox regression was used to assess the association between education and dementia related deaths. Both high and middle educational levels were associated with lower dementia related death risk compared to those with low education when follow-up started in adulthood (35-49 years, high versus low education: HR=0.68, 95% confidence interval (CI) 0.50-0.93; 50-69 years, high versus low education: HR=0.52, 95% CI 0.34-0.80). However, when follow-up started at old age (70-80 years) there was no significant association between education and dementia related death. Restricting the study population to those born during a five-year period 1925-29 (the birth cohort overlapping all three age groups), gave similar main findings. The protective effects found for both high and middle educational level compared to low education were robust to adjustment for cardiovascular health and life style factors, suggesting education to be a protective factor for dementia related death. Both high and middle educational levels were associated with decreased dementia related death risk compared with low educational level when follow-up started in adulthood, but no association was observed when follow-up started at old age.
PubMed ID
25034053 View in PubMed
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Antipsychotic Drug Use Is Not Associated With Long-Term Mortality Risk in Norwegian Nursing Home Patients.

https://arctichealth.org/en/permalink/ahliterature287422
Source
J Am Med Dir Assoc. 2016 May 01;17(5):464.e1-7
Publication Type
Article
Date
May-01-2016
Author
Geir Selbæk
Dag Aarsland
Clive Ballard
Knut Engedal
Ellen Melbye Langballe
Jurate Šaltyte Benth
Sverre Bergh
Source
J Am Med Dir Assoc. 2016 May 01;17(5):464.e1-7
Date
May-01-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antipsychotic Agents - therapeutic use
Female
Humans
Longitudinal Studies
Male
Mortality - trends
Norway
Nursing Homes
Proportional Hazards Models
Abstract
To assess the long-term mortality risk associated with antipsychotic drug (AP) use in nursing homes.
A longitudinal study with 5 assessments over a 75-month follow-up period.
A representative sample of nursing home patients in 4 Norwegian counties.
At baseline, 1163 patients were included. At the last follow-up, 98 patients were still alive.
Prevalent drug use at each assessment was registered. Level of dementia, neuropsychiatric symptoms, level of functioning, medical health, and use of restraints were recorded at each assessment. A Cox regression model with time-dependent psychotropic drug use as the main predictor was estimated and adjusted for confounders.
In unadjusted Cox regression, a lower mortality risk was associated with the use of other psychotropic drugs, but not APs, compared with nonusers. In the adjusted analysis, neither use of APs nor other psychiatric drugs was associated with increased mortality risk. Higher age, male gender, not being married, medical disease burden, lower level of functioning, more severe degree of dementia, and a higher number of drugs were all associated with increased mortality risk.
In this long-term study of nursing home patients, AP drug use was not associated with increased risk of mortality. This is in line with results from earlier studies of clinical samples, but contrasts with results from randomized controlled trials and registry-based studies. The findings should be interpreted with caution. Taking into account the modest benefit and high risk of adverse effects of AP drug use, nonpharmacological treatment remains the first-line treatment approach.
PubMed ID
26935533 View in PubMed
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Anxiety among older psychiatric patients: a hidden comorbidity?

https://arctichealth.org/en/permalink/ahliterature288354
Source
Aging Ment Health. 2016 Nov;20(11):1131-1138
Publication Type
Article
Date
Nov-2016
Author
Anette Bakkane Bendixen
Knut Engedal
Source
Aging Ment Health. 2016 Nov;20(11):1131-1138
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antipsychotic Agents - therapeutic use
Anxiety Disorders - epidemiology
Comorbidity
Female
Geriatric Psychiatry
Humans
Male
Norway - epidemiology
Psychiatric Status Rating Scales
Psychotic Disorders - epidemiology
Registries
Abstract
Our aims were to explore prevalence of anxiety among patients admitted to departments of geriatric psychiatry for treatment of various diagnoses and to examine how often anxiety was registered as a previous or ongoing diagnosis.
In all, 473 patients admitted to one of five departments of geriatric psychiatry were included in a quality register and examined according to a standardized protocol. The Geriatric Anxiety Inventory (GAI) was used to measure anxiety during the first week after admission. Diagnoses were made at discharge.
Using a cutoff on the GAI of 8/9, the prevalence of anxiety for the following diagnostic groups was depression 65.3%, psychosis 28%, dementia 38.8% and mania 33.3%. Of 24 patients with a primary diagnosis of anxiety, 66.7% scored above 8 on the GAI. Of 236 patients with a GAI score above 8, only 22 (9.3%) were reported to have a comorbid anxiety disorder by the treating psychiatrist. In a multiple regression analysis, we found that the severity of depression (beta 0.585, p
PubMed ID
26158426 View in PubMed
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Anxiety, Anxiety Symptoms, and Their Correlates in Persons with Dementia in Norwegian Nursing Homes: A Cause for Concern.

https://arctichealth.org/en/permalink/ahliterature292510
Source
Dement Geriatr Cogn Disord. 2017; 43(5-6):294-305
Publication Type
Journal Article
Date
2017
Author
Alka Rani Goyal
Sverre Bergh
Knut Engedal
Marit Kirkevold
Øyvind Kirkevold
Author Affiliation
Centre of Old Age Psychiatry Research, Innlandet Hospital Trust, Ottestad, Norway.
Source
Dement Geriatr Cogn Disord. 2017; 43(5-6):294-305
Date
2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Anti-Anxiety Agents - therapeutic use
Anxiety - diagnosis - drug therapy - etiology - psychology
Dementia - complications - diagnosis - epidemiology - psychology
Female
Homes for the Aged - statistics & numerical data
Humans
Male
Norway - epidemiology
Nursing Homes - statistics & numerical data
Patient Care Management - methods
Psychomotor Agitation - etiology - prevention & control - psychology
Abstract
Little is known about anxiety and its associations among persons with dementia in nursing homes. This study aims to examine anxiety, anxiety symptoms, and their correlates in persons with dementia in Norwegian nursing homes.
In all, 298 participants with dementia =65 years old from 17 nursing homes were assessed with a validated Norwegian version of the Rating Anxiety in Dementia scale (RAID-N). Associations between anxiety (RAID-N score) and demographic and clinical characteristics were analyzed with linear regression models.
Anxiety, according to a cutoff of =12 on the RAID-N, was found in 34.2% (n = 102) of the participants. Irritability (59.7%) and restlessness (53.0%) were the most frequent anxiety symptoms. The participants' general physical health, a wide range of neuropsychiatric symptoms, and anxiolytic use were significant correlates of higher RAID-N scores.
Knowledge about anxiety, anxiety symptoms, and their correlates may enhance early detection of anxiety and planning of necessary treatment and proactive measures among this population residing in nursing homes.
PubMed ID
28463828 View in PubMed
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Are coping strategies and locus of control orientation associated with health-related quality of life in older adults with and without depression?

https://arctichealth.org/en/permalink/ahliterature276290
Source
Arch Gerontol Geriatr. 2016 May-Jun;64:130-7
Publication Type
Article
Author
Anne-Sofie Helvik
Guro Hanevold Bjørkløf
Kirsten Corazzini
Geir Selbæk
Jerson Laks
Truls Østbye
Knut Engedal
Source
Arch Gerontol Geriatr. 2016 May-Jun;64:130-7
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adaptation, Psychological
Aged
Aged, 80 and over
Case-Control Studies
Cognition
Cross-Sectional Studies
Depression - complications - psychology
Depressive Disorder
Female
Health status
Humans
Internal-External Control
Logistic Models
Male
Middle Aged
Norway
Pain Measurement
Quality of Life - psychology
Residence Characteristics
Surveys and Questionnaires
Abstract
The aim of this study was to investigate relationships between coping and health related quality of life (HRQoL) in older adults (aged =60?years) with and without depression. This cross-sectional study included 144 depressed inpatients from seven psychogeriatric hospital units in Norway and 106 community-living older adults without depression. HRQoL was measured using Euro Qol Group's EQ-5D Index and visual analog scale (EQ-VAS). Two aspects of coping were of primary interest for HRQoL: locus of control (LOC) and ways of coping (WOC). Measures of depressive symptoms, cognitive functioning, instrumental activities of daily living, and general physical health were included as covariates. In linear regression analyses adjusted for age, stronger external LOC was associated with poorer HRQoL in both depressed and non-depressed older adults. In the fully-specified regression models for both groups, the association between stronger external LOC and poorer HRQoL remained significant for the EQ-VAS score but not the EQ-5D Index. WOC was not associated with HRQoL in either group. Total amount of explained variance in fully-specified models was considerably lower in the sample of depressed, hospitalized older adults (17.1% and 15.5% for EQ-5D index and EQ-VAS, respectively), than in the sample of non-depressed, community-based older adults (45.8% and 48.9% for EQ-5D Index and EQ-VAS, respectively). One aspect of coping (LOC orientation) was associated with HRQoL in both depressed and non-depressed older adult samples, and therefore may be an important target for intervention for both groups. Differences in the amount of variance explained in models for the two groups warrant further research.
PubMed ID
26874239 View in PubMed
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Assessment of dementia by a primary health care dementia team cooperating with the family doctor - the Norwegian model.

https://arctichealth.org/en/permalink/ahliterature118652
Source
Dement Geriatr Cogn Disord. 2012;34(5-6):263-70
Publication Type
Article
Date
2012
Author
Knut Engedal
Margit Gausdal
Linda Gjøra
Per Kristian Haugen
Author Affiliation
Norwegian Centre for Ageing and Health, Oslo University Hospital, Ullevaal and Vestfold Mental Health Trust, Tønsberg, Norway. knut.engedal@aldringoghelse.no
Source
Dement Geriatr Cogn Disord. 2012;34(5-6):263-70
Date
2012
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Alzheimer Disease - diagnosis
Caregivers
Delivery of Health Care
Dementia - classification - diagnosis - psychology
Family Practice
Female
General practitioners
Humans
Male
Neuropsychological Tests
Norway
Nurses
Patient care team
Primary Health Care
Abstract
To describe how dementia assessment could be organized in primary health care and how it works.
The project had two phases. In phase one 104 elderly patients were assessed by a local authority dementia team that used a standardized examination protocol, which enabled the family doctors to establish a dementia diagnosis. After evaluation and adjustments the model was extended to 31 local authorities and 474 patients were assessed.
The mean age of the patients was 84.4 (SD 5.6) and 81.8 (SD 7.8) years, respectively; 81 and 67% were women, respectively. The mean Mini Mental State Examination scores were 21.1 (SD 5.0) and 19.2 (SD 5.1), respectively. All patients in phase one and 70% in phase two were diagnosed with dementia. In 15 local authorities a specially assigned family doctor assisted in establishing diagnoses. In these local authorities 80% of the patients were diagnosed.
A local authority dementia team can collect the information required to enable a family doctor to establish a dementia diagnosis. Ideally, such teams should be assisted by a family doctor interested in dementia diagnostics.
PubMed ID
23183640 View in PubMed
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The association between depression, anxiety, and cognitive function in the elderly general population--the Hordaland Health Study.

https://arctichealth.org/en/permalink/ahliterature45650
Source
Int J Geriatr Psychiatry. 2005 Oct;20(10):989-97
Publication Type
Article
Date
Oct-2005
Author
Eva Biringer
Arnstein Mykletun
Alv A Dahl
A David Smith
Knut Engedal
Harald A Nygaard
Anders Lund
Author Affiliation
Institute of Clinical Medicine, University of Bergen, Norway. eva.biringer@psyk.uib.no
Source
Int J Geriatr Psychiatry. 2005 Oct;20(10):989-97
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Aged
Anxiety - epidemiology - psychology
Cognition Disorders - epidemiology - psychology
Comorbidity
Depression - epidemiology - psychology
Female
Humans
Male
Neuropsychological Tests
Norway - epidemiology
Research Support, Non-U.S. Gov't
Sex Distribution
Abstract
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.
PubMed ID
16163751 View in PubMed
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Association Between Random Measured Glucose Levels in Middle and Old Age and Risk of Dementia-Related Death.

https://arctichealth.org/en/permalink/ahliterature272888
Source
J Am Geriatr Soc. 2016 Jan;64(1):156-61
Publication Type
Article
Date
Jan-2016
Author
Tor Atle Rosness
Knut Engedal
Espen Bjertness
Bjørn Heine Strand
Source
J Am Geriatr Soc. 2016 Jan;64(1):156-61
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Blood Glucose - analysis
Cause of Death
Cohort Studies
Dementia - blood - complications - mortality
Diabetes Mellitus, Type 2 - blood - complications - epidemiology
Female
Humans
Hyperglycemia - blood - complications - etiology
Male
Middle Aged
Norway - epidemiology
Registries
Risk factors
Statistics as Topic
Survival Analysis
Time
Abstract
To investigate the association between random measured glucose levels in middle and old age and dementia-related death.
Population-based cohort study.
Norwegian Counties Study (middle-aged individuals; 35-49) and Cohort of Norway participants (older individuals; 65-80).
Individuals without (n=74,630) and with (n=3,095) known diabetes mellitus (N=77,725); 67,865 without and 2,341 with diabetes mellitus were included in the complete case analyses (nonmissing for all included covariates), of whom 1,580 without and 131 with diabetes mellitus died from dementia-related causes.
Dementia-related death was ascertained according to the Norwegian Cause of Death Registry. Cox regression was used to assess the relationship between random glucose levels (nonfasting) in individuals without and with diabetes mellitus and dementia-related death. Education, smoking, cardiovascular disease, body mass index, cholesterol, blood pressure, and physical activity were adjusted for.
Individuals without diabetes mellitus at midlife with glucose levels between 6.5 and 11.0 mmol/L had a significantly greater risk of dementia-related death than those with levels less than 5.1 mmol/L (hazard ratio=1.32, 95% confidence interval=1.04-1.67) in a fully adjusted model. A dose-response relationship (P=.02) was observed. No significant association between high glucose levels in individuals aged 65 to 80 and dementia-related death was detected.
High random glucose levels measured in middle-aged but not older age persons without known diabetes mellitus were associated with greater risk of dementia-related death up to four decades later.
PubMed ID
26782866 View in PubMed
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Association between vascular comorbidity and progression of Alzheimer's disease: a two-year observational study in Norwegian memory clinics.

https://arctichealth.org/en/permalink/ahliterature298599
Source
BMC Geriatr. 2018 05 22; 18(1):120
Publication Type
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Date
05-22-2018
Author
Rannveig Sakshaug Eldholm
Karin Persson
Maria Lage Barca
Anne-Brita Knapskog
Lena Cavallin
Knut Engedal
Geir Selbaek
Eva Skovlund
Ingvild Saltvedt
Author Affiliation
Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491, Trondheim, Norway. rannveig.s.eldholm@ntnu.no.
Source
BMC Geriatr. 2018 05 22; 18(1):120
Date
05-22-2018
Language
English
Publication Type
Journal Article
Observational Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - diagnosis - epidemiology
Brain Infarction - diagnostic imaging - etiology
Comorbidity
Disease Progression
Female
Heart Diseases - epidemiology
Humans
Longitudinal Studies
Magnetic Resonance Imaging - methods - statistics & numerical data
Male
Norway - epidemiology
Risk Assessment - methods
Risk factors
Vascular Diseases - complications - epidemiology
Abstract
Vascular risk factors increase the risk of Alzheimer's disease (AD), but there is limited evidence on whether comorbid vascular conditions and risk factors have an impact on disease progression. The aim of this study was to examine the association between vascular disease and vascular risk factors and progression of AD.
In a longitudinal observational study in three Norwegian memory clinics, 282 AD patients (mean age 73.3 years, 54% female) were followed for mean 24 (16-37) months. Vascular risk factors and vascular diseases were registered at baseline, and the vascular burden was estimated by the Framingham Stroke Risk Profile (FSRP). Cerebral medical resonance images (MRIs) were assessed for white matter hyperintensities (WMH), lacunar and cortical infarcts. The associations between vascular comorbidity and progression of dementia as measured by annual change in Clinical Dementia Rating Sum of Boxes (CDR-SB) scores were analysed by multiple regression analyses, adjusted for age and sex.
Hypertension occurred in 83%, hypercholesterolemia in 53%, diabetes in 9%, 41% were overweight, and 10% were smokers. One third had a history of vascular disease; 16% had heart disease and 15% had experienced a cerebrovascular event. MRI showed lacunar infarcts in 16%, WMH with Fazekas score 2 in 26%, and Fazekas score 3 in 33%. Neither the vascular risk factors and diseases, the FSRP score, nor cerebrovascular disease was associated with disease progression in AD.
Although vascular risk factors and vascular diseases were prevalent, no impact on the progression of AD after 2 years was shown.
PubMed ID
29788900 View in PubMed
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Association of psychological distress late in life and dementia-related mortality.

https://arctichealth.org/en/permalink/ahliterature279027
Source
Aging Ment Health. 2016;20(6):603-10
Publication Type
Article
Date
2016
Author
Tor Atle Rosness
Bjørn Heine Strand
Astrid Liv Mina Bergem
Per Nafstad
Ellen Melbye Langballe
Knut Engedal
Kristian Tambs
Espen Bjertness
Source
Aging Ment Health. 2016;20(6):603-10
Date
2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Comorbidity
Dementia - epidemiology - mortality
Female
Humans
Longitudinal Studies
Male
Middle Aged
Norway - epidemiology
Stress, Psychological - epidemiology - mortality
Abstract
It is not fully understood how subjective feelings of psychological distress prognosticate dementia. Our aim was to investigate the association between self-reported psychological distress and risk of dementia-related mortality.
We included 31,043 eligible individuals between the ages of 60 and 80 years, at time of examination, from the CONOR (Cohort of Norway) database. They were followed for a period of 17.4 years (mean 11.5 years). The CONOR Mental Health Index, a seven-item self-report scale was used. A cut-off score equal to or above 2.15 on the scale denoted psychological distress. Cox regression was used to assess the association between psychological distress and risk of dementia-related mortality.
Total number of registered deaths was 11,762 and 1118 (9.5%) were classified as cases of dementia-related mortality. We found that 2501 individuals (8.1%) had psychological distress, of these, 119 (10.6%) had concomitant dementia-related mortality. Individuals with psychological distress had an increased risk of dementia-related mortality HR = 1.52 (95% confidence interval (CI) 1.25-1.85) after adjusting for age, gender and education. The association remained significant although attenuated when implemented in a full adjusted model, including general health status, smoking, obesity, hypertension, diabetes and history of cardiovascular disease; hazard ratio, HR = 1.30 (95% CI 1.06-1.59).
Our results indicate that psychological distress in elderly individuals is associated with increased risk of dementia-related mortality. Individuals at increased risk of dementia may benefit from treatments or interventions that lessen psychological distress, but this needs to be confirmed in future clinical studies.
PubMed ID
25871314 View in PubMed
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82 records – page 1 of 9.