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Article ; Online: The impact of stroke on the ability to live an independent life at old age: a community-based cohort study of Swedish men.

Lindvall, Elias / Franzon, Kristin / Lundström, Erik / Kilander, Lena

2023 Volume 23, Issue 1, Page(s) 126

Abstract: Introduction: Few studies with controls from the same cohort have investigated the impact of stroke on the ability to live an independent life at old age. We aimed to analyze how great an impact being a stroke survivor would have on cognition and ... ...

Abstract	Introduction: Few studies with controls from the same cohort have investigated the impact of stroke on the ability to live an independent life at old age. We aimed to analyze how great an impact being a stroke survivor would have on cognition and disability. We also analyzed the predictive value of baseline cardiovascular risk factors. Methods: We included 1147 men, free from stroke, dementia, and disability, from the Uppsala Longitudinal Study of Adult Men, between 69-74 years of age. Follow-up data were collected between the ages of 85-89 years and were available for 481 of all 509 survivors. Data on stroke diagnosis were obtained through national registries. Dementia was diagnosed through a systematic review of medical charts and in accordance with the current diagnostic criteria. The primary outcome, preserved functions, was a composite outcome comprising four criteria: no dementia, independent in personal activities of daily living, ability to walk outside unassisted, and not living in an institution. Results: Among 481 survivors with outcome data, 64 (13%) suffered a stroke during the follow-up. Only 31% of stroke cases, compared to 72% of non-stroke cases (adjusted OR 0.20 [95% CI 0.11-0.37]), had preserved functions. The chance of being free of dementia was 60% lower in the stroke group, OR 0.40 [95% CI 0.22-0.72]. No cardiovascular risk factors were independently able to predict preserved functions among stroke cases. Conclusion: Stroke has long lasting consequences for many aspects of disability at very high age.
MeSH term(s)	Male ; Humans ; Aged, 80 and over ; Cohort Studies ; Longitudinal Studies ; Activities of Daily Living ; Sweden/epidemiology ; Cognition ; Stroke/diagnosis ; Stroke/epidemiology
Language	English
Publishing date	2023-03-06
Publishing country	England
Document type	Systematic Review ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-023-03817-1
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Article ; Online: Quantitative brain stem assessment in discriminating neurodegenerative disorders from normal pressure hydrocephalus.

Georgiopoulos, Charalampos / Papadimitriou, Stergios / Nyholm, Dag / Kilander, Lena / Löwenmark, Malin / Fällmar, David / Virhammar, Johan

Journal of neuroimaging : official journal of the American Society of Neuroimaging

2024

Abstract: Background and purpose: Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy-parkinsonian type (MSA-P), and vascular dementia (VaD) is ... ...

Abstract	Background and purpose: Differentiating idiopathic normal pressure hydrocephalus (iNPH) from neurodegenerative disorders such as progressive supranuclear palsy (PSP), Multiple System Atrophy-parkinsonian type (MSA-P), and vascular dementia (VaD) is challenging due to overlapping clinical and neuroimaging findings. This study assesses if quantitative brain stem and cerebellum metrics can aid in this differentiation. Methods: We retrospectively compared the sagittal midbrain area, midbrain to pons ratio, MR parkinsonism index (MRPI), and cerebellar atrophy in 30 PSP patients, 31 iNPH patients, 27 MSA-P patients, 32 VaD patients, and 25 healthy controls. Statistical analyses determined group differences, sensitivity, specificity, and the area under the receiver operating characteristic curves. Results: There was an overlap in midbrain morphology between PSP and iNPH, as assessed with MRPI, midbrain to pons ratio, and midbrain area. A cutoff value of MRPI > 13 exhibited 84% specificity in distinguishing PSP from iNPH and 100% in discriminating PSP from all other conditions. A cutoff value of midbrain to pons ratio at <0.15 yielded 95% specificity for differentiating PSP from iNPH and 100% from all other conditions. A cutoff value of midbrain area at <87 mm Conclusion: Our study questions MRPI's diagnostic performance in distinguishing PSP from iNPH. Simpler indices such as midbrain to pons ratio and midbrain area showed similar or better accuracy. However, all these indices displayed low sensitivity despite significant differences among PSP, MSA-P, and VaD.
Language	English
Publishing date	2024-04-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	1071724-9
ISSN	1552-6569 ; 1051-2284
ISSN (online)	1552-6569
ISSN	1051-2284
DOI	10.1111/jon.13204
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Article ; Online: Obstructive sleep apnea during rapid eye movement sleep and cognitive performance in adults.

Tan, Xiao / Ljunggren, Mirjam / Kilander, Lena / Benedict, Christian / Lindberg, Eva

Sleep medicine

2023 Volume 113, Page(s) 34–40

Abstract: Study objectives: Obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep is often characterized with more frequent and lengthy breathing events and greater oxygen desaturation than during other sleep stages. Current evidence suggests an ... ...

Abstract	Study objectives: Obstructive sleep apnea (OSA) during rapid eye movement (REM) sleep is often characterized with more frequent and lengthy breathing events and greater oxygen desaturation than during other sleep stages. Current evidence suggests an association between OSA and cognitive decline, however whether OSA during REM sleep plays a vital role in this link is understudied. Methods: A cross-sectional sample of 728 men and women (aged 59.1 ± 11.3 years) underwent a full night polysomnography for determining apnea-hypopnea index (AHI) and sleep stages. Trail Making Test (TMT) part A and B were conducted during the following day for assessing participants' cognitive function. Linear regression analyses were performed to test the possible association between AHI and AHI during REM sleep with TMT-A and B results. Similar analyses were carried out in a subsample involving participants aged ≥60 years with ≥30 min of REM sleep (n = 356). Results: Despite a slight difference in TMT-B between participants with and without OSA (AHI ≥5 vs AHI <5, β-coefficient: 4.83, 95 % CI: [-9.44, -0.22], P = 0.040), no other association between AHI or REM-AHI and TMT results were found in the full sample. In older participants (aged ≥60 years), a REM-AHI ≥5 events/hour was associated with longer time taken to finish TMT-A (vs REM-AHI <5 events/hour, 3.93, [0.96, 6.90], P = 0.010). There was no association between REM-AHI and time taken to finish TMT-B in older participants. Conclusions: The results indicate that OSA during REM sleep may be of particular concern for attention-related cognitive function in older adults.
MeSH term(s)	Male ; Humans ; Female ; Aged ; Sleep, REM ; Cross-Sectional Studies ; Sleep Apnea, Obstructive/complications ; Sleep Stages ; Cognition
Language	English
Publishing date	2023-11-11
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2012041-2
ISSN	1878-5506 ; 1389-9457
ISSN (online)	1878-5506
ISSN	1389-9457
DOI	10.1016/j.sleep.2023.11.017
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Zs.A 5315: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Mixed Pathologies in a Subject with a Novel PSEN1 G206R Mutation.

Libard, Sylwia / Giedraitis, Vilmantas / Kilander, Lena / Ingelsson, Martin / Alafuzoff, Irina

Journal of Alzheimer's disease : JAD

2022 Volume 90, Issue 4, Page(s) 1601–1614

Abstract: Background: There are more than 300 presenilin-1 (PSEN1) mutations identified but a thorough postmortem neuropathological assessment of the mutation carriers is seldom performed.: Objective: To assess neuropathological changes (NC) in a 73-year-old ... ...

Abstract	Background: There are more than 300 presenilin-1 (PSEN1) mutations identified but a thorough postmortem neuropathological assessment of the mutation carriers is seldom performed. Objective: To assess neuropathological changes (NC) in a 73-year-old subject with the novel PSEN1 G206R mutation suffering from cognitive decline in over 20 years. To compare these findings with an age- and gender-matched subject with sporadic Alzheimer's disease (sAD). Methods: The brains were assessed macro- and microscopically and the proteinopathies were staged according to current recommendations. Results: The AD neuropathological change (ADNC) was more extensive in the mutation carrier, although both individuals reached a high level of ADNC. The transactive DNA binding protein 43 pathology was at the end-stage in the index subject, a finding not previously described in familial AD. This pathology was moderate in the sAD subject. The PSEN1 G206R subject displayed full-blown alpha-synuclein pathology, while this proteinopathy was absent in the sAD case. Additionally, the mutation carrier displayed pronounced neuroinflammation, not previously described in association with PSEN1 mutations. Conclusion: Our findings are exceptional, as the PSEN1 G206R subject displayed an end-stage pathology of every common proteinopathy. It is unclear whether the observed alterations are caused by the mutation or are related to a cross-seeding mechanisms. The pronounced neuroinflammation in the index patient can be reactive to the extensive NC or a contributing factor to the proteinopathies. Thorough postmortem neuropathological and genetic assessment of subjects with familial AD is warranted, for further understanding of a dementing illness.
Language	English
Publishing date	2022-10-31
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-220655
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Article ; Online: Association between open-angle glaucoma and Alzheimer's disease in Sweden: a long-term population-based follow-up study.

Ekström, Curt / Puhto, Ida / Kilander, Lena

Upsala journal of medical sciences

2021 Volume 126

Abstract: Background: Open-angle glaucoma (OAG) and Alzheimer's disease (AD) are two age-related neurodegenerative diseases of significant public health importance. Epidemiological studies have indicated that there might be an association between the disorders.!## ...

Abstract	Background: Open-angle glaucoma (OAG) and Alzheimer's disease (AD) are two age-related neurodegenerative diseases of significant public health importance. Epidemiological studies have indicated that there might be an association between the disorders. Methods: Predictors of AD, including mixed and unspecified dementia, were analysed in a cohort of 712 residents aged 65-74 years, examined in a population survey in the rural district of Tierp, Sweden, from 1984 to 1986. To expand the sample size, 821 people were recruited by means of glaucoma case records established at the Eye Department in Tierp from 1978 to 2007. In this way, the cohort comprised 1,533 people, representing more than 21,000 person-years at risk. Medical records were reviewed to identify subjects diagnosed with dementia. Those with a follow-up duration shorter than 2 years were excluded. Results: By the conclusion of the study, in August 2020, 307 subjects had received a diagnosis of AD, including mixed and unspecified dementia. Of these cases, 55 were affected with definite OAG at baseline. Higher age and ischemic heart disease were the only predictors of AD identified. In multivariate analysis, adjusting for age, participation in the population survey and competing events, no association was found between OAG and AD (hazard ratio 1.08; 95% confidence interval: 0.80-1.47). Conclusion: In this long-term follow-up study of subjects aged 65-74 years old in Sweden, OAG was not associated with AD.
MeSH term(s)	Aged ; Alzheimer Disease/epidemiology ; Follow-Up Studies ; Glaucoma, Open-Angle/diagnosis ; Glaucoma, Open-Angle/epidemiology ; Humans ; Risk Factors ; Sweden/epidemiology
Language	English
Publishing date	2021-06-21
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	183949-4
ISSN	2000-1967 ; 0300-9734
ISSN (online)	2000-1967
ISSN	0300-9734
DOI	10.48101/ujms.v126.7819
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Article ; Online: Herpes Simplex Viral Infection Doubles the Risk of Dementia in a Contemporary Cohort of Older Adults: A Prospective Study.

Vestin, Erika / Boström, Gustaf / Olsson, Jan / Elgh, Fredrik / Lind, Lars / Kilander, Lena / Lövheim, Hugo / Weidung, Bodil

Journal of Alzheimer's disease : JAD

2024 Volume 97, Issue 4, Page(s) 1841–1850

Abstract: Background: Evidence indicates that herpes simplex virus (HSV) participates in the pathogenesis of Alzheimer's disease (AD).: Objective: We investigated AD and dementia risks according to the presence of herpesvirus antibodies in relation to anti- ... ...

Abstract	Background: Evidence indicates that herpes simplex virus (HSV) participates in the pathogenesis of Alzheimer's disease (AD). Objective: We investigated AD and dementia risks according to the presence of herpesvirus antibodies in relation to anti-herpesvirus treatment and potential APOE ɛ4 carriership interaction. Methods: This study was conducted with 1002 dementia-free 70-year-olds living in Sweden in 2001-2005 who were followed for 15 years. Serum samples were analyzed to detect anti-HSV and anti-HSV-1 immunoglobulin (Ig) G, anti-cytomegalovirus (CMV) IgG, anti-HSV IgM, and anti-HSV and anti-CMV IgG levels. Diagnoses and drug prescriptions were collected from medical records. Cox proportional-hazards regression models were applied. Results: Cumulative AD and all-cause dementia incidences were 4% and 7%, respectively. Eighty-two percent of participants were anti-HSV IgG carriers, of whom 6% received anti-herpesvirus treatment. Anti-HSV IgG was associated with a more than doubled dementia risk (fully adjusted hazard ratio = 2.26, p = 0.031). No significant association was found with AD, but the hazard ratio was of the same magnitude as for dementia. Anti-HSV IgM and anti-CMV IgG prevalence, anti-herpesvirus treatment, and anti-HSV and -CMV IgG levels were not associated with AD or dementia, nor were interactions between anti-HSV IgG and APOE ɛ4 or anti-CMV IgG. Similar results were obtained for HSV-1. Conclusions: HSV (but not CMV) infection may be indicative of doubled dementia risk. The low AD incidence in this cohort may have impaired the statistical power to detect associations with AD.
MeSH term(s)	Humans ; Aged ; Prospective Studies ; Herpes Simplex/complications ; Herpes Simplex/drug therapy ; Herpes Simplex/epidemiology ; Herpesvirus 1, Human ; Cytomegalovirus Infections/diagnosis ; Antibodies, Viral ; Immunoglobulin G ; Alzheimer Disease/diagnosis ; Immunoglobulin M ; Apolipoproteins E
Chemical Substances	Antibodies, Viral ; Immunoglobulin G ; Immunoglobulin M ; Apolipoproteins E
Language	English
Publishing date	2024-02-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1440127-7
ISSN	1875-8908 ; 1387-2877
ISSN (online)	1875-8908
ISSN	1387-2877
DOI	10.3233/JAD-230718
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Article: Milk and Fermented Milk Consumption and Risk of Stroke: Longitudinal Study

Olsson, Erika / Larsson, Susanna C. / Höijer, Jonas / Kilander, Lena / Byberg, Liisa

Nutrients. 2022 Mar. 03, v. 14, no. 5

2022

Abstract: The role of milk and fermented milk consumption in stroke risk is unclear. We investigated associations of time-updated information on milk and fermented milk consumption (1997 and 2009) with total stroke, cerebral infarction, and hemorrhagic stroke risk ...

Abstract	The role of milk and fermented milk consumption in stroke risk is unclear. We investigated associations of time-updated information on milk and fermented milk consumption (1997 and 2009) with total stroke, cerebral infarction, and hemorrhagic stroke risk among 79,618 Swedish women and men (mean age 61.3 years). During a mean follow-up of 17.7 years, we identified 9735 incident cases of total stroke, of which 7573 were cerebral infarctions, 1470 hemorrhagic strokes, and 692 unspecified strokes. Compared with an intake of 100 g/day of milk, the multivariable-adjusted hazard ratios (95% confidence interval) of cerebral infarction were 1.05 (1.02–1.08) for 0 g/day, 0.97 (0.95–0.99) for 200 g/day, 0.96 (0.92–1.00) for 400 g/day, 0.98 (0.94–1.03) for 600 g/day, and 1.01 (0.94–1.07) for 800 g/day. Corresponding estimates for hemorrhagic stroke were 0.98 (0.91–1.05) for 0 g/day, 1.02 (0.97–1.07) for 200 g/day, 1.07 (0.98–1.17) for 400 g/day, 1.13 (1.02–1.25) for 600 g/day, and 1.19 (1.03–1.36) for 800 g/day. No associations were observed between milk consumption and total stroke or for fermented milk consumption and any of the stroke outcomes. Higher long-term milk consumption based on repeated measures of intake was weakly and non-linearly associated with cerebral infarction, and was directly associated with hemorrhagic stroke.
Keywords	confidence interval ; fermented milk ; infarction ; longitudinal studies ; milk ; milk consumption ; risk ; stroke
Language	English
Dates of publication	2022-0303
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
ZDB-ID	2518386-2
ISSN	2072-6643
ISSN	2072-6643
DOI	10.3390/nu14051070
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Blood pressure screening in midlife aids in prediction of dementia later in life.

Moberg, Linn / Leppert, Jerzy / Liljeström, Simon / Rehn, Mattias / Kilander, Lena / Chabok, Abbas

Upsala journal of medical sciences

2022 Volume 127

Abstract: Background: There is substantial evidence that midlife hypertension is a risk factor for late life dementia. Our aim was to investigate if even high blood pressure at a single timepoint in midlife can predict an increased risk for all-cause dementia, ... ...

Abstract	Background: There is substantial evidence that midlife hypertension is a risk factor for late life dementia. Our aim was to investigate if even high blood pressure at a single timepoint in midlife can predict an increased risk for all-cause dementia, Alzheimer's disease (AD), or vascular dementia (VaD) later in life. Methods: The community-based study population comprised 30,102 dementia-free individuals from the Results: After a mean follow-up time of 24 years resulting in 662,244 person/years, 761 (2.5%) individuals had been diagnosed with dementia. Midlife high blood pressure at a single timepoint predicted all-cause dementia (hazard ratio [HR]: 1.22, 95% confidence interval [CI]: 1.02-1.45) and VaD (HR: 2.10, 95% CI: 1.47-3.00) but not AD (HR: 1.06, 95% CI: 0.81-1.38). Conclusion: This study suggests that even midlife high blood pressure at a single timepoint predicts all-cause dementia and more than doubles the risk for VaD later in life independently of established confounders. Even though there was no such association with AD, this strengthens the importance of midlife health examinations in order to identify individuals with hypertension and initiate treatment.
MeSH term(s)	Adult ; Alzheimer Disease ; Blood Pressure ; Dementia/diagnosis ; Dementia/epidemiology ; Dementia, Vascular ; Humans ; Risk Factors
Language	English
Publishing date	2022-01-03
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	183949-4
ISSN	2000-1967 ; 0300-9734
ISSN (online)	2000-1967
ISSN	0300-9734
DOI	10.48101/ujms.v127.7860
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Article ; Online: Milk and Fermented Milk Consumption and Risk of Stroke: Longitudinal Study.

Olsson, Erika / Larsson, Susanna C / Höijer, Jonas / Kilander, Lena / Byberg, Liisa

Nutrients

2022 Volume 14, Issue 5

Abstract	The role of milk and fermented milk consumption in stroke risk is unclear. We investigated associations of time-updated information on milk and fermented milk consumption (1997 and 2009) with total stroke, cerebral infarction, and hemorrhagic stroke risk among 79,618 Swedish women and men (mean age 61.3 years). During a mean follow-up of 17.7 years, we identified 9735 incident cases of total stroke, of which 7573 were cerebral infarctions, 1470 hemorrhagic strokes, and 692 unspecified strokes. Compared with an intake of 100 g/day of milk, the multivariable-adjusted hazard ratios (95% confidence interval) of cerebral infarction were 1.05 (1.02-1.08) for 0 g/day, 0.97 (0.95-0.99) for 200 g/day, 0.96 (0.92-1.00) for 400 g/day, 0.98 (0.94-1.03) for 600 g/day, and 1.01 (0.94-1.07) for 800 g/day. Corresponding estimates for hemorrhagic stroke were 0.98 (0.91-1.05) for 0 g/day, 1.02 (0.97-1.07) for 200 g/day, 1.07 (0.98-1.17) for 400 g/day, 1.13 (1.02-1.25) for 600 g/day, and 1.19 (1.03-1.36) for 800 g/day. No associations were observed between milk consumption and total stroke or for fermented milk consumption and any of the stroke outcomes. Higher long-term milk consumption based on repeated measures of intake was weakly and non-linearly associated with cerebral infarction, and was directly associated with hemorrhagic stroke.
MeSH term(s)	Animals ; Cohort Studies ; Female ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Milk/adverse effects ; Prospective Studies ; Risk Factors
Language	English
Publishing date	2022-03-03
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2518386-2
ISSN	2072-6643 ; 2072-6643
ISSN (online)	2072-6643
ISSN	2072-6643
DOI	10.3390/nu14051070
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Article ; Online: Open-angle glaucoma and Alzheimer's disease: a population-based 30-year follow-up study.

Ekström, Curt / Kilander, Lena

Acta ophthalmologica

2017 Volume 95, Issue 2, Page(s) e157–e158

MeSH term(s)	Aged ; Alzheimer Disease/complications ; Alzheimer Disease/epidemiology ; Female ; Follow-Up Studies ; Forecasting ; Glaucoma, Open-Angle/epidemiology ; Glaucoma, Open-Angle/etiology ; Humans ; Incidence ; Intraocular Pressure ; Male ; Population Surveillance ; Risk Factors ; Sweden/epidemiology
Language	English
Publishing date	2017-03
Publishing country	England
Document type	Letter
ZDB-ID	2408333-1
ISSN	1755-3768 ; 1755-375X
ISSN (online)	1755-3768
ISSN	1755-375X
DOI	10.1111/aos.13243
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