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The AGES-Reykjavik Study suggests that change in kidney measures is associated with subclinical brain pathology in older community-dwelling persons.

https://arctichealth.org/en/permalink/ahliterature300494
Source
Kidney Int. 2018 09; 94(3):608-615
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Date
09-2018
Author
Sanaz Sedaghat
Jie Ding
Gudny Eiriksdottir
Mark A van Buchem
Sigurdur Sigurdsson
M Arfan Ikram
Osorio Meirelles
Vilmundur Gudnason
Andrew S Levey
Lenore J Launer
Author Affiliation
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Source
Kidney Int. 2018 09; 94(3):608-615
Date
09-2018
Language
English
Publication Type
Journal Article
Research Support, N.I.H., Extramural
Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't
Keywords
Aged
Albuminuria - physiopathology - urine
Cerebral Small Vessel Diseases - diagnosis - epidemiology
Creatinine - urine
Disease Progression
Female
Follow-Up Studies
Glomerular Filtration Rate - physiology
Humans
Incidence
Independent living
Kidney - physiopathology
Magnetic Resonance Imaging
Male
Prospective Studies
Renal Insufficiency, Chronic - physiopathology - urine
Risk factors
Serum Albumin
White Matter - diagnostic imaging - pathology
Abstract
Decreased glomerular filtration rate (GFR) and albuminuria may be accompanied by brain pathology. Here we investigated whether changes in these kidney measures are linked to development of new MRI-detected infarcts and microbleeds, and progression of white matter hyperintensity volume. The study included 2671 participants from the population-based AGES-Reykjavik Study (mean age 75, 58.7% women). GFR was estimated from serum creatinine, and albuminuria was assessed by urinary albumin-to-creatinine ratio. Brain MRI was acquired at baseline (2002-2006) and 5 years later (2007-2011). New MRI-detected infarcts and microbleeds were counted on the follow-up scans. White matter hyperintensity progression was estimated as percent change in white matter hyperintensity volumes between the two exams. Participants with a large eGFR decline (over 3 ml/min/1.73m2 per year) had more incident subcortical infarcts (odds ratio 1.53; 95% confidence interval 1.05, 2.22), and more marked progression of white matter hyperintensity volume (difference: 8%; 95% confidence interval: 4%, 12%), compared to participants without a large decline. Participants with incident albuminuria (over 30 mg/g) had 21% more white matter hyperintensity volume progression (95% confidence interval: 14%, 29%) and 1.86 higher odds of developing new deep microbleeds (95% confidence interval 1.16, 2.98), compared to participants without incident albuminuria. The findings were independent of cardiovascular risk factors. Changes in kidney measures were not associated with occurrence of cortical infarcts. Thus, larger changes in eGFR and albuminuria are associated with increased risk for developing manifestations of cerebral small vessel disease. Individuals with larger changes in these kidney measures should be considered as a high risk population for accelerated brain pathology.
PubMed ID
29960746 View in PubMed
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Amount and type of alcohol consumption and missing teeth among community-dwelling older adults: findings from the Copenhagen Oral Health Senior study.

https://arctichealth.org/en/permalink/ahliterature127155
Source
J Public Health Dent. 2011;71(4):318-26
Publication Type
Article
Date
2011
Author
Karen Heegaard
Kirsten Avlund
Poul Holm-Pedersen
Ulla A Hvidtfeldt
Allan Bardow
Morten Grønbaek
Author Affiliation
Copenhagen Gerontological Oral Health Research Centre, University of Copenhagen, Copenhagen, Denmark. karen.heegaard@mail.tele.dk
Source
J Public Health Dent. 2011;71(4):318-26
Date
2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alcohol drinking - epidemiology
Alcoholic Beverages - classification - statistics & numerical data
Beer - statistics & numerical data
Cross-Sectional Studies
Denmark - epidemiology
Educational Status
Female
Follow-Up Studies
Humans
Income - statistics & numerical data
Independent Living - statistics & numerical data
Longitudinal Studies
Male
Population Surveillance
Sedentary lifestyle
Sex Factors
Smoking - epidemiology
Social Class
Temperance - statistics & numerical data
Tooth Loss - epidemiology
Wine - statistics & numerical data
Abstract
To study if an association between total weekly intake of alcohol, type-specific weekly alcohol intake, alcoholic beverage preference, and the number of teeth among older people exists.
A cross-sectional study including a total of 783 community-dwelling men and women aged 65-95 years who were interviewed about alcohol drinking habits and underwent a clinical oral and dental examination. Multiple regression analyses were applied for studying the association between total weekly alcohol consumption, beverage-specific alcohol consumption, beverage preference (defined as the highest intake of one beverage type compared with two other types), and the number of remaining teeth (= 20 versus >20 remaining teeth).
The odds ratio (OR) of having a low number of teeth decreased with the total intake of alcohol in women, with ORs for a low number of teeth of 0.40 [95 percent confidence interval (CI) 0.22-0.76] in women drinking 1-14 drinks per week and 0.34 (95 percent CI 0.16-0.74) in women with an intake of more than 14 drinks per week compared with abstainers. Similar relations could also be obtained for type-specific alcohol intake of wine and for wine and spirits preference among women. Men who preferred beer showed a decreased risk for a low number of teeth compared with men with other alcohol preferences.
In this study, alcohol consumption, wine drinking, and wine and spirits preference among women were associated with a higher number of teeth compared with abstainers. Among men, those who preferred beer also had a higher number of teeth.
PubMed ID
22320290 View in PubMed
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Change in Oral Impacts on Daily Performances (OIDP) with increasing age: testing the evaluative properties of the OIDP frequency inventory using prospective data from Norway and Sweden.

https://arctichealth.org/en/permalink/ahliterature258830
Source
BMC Oral Health. 2014;14:59
Publication Type
Article
Date
2014
Author
Ferda Gülcan
Elwalid Nasir
Gunnar Ekbäck
Sven Ordell
Anne Nordrehaug Åstrøm
Source
BMC Oral Health. 2014;14:59
Date
2014
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Age Factors
Aged
Cohort Studies
Eating - physiology
Esthetics, Dental
Female
Follow-Up Studies
Health status
Humans
Independent living
Longitudinal Studies
Male
Norway
Oral Health - statistics & numerical data
Personal Satisfaction
Prospective Studies
Quality of Life
Reproducibility of Results
Self Report
Smiling - psychology
Social Class
Sweden
Tooth Loss - psychology
Work
Abstract
Oral health-related quality of life, OHRQoL, among elderly is an important concern for the health and welfare policy in Norway and Sweden. The aim of the study was to assess reproducibility, longitudinal validity and responsiveness of the OIDP frequency score. Whether the temporal relationship between tooth loss and OIDP varied by country of residence was also investigated.
In 2007 and 2012, all inhabitants born in 1942 in three and two counties of Norway and Sweden were invited to participate in a self-administered questionnaire survey. In Norway the response rates were 58.0% (4211/7248) and 54.5% (3733/6841) in 2007 and 2012. Corresponding figures in Sweden were 73.1% (6078/8313) and 72.2% (5697/7889), respectively.
Reproducibility of the OIDP in terms of intra-class correlation coefficient (ICC) was 0.73 in Norway and 0.77 in Sweden. The mean change scores for OIDP were predominantly negative among those who worsened, zero in those who did not change and positive in participants who improved change scores of the reference variables; self-reported oral health and tooth loss. General Linear Models (GLM) repeated measures revealed significant interactions between OIDP and change scores of the reference variables (p?
Notes
Cites: Health Qual Life Outcomes. 2006;4:5616934161
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PubMed ID
24884798 View in PubMed
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Clinical characteristics and mortality risk in relation to obstructive and central sleep apnoea in community-dwelling elderly individuals: a 7-year follow-up.

https://arctichealth.org/en/permalink/ahliterature125918
Source
Age Ageing. 2012 Jul;41(4):468-74
Publication Type
Article
Date
Jul-2012
Author
Peter Johansson
Urban Alehagen
Eva Svanborg
Ulf Dahlström
Anders Broström
Author Affiliation
Department of Cardiology, Linkoping University Hospital, Linkoping, Sweden. peter.johansson@aries.vokby.se
Source
Age Ageing. 2012 Jul;41(4):468-74
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Aging
Cardiovascular Diseases - mortality - physiopathology
Cause of Death
Comorbidity
Female
Follow-Up Studies
Humans
Independent living
Kaplan-Meier Estimate
Male
Proportional Hazards Models
Risk assessment
Risk factors
Sleep
Sleep Apnea, Central - mortality - physiopathology
Sleep Apnea, Obstructive - mortality - physiopathology
Stroke Volume
Sweden - epidemiology
Systole
Time Factors
Ventricular Function, Left
Abstract
little is known about demographic and clinical characteristics associated with sleep-disordered breathing (SDB) and obstructive sleep apnoea (OSA) or central sleep apnoea (CSA) in community-dwelling elderly. We also examined these (OSA and CSA) associations to all-cause and cardiovascular (CV) mortality.
a total of 331 community-dwelling elderly aged 71-87 years underwent a clinical examination and one-night polygraphic recordings in their homes. Mortality data were collected after seven years.
a total of 55% had SDB, 38% had OSA and 17% had CSA. Compared with those with no SDB and OSA, more participants with CSA had a left ventricular ejection fraction 75 years does not appear to be associated with cardiovascular disease (CVD) disease or mortality, whereas CSA might be a pathological marker of CVD and impaired systolic function associated with higher mortality.
PubMed ID
22440587 View in PubMed
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Combined resistance and balance-jumping exercise reduces older women's injurious falls and fractures: 5-year follow-up study.

https://arctichealth.org/en/permalink/ahliterature273603
Source
Age Ageing. 2015 Sep;44(5):784-9
Publication Type
Article
Date
Sep-2015
Author
Saija Karinkanta
Pekka Kannus
Kirsti Uusi-Rasi
Ari Heinonen
Harri Sievänen
Source
Age Ageing. 2015 Sep;44(5):784-9
Date
Sep-2015
Language
English
Publication Type
Article
Keywords
Accidental Falls - prevention & control
Age Factors
Aged
Aging
Female
Finland - epidemiology
Follow-Up Studies
Fractures, Bone - diagnosis - epidemiology - physiopathology - prevention & control
Geriatric Assessment
Humans
Incidence
Independent living
Kaplan-Meier Estimate
Muscle strength
Odds Ratio
Postural Balance
Proportional Hazards Models
Prospective Studies
Registries
Resistance Training
Risk factors
Time Factors
Treatment Outcome
Women's health
Abstract
previously, a randomised controlled exercise intervention study (RCT) showed that combined resistance and balance-jumping training (COMB) improved physical functioning and bone strength. The purpose of this follow-up study was to assess whether this exercise intervention had long-lasting effects in reducing injurious falls and fractures.
five-year health-care register-based follow-up study after a 1-year, four-arm RCT.
community-dwelling older women in Finland.
one hundred and forty-five of the original 149 RCT participants; women aged 70-78 years at the beginning.
participants' health-care visits were collected from computerised patient register. An injurious fall was defined as an event in which the subject contacted the health-care professionals or was taken to a hospital, due to a fall. The rate of injured fallers was assessed by Cox proportional hazards model (hazard ratio, HR), and the rate of injurious falls and fractures by Poisson regression (risk ratio, RR).
eighty-one injurious falls including 26 fractures occurred during the follow-up. The rate of injured fallers was 62% lower in COMB group compared with the controls (HR 0.38, 95% CI 0.17 to 0.85). In addition, COMB group had 51% less injurious falls (RR 0.49, 95% CI 0.25 to 0.98) and 74% less fractures (RR 0.26, 95% CI 0.07 to 0.97).
home-dwelling older women who participated in a 12-month intensive multi-component exercise training showed a reduced incidence for injurious falls during 5-year post-intervention period. Reduction in fractures was also evident. These long-term effects need to be confirmed in future studies.
PubMed ID
25990940 View in PubMed
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Community-dwelling older people with an injurious fall are likely to sustain new injurious falls within 5 years--a prospective long-term follow-up study.

https://arctichealth.org/en/permalink/ahliterature264015
Source
BMC Geriatr. 2014;14:120
Publication Type
Article
Date
2014
Author
Petra Pohl
Ellinor Nordin
Anders Lundquist
Ulrica Bergström
Lillemor Lundin-Olsson
Source
BMC Geriatr. 2014;14:120
Date
2014
Language
English
Publication Type
Article
Keywords
Accidental Falls - prevention & control - statistics & numerical data
Aged
Aged, 80 and over
Female
Follow-Up Studies
Geriatric Assessment
Humans
Incidence
Independent living
Male
Motor Activity - physiology
Prospective Studies
Risk factors
Sweden - epidemiology
Time Factors
Abstract
Fall-related injuries in older people are a leading cause of morbidity and mortality. Self-reported fall events in the last year is often used to estimate fall risk in older people. However, it remains to be investigated if the fall frequency and the consequences of the falls have an impact on the risk for subsequent injurious falls in the long term. The objective of this study was to investigate if a history of one single non-injurious fall, at least two non-injurious falls, or at least one injurious fall within 12 months increases the risk of sustaining future injurious falls.
Community-dwelling individuals 75-93 years of age (n = 230) were initially followed prospectively with monthly calendars reporting falls over a period of 12 months. The participants were classified into four groups based on the number and type of falls (0, 1, =2 non-injurious falls, and =1 injurious fall severe enough to cause a visit to a hospital emergency department). The participants were then followed for several years (mean time 5.0 years ±1.1) regarding injurious falls requiring a visit to the emergency department. The Andersen-Gill method of Cox regression for multiple events was used to estimate the risk of injurious falls.
During the long-term follow-up period, thirty per cent of the participants suffered from at least one injurious fall. Those with a self-reported history of at least one injurious fall during the initial 12 months follow-up period showed a significantly higher risk for sustaining subsequent injurious falls in the long term (hazard ratio 2.78; 95% CI, 1.40-5.50) compared to those with no falls. No other group showed an increased risk.
In community-dwelling people over 75 years of age, a history of at least one self-reported injurious fall severe enough to cause a visit to the emergency department within a period of 12 months implies an increased risk of sustaining future injurious falls. Our results support the recommendations to offer a multifactorial fall-risk assessment coupled with adequate interventions to community-dwelling people over 75 years who present to the ED due to an injurious fall.
Notes
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PubMed ID
25407714 View in PubMed
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Distribution and evaluation of sense of coherence among older immigrants before and after a health promotion intervention - results from the RCT study promoting aging migrants' capability.

https://arctichealth.org/en/permalink/ahliterature297835
Source
Clin Interv Aging. 2018; 13:2317-2328
Publication Type
Journal Article
Randomized Controlled Trial
Date
2018
Author
L A Arola
E Barenfeld
S Dahlin-Ivanoff
G Häggblom-Kronlöf
Author Affiliation
Institute of Neuroscience and Physiology, Section for Health and Rehabilitation, The Sahlgrenska Academy, University of Gothenburg, Sweden, annikki.arola@arcada.fi.
Source
Clin Interv Aging. 2018; 13:2317-2328
Date
2018
Language
English
Publication Type
Journal Article
Randomized Controlled Trial
Keywords
Adaptation, Psychological
Aged
Aged, 80 and over
Balkan Peninsula - ethnology
Emigrants and Immigrants - psychology
Female
Finland - ethnology
Follow-Up Studies
Health Promotion - methods
Humans
Independent living
Male
Outcome Assessment (Health Care)
Sense of Coherence
Sweden
Abstract
The migration process can be a threat to a person's sense of coherence (SOC) and to their ability to experience life as comprehensible, manageable, and meaningful. Seen from a salutogenic perspective, this may have a negative impact on the experience of health.
We describe the distribution of SOC and its components among older persons with an immigrant background now aging in Sweden. In addition, we evaluated whether a group-based health promotion program with a person-centered approach could support the SOC among older persons in this group.
A randomized controlled trial with postintervention follow-ups at 6 and 12 months was conducted with 131 independently living persons aged =70 years from Finland and the Balkan Peninsula. Participants were randomly allocated to an intervention group (4 weeks of group intervention and one follow-up home visit) and a control group (no intervention but access to ordinary health care services). The outcome measure was the SOC measured by SOC-13. Chi-square and ORs were calculated.
There was a significant improvement in total SOC scores for the intervention group at 6-month follow-up. Also, the ORs for the SOC components were higher in the person-centered intervention group. However, we found no significant between-group differences nor did the effect last until the 12-month follow-up.
Persons who have lived a long time in a host country after migration seem to have a SOC similar to native-born persons. Interventions with a person-centered approach could support the SOC by capturing individual life situations. Such interventions could support older persons by making everyday life more comprehensible and manageable and helping them to cope with challenges in daily life caused by aging.
PubMed ID
30532522 View in PubMed
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The effect of comprehensive geriatric assessment on anticholinergic exposure assessed by four ranked anticholinergic lists.

https://arctichealth.org/en/permalink/ahliterature283602
Source
Arch Gerontol Geriatr. 2017 Jan - Feb;68:195-201
Publication Type
Article
Author
Pasi Lampela
Heidi Taipale
Piia Lavikainen
Sirpa Hartikainen
Source
Arch Gerontol Geriatr. 2017 Jan - Feb;68:195-201
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cholinergic Antagonists
Drug Utilization - statistics & numerical data
Female
Finland
Follow-Up Studies
Geriatric Assessment - methods
Humans
Independent living
Male
Outcome Assessment (Health Care)
Abstract
Older people often use multiple drugs, and some of them have anticholinergic activity. Anticholinergic drugs may cause adverse reactions, and therefore their use should be limited. To identify anticholinergic load, several ranked lists with different drugs and scoring systems have been developed and used widely in research. We investigated, if a comprehensive geriatric assessment (CGA) decreased the anticholinergic drug score in a 4-year period. We used four different anticholinergic ranked lists to determine the anticholinergic score and to describe how the results differ depending on the list used.
We analyzed data from population-based intervention study, in which a random sample of 1000 persons aged =75 years were randomized to either an intervention group or a control group. Those in the intervention group underwent CGA including medication assessment annually between 2004 and 2007. Current medication use was assessed annually. The anticholinergic load was calculated by using four ranked lists of anticholinergic drugs (Boustani's, Carnahan's, Chew's and Rudolph's) for each person and for each year.
CGA had no statistically significant effect on anticholinergic exposure during the 4-year follow-up, but improvements towards more appropriate medication use were observed especially in the intervention group. However, age, gender and functional comorbidity index were associated to higher anticholinergic exposure, depending on the list used.
Repeated CGAs may result as more appropriate anticholinergic medication use. The selection of the list may affect the results and therefore the selection of the list is important.
PubMed ID
27837709 View in PubMed
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Effects of the Finnish Alzheimer disease exercise trial (FINALEX): a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature114708
Source
JAMA Intern Med. 2013 May 27;173(10):894-901
Publication Type
Article
Date
May-27-2013
Author
Kaisu H Pitkälä
Minna M Pöysti
Marja-Liisa Laakkonen
Reijo S Tilvis
Niina Savikko
Hannu Kautiainen
Timo E Strandberg
Author Affiliation
Unit of Primary Health Care, Helsinki University Central Hospital, Finland. kaisu.pitkala@helsinki.fi
Source
JAMA Intern Med. 2013 May 27;173(10):894-901
Date
May-27-2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Alzheimer Disease - economics - therapy
Caregivers
Day Care - economics - organization & administration
Exercise Therapy - economics - methods - organization & administration
Female
Finland - epidemiology
Follow-Up Studies
House Calls - economics
Humans
Independent living
Male
Physical Therapists
Prospective Studies
Quality of Life
Treatment Outcome
Abstract
Few rigorous clinical trials have investigated the effectiveness of exercise on the physical functioning of patients with Alzheimer disease (AD).
To investigate the effects of intense and long-term exercise on the physical functioning and mobility of home-dwelling patients with AD and to explore its effects on the use and costs of health and social services.
A randomized controlled trial.
A total of 210 home-dwelling patients with AD living with their spousal caregiver.
The 3 trial arms included (1) group-based exercise (GE; 4-hour sessions with approximately 1-hour training) and (2) tailored home-based exercise (HE; 1-hour training), both twice a week for 1 year, and (3) a control group (CG) receiving the usual community care.
The Functional Independence Measure (FIM), the Short Physical Performance Battery, and information on the use and costs of social and health care services.
All groups deteriorated in functioning during the year after randomization, but deterioration was significantly faster in the CG than in the HE or GE group at 6 (P = .003) and 12 (P = .015) months. The FIM changes at 12 months were -7.1 (95% CI, -3.7 to -10.5), -10.3 (95% CI, -6.7 to -13.9), and -14.4 (95% CI, -10.9 to -18.0) in the HE group, GE group, and CG, respectively. The HE and GE groups had significantly fewer falls than the CG during the follow-up year. The total costs of health and social services for the HE patient-caregiver dyads (in US dollars per dyad per year) were $25,112 (95% CI, $17,642 to $32,581) (P = .13 for comparison with the CG), $22,066 in the GE group ($15,931 to $28,199; P = .03 vs CG), and $34,121 ($24,559 to $43,681) in the CG.
An intensive and long-term exercise program had beneficial effects on the physical functioning of patients with AD without increasing the total costs of health and social services or causing any significant adverse effects.
anzctr.org.au Identifier: ACTRN12608000037303.
Notes
Comment In: Ann Intern Med. 2013 Aug 20;159(4):JC1024026274
Comment In: MMW Fortschr Med. 2013 Nov 7;155(19):3224475662
Comment In: JAMA Intern Med. 2013 May 27;173(10):901-223588877
PubMed ID
23589097 View in PubMed
Less detail

Incidence of antidepressant use in community-dwelling persons with and without Alzheimer's disease: 13-year follow-up.

https://arctichealth.org/en/permalink/ahliterature295340
Source
Int J Geriatr Psychiatry. 2017 01; 32(1):94-101
Publication Type
Journal Article
Date
01-2017
Author
Arto Puranen
Heidi Taipale
Marjaana Koponen
Antti Tanskanen
Anna-Maija Tolppanen
Jari Tiihonen
Sirpa Hartikainen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Int J Geriatr Psychiatry. 2017 01; 32(1):94-101
Date
01-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - complications - drug therapy - psychology
Antidepressive Agents - administration & dosage - adverse effects - therapeutic use
Depression - complications - drug therapy - psychology
Female
Finland - epidemiology
Follow-Up Studies
Humans
Incidence
Independent living
Male
Middle Aged
Serotonin Uptake Inhibitors - administration & dosage - therapeutic use
Time Factors
Abstract
The study aimed to investigate the incidence of antidepressant use in persons with and without Alzheimer's disease (AD) from 9?years before to 4?years after AD diagnosis and to examine the incidence of different antidepressant groups.
We used register-based data from the Medication use and Alzheimer's disease cohort including all Finnish persons diagnosed with AD in 2005-2011 with their age-matched and gender-matched comparison persons without AD. In this study, 62,104 persons with AD and 62,104 comparison persons were included. Data on dispensed antidepressants during 1995-2012 were collected from the Prescription Register. A 1-year washout period was utilized to measure the rate of new antidepressant users every 6-month period starting from 9?years before and until 4?years after the AD diagnoses. The incidence rate between persons with and without AD was compared with Poisson regression.
The incidence of antidepressant use in persons with AD was higher during the whole study period compared with that in persons without AD. The incidence rate was highest at 6?months after AD diagnosis (incidence rate ratio?=?5.22, 95% confidence interval 4.77-5.72). Selective serotonin reuptake inhibitors were the most frequently initiated group (61.3% of initiations in persons with AD).
The incidence of antidepressant use was higher in persons with AD than in comparison persons, and it was not explained by history of hospital-treated psychiatric disorders. Widespread use of antidepressants in persons with AD is concerning as their efficacy is controversial and their use is associated with adverse events. Copyright © 2016 John Wiley & Sons, Ltd.
PubMed ID
26924266 View in PubMed
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