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Change in the prevalence of coronary heart disease among Finnish elderly men and women in the 1990s.

https://arctichealth.org/en/permalink/ahliterature183395
Source
Scand J Prim Health Care. 2003 Sep;21(3):178-81
Publication Type
Article
Date
Sep-2003
Author
Sirpa Hartikainen
Merja Ahto
Minna Löppönen
Hannu Puolijoki
Pekka Laippala
Ansa Ojanlatva
Sirkka-Liisa Kivelä
Raimo Isoaho
Author Affiliation
University of Kuopio, Department of Public Health and General Practice, Division of Geriatrics, Kuopio, Finland. sirpa.hartikainen@uku.fi
Source
Scand J Prim Health Care. 2003 Sep;21(3):178-81
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Aged
Coronary Disease - epidemiology
Female
Finland - epidemiology
Geriatric Assessment
Humans
Male
Middle Aged
Myocardial Infarction - epidemiology
Prevalence
Abstract
To characterise the prevalence of, and changes in, coronary heart disease (CHD) among men and women aged between 64 and 71 years in the 1990s.
A study of clinical epidemiology involving two cohorts of elderly persons in 1990-1991 and 1998-1999.
Primary health care in the municipality of Lieto in southwestern Finland.
Persons between 64 and 71 years of age in the southwest of Finland in 1990-1991 and 1998-1999.
The occurrences of CHD were estimated using the history of a previous myocardial infarction or coronary revascularisation procedure evident in the medical records and with ischaemia or infarction as established on ECG according to the Whitehall criteria.
The prevalence of 'probable' CHD decreased among men and women aged between 64 and 71 years, whereas the prevalence of 'possible' CHD decreased among women alone. Silent myocardial infarctions were common among women of both cohorts. Many more men of the second cohort, compared to the first one, had undergone a coronary angioplasty or bypass operation.
The prevalence of CHD decreased among elderly women more clearly than among young elderly men. The favourable development illustrating a decrease in the prevalence of CHD among women should be sustained, while health promotion activities will need to be directed more actively towards men.
PubMed ID
14531511 View in PubMed
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A Comparison of Sex Differences in Psychotropic Medication Use in Older People with Alzheimer's Disease in the US and Finland.

https://arctichealth.org/en/permalink/ahliterature285249
Source
Drugs Aging. 2017 Jan;34(1):55-65
Publication Type
Article
Date
Jan-2017
Author
Daniela C Moga
Heidi Taipale
Anna-Maija Tolppanen
Antti Tanskanen
Jari Tiihonen
Sirpa Hartikainen
Qishan Wu
Gregory A Jicha
Danijela Gnjidic
Source
Drugs Aging. 2017 Jan;34(1):55-65
Date
Jan-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy - psychology
Anti-Anxiety Agents - administration & dosage - therapeutic use
Antidepressive Agents - administration & dosage - therapeutic use
Antipsychotic Agents - administration & dosage - therapeutic use
Drug Utilization - statistics & numerical data
Female
Finland - epidemiology
Humans
Hypnotics and Sedatives - administration & dosage - therapeutic use
Logistic Models
Male
Middle Aged
Odds Ratio
Prevalence
Psychotropic Drugs - administration & dosage - therapeutic use
Sex Characteristics
United States - epidemiology
Abstract
Given the high prevalence of psychotropic medication use in people with dementia and the potential for different prescribing practices in men and women, our study aimed to investigate sex differences in psychotropic medication use in older adults with Alzheimer's disease (AD) living in the US and Finland.
We used data collected between 2005 and 2011 as part of the National Alzheimer's Coordinating Center (NACC) in the US, and Medication use and Alzheimer's disease (MEDALZ) cohorts in Finland. We evaluated psychotropic medication use (antidepressant, antipsychotic, anxiolytic, sedative, or hypnotic) in participants aged 65 years or older. We employed multivariable logistic regression adjusted for demographics, co-morbidities, and other medications to estimate the magnitude of the association (adjusted odds ratio [aOR] with 95% confidence intervals [CIs]) according to sex.
We included 1099 NACC participants (502 [45.68%] men, 597 [54.32%] women), and 67,049 participants from the MEDALZ cohort (22,961 [34.24%] men, 44,088 [65.75%] women). Women were more likely than men to use psychotropic medications: US, 46.2% vs. 33.1%, p 
Notes
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PubMed ID
27896799 View in PubMed
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Comprehensive geriatric assessment decreases prevalence of orthostatic hypotension in older persons.

https://arctichealth.org/en/permalink/ahliterature116373
Source
Scand J Public Health. 2013 Jun;41(4):351-8
Publication Type
Article
Date
Jun-2013
Author
Pasi Lampela
Piia Lavikainen
Risto Huupponen
Esko Leskinen
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. Pasi.Lampela@uef.fi
Source
Scand J Public Health. 2013 Jun;41(4):351-8
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Female
Finland - epidemiology
Follow-Up Studies
Geriatric Assessment - methods
Humans
Hypotension, Orthostatic - epidemiology - prevention & control
Male
Markov Chains
Models, Theoretical
Prevalence
Abstract
Orthostatic hypotension (OH) is associated with significant morbidity and mortality among older people. We have studied whether its prevalence can be reduced by a Comprehensive Geriatric Assessment (CGA).
1000 randomly-selected persons aged =75 years were divided into intervention (n = 500) and control groups (n = 500). We focused on those subjects in whom an orthostatic blood pressure test had been performed at least once during the study period (2004-2007) (n = 365 and 332 for intervention and control groups, respectively). A CGA, including evaluation of the adequacy of the medication, was performed annually in the intervention group but not in the control group. We conducted Markov models to study change in the OH profiles and the effect of CGA on it. Competing risk of mortality was modeled as an absorbing state to avoid attrition bias.
Over 3 years, the prevalence of OH decreased (35.0% ? 28.0%) in the intervention group, whereas its prevalence increased in the control group (32.8% ? 40.8%). By Markov models it was shown that CGA had a statistically significant effect on recovering from OH. In addition, CGA was shown to protect from developing OH.
Repeated CGA performed annually can reduce the prevalence of OH.
PubMed ID
23404180 View in PubMed
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Drug use in persons with and without Alzheimer's disease aged 90 years or more.

https://arctichealth.org/en/permalink/ahliterature287349
Source
Age Ageing. 2016 Nov;45(6):900-904
Publication Type
Article
Date
Nov-2016
Author
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Source
Age Ageing. 2016 Nov;45(6):900-904
Date
Nov-2016
Language
English
Publication Type
Article
Keywords
Age Factors
Aged, 80 and over
Alzheimer Disease - diagnosis - drug therapy - epidemiology - psychology
Antidepressive Agents - therapeutic use
Antipsychotic Agents - therapeutic use
Bone Density Conservation Agents - therapeutic use
Chi-Square Distribution
Drug Prescriptions
Female
Finland - epidemiology
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Logistic Models
Male
Odds Ratio
Polypharmacy
Practice Patterns, Physicians' - trends
Prevalence
Registries
Risk factors
Time Factors
Abstract
increasing number of persons reach very high age but few studies have investigated their drug use patterns.
to compare drug use among persons with Alzheimer's disease (AD) aged =90 years to persons without AD with similar age and to younger persons with AD.
register-based data were from the MEDALZ cohort including all community-dwelling persons diagnosed with AD 2005-11 in Finland. They were identified from Special Reimbursement register. One comparison person without AD was matched with age-, gender- and region of residence. Persons with AD were divided to those aged =90 years (N = 3,319) and
PubMed ID
27609205 View in PubMed
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High prevalence of psychotropic drug use among persons with and without Alzheimer's disease in Finnish nationwide cohort.

https://arctichealth.org/en/permalink/ahliterature266724
Source
Eur Neuropsychopharmacol. 2014 Nov;24(11):1729-37
Publication Type
Article
Date
Nov-2014
Author
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Source
Eur Neuropsychopharmacol. 2014 Nov;24(11):1729-37
Date
Nov-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy - epidemiology
Case-Control Studies
Cohort Studies
Drug Utilization - statistics & numerical data - trends
Female
Finland - epidemiology
Humans
Male
Mental Disorders - drug therapy - epidemiology
Middle Aged
Prevalence
Psychotropic Drugs - therapeutic use
Registries
Abstract
Psychotropic drugs are used for treatment of behavioral and psychological symptoms of dementia (BPSD) although they are associated with serious adverse drug events. Objective of our study was to investigate prevalence of psychotropic drug use one year after diagnoses of Alzheimer's disease (AD), to compare prevalence to persons without AD and to assess changes in prevalence over time. Data from the MEDALZ (Medication use and Alzheimer's disease) cohort was utilized in the study including all 69,080 community-dwelling persons with new diagnosis of AD during years 2005-2011 in Finland. Four age-, gender- and region of residence-matched persons without AD were identified for each case. Register-based data included prescription drug purchases and comorbidities from Special Reimbursement Register. Annual prevalence of psychotropic drug use one year after diagnosis was determined for each person. Psychotropic drugs were used by 53% of persons with AD compared with 33% of persons without AD during one year after diagnoses. Persons with AD were six times more likely to use antipsychotics and three times more likely to use antidepressants whereas benzodiazepine and related drug (BZDR) use was comparable between persons with and without AD. According to year of AD diagnoses during 2005-2011, antipsychotic use increased from 18% to 20% (p
PubMed ID
25453487 View in PubMed
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History of medically treated diabetes and risk of Alzheimer disease in a nationwide case-control study.

https://arctichealth.org/en/permalink/ahliterature117015
Source
Diabetes Care. 2013 Jul;36(7):2015-9
Publication Type
Article
Date
Jul-2013
Author
Anna-Maija Tolppanen
Piia Lavikainen
Alina Solomon
Miia Kivipelto
Matti Uusitupa
Hilkka Soininen
Sirpa Hartikainen
Author Affiliation
Institute of Clinical Medicine, Neurology, University of Kuopio, Kuopio, Finland. anna-maija.tolppanen@uef.fi
Source
Diabetes Care. 2013 Jul;36(7):2015-9
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Alzheimer Disease - epidemiology
Cardiovascular Diseases - epidemiology
Case-Control Studies
Diabetes Mellitus, Type 1 - epidemiology
Diabetes Mellitus, Type 2 - epidemiology
Female
Finland - epidemiology
Humans
Male
Middle Aged
Prevalence
Young Adult
Abstract
Type 2 diabetes in midlife or late life increases the risk of Alzheimer disease (AD), and type 1 diabetes has been associated with a higher risk of detrimental cognitive outcomes, although studies from older adults are lacking. We investigated whether individuals with AD were more likely to have a history of diabetes than matched controls from the general aged population.
Information on reimbursed diabetes medication (including both type 1 and 2 diabetes) of all Finnish individuals with reimbursed AD medication in 2005 (n = 28,093) and their AD-free control subjects during 1972-2005 was obtained from a special reimbursement register maintained by the Social Insurance Institute of Finland.
The prevalence of diabetes was 11.4% in the whole study population, 10.7% (n = 3,012) among control subjects, and 12.0% (n = 3,372) among AD case subjects. People with AD were more likely to have diabetes than matched control subjects (unadjusted OR 1.14 [95% CI 1.08-1.20]), even after adjusting for cardiovascular diseases (OR 1.31 [1.22-1.41]). The associations were stronger with diabetes diagnosed at midlife (adjusted OR 1.60 [1.34-1.84] and 1.25 [1.16-1.36] for midlife and late-life diabetes, respectively).
Individuals with clinically verified AD are more likely to have a history of clinically verified and medically treated diabetes than the general aged population, although the difference is small.
Notes
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PubMed ID
23340883 View in PubMed
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Impact of opioid initiation on antipsychotic and benzodiazepine and related drug use among persons with Alzheimer's disease.

https://arctichealth.org/en/permalink/ahliterature300965
Source
Int Psychogeriatr. 2018 07; 30(7):947-956
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
07-2018
Author
Aleksi Hamina
Piia Lavikainen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Heidi Taipale
Author Affiliation
Kuopio Research Centre of Geriatric Care,University of Eastern Finland,Kuopio,Finland.
Source
Int Psychogeriatr. 2018 07; 30(7):947-956
Date
07-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Aged
Alzheimer Disease - drug therapy - epidemiology - psychology
Analgesics, Opioid - administration & dosage
Antipsychotic Agents - therapeutic use
Benzodiazepines - therapeutic use
Cognition - drug effects
Female
Finland - epidemiology
Humans
Independent Living - psychology - statistics & numerical data
Interrupted Time Series Analysis
Male
Medication Adherence - psychology - statistics & numerical data
Pharmacoepidemiology
Prevalence
Registries - statistics & numerical data
Risk assessment
Risk factors
Abstract
ABSTRACTBackground:We analyzed the impact of opioid initiation on the prevalence of antipsychotic and benzodiazepine and related drug (BZDR) use among community-dwelling persons with Alzheimer's disease (AD).
We utilized the register-based Medication use and Alzheimer's disease (MEDALZ) cohort for this study. We included all community-dwelling persons diagnosed with AD during 2010-2011 in Finland initiating opioid use (n = 3,327) and a matched cohort of persons not initiating opioids (n = 3,325). Interrupted time series analyses were conducted to compare the prevalence of antipsychotic and BZDR use in 30-day periods within six months before opioid initiation to 30-day periods six months later.
Before opioid initiation, prevalence of antipsychotic use among opioid initiators was 13.3%, 18.3% at opioid initiation, and 17.3% six months later. Prevalences of BZDR use were 27.1% six months prior, 28.9% at opioid initiation, and 26.9% six months later. After opioid initiation, antipsychotic and BZDR use declined by 0.3 percentage points (pps, 95% confidence interval 0.1-0.5) and 0.4 pps (0.2-0.7) per month, respectively, until the end of the follow-up. Compared to persons not initiating opioid use, opioid initiation immediately resulted in an increase in prevalence of 1.9 pps (0.9-2.8) for antipsychotics and of 1.6 pps (0.9-2.2) for BZDR use. However, in total there was a comparative decrease of 0.5 pps (0.3-0.8) per month for antipsychotics and of 0.4 pps (0.2-0.6) for BZDR use until the end of the follow-up.
Our results suggest that opioid initiation may reduce antipsychotic and BZDR use among persons with AD.
PubMed ID
29559009 View in PubMed
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Incident hip fractures among community dwelling persons with Alzheimer's disease in a Finnish nationwide register-based cohort.

https://arctichealth.org/en/permalink/ahliterature115250
Source
PLoS One. 2013;8(3):e59124
Publication Type
Article
Date
2013
Author
Anna-Maija Tolppanen
Piia Lavikainen
Hilkka Soininen
Sirpa Hartikainen
Author Affiliation
Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland. anna-maija.tolppanen@uef.fi
Source
PLoS One. 2013;8(3):e59124
Date
2013
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Alzheimer Disease - complications - epidemiology
Cohort Studies
Female
Finland - epidemiology
Hip Fractures - complications - epidemiology
Humans
Male
Middle Aged
Prevalence
Proportional Hazards Models
Registries
Abstract
Previous cohort studies have shown that persons with Alzheimer's disease (AD) have a higher risk of hip fractures but recent data from large representative cohorts is scarce.
We investigated the association between AD and prevalent and incident hip fractures in an exposure-matched cohort study conducted in Finland 2002-2009 (the Medication and Alzheimer's disease in 2005 study; MEDALZ-2005). The study population included all community-dwelling persons with verified AD diagnosis in Finland on December 31, 2005 and one matched comparison person per AD case (N?=?56,186, mean age 79.9 (SD 6.8) years, range 42-101 years). The diagnosis of AD was extracted from a special reimbursement register. Data on hip fractures during 2002-2009 was extracted from the Finnish National hospital discharge register. Analyses of incident hip fractures (n?=?2,861) were restricted to years 2006-2009.
Persons with AD were twice as likely to have previous hip fracture in 2005 (odds ratio, 95% confidence interval 2.00, 1.82-2.20) than matched aged population without AD. They were also more likely to experience incident hip fracture during the four-year follow-up (hazard ratio, 95% confidence interval 2.57, 2.32-2.84, adjusted for health status, psychotropic drug and bisphosphonate use). The AD-associated risk increase decreased linearly across age groups. Although people with AD had higher risk of hip fractures regardless of sex, the risk increase was larger in men than women.
Findings from our nationwide study are in line with previous studies showing that persons with AD, regardless of sex or age, have higher risk of hip fracture in comparison to general population. Although there was some suggestion of effect modification by age or sex, AD was consistently associated with doubling of the risk of incident hip fracture.
Notes
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PubMed ID
23527106 View in PubMed
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Incident ischaemic heart disease in persons with Alzheimer's disease in a Finnish nationwide exposure-matched cohort.

https://arctichealth.org/en/permalink/ahliterature106289
Source
Int J Cardiol. 2013 Dec 10;170(2):195-201
Publication Type
Article
Date
Dec-10-2013
Author
Anna-Maija Tolppanen
Raimo Kettunen
Riitta Ahonen
Hilkka Soininen
Sirpa Hartikainen
Author Affiliation
Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland. Electronic address: anna-maija.tolppanen@uef.fi.
Source
Int J Cardiol. 2013 Dec 10;170(2):195-201
Date
Dec-10-2013
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Alzheimer Disease - epidemiology
Cohort Studies
Comorbidity
Confounding Factors (Epidemiology)
Female
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Myocardial Ischemia - epidemiology - therapy
Outcome Assessment (Health Care)
Prevalence
Registries - statistics & numerical data
Risk factors
Abstract
Previous studies on the association between cardiovascular diseases and Alzheimer's disease (AD) have been inconsistent despite the overlapping risk factor profile. We assessed whether the incidence of ischaemic heart disease (IHD) and revascularisation procedures are different in persons with AD than in the matched population without AD.
We conducted a nationwide exposure-matched cohort study including all 28,093 community-dwelling individuals with clinically verified diagnosis of AD, residing in Finland and alive on December 31, 2005. Participants were identified from the Special Reimbursement Register. One matched comparison person was identified for each participant with AD. We assessed the associations between AD and any IHD event (diagnosed IHD/revascularisation procedure), diagnosed IHD (myocardial infarctions and other IHD), and revascularisation procedure (angioplasty or bypass). Information on outcomes was extracted from the Hospital Discharge Register. Analyses were restricted to incident events during 2006-2009 and 25,325 AD-comparison person pairs were included in the analysis after excluding events occurring in 2002-2005.
People with AD were more likely to have incident IHD diagnosis than AD-free comparison persons (adjusted HR, 95% CI 1.16, 1.06-1.28) but less likely to undergo revascularisation procedures (0.12, 0.08-0.20). There were no differences in all incident IHD events (0.95, 0.87-1.04).
Persons with AD had a higher risk of incident ischaemic heart disease when comorbidities and cardiovascular medication were taken into account, but they were less likely to undergo revascularisation procedures. This was not entirely explained by contraindications. We acknowledge the need for more detailed studies assessing whether this reflects undertreatment of cardiac problems among persons with AD.
PubMed ID
24200309 View in PubMed
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Long-term use of antipsychotics among community-dwelling persons with Alzheimer?s disease: A nationwide register-based study.

https://arctichealth.org/en/permalink/ahliterature274473
Source
Eur Neuropsychopharmacol. 2015 Oct;25(10):1706-13
Publication Type
Article
Date
Oct-2015
Author
Marjaana Koponen
Heidi Taipale
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Riitta Ahonen
Sirpa Hartikainen
Source
Eur Neuropsychopharmacol. 2015 Oct;25(10):1706-13
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - drug therapy - epidemiology
Antipsychotic Agents - therapeutic use
Cohort Studies
Female
Finland - epidemiology
Follow-Up Studies
Haloperidol - therapeutic use
Humans
Male
Prevalence
Quetiapine Fumarate - therapeutic use
Registries
Risperidone - therapeutic use
Time Factors
Treatment Outcome
Abstract
Antipsychotics are recommended only for short-term treatment of severe behavioral and psychological symptoms of dementia. Our objective was to study the duration of antipsychotic use and factors associated with long-term use (365 days or over) among community-dwelling persons with Alzheimer?s disease (AD) during a 7-year follow-up. This was a nationwide register-based cohort study including all community-dwelling residents in Finland diagnosed with AD in 2005 (n=7217). The follow-up for antipsychotic use started 3 years before the diagnosis of AD and we applied a 7-year washout period to ascertain truly incident antipsychotic use. Follow-up ended on institutionalization, death or at the end of study period (December 31, 2009). Duration of antipsychotic use was modeled from individual purchase histories recorded in the Finnish Prescription Register. During the 7-year follow-up, 34% (2287/6740) of persons initiated antipsychotic use. Median duration of the first antipsychotic use period was 219 (interquartile range 85-583) days. Of those who discontinued antipsychotic use (n=1303), 44% restarted use later. Among users with at least one year of follow-up time after initiating antipsychotic use, prevalence of long-term use was 57% (893/1563). Long-term use was associated with initiation of use after AD diagnosis and choice of antipsychotic. Duration of use was more likely to be shorter among haloperidol users and longer among quetiapine users compared with risperidone users. In conclusion, long-term use of antipsychotics is frequent among community-dwelling persons with AD. Duration of use is not in line with the guidelines recommending time-limited use of antipsychotics.
PubMed ID
26233607 View in PubMed
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