147 results on '"Garcia-Ptacek, Sara"'
Search Results
102. Differences in diagnostic process, treatment and social Support for Alzheimer's dementia between primary and specialist care: resultss from the Swedish Dementia Registry
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Garcia-Ptacek, Sara, primary, Modéer, Ingrid Nilsson, additional, Kåreholt, Ingemar, additional, Fereshtehnejad, Seyed-Mohammad, additional, Farahmand, Bahman, additional, Religa, Dorota, additional, and Eriksdotter, Maria, additional
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- 2016
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103. Causes of Death According to Death Certificates in Individuals with Dementia: A Cohort from the Swedish Dementia Registry
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Garcia‐Ptacek, Sara, primary, Kåreholt, Ingemar, additional, Cermakova, Pavla, additional, Rizzuto, Debora, additional, Religa, Dorota, additional, and Eriksdotter, Maria, additional
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- 2016
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104. Statins, Risk of Death and Ischemic Stroke in Patients with Dementia: A Registry-Based Observational Cohort Study
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Petek, Bojana, Xu, Hong, Villa-Lopez, Marta, Winblad, Bengt, Kramberger, Milica G., Eriksdotter, Maria, and Garcia-Ptacek, Sara
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Background: Survival in patients with dementia is variable. Statins are a cornerstone of cardiovascular prevention. However, the effect of statins on mortality and risk for stroke in patients with dementia is not clear. Objective: The aim of the study was to analyse the association between the use of statins and the risk of all-cause death and first ischemic stroke in patients diagnosed with dementia. Methods: A longitudinal cohort study of 48 771 patients based on combined Swedish registries was conducted. The association between the incident use of statins one year prior to dementia diagnosis, allcause mortality and first ischemic stroke was examined using propensity score-matched flexible parametric or Cox hazard survival models and is presented with hazard ratios and corresponding 95% confidence intervals. Results: After propensity score matching, incident users of statins (n=1412) had a lower risk of all-cause death (HR 0.82, 95% CI 0.74-0.91) and ischemic stroke (HR 0.62, 95% CI 0.43-0.89) compared to matched non-users (n=4482). In stratified analysis, the protective association between incident statin use and survival was observed in men, patients older than 75 years, with Alzheimer's disease and vascular dementia. Furthermore, we observed a protective association between incident use of statins and first ischemic stroke risk in men, patients older than 75 years and with mixed dementia. There was a graded association between cumulative doses of statins and mortality. Conclusion: The use of statins might be beneficial for the survival and ischemic stroke risk in patients with dementia in a dose-dependent manner.
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- 2020
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105. The caregiving phenomenon and caregiver participation in dementia.
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Garcia‐Ptacek, Sara, Eriksdotter, Maria, Dahlrup, Beth, Edlund, Ann‐Katrin, and Wijk, Helle
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PSYCHOLOGY of caregivers , *DEMENTIA , *REPORTING of diseases , *INTERPERSONAL relations , *MEDICAL care , *PATIENT-professional relations , *PATIENTS , *RESEARCH funding , *TIME , *PATIENT participation , *ADVANCE directives (Medical care) , *BURDEN of care - Abstract
Background: Dementia presents barriers to the collaboration between individuals and the healthcare system. Caregivers perform multiple functions helping patients with basic and instrumental activities but also communicating and mediating the dyads' needs within the broader social group. Interventions focusing on caregivers show that caregiver burden can be reduced, improving patient outcomes in a cost‐effective way, but the generalisation of these findings is limited by several factors such as low participation rates of caregivers in studies. There is a global push to increase patient participation in health care, but this can be difficult for patients with dementia. Caregiver participation has arisen as a substitute, but there is a lack of standardised definitions, goals and outcome measurement tools for this participation. Methods: In 2015, the Swedish Association of Local Authorities and Regions commissioned a study on possibilities of increasing caregiver participation within the Swedish Dementia Registry (SveDem). This discussion paper updates and adapts that report, aiming to broadly summarise the caregiving phenomenon in order to provide a backdrop for clinicians seeking to understand the legal, ethical and practical considerations of caregiver participation in dementia. Relevant literature on caregiver participation is presented, and its definition, extent and practical implementation are discussed. Discussion: The Swedish legal framework compels care providers to facilitate patient and caregiver participation in dementia and provides support to caregivers through the local level of government, but further work is needed to clarify and define the extension and form that this participation must take in clinical practice. Advanced directives are one step in extending patient participation to the period of advanced dementia. Conclusion: Little research exists on caregiver participation. There is a need to develop a framework for caregiver and patient participation to determine the extent, type and form that such participation should take in health care, research and quality initiatives pertaining to persons with dementia. [ABSTRACT FROM AUTHOR]
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- 2019
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106. The Impact of Antipsychotic Drugs on Long-term Care, Nursing Home Admission, and Death in Dementia Patients.
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Nerius, Michael, Johnell, Kristina, Garcia-Ptacek, Sara, Eriksdotter, Maria, Haenisch, Britta, and Doblhammer, Gabriele
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TREATMENT of dementia ,SYMPTOMS ,ANTIPSYCHOTIC agents ,NURSING care facilities ,DEMENTIA patients - Abstract
Background: Behavioral and psychological symptoms of dementia are commonly treated with antipsychotic drugs (APDs), which have been associated with adverse health effects. We examine the effect of APDs on long-term care (LTC), nursing home (NH) admission, and death of dementia patients.Methods: We used health claims data of the largest German health insurer from 2004 to 2010 and followed newly-diagnosed dementia patients aged 60 years and older into LTC, NH, and until death. Cox proportional hazards models were estimated to explore whether the risk of these outcomes differed between patients receiving haloperidol, melperone, risperidone, or quetiapine.Results: In a cohort of 6,930 dementia patients who were initially free of LTC dependency, APD users generally faced a twofold increased risk of LTC relative to nonusers. Quetiapine was the exception, showing a comparatively lower risk (HR = 1.64; CI = 1.35-1.98). Among 9,950 dementia patients initially living in private homes, the risk of moving into a NH was generally increased by about 50% among APD users relative to nonusers. Risk of death (N = 10,921) was significantly higher for haloperidol-, melperone-, and risperidone- but not for quetiapine users (HR = 0.91; CI = 0.78-1.08). The excess mortality associated with haloperidol and melperone was greater among patients living in private households.Conclusions: In our study, APDs appeared to accelerate adverse health outcomes in German dementia patients. Differentiating between the effect of antipsychotic drug use among dementia patients residing in private households and in NHs, we found that excess mortality for haloperidol and melperone users was higher in private settings. [ABSTRACT FROM AUTHOR]- Published
- 2018
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107. ASSOCIATION WITH REDUCED MORTALITY USING CHOLINESTERASE INHIBITORS IN PATIENTS WITH DEMENTIA: DATA FROM SVEDEM, THE SWEDISH DEMENTIA REGISTRY
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Xu, Hong, Garcia-Ptacek, Sara, Jonsson, Linus, Wimo, Anders, Nordström, Peter, and Eriksdotter, Maria
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- 2019
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108. CHOLINESTERASE INHIBITORS AND MORTALITY IN PATIENTS WITH DIABETES MELLITUS AND DEMENTIA: A COHORT STUDY OF ∼3,000 PATIENTS FROM THE SWEDISH DEMENTIA REGISTRY.
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Secnik, Juraj, Schwertner, Emilia, Alvarsson, Michael, Hammar, Niklas, Fastbom, Johan, Winblad, Bengt, Garcia-Ptacek, Sara, Religa, Dorota, and Eriksdotter, Maria
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- 2019
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109. Parkinson Disease and Dementia
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Garcia-Ptacek, Sara, primary and Kramberger, Milica G., additional
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- 2016
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110. Diagnosis of Dementia in the Specialist Setting: A Comparison Between the Swedish Dementia Registry (SveDem) and the Registry of Dementias of Girona (ReDeGi)
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Garre-Olmo, Josep, primary, Garcia-Ptacek, Sara, additional, Calvó-Perxas, Laia, additional, Turró-Garriga, Oriol, additional, López-Pousa, Secundino, additional, and Eriksdotter, Maria, additional
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- 2016
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111. Cardiovascular Diseases in ∼30,000 Patients in the Swedish Dementia Registry
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Cermakova, Pavla, primary, Johnell, Kristina, additional, Fastbom, Johan, additional, Garcia-Ptacek, Sara, additional, Lund, Lars H., additional, Winblad, Bengt, additional, Eriksdotter, Maria, additional, and Religa, Dorota, additional
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- 2015
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112. SEX DIFFERENCES IN ACUTE STROKE CARE
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Zupanic, Eva, Garcia-Ptacek, Sara, Religa, Dorota, Kramberger, Milica G., Norrving, Bo, Winblad, Bengt, von Euler, Mia, and Eriksdotter, Maria
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- 2018
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113. P1-247: Cardiovascular comorbidities in dementia
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Cermakova, Pavla, primary, Johnell, Kristina, additional, Fastbom, Johan, additional, Garcia-Ptacek, Sara, additional, Winblad, Bengt, additional, Eriksdotter, Maria, additional, and Religa, Dorota, additional
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- 2015
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114. SveDem, the Swedish Dementia Registry – A Tool for Improving the Quality of Diagnostics, Treatment and Care of Dementia Patients in Clinical Practice
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Religa, Dorota, primary, Fereshtehnejad, Seyed-Mohammad, additional, Cermakova, Pavla, additional, Edlund, Ann-Katrin, additional, Garcia-Ptacek, Sara, additional, Granqvist, Nicklas, additional, Hallbäck, Anne, additional, Kåwe, Kerstin, additional, Farahmand, Bahman, additional, Kilander, Lena, additional, Mattsson, Ulla-Britt, additional, Nägga, Katarina, additional, Nordström, Peter, additional, Wijk, Helle, additional, Wimo, Anders, additional, Winblad, Bengt, additional, and Eriksdotter, Maria, additional
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- 2015
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115. Long-Term Cognitive Decline in Dementia with Lewy Bodies in a Large Multicenter, International Cohort.
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Kramberger, Milica G., Auestad, Bjørn, Garcia-Ptacek, Sara, Abdelnour, Carla, Olmo, Josep Garre, Walker, Zuzana, Lemstra, Afina W., Londos, Elisabet, Blanc, Frederic, Bonanni, Laura, McKeith, Ian, Winblad, Bengt, de Jong, Frank Jan, Nobili, Flavio, Stefanova, Elka, Petrova, Maria, Falup-Pecurariu, Cristian, Rektorova, Irena, Bostantjopoulou, Sevasti, and Biundo, Roberta
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COGNITION ,DEMENTIA ,ALZHEIMER'S disease ,DOPAMINE ,NEURODEGENERATION ,COGNITION disorders diagnosis ,ANALYSIS of variance ,COGNITION disorders ,COMPARATIVE studies ,INTERNATIONAL relations ,LEWY body dementia ,LONGITUDINAL method ,RESEARCH methodology ,MEDICAL cooperation ,PSYCHOLOGICAL tests ,QUESTIONNAIRES ,RESEARCH ,RESEARCH funding ,EVALUATION research ,DISEASE complications ,DIAGNOSIS - Abstract
Background/objective: The aim of this study was to describe the rate and clinical predictors of cognitive decline in dementia with Lewy bodies (DLB), and compare the findings with Alzheimer's disease (AD) and Parkinson's disease dementia (PDD) patients.Methods: Longitudinal scores for the Mini-Mental State Examination (MMSE) in 1,290 patients (835 DLB, 198 PDD, and 257 AD) were available from 18 centers with up to three years longitudinal data. Linear mixed effects analyses with appropriate covariates were used to model MMSE decline over time. Several subgroup analyses were performed, defined by anti-dementia medication use, baseline MMSE score, and DLB core features.Results: The mean annual decline in MMSE score was 2.1 points in DLB, compared to 1.6 in AD (p = 0.07 compared to DLB) and 1.8 in PDD (p = 0.19). Rates of decline were significantly higher in DLB compared to AD and PDD when baseline MMSE score was included as a covariate, and when only those DLB patients with an abnormal dopamine transporter SPECT scan were included. Decline was not predicted by sex, baseline MMSE score, or presence of specific DLB core features.Conclusions: The average annual decline in MMSE score in DLB is approximately two points. Although in the overall analyses there were no differences in the rate of decline between the three neurodegenerative disorders, there were indications of a more rapid decline in DLB than in AD and PDD. Further studies are needed to understand the predictors and mechanisms of cognitive decline in DLB. [ABSTRACT FROM AUTHOR]- Published
- 2017
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116. Deep brain stimulation for Huntington's disease: long-term results of a prospective open-label study
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Gonzalez, Victoria, primary, Cif, Laura, additional, Biolsi, Brigitte, additional, Garcia-Ptacek, Sara, additional, Seychelles, Anne, additional, Sanrey, Emily, additional, Descours, Irene, additional, Coubes, Christine, additional, de Moura, Ana-Maria Ribeiro, additional, Corlobe, Astrid, additional, James, Syril, additional, Roujeau, Thomas, additional, and Coubes, Philippe, additional
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- 2014
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117. P3‐288: DIAGNOSIS AND TREATMENT OF ALZHEIMER'S DISEASE IN SPECIALIST UNITS COMPARED TO PRIMARY CARE
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Religa, Dorota, primary, Modéer, Ingrid Nilsson, additional, Fereshtehnejad, Seyed‐Mohammad, additional, Falahati, Farshad, additional, Garcia‐Ptacek, Sara, additional, and Eriksdotter, Maria, additional
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- 2014
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118. O1-11-05: MORTALITY IN DEMENTIA: DATA FROM SVEDEM, SWEDISH DEMENTIA REGISTRY
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Garcia-Ptacek, Sara, primary, Farahmand, Bahman, additional, Kåreholt, Ingemar, additional, Religa, Dorota, additional, Cuadrado, Maria Luz, additional, and Eriksdotter, Maria, additional
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- 2014
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119. Mortality Risk after Dementia Diagnosis by Dementia Type and Underlying Factors: A Cohort of 15,209 Patients based on the Swedish Dementia Registry
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Garcia-Ptacek, Sara, primary, Farahmand, Bahman, additional, Kåreholt, Ingemar, additional, Religa, Dorota, additional, Cuadrado, Maria Luz, additional, and Eriksdotter, Maria, additional
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- 2014
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120. AtypicalPLA2G6-Associated Neurodegeneration: Social Communication Impairment, Dystonia and Response to Deep Brain Stimulation
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Cif, Laura, primary, Kurian, Manju A., additional, Gonzalez, Victoria, additional, Garcia-Ptacek, Sara, additional, Roujeau, Thomas, additional, Gelisse, Philippe, additional, Moura de Ribeiro, Ana Maria, additional, Crespel, Arielle, additional, MacPherson, Lesley, additional, and Coubes, Philippe, additional
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- 2014
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121. Cardiovascular Diseases in ~30,000 Patients in the Swedish Dementia Registry.
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Cermakova, Pavla, Johnell, Kristina, Fastbom, Johan, Garcia-Ptacek, Sara, Lund, Lars H., Winblad, Bengt, Eriksdotter, Maria, and Religa, Dorota
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CARDIOVASCULAR disease related mortality ,DEMENTIA ,ALZHEIMER'S disease diagnosis ,PARKINSON'S disease ,ATRIAL fibrillation ,CARDIOVASCULAR diseases ,LONGITUDINAL method ,LOGISTIC regression analysis ,ACQUISITION of data ,PROPORTIONAL hazards models ,DISEASE complications - Abstract
Background: Cardiovascular diseases are leading causes of death and patients with dementia are often affected by them.Objective: Investigate associations of cardiovascular diseases with different dementia disorders and determine their impact on mortality.Methods: This study included 29,630 patients from the Swedish Dementia Registry (mean age 79 years, 59% women) diagnosed with Alzheimer's disease (AD), mixed dementia, vascular dementia, dementia with Lewy bodies (DLB), Parkinson's disease dementia (PDD), frontotemporal dementia (FTD), or unspecified dementia. Records of cardiovascular diseases come from the Swedish National Patient Register. Multinomial logistic regression and cox proportional hazard models were applied.Results: Compared to AD, we found a higher burden of all cardiovascular diseases in mixed and vascular dementia. Cerebrovascular diseases were more associated with DLB than with AD. Diabetes mellitus was less associated with PDD and DLB than with AD. Ischemic heart disease was less associated with PDD and FTD than AD. All cardiovascular diseases predicted death in patients with AD, mixed, and vascular dementia. Only ischemic heart disease significantly predicted death in DLB patients (HR = 1.72; 95% CI = 1.16-2.55). In PDD patients, heart failure and diabetes mellitus were associated with a higher risk of death (HR = 3.06; 95% CI = 1.74-5.41 and HR = 3.44; 95% CI = 1.31-9.03). In FTD patients, ischemic heart disease and atrial fibrillation or flutter significantly predicted death (HR = 2.11; 95% CI = 1.08-4.14 and HR = 3.15; 95% CI = 1.60-6.22, respectively).Conclusion: Our study highlights differences in the occurrence and prognostic significance of cardiovascular diseases in several dementia disorders. This has implications for the care and treatment of the different dementia disorders. [ABSTRACT FROM AUTHOR]- Published
- 2015
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122. Mechanical endovascular treatment of acute stroke due to cardiac myxoma
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Garcia-Ptacek, Sara, primary, Matias-Guiu, Jordi A, additional, Valencia-Sánchez, Cristina, additional, Gil, Alberto, additional, Bernal-Becerra, Israel, additional, De las Heras-Revilla, Virginia, additional, and Serna-Candel, Carmen, additional
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- 2012
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123. MORTALITY IN DEMENTIA: DATA FROM SVEDEM, SWEDISH DEMENTIA REGISTRY
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Garcia-Ptacek, Sara, Farahmand, Bahman, Kåreholt, Ingemar, Religa, Dorota, Cuadrado, Maria Luz, and Eriksdotter, Maria
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- 2014
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124. Kidney Function, Kidney Function Decline, and the Risk of Dementia in Older Adults: A Registry-Based Study.
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Hong Xu, Garcia-Ptacek, Sara, Trevisan, Marco, Xu, Hong, Evans, Marie, Lindholm, Bengt, Eriksdotter, Maria, and Carrero Pharm, Juan Jesus
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- 2021
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125. Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality.
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Hong Xu, Garcia-Ptacek, Sara, Jönsson, Linus, Xu, Hong, Anders, Wimo, Nordström, Peter, Eriksdotter, Maria, and Wimo, Anders
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- 2021
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126. Thrombolysis in acute ischemic stroke in patients with dementia
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Zupanic, Eva, von Euler, Mia, Kåreholt, Ingemar, Contreras Escamez, Beatriz, Fastbom, Johan, Norrving, Bo, Religa, Dorota, Kramberger, Milica G., Winblad, Bengt, Johnell, Kristina, Eriksdotter, Maria, and Garcia-Ptacek, Sara
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Aged, 80 and over ,Male ,Sweden ,Age Factors ,Article ,Statistics, Nonparametric ,Brain Ischemia ,Cohort Studies ,Stroke ,Treatment Outcome ,Fibrinolytic Agents ,Case-Control Studies ,mental disorders ,Humans ,Dementia ,Female ,Registries - Abstract
Objective: To compare access to intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) and its outcomes in patients with and without dementia. Methods: This was a longitudinal cohort study of the Swedish dementia and stroke registries. Patients with preexisting dementia who had AIS from 2010 to 2014 (n = 1,356) were compared with matched patients without dementia (n = 6,755). We examined access to thrombolysis and its outcomes at 3 months (death, residency, and modified Rankin Scale [mRS] score). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with logistic and ordinal logistic regression. Results: The median age at stroke onset was 83 years in both groups. IVT was administered to 94 (7.0%) patients with dementia and 639 (9.5%) patients without dementia. The OR of receiving IVT was 0.68 (95% CI 0.54–0.86) for patients with dementia. When the analysis was repeated exclusively among patients independent in everyday activities, dementia status was no longer significant (OR 0.79, 95% CI 0.60–1.06). However, differences persisted in patients ≤80 years of age (OR 0.58, 95% CI 0.36–0.94). In patients who received thrombolysis, the incidence of symptomatic intracerebral hemorrhage (sICH; 7.4% vs 7.3%) and death at 3 months (22.0% vs 18.8%) did not differ significantly between the 2 groups. However, mRS score and accommodation status were worse among patients with dementia after 3 months in adjusted analyses (both p < 0.001). Unfavorable outcomes with an mRS score of 5 to 6 were doubled in patients with dementia (56.1% vs 28.1%). Conclusions: Younger patients with dementia and AIS are less likely to receive IVT. Among patients receiving thrombolysis, there are no differences in sICH or death, although patients with dementia have worse accommodation and functional outcomes at 3 months.
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127. Metabolic correlates of dopaminergic loss in dementia with lewy bodies
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Huber, Maria, Beyer, Leonie, Prix, Catharina, Schönecker, Sonja, Palleis, Carla, Rauchmann, Boris-Stephan, Morbelli, Silvia, Chincarini, Andrea, Bruffaerts, Rose, Vandenberghe, Rik, Van Laere, Koen, Kramberger, Milica G, Trost, Maja, Grmek, Marko, Garibotto, Valentina, Nicastro, Nicolas, Frisoni, Giovanni B, Lemstra, Afina W, Van Der Zande, Jessica, Pilotto, Andrea, Padovani, Alessandro, Garcia-Ptacek, Sara, Savitcheva, Irina, Ochoa-Figueroa, Miguel A, Davidsson, Anette, Camacho, Valle, Peira, Enrico, Arnaldi, Dario, Bauckneht, Matteo, Pardini, Matteo, Sambuceti, Gianmario, Vöglein, Jonathan, Schnabel, Jonas, Unterrainer, Marcus, Perneczky, Robert, Pogarell, Oliver, Buerger, Katharina, Catak, Cihan, Bartenstein, Peter, Cumming, Paul, Ewers, Michael, Danek, Adrian, Levin, Johannes, Aarsland, Dag, Nobili, Flavio, Rominger, Axel, and Brendel, Matthias
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610 Medicine & health ,3. Good health - Abstract
BACKGROUND Striatal dopamine deficiency and metabolic changes are well-known phenomena in dementia with Lewy bodies and can be quantified in vivo by 123 I-Ioflupane brain single-photon emission computed tomography of dopamine transporter and 18 F-fluorodesoxyglucose PET. However, the linkage between both biomarkers is ill-understood. OBJECTIVE We used the hitherto largest study cohort of combined imaging from the European consortium to elucidate the role of both biomarkers in the pathophysiological course of dementia with Lewy bodies. METHODS We compared striatal dopamine deficiency and glucose metabolism of 84 dementia with Lewy body patients and comparable healthy controls. After normalization of data, we tested their correlation by region-of-interest-based and voxel-based methods, controlled for study center, age, sex, education, and current cognitive impairment. Metabolic connectivity was analyzed by inter-region coefficients stratified by dopamine deficiency and compared to healthy controls. RESULTS There was an inverse relationship between striatal dopamine availability and relative glucose hypermetabolism, pronounced in the basal ganglia and in limbic regions. With increasing dopamine deficiency, metabolic connectivity showed strong deteriorations in distinct brain regions implicated in disease symptoms, with greatest disruptions in the basal ganglia and limbic system, coincident with the pattern of relative hypermetabolism. CONCLUSIONS Relative glucose hypermetabolism and disturbed metabolic connectivity of limbic and basal ganglia circuits are metabolic correlates of dopamine deficiency in dementia with Lewy bodies. Identification of specific metabolic network alterations in patients with early dopamine deficiency may serve as an additional supporting biomarker for timely diagnosis of dementia with Lewy bodies. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.
128. Cardiovascular comorbidities in dementia.
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Cermakova, Pavla, Johnell, Kristina, Fastbom, Johan, Garcia-Ptacek, Sara, Winblad, Bengt, Eriksdotter, Maria, and Religa, Dorota
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- 2015
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129. Neurological Disorders in Central Spain, Second Survey: Feasibility Pilot Observational Study
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Sara Llamas-Velasco, Juan-Francisco Gil-García, Alberto Villarejo-Galende, Esther Cubo, Jesús Hernández-Gallego, Ester Tapias-Merino, Eva Carro, Julián Benito-León, Sara Garcia-Ptacek, José Ignacio Serrano, Jesus L. Cacho, Emiliano Rodríguez-Sánchez, Elina Boycheva, Rosalía García García-Patino, José-María Vizcaino Sánchez-Rodrigo, Saturio Vega, Israel Contador, Félix Bermejo-Pareja, F. Sierra-Hidalgo, Rocío Trincado, Instituto de Salud Carlos III, Centro Investigación Biomédica en Red Enfermedades Neurodegenerativas (España), Hernández-Gallego, Jesús [0000-0002-9410-1720], Llamas-Velasco, Sara [0000-0002-9174-2610], Bermejo-Pareja, Felix [0000-0002-5413-232X], Vega, Saturio [0000-0001-5034-0140], Tapias-Merino, Ester [0000-0002-8720-7375], Rodríguez-Sánchez, Emiliano [0000-0003-3667-7155], Boycheva, Elina [0000-0002-9506-8491], González-Serrano, José Ignacio [0000-0003-0795-3026], Vizcaino Sánchez-Rodrigo, José-María [0000-0001-9464-9393], Contador, Israel [0000-0002-7841-1307], Garcia-Ptacek, Sara [0000-0002-1537-6129], Sierra-Hidalgo, Fernando [0000-0003-4044-8304], Carro, Eva [0000-0002-6504-4579], Villarejo-Galende, Alberto [0000-0002-6834-7620], Benito-León, Julián [0000-0002-1769-4809], Hernández-Gallego, Jesús, Llamas-Velasco, Sara, Bermejo-Pareja, Felix, Vega, Saturio, Tapias-Merino, Ester, Rodríguez-Sánchez, Emiliano, Boycheva, Elina, González-Serrano, José Ignacio, Vizcaino Sánchez-Rodrigo, José-María, Contador, Israel, Garcia-Ptacek, Sara, Sierra-Hidalgo, Fernando, Carro, Eva, Villarejo-Galende, Alberto, and Benito-León, Julián
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Longitudinal study ,medicine.medical_specialty ,020205 medical informatics ,Demographics ,02 engineering and technology ,03 medical and health sciences ,0302 clinical medicine ,mild cognitive impairment ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Dementia ,030212 general & internal medicine ,NEDICES ,Medical diagnosis ,Original Paper ,business.industry ,pilot study ,Headache ,General Medicine ,medicine.disease ,Biobank ,stroke ,Test (assessment) ,population-based study ,Family medicine ,Parkinson’s disease ,Essential tremor ,Observational study ,observational study ,Lifestyle habits ,business - Abstract
Background The Neurological Disorders in Central Spain, second survey (NEDICES-2) is a population-based, closed-cohort study that will include over 8000 subjects aged ≥55 years. It will also include a biobank. Objective The objective of this study was to evaluate all major aspects of the NEDICES-2 (methods, database, screening instruments, and questionnaires, as well as interexpert rating of the neurological diagnoses) in each one of the planned areas (all of them in central Spain) and to test the possibility of obtaining biological samples from each participant. Methods A selection of patients and participants of the planned NEDICES-2 underwent face-to-face interviews including a comprehensive questionnaire on demographics, current medications, medical conditions, and lifestyle habits. Biological samples (blood, saliva, urine, and hair) were also obtained. Furthermore, every participant was examined by a neurologist. Results In this pilot study, 567 study participants were enrolled (196 from hospitals and 371 from primary care physician lists). Of these 567, 310 completed all study procedures (questionnaires and the neurological evaluation). The study was time-consuming for several primary care physicians. Hence, a few primary care physicians from some areas refused to participate, which led to a reconfiguration of study areas. In addition, the central biobank needed to be supplemented by the biobanks of local Spanish National Health System hospitals. Conclusions Population-based epidemiological surveys, such as the NEDICES-2, require a pilot study to evaluate the feasibility of all aspects of a future field study (population selection, methods and instruments to be used, neurological diagnosis agreement, and data collection)., Our thanks to all collaborators in this feasibility pilot study, the Instituto de Salud Carlos III and the Biomedical Research Networking Center on Neurodegenerative Diseases (CIBERNED), and the two hospital computer experts (Victoria Garcia Baquero and Teresa Garcia Morales), who created the website (http://nedices2.ciberned.com/estudio-de-salud-nedices-2/). We would also like to thank Miss Jennifer Gates for the editing and proofreading of the manuscript.
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- 2019
130. Acute Kidney Injury and Its Association With Dementia and Specific Dementia Types: Findings From a Population-Based Study in Sweden.
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Xu H, Eriksdotter M, Garcia-Ptacek S, Ferreira D, Ji D, Bruchfeld A, Xu Y, and Carrero JJ
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- Humans, Sweden epidemiology, Female, Male, Aged, Aged, 80 and over, Registries, Dementia epidemiology, Dementia etiology, Acute Kidney Injury epidemiology
- Abstract
Background and Objectives: Preclinical studies suggest that acute kidney injury (AKI) results in biochemical and pathologic changes in the brain. We aimed to explore the association between experiencing AKI and subsequent risks of developing dementia., Methods: We conducted a study involving individuals aged 65 years and older in Stockholm from 2006 to 2019, who were free from dementia diagnosis and had data on kidney function. The exposure was an episode of AKI (time varying), ascertained by issued clinical diagnoses and transient creatinine elevations according to Kidney Disease Improving Global Outcomes criteria. The outcome was all-cause dementia and specific types of dementia, ascertained by clinically confirmed cases in the Swedish registry of cognitive/dementia disorders, the presence of 2 issued dementia diagnoses in outpatient care, or initiation of specific antidementia medications. We investigated associations with dementia through Cox proportional hazard regression by AKI, severity levels of AKI, AKI recurrence, and setting (community-acquired or hospital-acquired AKI)., Results: We included 305,122 individuals with a median age of 75 ± 8 years (56.6% women). During a median follow-up of 12.3 (interquartile range 8.7-13.3) years, there were 79,888 individuals (26%) suffering from at least 1 episode of AKI and 47,938 incident cases (16%) of dementia. The rate of dementia cases was 37.0 per 1,000 person-years (95% CI 36.2-37.8) after developing AKI, which was approximately 2 times higher than the rate observed during the periods before AKI (17.3, 95% CI 17.2-17.5). After multivariable adjustment, developing AKI was associated with a 49% higher rate of subsequent dementia (adjusted hazard ratio hazard ratio [HR] 1.49, 95% CI 1.45-1.53). This pattern was consistent across dementia types, with HRs of 1.88 (95% CI 1.53-2.32), 1.47 (1.38-1.56), and 1.31 (1.25-1.38) for dementia with Lewy bodies and Parkinson disease with dementia, vascular dementia, and Alzheimer dementia, respectively. Risk associations were stronger in magnitude across more severe AKIs and in hospital-acquired vs community-acquired AKI., Discussion: Individuals who experienced an AKI were at increased risk of receiving a diagnosis of dementia.
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- 2024
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131. Immigration and access to dementia diagnostics and treatment: A nationwide study in Sweden.
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Hoang MT, Kåreholt I, Lindgren E, von Koch L, Xu H, Tan ECK, Johnell K, Nägga K, Eriksdotter M, and Garcia-Ptacek S
- Abstract
•Compared to Swedish-born people, foreign-born people were less likely to receive dementia diagnostic tests.•Being born in Africa or Europe was associated with lower chance of receiving cholinesterase inhibitors.•Asian-born people had higher chance of receiving cholinesterase inhibitors, but were less likely to receive memantine.•Disparities existed in dementia diagnostics and treatment between Swedish-born and foreign-born people, but were not consistent after adjusting for MMSE scores., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)
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- 2023
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132. Influence of Education and Income on Receipt of Dementia Care in Sweden.
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Hoang MT, Kåreholt I, von Koch L, Xu H, Secnik J, Religa D, Tan ECK, Johnell K, and Garcia-Ptacek S
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- Cohort Studies, Educational Status, Humans, Sweden, Dementia diagnosis, Dementia drug therapy, Income
- Abstract
Objective: To explore the dementia diagnostic process and drug prescription for persons with dementia (PWD) with different socioeconomic status (SES)., Design: Register-based cohort study., Setting and Participants: This study included 74,414 PWD aged ≥65 years from the Swedish Dementia Register (2007-2018). Their data were linked with the Swedish Longitudinal Integrated Database for Health Insurance and Labor Market Studies (2006-2017) to acquire the SES information 1 year before dementia diagnosis., Methods: Education and income-2 traditional SES indicators-were divided into 5 levels. Outcomes comprised the dementia diagnostic examinations, types of dementia diagnosis, diagnostic unit, and prescription of antidementia drugs. Binary logistic regression was performed to evaluate socioeconomic inequalities., Results: Compared to PWD with the lowest educational level, PWD with the highest educational level had a higher probability of receiving the basic diagnostic workup [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.10-1.29], clock test (OR 1.12, 95% CI 1.02-1.24) and neuroimaging (OR 1.23, 95% CI 1.09-1.39). Compared with PWD in the lowest income quintile, PWD in the highest income quintile presented a higher chance of receiving the basic diagnostic workup (OR 1.35, 95% CI 1.26-1.46), clock test (OR 1.40, 95% CI 1.28-1.52), blood analysis (OR 1.21, 95% CI 1.06-1.39), Mini-Mental State Examination (OR 1.47, 95% CI 1.26-1.70), and neuroimaging (OR 1.30, 95% CI 1.18-1.44). PWD with higher education or income had a higher likelihood of obtaining a specified dementia diagnosis or being diagnosed at a memory clinic. SES presented no association with prescription of antidementia medication, except for the association between education and the use of memantine., Conclusions and Implications: Higher education or income was significantly associated with higher chance of receiving dementia diagnostic examinations, a specified dementia diagnosis, being diagnosed at a memory clinic, and using memantine. Socioeconomic inequalities in dementia diagnostic process and prescription of memantine occurred among PWD with different education or income levels., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2021
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133. Decreased Mortality Over Time During the First Wave in Patients With COVID-19 in Geriatric Care: Data From the Stockholm GeroCovid Study.
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Xu H, Garcia-Ptacek S, Annetorp M, Cederholm T, Engel G, Engström M, Erlandsson H, Julius C, Kivipelto M, Lundberg LG, Metzner C, Sandberg L, Skogö Nyvang J, Sühl Öberg C, Åkesson E, Religa D, and Eriksdotter M
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- Aged, Hospital Mortality, Hospitalization, Humans, SARS-CoV-2, COVID-19, Pandemics
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Objective: To describe temporal changes in treatment, care, and short-term mortality outcomes of geriatric patients during the first wave of the COVID-19 pandemic., Design: Observational study., Setting and Participants: Altogether 1785 patients diagnosed with COVID-19 and 6744 hospitalized for non-COVID-19 causes at 7 geriatric clinics in Stockholm from March 6 to July 31, 2020, were included., Methods: Across admission month, patient vital signs and pharmacological treatment in relationship to risk for in-hospital death were analyzed using the Poisson regression model. Incidence rates (IRs) and incidence rate ratios (IRRs) of death are presented., Results: In patients with COVID-19, the IR of mortality were 27%, 17%, 10%, 8%, and 2% from March to July, respectively, after standardization for demographics and vital signs. Compared with patients admitted in March, the risk of in-hospital death decreased by 29% [IRR 0.71, 95% confidence interval (CI) 0.51-0.99] in April, 61% (0.39, 0.26-0.58) in May, 68% (0.32, 0.19-0.55) in June, and 86% (0.14, 0.03-0.58) in July. The proportion of patients admitted for geriatric care with oxygen saturation <90% decreased from 13% to 1%, which partly explains the improvement of COVID-19 patient survival. In non-COVID-19 patients during the pandemic, mortality rates remained relatively stable (IR 1.3%-2.3%). Compared with non-COVID-19 geriatric patients, the IRR of death declined from 11 times higher (IRR 11.7, 95% CI 6.11-22.3) to 1.6 times (2.61, 0.50-13.7) between March and July in patients with COVID-19., Conclusions and Implications: Mortality risk in geriatric patients from the Stockholm region declined over time throughout the first pandemic wave of COVID-19. The improved survival rate over time was only partly related to improvement in saturation status at the admission of the patients hospitalized later throughout the pandemic. Lower incidence during the later months could have led to less severe hospitalized cases driving down mortality., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2021
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134. Changes in Drug Prescribing Practices Are Associated With Improved Outcomes in Patients With Dementia in Sweden: Experience from the Swedish Dementia Registry 2008-2017.
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Xu H, Garcia-Ptacek S, Secnik J, Edlund AK, Westling K, Hoang MT, Johnell K, Tan ECK, Religa D, and Eriksdotter M
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- Cohort Studies, Drug Prescriptions, Humans, Registries, Sweden epidemiology, Dementia drug therapy, Dementia epidemiology
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Objectives: Evidence is lacking on how treatment of comorbidities improves outcomes in patients with dementia. In this study, we evaluated temporal changes in the management of comorbidities in relation to survival rates in incident dementia over a 10-year period in Sweden., Design: Observational cohort study., Setting and Participants: A total of 40,219 patients with recently diagnosed dementia in memory clinics from the Swedish Dementia Registry (SveDem) from 2008 to 2017., Methods: In 1-year blocks, pharmacological treatment of dementia and comorbidities in relationship to risk for fractures, major cardiovascular events (MACE), and death were analyzed using Cox models. Standardized Incidence Ratios (SIR) of death are presented., Results: After standardization for demographics and comorbidities, the risk of fracture, MACE, and mortality decreased by 16%, 23%, and 28%, respectively, between 2008 and 2016. Each year decreased the risk of fracture by 3% (hazard ratio 0.97, 95% confidence interval 0.96-0.99), MACE by 4% (0.96, 0.95-0.97), and death by 5% (0.95, 0.93-0.97). Adjustment for changes in medication use attenuated these associations. Compared with the general population, the risk of death declined by 11%, corresponding to standardized incidence rate ratio, between 2008 and 2016., Conclusions and Implications: Over 10 years, a reduction in the short-term risks of fracture, MACE, and death in patients with dementia was associated with changes in drug prescribing practices. These improvements seem to be partly explained by progressive implementation of dementia diagnostic, treatment guidelines, and general management of comorbidities., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2021
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135. Acute kidney injury and mortality risk in older adults with COVID-19.
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Xu H, Garcia-Ptacek S, Annetorp M, Bruchfeld A, Cederholm T, Johnson P, Kivipelto M, Metzner C, Religa D, and Eriksdotter M
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- Acute Kidney Injury mortality, Aged, 80 and over, COVID-19 epidemiology, Female, Hospital Mortality trends, Humans, Incidence, Male, Retrospective Studies, Risk Factors, Survival Rate trends, Sweden epidemiology, Acute Kidney Injury etiology, COVID-19 complications, Pandemics, Risk Assessment methods
- Abstract
Background: Research regarding COVID-19 and acute kidney injury (AKI) in older adults is scarce. We evaluated risk factors and outcomes of AKI in hospitalized older adults with and without COVID-19., Methods: Observational study of patients admitted to two geriatric clinics in Stockholm from March 1st to June 15th, 2020. The difference in incidence, risk factors and adverse outcomes for AKI between patients with or without COVID-19 were examined. Odds ratios (OR) for the risk of AKI and in-hospital death were obtained from logistic regression., Results: Three hundred-sixteen older patients were hospitalized for COVID-19 and 876 patients for non-COVID-19 diagnoses. AKI occurred in 92 (29%) patients with COVID-19 vs. 159 (18%) without COVID-19. The odds for developing AKI were higher in patients with COVID-19 (adjusted OR, 1.70; 95% confidence interval [CI] 1.04-2.76), low baseline kidney function as depicted by estimated glomerular filtration rate (eGFR) [4.19 (2.48-7.05), for eGFR 30 to < 60 mL/min, and 20.3 (9.95-41.3) for eGFR < 30 mL/min], and higher C reactive protein (CRP) (OR 1.81 (1.11-2.95) in patients with initial CRP > 10 mg/L). Compared to patients without COVID-19 and without AKI, the risk of in-hospital death was highest in patients with COVID-19 and AKI [OR 80.3, 95% CI (27.3-235.6)], followed by COVID-19 without AKI [16.3 (6.28-42.4)], and by patients without COVID-19 and with AKI [10.2 (3.66-28.2)]., Conclusions: Geriatric patients hospitalized with COVID-19 had a higher incidence of AKI compared to patients hospitalized for other diagnoses. COVID-19 and reduced baseline kidney function were risk factors for developing AKI. AKI and COVID-19 were associated with in-hospital death.
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- 2021
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136. Risk of epilepsy diagnosis after a first unprovoked seizure in dementia.
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Mahamud Z, Mononen CP, Brigo F, Garcia-Ptacek S, and Zelano J
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- Aged, Humans, Risk, Risk Factors, Seizures diagnosis, Seizures epidemiology, Seizures etiology, Sweden epidemiology, Alzheimer Disease, Epilepsy complications, Epilepsy diagnosis, Epilepsy epidemiology
- Abstract
Purpose: To estimate the risk of an epilepsy diagnosis after a first unprovoked seizure in dementia, in relation to the 60 % cut-off specified in the ILAE definition of epilepsy., Methods: The study was register-based. Individuals with diagnostic codes of a first unprovoked seizure were identified in the Swedish Dementia Register (SveDem) or a three times larger age- and sex- matched pool of controls (n = 1039 in SveDem and 743 controls). The risk of a diagnostic code for epilepsy was estimated by Kaplan Meier analysis., Results: The 5-year risk of a subsequent epilepsy diagnosis after a first unprovoked seizure was 32 % (95 % CI 27-37) in patients with dementia and 31 % (95 % CI 25-38) in controls. The 5-year risk of epilepsy was 48 % (95 % CI 37-59) for individuals age 70 years or below. The dementia subtype with the highest risk of epilepsy was early onset Alzheimer., Conclusion: The risk of an epilepsy diagnosis after a first unprovoked seizure is similar in patients with dementia and in controls. Our results indicate that epilepsy cannot be diagnosed after a first seizure simply on the basis of the patient having dementia. Instead, more studies are needed for individualized prediction of recurrence risk in dementia. Such studies should focus on particular dementia subtypes, younger patients, and identifying biomarkers., (Copyright © 2020 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)
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- 2020
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137. Age, Frailty, and Comorbidity as Prognostic Factors for Short-Term Outcomes in Patients With Coronavirus Disease 2019 in Geriatric Care.
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Hägg S, Jylhävä J, Wang Y, Xu H, Metzner C, Annetorp M, Garcia-Ptacek S, Khedri M, Boström AM, Kadir A, Johansson A, Kivipelto M, Eriksdotter M, Cederholm T, and Religa D
- Subjects
- Age Factors, Aged, Aged, 80 and over, Betacoronavirus, COVID-19, Female, Geriatrics, Humans, Male, Models, Statistical, Pandemics, Prognosis, SARS-CoV-2, Survival Analysis, Sweden, Comorbidity, Coronavirus Infections diagnosis, Frail Elderly, Outcome Assessment, Health Care, Pneumonia, Viral diagnosis
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Objectives: To analyze whether frailty and comorbidities are associated with in-hospital mortality and discharge to home in older adults hospitalized for coronavirus disease 2019 (COVID-19)., Design: Single-center observational study., Setting and Participants: Patients admitted to geriatric care in a large hospital in Sweden between March 1 and June 11, 2020; 250 were treated for COVID-19 and 717 for other diagnoses., Methods: COVID-19 diagnosis was clinically confirmed by positive reverse transcription polymerase chain reaction test or, if negative, by other methods. Patient data were extracted from electronic medical records, which included Clinical Frailty Scale (CFS), and were further used for assessments of the Hospital Frailty Risk Score (HFRS) and the Charlson Comorbidity Index (CCI). In-hospital mortality and home discharge were followed up for up to 25 and 28 days, respectively. Multivariate Cox regression models adjusted for age and sex were used., Results: Among the patients with COVID-19, in-hospital mortality rate was 24% and home discharge rate was 44%. Higher age was associated with in-hospital mortality (hazard ratio [HR] 1.05 per each year, 95% confidence interval [CI] 1.01‒1.08) and lower probability of home discharge (HR 0.97, 95% CI 0.95‒0.99). CFS (>5) and CCI, but not HFRS, were predictive of in-hospital mortality (HR 1.93, 95% CI 1.02‒3.65 and HR 1.27, 95% CI 1.02‒1.58, respectively). Patients with CFS >5 had a lower probability of being discharged home (HR 0.38, 95% CI 0.25‒0.58). CCI and HFRS were not associated with home discharge. In general, effects were more pronounced in men. Acute kidney injury was associated with in-hospital mortality and hypertension with discharge to home. Other comorbidities (diabetes, cardiovascular disease, lung diseases, chronic kidney disease and dementia) were not associated with either outcome., Conclusions and Implications: Of all geriatric patients with COVID-19, 3 out of 4 survived during the study period. Our results indicate that in addition to age, the level of frailty is a useful predictor of short-term COVID-19 outcomes in geriatric patients., (Copyright © 2020 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
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- 2020
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138. Metabolic Correlates of Dopaminergic Loss in Dementia with Lewy Bodies.
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Huber M, Beyer L, Prix C, Schönecker S, Palleis C, Rauchmann BS, Morbelli S, Chincarini A, Bruffaerts R, Vandenberghe R, Van Laere K, Kramberger MG, Trost M, Grmek M, Garibotto V, Nicastro N, Frisoni GB, Lemstra AW, van der Zande J, Pilotto A, Padovani A, Garcia-Ptacek S, Savitcheva I, Ochoa-Figueroa MA, Davidsson A, Camacho V, Peira E, Arnaldi D, Bauckneht M, Pardini M, Sambuceti G, Vöglein J, Schnabel J, Unterrainer M, Perneczky R, Pogarell O, Buerger K, Catak C, Bartenstein P, Cumming P, Ewers M, Danek A, Levin J, Aarsland D, Nobili F, Rominger A, and Brendel M
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- Brain, Cohort Studies, Dopamine, Humans, Lewy Bodies, Lewy Body Disease diagnostic imaging
- Abstract
Background: Striatal dopamine deficiency and metabolic changes are well-known phenomena in dementia with Lewy bodies and can be quantified in vivo by
123 I-Ioflupane brain single-photon emission computed tomography of dopamine transporter and18 F-fluorodesoxyglucose PET. However, the linkage between both biomarkers is ill-understood., Objective: We used the hitherto largest study cohort of combined imaging from the European consortium to elucidate the role of both biomarkers in the pathophysiological course of dementia with Lewy bodies., Methods: We compared striatal dopamine deficiency and glucose metabolism of 84 dementia with Lewy body patients and comparable healthy controls. After normalization of data, we tested their correlation by region-of-interest-based and voxel-based methods, controlled for study center, age, sex, education, and current cognitive impairment. Metabolic connectivity was analyzed by inter-region coefficients stratified by dopamine deficiency and compared to healthy controls., Results: There was an inverse relationship between striatal dopamine availability and relative glucose hypermetabolism, pronounced in the basal ganglia and in limbic regions. With increasing dopamine deficiency, metabolic connectivity showed strong deteriorations in distinct brain regions implicated in disease symptoms, with greatest disruptions in the basal ganglia and limbic system, coincident with the pattern of relative hypermetabolism., Conclusions: Relative glucose hypermetabolism and disturbed metabolic connectivity of limbic and basal ganglia circuits are metabolic correlates of dopamine deficiency in dementia with Lewy bodies. Identification of specific metabolic network alterations in patients with early dopamine deficiency may serve as an additional supporting biomarker for timely diagnosis of dementia with Lewy bodies. © 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society., (© 2019 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.)- Published
- 2020
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139. Do Acetylcholinesterase Inhibitors Prevent or Delay Psychotropic Prescribing in People With Dementia? Analyses of the Swedish Dementia Registry.
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Tan ECK, Johnell K, Bell JS, Garcia-Ptacek S, Fastbom J, Nordström P, and Eriksdotter M
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- Aged, Aged, 80 and over, Alzheimer Disease complications, Alzheimer Disease drug therapy, Behavioral Symptoms etiology, Cohort Studies, Dementia complications, Female, Humans, Lewy Body Disease complications, Lewy Body Disease drug therapy, Male, Sweden, Time Factors, Anti-Anxiety Agents therapeutic use, Antipsychotic Agents therapeutic use, Behavioral Symptoms drug therapy, Cholinesterase Inhibitors therapeutic use, Dementia drug therapy, Drug Prescriptions statistics & numerical data, Registries
- Abstract
Objectives: To investigate whether acetylcholinesterase inhibitor (AChEI) use prevents or delays subsequent initiation of psychotropic medications in people with Alzheimer's disease (AD) and Lewy body dementia (LBD)., Methods: Cohort study of 17,763 people with AD and LBD, without prior psychotropic use at time of dementia diagnosis, registered in the Swedish Dementia Registry from 2007 to 2015. Propensity score-matched regression models were used to compute hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between time-dependent AChEI use and risk of psychotropic initiation., Results: Compared with matched comparators, AChEI users had a lower risk of antipsychotic (HR: 0.85, 95%CI: 0.75-0.95) and anxiolytic (HR: 0.76, 95%CI: 0.72-0.80) initiation. In subanalyses, this association remained significant at higher AChEI doses, and in AD but not LBD. There were no associations between AChEI use and initiation of antidepressants or hypnotics., Conclusion: AChEI use may be associated with lower risk of antipsychotic and anxiolytic initiation in AD, particularly at higher doses. Further investigation into aceytylcholinesterase inhibitors in behavioral and psychological symptoms of dementia management in LBD is warranted., (Copyright © 2019 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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140. Antipsychotic Treatment Associated With Increased Mortality Risk in Patients With Dementia. A Registry-Based Observational Cohort Study.
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Schwertner E, Secnik J, Garcia-Ptacek S, Johansson B, Nagga K, Eriksdotter M, Winblad B, and Religa D
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- Aged, Aged, 80 and over, Female, Humans, Male, Registries, Risk Assessment, Sweden epidemiology, Antipsychotic Agents therapeutic use, Death, Dementia, Vascular drug therapy
- Abstract
Objective: To assess all-cause mortality patients with dementia treated with typical and atypical antipsychotic drugs (APDs)., Design: Registry-based cohort study., Setting and Participants: A total of 58,412 patients diagnosed with dementia and registered in the Swedish Dementia Registry were included in the study. Of the study sample, 2526 of the patients were prescribed APDs. Of these, 602 patients were prescribed typical APDs and 1833 patients were prescribed atypical APDs. Ninety-one patients were prescribed both typical and atypical APDs., Measurements: All-cause mortality based on Swedish Cause of Death Register. Adjusted hazard ratios of mortality were calculated according to class of APDs (typical or atypical) prescribed. Final models were adjusted for age at dementia diagnosis, sex, Charlson comorbidity index, living arrangement, and Mini-Mental State Examination., Results: In the adjusted models, use of APDs at the time of dementia diagnosis was associated with increased mortality risk in the total cohort (hazard ratio = 1.4; 95% confidence interval 1.3-1.5). After stratifying for dementia types, increased mortality risks associated with APDs were found in patients with Alzheimer's disease, mixed dementia, unspecified dementia, and vascular dementia. Higher risk for mortality was found with typical APDs in patients with mixed and vascular dementia and with atypical APDs in patients with Alzheimer's disease, mixed, unspecified, and vascular dementia. Furthermore, in patients with Alzheimer's disease who had typical APDs, use lower risk of death emerged in comparison with patients with atypical APDs., Conclusions/implications: Both the use of atypical and typical APDs increased the risk of death in patients with dementia even after adjusting for differences in basic characteristics between groups. Although we cannot rule out the influence of residual confounding, these results would seem to add to studies suggesting caution in APD prescription for patients with dementia., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2019
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141. The Impact of Frailty and Comorbidity on Institutionalization and Mortality in Persons With Dementia: A Prospective Cohort Study.
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Haaksma ML, Rizzuto D, Ramakers IHGB, Garcia-Ptacek S, Marengoni A, van der Flier WM, Verhey FRJ, Olde Rikkert MGM, and Melis RJF
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- Aged, Aged, 80 and over, Female, Geriatric Assessment, Humans, Male, Netherlands epidemiology, Prognosis, Prospective Studies, Survival Analysis, Comorbidity, Dementia mortality, Frail Elderly, Institutionalization
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Objectives: The predictive value of frailty and comorbidity, in addition to more readily available information, is not widely studied. We determined the incremental predictive value of frailty and comorbidity for mortality and institutionalization across both short and long prediction periods in persons with dementia., Design: Longitudinal clinical cohort study with a follow-up of institutionalization and mortality occurrence across 7 years after baseline., Setting and Participants: 331 newly diagnosed dementia patients, originating from 3 Alzheimer centers (Amsterdam, Maastricht, and Nijmegen) in the Netherlands, contributed to the Clinical Course of Cognition and Comorbidity (4C) Study., Measures: We measured comorbidity burden using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and constructed a Frailty Index (FI) based on 35 items. Time-to-death and time-to-institutionalization from dementia diagnosis onward were verified through linkage to the Dutch population registry., Results: After 7 years, 131 patients were institutionalized and 160 patients had died. Compared with a previously developed prediction model for survival in dementia, our Cox regression model showed a significant improvement in model concordance (U) after the addition of baseline CIRS-G or FI when examining mortality across 3 years (FI: U = 0.178, P = .005, CIRS-G: U = 0.180, P = .012), but not for mortality across 6 years (FI: U = 0.068, P = .176, CIRS-G: U = 0.084, P = .119). In a competing risk regression model for time-to-institutionalization, baseline CIRS-G and FI did not improve the prediction across any of the periods., Conclusions: Characteristics such as frailty and comorbidity change over time and therefore their predictive value is likely maximized in the short term. These results call for a shift in our approach to prognostic modeling for chronic diseases, focusing on yearly predictions rather than a single prediction across multiple years. Our findings underline the importance of considering possible fluctuations in predictors over time by performing regular longitudinal assessments in future studies as well as in clinical practice., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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142. The Effect of Xerostomic Medication on Oral Health in Persons With Dementia.
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Lexomboon D, Tan EC, Höijer J, Garcia-Ptacek S, Eriksdotter M, Religa D, Fastbom J, Johnell K, and Sandborgh-Englund G
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- Aged, Aged, 80 and over, Dose-Response Relationship, Drug, Drug-Related Side Effects and Adverse Reactions, Female, Humans, Longitudinal Studies, Male, Polypharmacy, Risk, Sweden epidemiology, Dementia complications, Salivation drug effects, Tooth Diseases epidemiology, Tooth Diseases etiology, Xerostomia chemically induced, Xerostomia complications
- Abstract
Objectives: Medication-induced hyposalivation can increase the risk for oral complications, including dental caries and tooth loss. This problem is particularly important in people with dementia because of their declining ability to maintain oral care. The objective of this study was to describe the association between the number of xerostomic medications used and tooth loss and restorative and dental preventive treatment in a population of persons with dementia., Design: A longitudinal population-based register study with a 3-year follow-up was conducted. Data were extracted from the Swedish Dementia Registry (SveDem), the Swedish Prescribed Drug Register (SPDR), the Swedish National Patient Register (SNPR), and the Dental Health Register (DHR)., Setting and Participants: Participants were persons with dementia who were registered in the SveDem at the time of their dementia diagnosis., Measures: The exposure was continuous use of xerostomic medications over the 3 years prior to dementia diagnosis (baseline). The outcomes were the incidence of tooth extractions, tooth restorations, and dental preventive procedures. Poisson regression models were used to estimate incidence rate ratios (IRRs) for the association between the exposure and outcomes, adjusting for relevant confounders., Results: A total of 34,037 persons were included in the analysis. A dose-response relationship between the exposure and tooth extractions was observed. Compared with nonusers of xerostomic medication, the rate of tooth extractions increased with increasing number of xerostomic medications used (IRR = 1.03, 1.11, and 1.40 for persons using an average >0-1, >1-3, and >3 xerostomic medications, respectively). However, the risk for having new dental restorations and receiving preventive procedures did not differ between groups., Conclusion: Continuous use of xerostomic medications can increase the risk for tooth extraction in people with dementia. This study highlights the importance of careful consideration when prescribing xerostomic medications to people with dementia, and the need for regular and ongoing dental care., (Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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143. Acetylcholinesterase inhibitors and risk of stroke and death in people with dementia.
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Tan ECK, Johnell K, Garcia-Ptacek S, Haaksma ML, Fastbom J, Bell JS, and Eriksdotter M
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- Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Male, Registries, Risk, Sweden epidemiology, Alzheimer Disease complications, Cause of Death, Cholinesterase Inhibitors therapeutic use, Stroke epidemiology
- Abstract
Introduction: The aim of this study was to investigate the association between acetylcholinesterase inhibitor (AChEI) use and risk of ischemic stroke and death in people with dementia., Methods: A cohort study of 44,288 people with dementia registered in the Swedish Dementia Registry from 2007 to 2014. Propensity score-matched competing risk regression models were used to compute hazard ratios and 95% confidence intervals for the association between time-dependent AChEI use and risk of stroke and death., Results: Compared with matched controls, AChEI users had a lower risk of stroke (hazard ratio: 0.85, 95% confidence interval: 0.75-0.95) and all-cause death (hazard ratio: 0.76, 95% confidence interval: 0.72-0.80). After considering competing risk of death, high doses (≥1.33 defined daily doses) of AChEI remained significantly associated with reduced stroke risk., Discussion: The use of AChEIs in people with dementia may be associated with reduced risk of ischemic stroke and death. These results call for a closer examination of the cardiovascular effects of AChEIs., (Copyright © 2018 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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144. Prestroke Mobility and Dementia as Predictors of Stroke Outcomes in Patients Over 65 Years of Age: A Cohort Study From The Swedish Dementia and Stroke Registries.
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Garcia-Ptacek S, Contreras Escamez B, Zupanic E, Religa D, von Koch L, Johnell K, von Euler M, Kåreholt I, and Eriksdotter M
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- Activities of Daily Living, Aged, Aged, 80 and over, Dementia mortality, Female, Hospital Mortality, Humans, Longitudinal Studies, Male, Registries, Stroke mortality, Sweden epidemiology, Dementia complications, Mobility Limitation, Stroke complications
- Abstract
Objectives: To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age., Design: Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry., Participants: A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke., Measurements: Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors)., Results: Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P < .001). Mortality at 3 months was higher in patients with dementia (31% vs 23% P < .001) and fewer were living at home without help (21% vs 55%; P < .001). In adjusted analyses, prestroke dementia was associated with higher risk of 3-month mortality (OR 1.34; 95% CI 1.18-1.52), requiring a higher level of residential assistance (OR 4.07; 3.49-.75) and suffering from more dependency in relation to mobility (OR 2.57; 2.20-3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P < .001), but there were no differences in discharge to geriatric rehabilitation (19% for both; P = .976). Patients, who moved independently before stroke, were more often discharged home (60% vs 28%) and had lower mortality. In adjusted analyses, prestroke mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death., Conclusions: Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations., (Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
145. Dental care utilization in patients with different types of dementia: A longitudinal nationwide study of 58,037 individuals.
- Author
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Fereshtehnejad SM, Garcia-Ptacek S, Religa D, Holmer J, Buhlin K, Eriksdotter M, and Sandborgh-Englund G
- Subjects
- Aged, Aged, 80 and over, Dementia etiology, Dental Care statistics & numerical data, Female, Humans, Linear Models, Longitudinal Studies, Male, Mental Status Schedule, Neuropsychological Tests, Registries, Retrospective Studies, Sweden epidemiology, Dementia classification, Dementia epidemiology, Dental Care adverse effects
- Abstract
Introduction: Dementia may be associated with discontinuation of regular dental checkups, which in turn results in poorer oral health., Methods: We investigated the trend of change in dental care utilization and the number of teeth before and after being diagnosed with dementia. Longitudinal cognitive- and dental health-related information were merged using data on 58,037 newly diagnosed individuals from the Swedish Dementia Registry and Swedish Dental Health Register during 2007 to 2015., Results: Following dementia diagnosis, rate of dental care visits significantly declined. Individuals with mixed dementia, dementia with parkinsonism, and those with more severe and faster cognitive impairment had significantly higher rate of decline in dental care utilization. Vascular dementia and lower baseline Mini-Mental State Examination score were significant predictors of faster loss of teeth., Discussion: Dental care utilization markedly declines following dementia diagnosis. The reduction is more prominent in those with rapid progressive cognitive impairment and the ones with extra frailty burden., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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146. EEG Markers of Dementia with Lewy Bodies: A Multicenter Cohort Study.
- Author
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Bonanni L, Franciotti R, Nobili F, Kramberger MG, Taylor JP, Garcia-Ptacek S, Falasca NW, Famá F, Cromarty R, Onofrj M, and Aarsland D
- Subjects
- Aged, Aged, 80 and over, Alzheimer Disease diagnosis, Alzheimer Disease epidemiology, Alzheimer Disease physiopathology, Brain Waves physiology, Cohort Studies, Diagnosis, Differential, Europe epidemiology, Female, Humans, Internationality, Lewy Body Disease epidemiology, Male, Electroencephalography trends, Lewy Body Disease diagnosis, Lewy Body Disease physiopathology
- Abstract
Quantitative EEG (QEEG) has demonstrated good discriminative capacity for dementia with Lewy bodies (DLB) diagnosis as compared to Alzheimer's disease (AD) with a predictive value of 100% in a single cohort study. EEG in DLB was characterized by a dominant frequency (DF) in pre-alpha (5.5-7.5 Hz), theta, or delta bands and DF variability (DFV) >1.2 Hz, frequency prevalence (FP) pre-alpha in >40% and FP alpha in <32% of the epochs. To validate the aforementioned QEEG findings in independent cohorts of clinically diagnosed DLB versus AD patients, we analyzed EEG traces of 79 DLB and 133 AD patients (MMSE >20) collected from four European Centers. EEG traces from 19 scalp derivations were acquired as at least 10 min continuous signals and epoched in off-setting as series of 2-second-long epochs, subsequently processed by Fast Fourier Transform (frequency resolution 0.5 Hz). DLB patients showed EEG specific abnormalities in posterior derivations characterized by DF <8 Hz FP pre-alpha >50%, FP alpha <25%. DFV was >0.5 Hz. AD patients displayed stable alpha DF, DFV <0.5 Hz, FP pre-alpha <30%, and FP alpha >55%. DLB and AD differed for DF (p < 10-6), DFV (p < 0.05), FP pre-alpha (p < 10-12) and FP alpha (p < 10-12). Discriminant analysis detected specific cut-offs for every EEG mathematical descriptor; DF = 8, DFV = 2.2 Hz, FP pre-alpha=33%, FP alpha = 41% for posterior derivations. If at least one of the cut-off values was met, the percentage of DLB and AD patients correctly classified was 90% and 64%, respectively. The findings in this multicenter study support the validity of QEEG analysis as a tool for diagnosis in DLB patients.
- Published
- 2016
- Full Text
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147. Atypical PLA2G6 -Associated Neurodegeneration: Social Communication Impairment, Dystonia and Response to Deep Brain Stimulation.
- Author
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Cif L, Kurian MA, Gonzalez V, Garcia-Ptacek S, Roujeau T, Gelisse P, Moura de Ribeiro AM, Crespel A, MacPherson L, and Coubes P
- Published
- 2014
- Full Text
- View/download PDF
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