Bertil Steen

High total cholesterol levels in late life associated with a reduced risk of dementia

Objective: To examine the longitudinal association between plasma total cholesterol and triglyceride levels and incident dementia. Methods: Neuropsychiatric, anthropometric, laboratory, and other assessments were conducted for 392 participants of a 1901 to 1902 birth cohort first examined at age 70. Follow-up examinations were at ages 75, 79, 81, 83, 85, and 88. Information on those lost to follow-up was collected from case records, hospital linkage system, and death certificates. Cox proportional hazards regression examined lipid levels at ages 70, 75, and 79 and incident dementia between ages 70 and 88. Results: Increasing cholesterol levels (per mmol/L) at ages 70 (hazard ratio [HR] 0.77, 95% CI: 0.61 to 0.96, p = 0.02), 75 (HR 0.70, CI: 0.52 to 0.93, p = 0.01), and 79 (HR 0.73, CI: 0.55 to 0.98, p = 0.04) were associated with a reduced risk of dementia between ages 79 and 88. Examination of cholesterol levels in quartiles showed that the risk reduction was apparent only among the highest quartile at ages 70 (8.03 to 11.44 mmol/L [311 to 442 mg/dL]; HR 0.31, CI: 0.11 to 0.85, p = 0.03), 75 (7.03 to 9.29 mmol/L [272 to 359 mg/dL]; HR 0.20, CI: 0.05 to 0.75, p = 0.02), and 79 (6.82 to 9.10 mmol/L [264 to 352 mg/dL]; HR 0.45, CI: 0.17 to 1.23, p = 0.12). Triglyceride levels were not associated with dementia. Conclusions: High cholesterol in late life was associated with decreased dementia risk, which is in contrast to previous studies suggesting high cholesterol in mid-life is a risk factor for later dementia. The conflicting results may be explained by the timing of the cholesterol measurements in relationship to age and the clinical onset of dementia.

The Swedish SF-36 Health Survey II. Evaluation of Clinical Validity: Results from Population Studies of Elderly and Women in Gothenborg

The validity of the Swedish SF-36 Health Survey was examined, replicating techniques used in the U.S. validation. Principal components analysis was used to test the internal structure of the eight SF-36 scales in relation to hypothesized associations with the two major dimensions of health--physical and mental. Hypothesized relationships between scales and external criteria were also examined by means of clinical group contrasts. Both the principal components analysis and clinical group contrasts largely replicated U.S. findings, which supported the cross-cultural stability of the SF-36 in Sweden. As expected, the Physical Functioning and Mental Health scales were most sensitive to clinical manifestations of medical and mental health, respectively. The General Health scale was associated more with physical than mental health. However, the Social Functioning scale and particularly the Vitality scale were more related to mental health in Sweden than in the corresponding U.S. study. Cultural differences and variation in study samples and selection criteria were suggested as possible explanatory factors for these differences.

Mental disorders and the use of psychotropic drugs in an 85-year-old urban population.

The prevalence of mental disorders was studied in a representative sample of 85-year-olds living in Gothenburg, Sweden, (n = 494). All subjects were examined by a psychiatrist, whose diagnoses were defined according to the DSM-III-R criteria. In the sample, the prevalence of dementia was 29.8%, and of any other mental disorder was 24.3%. Psychotic disorders were present in 4.7%, depressive disorders in 12.6%, and anxiety disorders in 10.5%. Anxiety disorders were more common in women than in men. Of all subjects, 42.5% used a psychotropic drug (men 30.1%, women 47.6%, p < 0.001), 34.2% used anxiolytic-sedatives, 14.0% used antidepressants, and 5.7% used neuroleptics. Women used significantly more anxiolytic-sedatives and antidepressants than did men. Of those with no mental disorders, 29.1% used a psychotropic drug. Although the prescription of psychotropic drugs was high, only one fifth of those with depressive disorders received antidepressant drug therapy and one tenth of those with psychotic disorders received neuroleptics.

Cognitive impairment and dementia 20 months after stroke

Background and Purpose: Dementia is common after stroke, but the dementia syndrome does not cover the whole spectrum of cognitive impairment. Our aim was to quantify and compare dementia and cognitive impairments in elderly patients 1.5 years after stroke and a matched normal population. Subjects and Methods: We examined dementia and cognitive impairments in 149 out of an initial total of 243 acute stroke patients after a mean 20 months. Inclusion criteria were age ≧70 years, not living in an institution and no previous cerebral lesion. The patients’ mean age was 81 years. Five controls matched by age and gender and fulfilling the same exclusion criteria were selected for each patient (n = 745) from a population-based survey in the same area. Dementia was diagnosed according to the DSM-III-R criteria, and impairments in different dimensions of cognitive function were assessed. Results: The prevalence of dementia was 28% in the stroke patients and 7.4% in the controls (OR 4.7; 95% CI 3.0–7.5). Seventy-two percent of the patients had cognitive impairments compared to 36% in the controls. Cognitive impairments were more common in nondemented stroke patients than in nondemented controls: 61 vs. 31% (OR 3.5; 95% CI 2.3–5.3). The risk increase attributable to stroke was highest for patients below 80 years of age. Conclusions: Stroke confers an increased risk of dementia and cognitive impairments in the elderly, especially in the younger ones. Apraxia is the most frequent neuropsychiatric impairment after stroke. The concept of dementia does not describe cognitive impairments well, since it underestimates their extent not only after stroke but also in normal ageing.

Postural balance and self-reported functional ability in 75-year-old men and women: a cross-national comparative study

OBJECTIVE: To study postural balance in relation to selfreported functional ability (mobility and ADL) and general physical activity in elderly men and women living in three different Nordic environments.

Body mass index and white matter lesions in elderly women. An 18-year longitudinal study.

BACKGROUND We investigated the longitudinal relationship between body mass index (BMI), a major vascular risk factor, and white matter lesions (WMLs) in older women. METHODS Twenty-seven Swedish women were followed from age 70 to 88. Measurements of BMI, and systolic and diastolic blood pressures were conducted at 70, 75, 79, 85, and 88 years. WMLs were measured using computerized tomography at age 85 and 88 (85/88). RESULTS Women with any WMLs at age 85/88 had higher BMI at age 70 (p = 0.003) and 75 (p = 0.006), compared to women without WMLs. Increasing severity of WMLs was related to BMI at age 70 (p < 0.001), 75 (p < 0.001), 79 (p = 0.017), and 85 (p = 0.025). After consideration of other vascular factors, BMI at age 70, 75, and 79 was most significantly related to WML at 85/88. Every 1.0 kg/m2 increase in BMI at age 70 increased risk of WMLs twofold. CONCLUSIONS Overweight and obesity may be important contributors to the presence of WMLs in the elderly.

Performance of the SF-36 Health Survey in screening for depressive and anxiety disorders in an elderly female Swedish population

Objective: To assess the sensitivity, specificity and predictive validity of suggested cut-off scores in the SF-36 mental health (MH) and mental component summary (MCS) in screening for depressive and anxiety disorders in a population sample of older Swedish women. Method: The sample comprised 586 randomly selected females aged 70–84 years who took part in an in-depth psychiatric examination. This provided the ‘gold standard’ against which the usefulness of SF-36 recommended thresholds for screening for depressive and anxiety disorders in older Swedish women was examined. Results: Based on DSM-III-R criteria, 69 women (12) were diagnosed with depression (major depression, dysthymia and/or depression NOS) and 49 (8) with generalised anxiety and panic disorders. The previously recommended MH and MCS cut-offs (i.e. 52 and 42) gave a specificity for diagnosis of depression of 92 and 82 and sensitivity of 58 and 71, respectively. Both the MH and MCS were good predictors of depressive disorders but poor predictors of anxiety disorders. Conclusion: The study supports the predictive validity of suggested SF-36 MH and MCS cut-off scores in screening for depressive disorder but not for anxiety disorder in older women in Sweden.

Skin Wrinkling: Can Food Make a Difference?

Objectives: This study addressed whether food and nutrient intakes were correlated with skin wrinkling in a sun-exposed site. Methods: 177 Greek-born subjects living in Melbourne (GRM), 69 Greek subjects living in rural Greece (GRG), 48 Anglo-Celtic Australian (ACA) elderly living in Melbourne and 159 Swedish subjects living in Sweden (SWE) participating in the International Union of Nutritional Sciences IUNS [Food Habits in Later Lifersqb; study had their dietary intakes measured and their skin assessed. Food and nutrient intakes were assessed using a validated semi-quantitative food frequency questionnaire (FFQ). Skin wrinkling was measured using a cutaneous microtopographic method. Results: SWE elderly had the least skin wrinkling in a sun-exposed site, followed by GRM, GRG and ACA. Correlation analyses on the pooled data and using the major food groups suggested that there may be less actinic skin damage with a higher intake of vegetables (rs=−0.31, p<0.0001), olive oil (rs=−0.29, p<0.0001), fish (rs=−0.24, p<0.0001) and legumes (rs=−0.16, p<0.0001), and lower intakes of butter (rs=0.46, p<0.0001) and margarine (rs=0.24, p<0.001), milk products (rs=0.16, p<0.01) and sugar products (rs=0.12, p<0.01). Similar findings were obtained using regression analyses, except fish was no longer significant; 32% of the variance for actinic skin damage was predicted by six out of the ten major food groups. In particular, a high intake of vegetables, legumes and olive oil appeared to be protective against cutaneous actinic damage (collectively explaining 20% of the variance); a high intake of meat, dairy and butter appeared to be adverse (explaining <5% of the variance). Prunes, apples and tea explained 34% of variance amongst ACA. Conclusion: This study illustrates that skin wrinkling in a sun-exposed site in older people of various ethnic backgrounds may be influenced by the types of foods consumed.

Utilization of dental services in relation to socioeconomic and health factors in the middle-aged and elderly Swedish population

The aims of this study were to describe the change in reported time since the latest visit to a dentist between the years 1980/81 and 1988/89 and the reported use of dental services in relation to age, dental state, and socioeconomic and health characteristics in a sample of the Swedish population in 1988/89. The studies are based on interviews by Statistics Sweden about the living conditions. In the investigations in 1980/81, 14,964 inhabitants between 16 and 84 years of age participated, and in 1988/89, 13,309 inhabitants. In all age groups there was a significantly higher frequency of reported visits to a dentist last year in 1988/89 than in 1980/81. In the age group 50-64 years old this figure increased from 54% to 75%, and in the age group 65-84 years old it increased from 26% to 39%. In the investigation in 1988/89 about 75% of the dentulous women in all age groups up to 75 years reported visiting a dentist last year. The relative risk for not visiting a dentist last year, adjusted for age, gender, and dental state, was higher in dentulous subjects with low income and education, not married, not native-born, living in rural areas, smoking, and low social and physical activity. The results of the logistic regression analysis showed that, among the elderly, functional ability and general health factors have lower significance for time since last visit to a dentist than socioeconomic, social support, and life-style factors.

Waist circumference, body mass index, and risk for stroke in older people: a 15 year longitudinal population study of 70- year-olds.

OBJECTIVES: To investigate waist circumference (WC) and body mass index (BMI) at age 70 as risk factors for stroke.