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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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Anxiety, depression, and 1-year incident cognitive impairment in community-dwelling older adults.

https://arctichealth.org/en/permalink/ahliterature132631
Source
J Am Geriatr Soc. 2011 Aug;59(8):1421-8
Publication Type
Article
Date
Aug-2011
Author
Olivier Potvin
Hélène Forget
Sébastien Grenier
Michel Préville
Carol Hudon
Author Affiliation
Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada. Olivier.Potvin@crulrg.ulaval.ca
Source
J Am Geriatr Soc. 2011 Aug;59(8):1421-8
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anxiety Disorders - diagnosis - epidemiology - psychology
Cognition Disorders - diagnosis - epidemiology - psychology
Comorbidity
Cross-Sectional Studies
Depressive Disorder - diagnosis - epidemiology - psychology
Diagnostic and Statistical Manual of Mental Disorders
Female
Geriatric Assessment - statistics & numerical data
Health Surveys
Humans
Incidence
Independent Living - psychology
Male
Mental Status Schedule - statistics & numerical data
Psychometrics
Quebec
Abstract
To examine in men and women the independent associations between anxiety and depression and 1-year incident cognitive impairment and to examine the association of cognitive impairment, no dementia (CIND) and incident cognitive impairment with 1-year incident anxiety or depression.
Prospective cohort study.
General community.
Population-based sample of 1,942 individuals aged 65 to 96.
Two structured interviews 12 months apart evaluated anxiety and mood symptoms and disorders according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Incident cognitive impairment was defined as no CIND at baseline and a follow-up Mini-Mental State Examination score at least 2 points below baseline and below the 15th percentile according to normative data. The associations between cognitive impairment and anxiety or depression were assessed using logistic regression adjusted for potential confounders.
Incident cognitive impairment was, independently of depression, associated with baseline anxiety disorders in men (odds ratio (OR)=6.27, 95% confidence interval (CI)=1.39-28.29) and anxiety symptoms in women (OR=2.14, 95%=1.06-4.34). Moreover, the results indicated that depression disorders in men (OR=8.87, 95%=2.13-36.96) and anxiety symptoms in women (OR=4.31, 95%=1.74-10.67) were particularly linked to incident amnestic cognitive impairment, whereas anxiety disorders in men (OR=12.01, 95%=1.73-83.26) were especially associated with incident nonamnestic cognitive impairment. CIND at baseline and incident cognitive impairment were not associated with incident anxiety or depression.
Anxiety and depression appear to have different relationships with incident cognitive impairment according to sex and the nature of cognitive impairment. Clinicians should pay particular attention to anxiety in older adults because it may shortly be followed by incident cognitive treatment.
PubMed ID
21797836 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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Comparison of predictors of hip fracture and mortality after hip fracture in community-dwellers with and without Alzheimer's disease - exposure-matched cohort study.

https://arctichealth.org/en/permalink/ahliterature283663
Source
BMC Geriatr. 2016 Dec 01;16(1):204
Publication Type
Article
Date
Dec-01-2016
Author
Anna-Maija Tolppanen
Heidi Taipale
Antti Tanskanen
Jari Tiihonen
Sirpa Hartikainen
Source
BMC Geriatr. 2016 Dec 01;16(1):204
Date
Dec-01-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - epidemiology
Causality
Cohort Studies
Comorbidity
Demography
Female
Finland - epidemiology
Hip Fractures - epidemiology - mortality
Humans
Incidence
Independent Living - statistics & numerical data
Male
Proportional Hazards Models
Risk factors
Socioeconomic Factors
Abstract
Dementia, with Alzheimer's disease (AD) being the most common form, is a major hip fracture risk factor, but currently it is not known whether the same factors predict hip fracture among persons with and without dementia/AD. We compared the predictors of hip fracture and mortality after hip fracture in persons with and without AD.
An exposure-matched cohort of all community-dwellers of Finland who received a new clinically verified AD diagnosis in 2005-2011 and had no history of previous hip fracture (N = 67,072) and an age, sex, and region-matched cohort of persons without AD (N = 67,072). Associations between sociodemographic characteristics, comorbidities and medications and risk of hip fracture and mortality after hip fracture were assessed with Cox regression.
As expected, the incidence of hip fractures in 2005-2012 (2.19/100 person-years vs 0.90/100 person-years in the non-AD cohort), as well as mortality after hip fracture (29/100 person-years vs 23/100 person-years in the non-AD cohort) were higher in the AD cohort. This difference was evident regardless of the risk factors. Mental and behavioural disorders (adjusted hazard ratio; HR 95% confidence interval CI: 1.16, 1.09-1.24 and 1.71, 1.52-1.92 in the AD and non-AD-cohorts), antipsychotics (1.12, 1.04-1.20 and 1.56, 1.38-1.76 for AD and non-AD-cohorts) and antidepressants (1.06, 1.00-1.12 and 1.34 1.22-1.47 for AD and non-AD-cohorts) were related to higher, and estrogen/combination hormone therapy (0.87, 0.77-0.9 and 0.79, 0.64-0.98 for AD and non-AD-cohorts) to lower hip fracture risk in both cohorts. Stroke (1.42, 1.26-1.62), diabetes (1.13, 0.99-1.28), active cancer treatment (1.67, 1.22-2.30), proton pump inhibitors (1.14, 1.05-1.25), antiepileptics (1.27, 1.11-1.46) and opioids (1.10, 1.01-1.19) were associated with higher hip fracture risk in the non-AD cohort. Similarly, the associations between mortality risk factors (age, sex, several comorbidities and medications) were stronger in the non-AD cohort.
AD itself appears to be such a significant risk factor for hip fracture, and mortality after hip fracture, that it overrules or diminishes the effect of other risk factors. Thus, it is important to develop and implement preventive interventions that are suitable and effective in this population.
Notes
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PubMed ID
27908278 View in PubMed
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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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Incidence of Bisphosphonate Use in Relation to Diagnosis of Alzheimer's Disease in Community-Dwelling Persons.

https://arctichealth.org/en/permalink/ahliterature294596
Source
J Am Geriatr Soc. 2016 09; 64(9):e48-9
Publication Type
Letter
Date
09-2016

Incident opioid use and risk of hip fracture among persons with Alzheimer disease: a nationwide matched cohort study.

https://arctichealth.org/en/permalink/ahliterature301336
Source
Pain. 2019 Feb; 160(2):417-423
Publication Type
Journal Article
Date
Feb-2019
Author
Heidi Taipale
Aleksi Hamina
Niina Karttunen
Marjaana Koponen
Antti Tanskanen
Jari Tiihonen
Sirpa Hartikainen
Anna-Maija Tolppanen
Author Affiliation
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland.
Source
Pain. 2019 Feb; 160(2):417-423
Date
Feb-2019
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Alzheimer Disease - complications - epidemiology
Cohort Studies
Female
Finland - epidemiology
Hip Fractures - epidemiology - etiology
Humans
Incidence
Independent living
Male
Opioid-Related Disorders - epidemiology
Proportional Hazards Models
Abstract
The objective of this study was to investigate whether incident opioid use is associated with an increased risk of hip fractures among community-dwelling persons with Alzheimer disease (AD) and to assess the association in terms of duration of use and opioid strength. Among community-dwelling persons with AD diagnosed in 2010 to 2011 (N = 23,100), a matched cohort study comparing incident opioid users (N = 4750) with opioid nonusers (N = 4750) was constructed. Matching was based on age, sex, and time since AD diagnosis at opioid initiation. Data on drug use and hip fractures were retrieved from nationwide registers. Incident opioid users were identified with a 1-year washout. Cox proportional hazard models compared the risk of hip fracture between opioid use and nonuse, and were weighted with inverse probability of treatment (IPT), based on a propensity score. Age-adjusted incidence rate of hip fractures was 3.47 (95% confidence interval [CI] 2.62-4.33) during opioid use and 1.94 (95% CI 1.65-2.22) during nonuse. Opioid use was associated with an increased risk of hip fracture (IPT-weighted hazard ratio [HR] 1.96, 95% CI 1.27-3.02). The risk was observed during the first 2 months of use (IPT-weighted HR 2.37, 1.04-5.41) and attenuated after that. The results suggest an increase in the risk of hip fracture by increasing opioid strength; weak opioids IPT-weighted HR 1.75 (0.91-3.35), buprenorphine IPT-weighted HR 2.10 (1.41-3.13), and strong opioids IPT-weighted HR 2.89 (1.32-6.32). Further research is needed to find out whether the risk of injurious falls is avoidable by slow titration of opioid doses in the beginning of treatment.
PubMed ID
30325873 View in PubMed
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Mild Hypokalemia and Supraventricular Ectopy Increases the Risk of Stroke in Community-Dwelling Subjects.

https://arctichealth.org/en/permalink/ahliterature283189
Source
Stroke. 2017 Mar;48(3):537-543
Publication Type
Article
Date
Mar-2017
Author
Nick Mattsson
Preman Kumarathurai
Bjørn Strøier Larsen
Olav Wendelboe Nielsen
Ahmad Sajadieh
Source
Stroke. 2017 Mar;48(3):537-543
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Aged
Atrial Premature Complexes - complications - epidemiology
Denmark - epidemiology
Electrocardiography, Ambulatory
Female
Humans
Hypokalemia - complications - epidemiology
Incidence
Independent living
Male
Middle Aged
Risk
Stroke - epidemiology - etiology
Abstract
Stroke is independently associated with the common conditions of hypokalemia and supraventricular ectopy, and we hypothesize that the combination of excessive supraventricular ectopic activity and hypokalemia has a synergistic impact on the prognosis in terms of stroke in the general population.
Subjects (55-75 years old) from the Copenhagen Holter Study cohort (N=671) with no history of atrial fibrillation or stroke were studied-including baseline values of potassium and ambulatory 48-hour Holter monitoring. Excessive supraventricular ectopic activity is defined as =30 premature atrial complexes per hour or any episodes of runs of =20. Hypokalemia was defined as plasma-potassium =3.6 mmol/L. The primary end point was ischemic stroke. Cox models were used.
Hypokalemia was mild (mean, 3.4 mmol/L; range, 2.7-3.6). Hypokalemic subjects were older (67.0±6.94 versus 64.0±6.66 years; P
PubMed ID
28174323 View in PubMed
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12 records – page 1 of 2.