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Voikukka on yleinen rikkakasvi säilörehunurmipelloilla ja etenkin vanhoilla nurmilla (Kajan ja Nousiainen 2006). Syväjuurinen voikukka levittäytyy nopeasti nurmen aukkopaikkoihin vieden valoa, vettä ja ravinteita nurmikasveilta. Karjatilan kannattava peltoviljely-hanke järjesti kesällä 2010 MTT Maaningalla timotei-voikukka-minisiilokokeen. Minisiilokokeen tavoitteena oli selvittää, kuinka eri voikukkapitoisuudet (0, 25, 50, 75 ja 100 % tuorepainosta) vaikuttavat timoteisäilörehun säilönnälliseen laatuun, kemialliseen koostumukseen ja rehuarvoihin ensimmäisessä sadossa. Timotein ja voikukan raaka-ainenäytteet sekä siilojen säilörehut analysoitiin 90 päivän säilönnän jälkeen. Minisiilokokeen tuloksia verrattiin muihin ulkomaalaisiin voikukasta tehtyihin tutkimustuloksiin ja kirjallisuuteen sekä lypsylehmien hyvän nurmisäilörehun laatu- ja ruokintasuosituksiin. Samaan aikaan korjatun voikukan ja timotein D-arvot olivat varsin samanlaisia (erotus 27 g/kg ka). Voikukkapitoisen säilörehun NDF-pitoisuus oli huomattavasti timotei-säilörehua alhaisempi (310 vs. 557 g/kg ka). Voikukkaa sisältävässä säilörehussa etenkin kaliumin, magnesiumin ja kalsiumin määrät lisääntyivät. Kuitenkin ekvivalenttisuhteena laskettuna voikukan sisältämän kaliumin suhde kalsiumin ja magnesiumin yhteismäärään oli pienempi kuin timotein. Tässä kokeessa kaikkien koesiilojen pH laski alle 4. Voikukka ei vaikuttanut säilönnän aikana haihtuvien rasvahappojen eikä sokereiden määrään. Liukoisen typen osuus kokonaistypestä pieneni, kun voikukan määrä lisääntyi säilörehussa. Kaikissa koesiiloissa liukoisen typen määrät ylittivät hyvän säilörehun suositusarvon. Voikukan määrän muuttuessa ainoastaan ammoniumtypen osuus kokonaistypen määrästä ei muuttunut systemaattisesti. Tämän kokeen ja kirjallisuuden perusteella voidaan olettaa, että voikukkapitoisesta nurmesta voidaan saada säilöntälaadultaan laadukasta rehua, ja ettei voikukan nurmea korkeampi puskurikapasiteetti ole ongelma etenkään, jos säilönnän onnistumisen muut edellytykset ovat kunnossa. Voikukan pienempi kuiva-ainepitoisuus verrattuna timoteihin voi lisätä säilörehun puristenestemäärää. Pelkän timoteisäilörehun kuiva-ainepitoisuus oli 329 g/kg ja puhtaan voikukkasäilörehun 156 g/kg, kun niiden esikuivatusaika oli sama. Jos voikukkapitoisen säilörehun esikuivatusaikaa ei lisätä, kuiva-ainepitoisuus jää matalaksi ja puristenesteen määrä lisääntyy. Tässä artikkelissa ei oteta kantaa vaikutuksiin, joita voikukalla voi olla nurmen satotasoon.

Delirium is the most common neuropsychiatric syndrome in elderly ill patients. Previously, associations between delirium and the dopamine transporter gene (solute carrier family 6, member 3 (SLC6A3)) and dopamine receptor 2 gene (DRD2) were found. The aim of this study was to validate whether markers of the SLC6A3 and DRD2 genes are were associated with delirium in independent populations. Six European populations collected DNA of older delirious patients. Associations were determined per population and results were combined in a meta-analysis. In total 820 medical inpatients, 185 cardiac surgery patients, 134 non-cardiac surgery patients and 502 population-based elderly subjects were included. Mean age was 82 years (SD 7.5 years), 598 (36%) were male, 665 (41%) had preexisting cognitive impairment, and 558 (34%) experienced delirium. The SLC6A3 rs393795 homozygous AA genotype was more frequent in patients without delirium in all populations. The meta-analysis showed an Odds Ratio (OR) for delirium of 0.4 (95% confidence interval (C.I.) 0.2-0.6, P= 0.0003) for subjects with AA genotype compared to the AG and GG genotypes. SLC6A3 marker rs1042098 showed no association with delirium. In meta-analysis the DRD2 rs6276 homozygous GG genotype showed an OR of 0.8 for delirium (95% C.I. 0.6-1.1, P=0.24). When subjects were stratified for cognitive status the rs6276 GG genotype showed ORs of 0.6 (95% C.I. 0.4-1.0, P=0.06) and 0.8 (95% C.I. 0.5-1.5, P=0.51) for delirium in patients with and without cognitive impairment, respectively. In independent cohorts, a variation in the SLC6A3 gene and possibly the DRD2 gene were found to protect for delirium. (C) 2009 Wiley-Liss, Inc.

BACKGROUND: Delirium is a profound neuropsychiatric disturbance precipitated by acute illness. Although dementia is the major risk factor this has typically been considered a binary quantity (i.e., cognitively impaired versus cognitively normal) with respect to delirium risk. We used humans and mice to address the hypothesis that the severity of underlying neurodegenerative changes and/or cognitive impairment progressively alters delirium risk.METHODS: Humans in a population-based longitudinal study, Vantaa 85+, were followed for incident delirium. Odds for reporting delirium at follow-up (outcome) were modeled using random-effects logistic regression, where prior cognitive impairment measured by Mini-Mental State Exam (MMSE) (exposure) was considered. To address whether underlying neurodegenerative pathology increased susceptibility to acute cognitive change, mice at three stages of neurodegenerative disease progression (ME7 model of neurodegeneration: controls, 12 weeks, and 16 weeks) were assessed for acute cognitive dysfunction upon systemic inflammation induced by bacterial lipopolysaccharide (LPS; 100 μg/kg). Synaptic and axonal correlates of susceptibility to acute dysfunction were assessed using immunohistochemistry.RESULTS: In the Vantaa cohort, 465 persons (88.4 ± 2.8 years) completed MMSE at baseline. For every MMSE point lost, risk of incident delirium increased by 5% (p = 0.02). LPS precipitated severe and fluctuating cognitive deficits in 16-week ME7 mice but lower incidence or no deficits in 12-week ME7 and controls, respectively. This was associated with progressive thalamic synaptic loss and axonal pathology.CONCLUSIONS: A human population-based cohort with graded severity of existing cognitive impairment and a mouse model with progressing neurodegeneration both indicate that the risk of delirium increases with greater severity of pre-existing cognitive impairment and neuropathology.

The present study aimed to examine the use of psychotropics and its relation to survival in demented elderly persons. A random sample of 700 individuals, aged 75 years or older, was drawn from the population of Kuopio city in January 1998. A geriatrician and a nurse carried out clinical examinations of 601 individuals, of whom 137 suffered from dementia according to DSM-IV criteria. The lifespan was calculated from the date of examination in 1998 to the end of 2003. In survival analyses, subjects were divided according to psychotropic use into groups: (i) users of only one of kind of psychotropics and (ii) concomitant users of all kinds of psychotropics. Psychotropics were classified into antipsychotics, antidepressants and a group of anxiolytics and hypnotics/sedatives. Seventy-one percent (n = 97) of demented elderly individuals used a psychotropic drug. Age- and sex-adjusted survival did not differ by severity of dementia (P = 0.076) or by the diagnosis of dementia (P = 0.54). When survival was compared with nonusers of psychotropics, the hazard ratio was 2.75 (P = 0.002) for individuals who used antipsychotics as their only psychotropic medicine and 1.76 (95% confidence interval 1.09-2.86) for concomitant users of all kinds of psychotropics. The use of several psychotropics or antipsychotics is a risk factor for death in demented elderly persons.

The elderly use more psychotropic medication than the general population, and its use has grown during recent decades. The aim of this study was to describe the use of psychotropics in the home-dwelling elderly aged 75 years or older in Finland. This Kuopio 75+ Study is a population-based health survey. A random sample of 700 subjects were drawn from the total population of people aged 75 years or more in January 1998. A geriatrician and a trained nurse carried out clinical examination and interview about the use of medicines for 523 home-dwelling elderly. At least one psychotropic medication was used by 37% of the sample, and 12% were using two or more psychotropics concomitantly. The psychotropic users were older, more often widowed and living alone compared to subjects without psychotropic medication. The probability of psychotropic use increased linearly with age for anxiolytics/hypnotics or antipsychotics, but not for antidepressants. Psychotropics are commonly used in the elderly, particularly among those aged 85 years or more, who are most vulnerable to adverse effects. Careful consideration is needed before prescribing psychotropics to the elderly.

The elderly use more psychotropic medication than the general population, and its use has grown during recent decades. The aim of this study was to describe the use of psychotropics in the home-dwelling elderly aged 75 years or older in Finland. This Kuopio 75 + Study is a population-based health survey. A random sample of 700 subjects were drawn from the total population of people aged 75 years or more in January 1998. A geriatrician and a trained nurse carried out clinical examination and interview about the use of medicines for 523 home-dwelling elderly. At least one psychotropic medication was used by 37% of the sample, and 12% were using two or more psychotropics concomitantly. The psychotropic users were older, more often widowed and living alone compared to subjects without psychotropic medication. The probability of psychotropic use increased linearly with age for anxiolytics/ hypnotics or antipsychotics, but not for antidepressants. Psychotropics are commonly used in the elderly, particularly among those aged 85 years or more, who are most vulnerable to adverse effects. Careful consideration is needed before prescribing psychotropics to the elderly.

Objective To describe the use of psychotropics in the nondemented and demented elderly. Participants The home-dwelling elderly (n=523) among the random sample of 700 subjects from the total population of individuals aged 75 years or more in 1998 and living in the city of Kuopio, Finland. Methods A trained nurse interviewed the participants about their health and current use of medicines. A geriatrician performed clinical examinations and diagnosed diseases. Dementia and depression were diagnosed according to the DSM-IV criteria. Results The demented subjects used more medicines of all kinds (p

Many studies indicate that the cessation of caregiving of demented patients has positive effects on caregivers' lives but contradictory findings have also been reported. The aim of this study was to investigate how the caregivers of demented patients experienced the cessation of caregiving, how caregivers' lives changed after this event, and which factors predicted emotional reactions and life changes. Data were collected from 64 caregivers of demented patients, recruited from a previous controlled intervention study. The semi-structured telephone interviews sought (1) sociodemographic data, (2) emotional reactions the caregivers recalled from the point of cessation of caregiving, and (3) life changes experienced after that time point. At the point of cessation of caregiving, spouse caregivers had higher risk for loneliness, depressive feelings and sorrow than non-spouse caregivers. Feelings of relief were associated with non-spouses. Community care support obtained during the previous intervention study had protected the caregivers from loneliness, depressive feelings and sorrow. After the end of caregiving, spouse caregivers tended to experience more negative life changes. The increased number of leisure activities was associated with the support during community care.

Background The oldest old are prone to develop delirium. Studies into risk factors for delirium have been carried out predominantly in younger age groups. The aim of this population-based follow-up study was to investigate the risk factors for delirium requiring medical attention and subsequent prognosis in the non-demented general population aged ≥ 85 years. Method The study included the non-demented subjects in the population-based Vantaa 85+ study. After the 3-year observation period, 199 subjects (91% of those surviving) were re-examined and their medical records were evaluated for episodes of delirium. The subjects were followed up with respect to mortality for another 2 years. Results During the 3-year observational period, 20 subjects (10%) had been diagnosed as having had an episode of delirium. A Mini-Mental State Examination score of

Recent studies suggest that delirium is associated with risk of dementia and also acceleration of decline in existing dementia. However, previous studies may have been confounded by incomplete ascertainment of cognitive status at baseline. Herein, we used a true population sample to determine if delirium is a risk factor for incident dementia and cognitive decline. We also examined the effect of delirium at the pathological level by determining associations between dementia and neuropathological markers of dementia in patients with and without a history of delirium. The Vantaa 85+ study examined 553 individuals (92% of those eligible) aged ≥85 years at baseline, 3, 5, 8 and 10 years. Brain autopsy was performed in 52%. Fixed and random-effects regression models were used to assess associations between (i) delirium and incident dementia and (ii) decline in Mini-Mental State Examination scores in the whole group. The relationship between dementia and common neuropathological markers (Alzheimer-type, infarcts and Lewy-body) was modelled, stratified by history of delirium. Delirium increased the risk of incident dementia (odds ratio 8.7, 95% confidence interval 2.1–35). Delirium was also associated with worsening dementia severity (odds ratio 3.1, 95% confidence interval 1.5–6.3) as well as deterioration in global function score (odds ratio 2.8, 95% confidence interval 1.4–5.5). In the whole study population, delirium was associated with loss of 1.0 more Mini-Mental State Examination points per year (95% confidence interval 0.11–1.89) than those with no history of delirium. In individuals with dementia and no history of delirium (n = 232), all pathologies were significantly associated with dementia. However, in individuals with delirium and dementia (n = 58), no relationship between dementia and these markers was found. For example, higher Braak stage was associated with dementia when no history of delirium (odds ratio 2.0, 95% confidence interval 1.1–3.5, P = 0.02), but in those with a history of delirium, there was no significant relationship (odds ratio 1.2, 95% confidence interval 0.2–6.7, P = 0.85). This trend for odds ratios to be closer to unity in the delirium and dementia group was observed for neuritic amyloid, apolipoprotein ε status, presence of infarcts, α-synucleinopathy and neuronal loss in substantia nigra. These findings are the first to demonstrate in a true population study that delirium is a strong risk factor for incident dementia and cognitive decline in the oldest-old. However, in this study, the relationship did not appear to be mediated by classical neuropathologies associated with dementia. Refereed/Peer-reviewed

The treatment of a memory disorder patient is multiprofessional teamwork requiring professional personnel specialized in memory disorders. The memory disorder clinic plays a central role especially at the diagnostic stage. Treatment should be carried out as local services and according to the needs of the patients. A memory coordinator is a central person in the monitoring and supporting of a memory patient and his/her close relatives within outpatient care. In long-term therapy, know-how in rehabilitation and palliative treatment are essential. Development of the treatment and service chain requires capable management, systematic planning, regular updating of guidelines and contracts as well as financial input.

Objective: To estimate the prevalence of dementia with Lewy bodies (DLB) according to the consensus criteria in a general population aged 75 years or older. Methods: The “Kuopio 75+ study” is a population based health survey focused on the clinical epidemiology of dementia and functional capacity among elderly subjects aged 75 years or older. On 1 January 1998, a random sample of 700 subjects was drawn from a total population born before 1 January 1923, living in the city of Kuopio, northeast Finland (n = 4518). The study subjects underwent a structured interview and clinical examination. Results: 601 elderly subjects (86% of the random sample) were examined. A dementia disorder was diagnosed in 137—a prevalence of 22.8% (95% confidence interval 19.4% to 26.2%). The prevalence of DLB was 5.0% (3.2% to 6.7%), comprising 22% of all demented subjects. Probable DLB was diagnosed in 20 subjects (3.3% (1.9% to 4.8%)), and possible DLB in 10 (1.7% (0.6% to 2.7%)). The prevalence of Alzheimer’s disease was 10.6% (47% of all demented subjects), of vascular dementia, 5.3% (23%), and of other types of dementing disorders, 1.8% (8%). Conclusions: In a general population aged 75 years and older, the prevalence of a disorder fulfilling the diagnostic criteria of DLB is half that of Alzheimer’s disease and the same as for vascular dementia.

Objectives: To investigate what kind of changes spouse caregivers of demented patients experience after the onset of dementia (a) in the general atmosphere, happiness, and relations of marriage and (b) in the sexual side of marriage. Design: Semistructured telephone interviews of spouse caregivers of demented patients. Setting: Community-living demented patients and their spouse caregivers in eastern Finland. Participants: The spouse caregivers of 42 demented patients recruited from a previous intervention study. Measures: The questionnaire covered different areas of marriage from the time before and after the onset of dementia. Results: A statistically significant decline had occured in extent of happiness (p = .012), in equal relations (p = .001), and in patients' expressions of sexual needs (p < .001) when compared the time before and after dementia. Twenty-five (60%) of the caregivers reported that the demented patient had shown at least one negative sexual behavioral change during the course of dementia. Seven male patients (24%) had shown the behavioral symptom of constantly expressing need for making love. One in 10 caregivers had experienced positive sexual behavioral changes. In one third of the patients, the expressions of tenderness towards the caregiver had increased. Dementia did not affect significantly the general atmosphere of the marriage. Out of those still in home care, at 3 years from the onset of dementia, 19 couples (46%) continued to practice intercourse, at 5 years the number was 15 couples (41%), and at 7 years it had declined to 7 couples (28%). Conclusions: Dementing illness has a major negative impact on many dimensions of marriage. However, there are also positive changes and preserved aspects of marriage. Dementia seems to have a surprisingly little impact on whether the couple continues to have intercourse when compared with the general aging population.

Background: The etiologic factors of delirium have been frequently studied in hospitalized elderly patients who usually have an underlying disorder, i.e., hip fracture or dementia predisposing to delirium. The etiologic factors of delirium and prognosis in healthy elderly remain unstudied. The aim of our study was to detect the primary and additional etiologic factors contributing to delirium among community-dwelling healthy elderly people without predisposing disorders to delirium and to evaluate 1-year prognosis after discharge to home. Method: The study subjects consisted of 51 community-dwelling people over 65 years of age, without severe underlying disorders predisposing to delirium, admitted consecutively to the hospital because of a delirious state. The diagnosis of delirium was based on the DSM-III-R criteria. After discharge to home, the subjects were followed up for 1 year. Results: The most important primary causes of delirium were infections in 22 cases (43%) and cerebrovascular attacks in 13 cases (25%). After the 1-year follow-up period, 10 patients (20%) had been taken into long-term care and 5 patients (10%) had died. Discussion: The plausible etiologic factor of delirium was detected in all cases. Among healthy elderly people, infections and cerebrovascular attacks were the most important etiologic factors for delirium. After discharge to home, 30% of the patients had to be taken into long-term care or had died within 1 year of the delirium.

Cognitive decline is commonly stated as one of the main risk factors for delirium. The aim was to assess the importance of a delirium episode as a symptom of an underlying dementia among community dwelling healthy elderly people in a prospective 2 year follow up study. The study patients consisted of 51 people living at home and older than 65 years of age, without severe underlying disorders including diagnosed dementia, admitted consecutively as emergency cases to hospital because of an acute delirious state and followed up for 2 years. The diagnosis of delirium and dementia were based on the DSM-III-R criteria. The community dwelling patients were evaluated and tested annually by a clinical investigator, a geriatric study nurse, and a neuropsychologist. The medical records of the institutionalised patients were also evaluated. Dementia was diagnosed immediately after the assurance that delirium symptoms had subsided in 14 out of 51 subjects (27%) and the additional 14 subjects were diagnosed as being demented during the 2 year follow up, 28 out of 51 patients (55%) altogether. Alzheimer's disease or mixed dementia was diagnosed in 14 out of 51 patients (27%), vascular dementia in 10 (20%), and dementia with Lewy bodies in two (4%). One case of alcoholic dementia and one case of a non-alcoholic hepatic encephalopathia were also found. A delirium episode is often the first sign of dementia requiring attention from medical and social professionals.