Gunilla Steen

Pain and its relation to cognitive function and depressive symptoms: a Swedish population study of 70-year-old men and women.

The aim of this study was to investigate the prevalence of pain and its characteristics, and to examine the association of pain with cognitive function and depressive symptoms, in a representative sample of 70-year-old men and women. Data were collected within the gerontological and geriatric population studies in Göteborg, Sweden (H-70). A sample of 124 men and 117 women living in the community took part in the study. A questionnaire was applied which included four different aspects of pain experience: prevalence, frequency of episodes of pain, duration and number of locations. In close connection to this, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The prevalence of pain during the last 14 days was higher in women (79%; n=91) than in men (53%; n=65) (P<0.001). Women (68%; n=78) also reported pain that had lasted for >6 months to a greater extent than men (38%; n=46) (P<0.001). The frequency of episodes of pain was also higher among women, 64% (n=74) reporting daily pain or pain several days during the last 14 days while 37% of the men (n=45) did so (P<0.001). Women (33%, n=38) also reported pain experience from >/=3 locations more often than men (11%; n=13) (P<0.001). On the other hand, the association between depressive symptoms and pain experience was more evident in men than in women. Women were taking significantly more antidepressants compared to men (P<0.03). The results show that pain is common in 70-year-old people and especially in women. However, associations between depressive symptoms and the four aspects of pain experience were more pronounced among men.

Cognitive function and functional ability. A cross- sectional and longitudinal study at ages 85 and 95 in a non-demented population

We studied the relationship between cognitive function and ability in daily life activities (ADL) at ages 85 (N=332) and 95 (N=63) cross- sectionally and longitudinally in representative populations of non- demented persons, in order to focus on manifestations related to healthy aging. Among the 85- year olds, 31% were independent, 42% were dependent on personal assistance in instrumental ADL (IADL) and 27% in personal ADL (PADL); the corresponding figures for the 95- year olds were 8, 40 and 52%, respectively. Regarding the relationship between cognitive function and ADL, the analysis could only be performed in the cross- sectional data. At age 85 a significant trend was found regarding nearly all cognitive tests for both men and women, indicating that subjects who were ADL- indepen- dent had better results than those dependent in IADL, and both IADL and PADL. At age 95, no such trend was found in males, but in females the trend was significant, and those dependent in ADL had poorer results in the separate cognitive tests. By combining the different cognitive tests into a compiled cognitive index, it was seen that the most ADL- dependent persons were more cognitively impaired both at ages 85 and 95, compared to persons who were ADL- independent. Not only cognitive functioning (OR 3.3), but also mobility (OR 4.9) and tiredness (OR 3.3) were independent predictors for ADL- dependence among the 85- year olds.

Adaptive behavior in stressful situations and stroke incidence in hypertensive men: results from prospective cohort study "men born in 1914" in Malmö, Sweden.

Background and Purpose— Although hypertension is a major risk factor for stroke, many hypertensive persons remain healthy. The aim of the present study was to analyze whether adaptation in a stressful situation was associated with the incidence of stroke in hypertensive men. Methods— Two hundred thirty-eight hypertensive men were followed from baseline in 1982/1983 until first stroke, death, or December 31, 1996. Adaptation to stress was studied with the serial Color-Word Test. In the Regression dimension, 4 patterns of adaptation could be distinguished according to mastering of the test. Successful mastering of the test was shown in stabilized patterns, increasing difficulty in cumulative patterns, fluctuating difficulty in dissociative patterns, and fluctuating difficulty that increased during testing in cumulative-dissociative patterns. The patterns were compared regarding stroke incidence. Results— Forty-three men experienced a stroke during follow-up. Stroke rates per 1000 person-years were 12.6 for men with stabilized patterns, 14.3 for men with cumulative patterns, 16.2 for men with dissociative patterns, and 31.2 for men with cumulative-dissociative patterns. Multivariate analysis, adjusted for relevant cerebrovascular risk factors, showed that the cumulative-dissociative pattern of the Regression dimension was associated with an increased risk of stroke during follow-up (relative risk 3.00, 95% CI 1.32 to 6.81). Conclusions— The specific behavior pattern, characterized by the greatest difficulties in managing the test, was associated with incidence of stroke in hypertensive men. One interpretation is that hypertensive men who chronically fail to find successful strategies in stressful situations are vulnerable to the damaging effects of stress and thereby at an increased risk of a future stroke.

A Comparison of Cognitive Ability in Normotensive and Hypertensive 68-Year-Old Men: Results from Population Study “Men Born in 1914,” in Malmö, Sweden

Abstract Hypertension and its consequences on cognition was analyzed using data from the study “Men born in 1914” in Malmö, Sweden, a prospective cohort study of cardiovascular disease. The baseline examinations took place in 1982/83 where 500 men participated in extensive medical and social examinations. A neuropsychological investigation was completed including five standardized cognitive tests. The specific purpose of the study was to investigate whether hypertension was associated with cognitive performance. By the use of multiple regression analyses, normal blood pressure and three stages of hypertension were analyzed in relation to test performance. Hypertension Stage 3 was associated with lower performance on tests measuring psychomotor speed and visuospatial memory, whereas hypertension Stage 1 was associated with higher performance on tests measuring verbal ability and constructional ability. The associations were unconfounded by clinical manifestations of atherosclerosis, history of stroke, depressive mood, and antihypertensive drug treatment.

Dental caries and related factors in 88- and 92-year-olds. Cross-sectional and longitudinal comparisons.

Our aim was to compare two groups of 88- and 92-year-olds (n = 92 and n = 40), respectively, with regard to teeth, caries, and salivary and microbial conditions. Oral variables were analyzed in relation to functional capacity and use of cardiovascular agents and psychoactive drugs. Untreated root caries, plaque score, and counts of lactobacilli increased between the ages of 88 and 92 years (P < 0.01). Nine of the 24 longitudinally followed up subjects had lost 1-5 teeth over 4 years, and 17 subjects had developed new caries (DFS). The mean caries increment over 4 years was 1.3 coronal and 3.6 root surfaces, and new DFS per 100 surfaces at risk was 4.3 coronal and 17.5 root surfaces. Plaque score and final pH of buffer capacity increased (P < 0.05 and 0.01, respectively), whereas saliva flow, independent of gender, was unchanged. Use of cardiovascular agents and psychoactive drugs was associated with a deteriorated dental status.

Cognitive function in 70-year-old men and women. A 16-year cohort difference population study

Cohort differences in cognitive functioning were studied in two 70-year-old samples born 16 years apart, 1906/07 and 1922, and living in Göteborg, Sweden. Psychometric tests measuring verbal ability, inductive reasoning, spatial ability, perceptual speed, secondary memory, and primary memory were used. All tests showed significantly better results in the latter 70-year-old cohort. Longer education and better living conditions in this cohort help to explain the results. Differences in somatic health could not explain the cognitive differences in this population. If biological age is defined as inversely related to the remainder of an individuals life span, the increasing life expectancy also means that the 70-year olds in 1992 are biologically younger than their 1976/77 counterparts.

The compression of morbidity debate in aging: an empirical test using the gerontological and geriatric population studies in Goteborg, Sweden (H70)

The H70 longitudinal study of aging, Göteborg, Sweden is used to empirically test the compression of morbidity theory advanced by. We reconceptualize compression as postponement of morbidity in the sense of decreasing amounts of illness for increasingly long life spans. Operationally, morbidity is defined as the average number of hospital days in the last year of life. The date of death and the date of 1-year prior to death define the risk period. The linear regression model with age at death, age at death squared, year of birth, and sex are statistically significant with the oldest having the fewest hospital days. The findings offer partial support for the compression of morbidity theory.

Adaptive Behavior in Stressful Situations in Relation to Postinfarction Mortality Results From Prospective Cohort Study "Men Born in 1914" in Malmö, Sweden

The serial Color Word Test, which is a semi-experimental way to differentiate adaptive behavior in stressful situations, was administered at baseline to men participating in the prospective cohort study ‘Men born in 1914’. During follow-up, from 1982-1983 until December 31, 1996, 133 men experienced a myocardial infarction. Four patterns of adaptive behavior in 2 separate dimensions, the Variability and the Regression, can be discerned during testing. These patterns were compared regarding outcome following the myocardial infarction. The Cumulative-dissociative pattern of the Regression dimension was univariately associated with mortality within 28 days (OR 5.75, CI 1.85-17.88, p = .003). Dissociative (OR 3.87, CI 1.21-12.42, p = .023) and Cumulative-dissociative (OR 5.46, CI 1.66-17.96, p= .005) patterns, of the same dimension, were independently associated with mortality within one year. Specific difficulties in adaptation to stressful situations were associated with increased risk of death following a myocardial infarction. In this male sample, these difficulties could be identified with the serial Color Word Test.

Adaptive Behavior in Stressful Situations and Stroke Incidence in Hypertensive Men

Background and Purpose— Although hypertension is a major risk factor for stroke, many hypertensive persons remain healthy. The aim of the present study was to analyze whether adaptation in a stressful situation was associated with the incidence of stroke in hypertensive men. Methods— Two hundred thirty-eight hypertensive men were followed from baseline in 1982/1983 until first stroke, death, or December 31, 1996. Adaptation to stress was studied with the serial Color-Word Test. In the Regression dimension, 4 patterns of adaptation could be distinguished according to mastering of the test. Successful mastering of the test was shown in stabilized patterns, increasing difficulty in cumulative patterns, fluctuating difficulty in dissociative patterns, and fluctuating difficulty that increased during testing in cumulative-dissociative patterns. The patterns were compared regarding stroke incidence. Results— Forty-three men experienced a stroke during follow-up. Stroke rates per 1000 person-years were 12.6 for men with stabilized patterns, 14.3 for men with cumulative patterns, 16.2 for men with dissociative patterns, and 31.2 for men with cumulative-dissociative patterns. Multivariate analysis, adjusted for relevant cerebrovascular risk factors, showed that the cumulative-dissociative pattern of the Regression dimension was associated with an increased risk of stroke during follow-up (relative risk 3.00, 95% CI 1.32 to 6.81). Conclusions— The specific behavior pattern, characterized by the greatest difficulties in managing the test, was associated with incidence of stroke in hypertensive men. One interpretation is that hypertensive men who chronically fail to find successful strategies in stressful situations are vulnerable to the damaging effects of stress and thereby at an increased risk of a future stroke.

Adaptive Behavior in Stressful Situations and Stroke Incidence in Hypertensive Men: Results From Prospective Cohort Study "Men Born in 1914" in Malmo, Sweden Editorial Comment: Results From Prospective Cohort Study "Men Born in 1914" in Malmo, Sweden

Background and Purpose— Although hypertension is a major risk factor for stroke, many hypertensive persons remain healthy. The aim of the present study was to analyze whether adaptation in a stressful situation was associated with the incidence of stroke in hypertensive men. Methods— Two hundred thirty-eight hypertensive men were followed from baseline in 1982/1983 until first stroke, death, or December 31, 1996. Adaptation to stress was studied with the serial Color-Word Test. In the Regression dimension, 4 patterns of adaptation could be distinguished according to mastering of the test. Successful mastering of the test was shown in stabilized patterns, increasing difficulty in cumulative patterns, fluctuating difficulty in dissociative patterns, and fluctuating difficulty that increased during testing in cumulative-dissociative patterns. The patterns were compared regarding stroke incidence. Results— Forty-three men experienced a stroke during follow-up. Stroke rates per 1000 person-years were 12.6 for men with stabilized patterns, 14.3 for men with cumulative patterns, 16.2 for men with dissociative patterns, and 31.2 for men with cumulative-dissociative patterns. Multivariate analysis, adjusted for relevant cerebrovascular risk factors, showed that the cumulative-dissociative pattern of the Regression dimension was associated with an increased risk of stroke during follow-up (relative risk 3.00, 95% CI 1.32 to 6.81). Conclusions— The specific behavior pattern, characterized by the greatest difficulties in managing the test, was associated with incidence of stroke in hypertensive men. One interpretation is that hypertensive men who chronically fail to find successful strategies in stressful situations are vulnerable to the damaging effects of stress and thereby at an increased risk of a future stroke.