Plasma free choline, betaine and cognitive performance: the Hordaland Health Study.

Choline and betaine are nutrients involved in one-carbon metabolism. Choline is essential for neurodevelopment and brain function. We studied the associations between cognitive function and plasma concentrations of free choline and betaine. In a cross-sectional study, 2195 subjects (55 % women), aged 70-74 years, underwent extensive cognitive testing including the Kendrick Object Learning Test (KOLT), Trail Making Test (part A, TMT-A), modified versions of the Digit Symbol Test (m-DST), Block Design (m-BD), Mini-Mental State Examination (m-MMSE) and Controlled Oral Word Association Test (COWAT). Compared with low concentrations, high choline (>8·4 µmol/l) was associated with better test scores in the TMT-A (56·0 v. 61·5, P=0·004), m-DST (10·5 v. 9·8, P=0·005) and m-MMSE (11·5 v. 11·4, P=0·01). A generalised additive regression model showed a positive dose-response relationship between the m-MMSE and choline (P=0·012 from a corresponding linear regression model). Betaine was associated with the KOLT, TMT-A and COWAT, but after adjustments for potential confounders, the associations lost significance. Risk ratios (RR) for poor test performance roughly tripled when low choline was combined with either low plasma vitamin B12 (≤257 pmol/l) concentrations (RR(KOLT)=2·6, 95 % CI 1·1, 6·1; RR(m-MMSE)=2·7, 95 % CI 1·1, 6·6; RR(COWAT)=3·1, 95 % CI 1·4, 7·2) or high methylmalonic acid (MMA) (≥3·95 µmol/l) concentrations (RR(m-BD)=2·8, 95 % CI 1·3, 6·1). Low betaine (≤31·1 µmol/l) combined with high MMA was associated with elevated RR on KOLT (RR(KOLT)=2·5, 95 % CI 1·0, 6·2). Low plasma free choline concentrations are associated with poor cognitive performance. There were significant interactions between low choline or betaine and low vitamin B12 or high MMA on cognitive performance.

Cognitive function in an elderly population: interaction between vitamin B12 status, depression, and apolipoprotein E ε4: the Hordaland Homocysteine Study.

OBJECTIVE: To investigate the cross-sectional relation between metabolic markers of vitamin B(12) status and cognitive performance, and possible effect modification by the presence of depression and apolipoprotein E (ApoE) ε4. METHODS: This is a population-based study of 1935 participants, aged 71 to 74 years, from Norway. Participants were administered a cognitive test battery, and vitamin B(12) status was assessed by measurements of plasma vitamin B(12), holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine. RESULTS: The geometric mean (95% confidence interval) for vitamin B(12) was 348 pM (341-354), whereas 5.9% of participants had vitamin B(12) levels lower than 200 pM. In linear regression analyses, holoTC (p = .039) and the holoTC/vitamin B(12) ratio (p = .013) were positively related, whereas MMA (p = .010) was inversely related, to global cognition, after adjustment for sex, education, ApoE status, plasma creatinine, and history of diabetes, cardiovascular disease, hypertension, and depression. Among those positive for ApoE ε4, but not among those without the ε4 allele, plasma vitamin B(12) was positively associated with global cognition (p = .015), whereas MMA was inversely related to global cognition (p = .036) and executive function (p = .014). In participants with depression, MMA was inversely associated with global cognition (p < .001) and episodic memory (p = .001). CONCLUSIONS: Among the well-nourished elderly, low vitamin B(12) status is associated with cognitive deficit, particularly in those with the ApoE ε4 allele or with depression.

Association between self-reported care needs and the allocation of care in Norwegian home nursing care recipients.

OBJECTIVES: This study investigated the relationship between patients' self-reported illness, daily afflictions, and the frequency of home nursing care, and whether patients' coping resources influenced the allocation of care. DESIGN, SAMPLE AND MEASUREMENTS: A cross-sectional survey was adopted. Two hundred and forty-two people aged 75 years and above receiving home nursing care participated in the study. Binary logistic regression model was used to test the effects of the independent variables on home nursing care. RESULTS: Poor capacity to perform activities of daily living and high level of education were directly associated with a high frequency of home nursing care. Lack of perceived social support affected the amount of home nursing care allocated only when feelings of loneliness were connected with poor activities of daily living functioning. Interaction effects revealed that perceived social support influenced the amount of home nursing care in persons with higher education, in persons with low education, no such association were found. No associations were found between coping resources and home nursing care. CONCLUSIONS: Impaired capacity to perform activities of daily living was the main reason for care allocation. Education was associated with more formal care. Patients with low perceived social support combined with a low education level was a particularly vulnerable group.

A novel blood test for the early detection of Alzheimer's disease.

Despite a variety of testing approaches, it is often difficult to make an accurate diagnosis of Alzheimer's disease (AD), especially at an early stage of the disease. Diagnosis is based on clinical criteria as well as exclusion of other causes of dementia but a definitive diagnosis can only be made at autopsy. We have investigated the diagnostic value of a 96-gene expression array for detection of early AD. Gene expression analysis was performed on blood RNA from a cohort of 203 probable AD and 209 cognitively healthy age matched controls. A disease classification algorithm was developed on samples from 208 individuals (AD = 103; controls = 105) and was validated in two steps using an independent initial test set (n = 74; AD = 32; controls = 42) and another second test set (n = 130; AD = 68; controls = 62). In the initial analysis, diagnostic accuracy was 71.6 ± 10.3%, with sensitivity 71.9 ± 15.6% and specificity 71.4 ± 13.7%. Essentially the same level of agreement was achieved in the two independent test sets. High agreement (24/30; 80%) between algorithm prediction and subjects with available cerebrospinal fluid biomarker was found. Assuming a clinical accuracy of 80%, calculations indicate that the agreement with underlying true pathology is in the range 85%-90%. These findings suggest that the gene expression blood test can aid in the diagnosis of mild to moderate AD, but further studies are needed to confirm these findings.

Cognitive performance among the elderly in relation to the intake of plant foods. The Hordaland Health Study.

Fruits and vegetables are among the most nutritious and healthy of foods, and are related to the prevention of many chronic diseases. The aim of the study was to examine the relationship between intake of different plant foods and cognitive performance in elderly individuals in a cross-sectional study. Two thousand and thirty-one elderly subjects (aged 70-74 years; 55% women) recruited from the general population in Western Norway underwent extensive cognitive testing and completed a comprehensive FFQ. The cognitive test battery covered several domains (Kendrick Object Learning Test, Trail Making Test--part A, modified versions of the Digit Symbol Test, Block Design, Mini-Mental State Examination and Controlled Oral Word Association Test). A validated and self-reported FFQ was used to assess habitual food intake. Subjects with intakes of >10th percentile of fruits, vegetables, grain products and mushrooms performed significantly better in cognitive tests than those with very low or no intake. The associations were strongest between cognition and the combined intake of fruits and vegetables, with a marked dose-dependent relationship up to about 500 g/d. The dose-related increase of intakes of grain products and potatoes reached a plateau at about 100-150 g/d, levelling off or decreasing thereafter, whereas the associations were linear for mushrooms. For individual plant foods, the positive cognitive associations of carrots, cruciferous vegetables, citrus fruits and high-fibre bread were most pronounced. The only negative cognitive association was with increased intake of white bread. In the elderly, a diet rich in plant foods is associated with better performance in several cognitive abilities in a dose-dependent manner.

Diffusion tensor imaging (DTI) in dementia patients with frontal lobe symptoms.

BACKGROUND: Diffusion tensor imaging (DTI) is a recent MRI technique demonstrating white matter tracts in the brain. Dementia is a neurodegenerative disease and this method has been used to demonstrate the loss of axonal fibers and myelin and decrease of fiber density in this condition. PURPOSE: To study a possible correlation between frontal lobe symptoms in patients with dementia and reduced fractional anisotropy (FA) in white matter/fascicles in the frontal lobes. MATERIAL AND METHODS: The study included 23 patients with dementia and frontal lobe symptoms and 20 controls (10 Alzheimer patients without frontal lobe symptoms and 10 normal controls). Clinical tests and MRI with DTI were performed. FA in subcortical white matter of both the frontal lobes was analyzed and correlated with clinical frontal score tests. RESULTS: We found a significant correlation between frontal score results and reduction in FA in the frontal lobes. The FA in the study group was significantly lower than the FA in the control group. CONCLUSION: The present study reveals that there is a probable correlation between the extent of frontal lobe symptoms and FA in fascicles/white matter tissue in the frontal lobes.

Staff attitudes towards institutionalised dementia residents.

AIM: To explore the attitudes of staff caring for institutionalised dementia residents and the variables associated with these attitudes. METHODS: Fourteen nursing homes and one hospital-based geriatric ward in Bergen, Norway were surveyed, using the translation of an Approach to Dementia Questionnaire. The study population (n = 291) was a mixture of registered nurses, auxiliary nurses, nursing assistants and non-trained aides. DESIGN: Survey. RESULTS: Significant differences in hope and person-centred attitudes were identified in this study. Nursing assistants, compared with registered nurses (p = 0.02), had significantly lower hope attitudes. Staff over 50 years of age reported significantly lower hope attitudes (p = 0.01) than those under 40 years of age. Staff with 10 and fewer years of work experience reported significantly lower hope attitudes (p = 0.02) than those with more than 10 years of experience. Nurses with specialised training in geriatrics, psychiatry or dementia care had significantly higher hope attitudes, compared with nurses without any special training (p = 0.04). The person-centred attitude was lower among participants who were over 50 years old, compared with their counterparts under the age of 40 (p < or = 0.01). DISCUSSION: Education, age, work experience, care unit size and specialised training are associated with differences in attitudes. We recommend that employers be proactive in encouraging and facilitating staff development by offering further training that aims to impart more positive attitudes. RELEVANCE TO CLINICAL PRACTICE: Improvements in staff competency levels will be more important in the future, as a result of the forecasted increase in the percentage of the population who will suffer from dementia and reside in nursing homes.

The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) is associated with informant stress.

OBJECTIVE: To study the association between informant stress and appraisal of patients' cognitive functioning as reported by the Informant Questionnaire on Cognitive Decline in the Elderly--IQCODE. METHODS: Routinely collected data from a geriatric outpatient department (207 dyads) during the years 1995-1998 were analysed. Relative stress scale (RSS) has been categorised for possible low, intermediate and high risk of psychiatric morbidity and caregivers were combined to four groups (female and male spouses and female and male non-spouses, respectively). The relationship between IQCODE (dependent) and categorised RSS and informant groups and patient age was further studied by means of the general linear model (GLM-UNIANOVA). RESULTS: In general, spouses reported better cognitive functioning than non-spouses. There was a significant association between IQCODE and RSS (p < 0.001), and the composite variable informant group and informant gender (p < 0.001). The main effect of the interaction term RSS x informant group + informant gender was not significant. Post hoc test, however, revealed a significant effect of the interaction term RSS x female spouses (p < 0.001) on IQCODE. CONCLUSION: IQCODE is associated with informant stress. Categorisation of RSS score into groups of low, intermediate and high risk for psychiatric morbidity can be a valuable contribution to a more meaningful application of RSS in general practice.

The impact of social support and sense of coherence on health-related quality of life among nursing home residents--a questionnaire survey in Bergen, Norway.

BACKGROUND AND OBJECTIVES: Few studies have examined the association between social support and health-related quality of life (HRQOL) among nursing home residents and whether the sense of coherence (SOC) modifies the effect of social support on health-related quality of life. The main aims of this study were to determine the relationship between social support and HRQOL and to investigate whether the SOC modifies the effect of social support on HRQOL. DESIGN: A cross-sectional, descriptive, correlational design. SETTINGS: All 30 nursing homes in Bergen in western Norway. PARTICIPANTS: Two hundred and twenty-seven mentally intact long-term nursing home residents 65 years and older. METHODS: Data were obtained through face-to-face interviews using the SF-36 Health Survey, Social Provisions Scale and Sense of Coherence Scale. Possible relationships between the Social Provisions Scale and the eight SF-36 subdimensions were analysed using multiple linear regression while controlling for age, sex, marital status, education and comorbid illness. Interactions between the Sense of Coherence Scale and Social Provisions Scale were investigated. RESULTS: Attachment affected the mental health subdimension (p=0.001), opportunity for nurturance affected social functioning (p=0.003) and reassurance of worth affected vitality (p=0.001) after adjustment for demographic variables and comorbid illness. After the analysis included the sense of coherence, nurturance still significantly affected social functioning and reassurance of worth still significantly affected vitality. No interaction with sense of coherence was found, and sense of coherence significantly affected all SF-36 subdimensions. CONCLUSIONS: The opportunity to provide nurturance for others appears to be important for social functioning, and sense of competence and sense of self-esteem appear to be important for vitality. Further, the residents' relationships with significant others comprise an important component of mental health. Finally, independent of the level of sense of coherence, social support is an important resource for better health-related quality of life. Clinical nurses should recognize that social support is associated with health-related quality of life and pay attention to the importance of social support for the residents in daily practice.

Intake of flavonoid-rich wine, tea, and chocolate by elderly men and women is associated with better cognitive test performance.

In a cross-sectional study, we examined the relation between intake of 3 common foodstuffs that contain flavonoids (chocolate, wine, and tea) and cognitive performance. 2031 participants (70-74 y, 55% women) recruited from the population-based Hordaland Health Study in Norway underwent cognitive testing. A cognitive test battery included the Kendrick Object Learning Test, Trail Making Test, part A (TMT-A), modified versions of the Digit Symbol Test, Block Design, Mini-Mental State Examination, and Controlled Oral Word Association Test. Poor cognitive performance was defined as a score in the highest decile for the TMT-A and in the lowest decile for all other tests. A self-reported FFQ was used to assess habitual food intake. Participants who consumed chocolate, wine, or tea had significantly better mean test scores and lower prevalence of poor cognitive performance than those who did not. Participants who consumed all 3 studied items had the best test scores and the lowest risks for poor test performance. The associations between intake of these foodstuffs and cognition were dose dependent, with maximum effect at intakes of approximately 10 g/d for chocolate and approximately 75-100 mL/d for wine, but approximately linear for tea. Most cognitive functions tested were influenced by intake of these 3 foodstuffs. The effect was most pronounced for wine and modestly weaker for chocolate intake. Thus, in the elderly, a diet high in some flavonoid-rich foods is associated with better performance in several cognitive abilities in a dose-dependent manner.

Predicting needs for nursing home admission - does sense of coherence delay nursing home admission in care dependent older people? A longitudinal study.

Objectives. This study examined predisposing, enabling and need variables (Andersen's Behavioral Model) influencing the need for nursing home admission (NHA) in older people receiving home nursing care. In particular, the potential role of coping ability, measured as 'sense of coherence' (SOC), was studied. Design, sample, and measurements. A survey with baseline- and follow-up data after a 2-year period was undertaken with 208 patients aged 75+. The measures used were: gender, education, age, social visits, SOC, social provision scale (SPS), self-rated health (SRH), general health questionnaire (GHQ), clinical dementia rating (CDR), Barthel activities of daily living (ADL) index, and registered illnesses (RI). A Cox proportional model was used to examine factors that could explain risk of NHA. Results. Measures with predictive properties were Barthel ADL index, SPS, SRH, and gender. SOC, along with subjective health complaints, general health questionnaire, RI and social visits did not predict NHA. Conclusions. It is concluded that the patients' subjective evaluations of both their health and perceived social support were important predictors of future NHA needs, and should be seriously taken into consideration, along with the more commonly used objective measures of ADL and CDR.

Sense of coherence as a resource in relation to health-related quality of life among mentally intact nursing home residents - a questionnaire study.

BACKGROUND: Sense of coherence (SOC) is a strong determinant of positive health and successful coping. For older people living in the community or staying in a hospital, SOC has been shown to be associated with health-related quality of life (HRQOL). Studies focusing on this aspect among nursing home (NH) residents have been limited. This study investigated the relationship between SOC and HRQOL among older people living in NHs in Bergen, Norway. METHODS: Based on the salutogenic theoretical framework, we used a descriptive correlation design using personal interviews. We collected data from 227 mentally intact NH residents for 14 months in 2004-2005. The residents' HRQOL and coping ability were measured using the SF-36 Health Survey and the Sense of Coherence Scale (SOC-13), respectively. We analyzed possible relationships between the SOC-13 variables and SF-36 subdimensions, controlling for age, sex, marital status, education and comorbidity, and investigated interactions between the SOC and demographic variables by using multiple regression. RESULTS: SOC scores were significantly correlated with all SF-36 subscales: the strongest with mental health (r = 0.61) and the weakest with bodily pain (r = 0.28). These did not change substantially after adjusting for the associations with demographic variables and comorbidity. SOC-13 did not interact significantly with the other covariates. CONCLUSION: These findings suggest that more coping resources improve HRQOL. This may indicate the importance of strengthening the residents' SOC to improve the perceived HRQOL. Such knowledge may help the international community in developing nursing regimens to improve HRQOL for older people living in NHs.

Quality and general practitioner satisfaction with reply letters for dementia patients.

OBJECTIVE: The exchange of information between specialists and general practitioners (GPs) is an important aspect of the referral process at the stage of diagnosis. Comprehensive and satisfactory information from specialists guides GPs in choosing the best possible management. The objective of this study was to assess the quality of information in reply letters with regard to the GPs' problem as presented, and the level of GP satisfaction, and to determine if there is any relation between the quality of the referrals and the reply letters. DESIGN: A retrospective review of reply letters from the Department of Geriatric Medicine to primary health care. A data sheet was developed using the existing literature. Three GPs assessed the quality of the reply letters and GP satisfaction. SETTING: Patient records in the geriatric department were collected, registered and examined according to pre-defined criteria. SUBJECTS: A total of 135 first-time replies from January 2002 to December 2002 were evaluated. All patients and relatives were informed that participation was voluntary and anonymity was guaranteed. MAIN OUTCOMES: Assessment of the quality of replies and GP satisfaction. RESULTS: The mean age of all referred patients was 78.7 years (standard deviation (SD) 7.3, range: 42 to 90 years) and 61.5% were female. Multi-rater agreement analysis showed that 86% of the replies were classified as very good/good quality, 10% as fair, and 4% as poor quality. The mean agreement was 85% (kappa 0.37; 95% confidence interval (CI) 0.29-0.45; P < 0.0001); 89% of the replies were classified as very satisfactory/satisfactory, 9% as less satisfactory and 2% as unsatisfactory. The mean agreement was 86% (kappa 0.34; 95% CI 0.25-0.42; P < 0.0001). CONCLUSION: The reply letters were overall of good quality and GPs were generally satisfied with the reply letters. No association between the quality of referral and reply letters was found.

Validation of the Seven Minute Screen and Syndrom Kurztest among elderly Norwegian outpatients.

BACKGROUND: Brief cognitive tests represent a first step in the assessment of elderly people referred to outpatient clinics because of cognitive impairment. The aim of this study is to determine sensitivity, specificity and likelihood ratio for a positive result (LR+) for the brief cognitive tests Seven Minute Screen (7MS) and Syndrom Kurztest (SKT) in an outpatient sample of elderly patients with no dementia or mild dementia. METHODS: Ninety-five patients aged 65 years or more from 10 Norwegian geriatric and psychogeriatric outpatient clinics were included in the study. All the subjects had a Mini-mental State Examination score of 22-30. A consensus diagnosis of dementia according to ICD-10 was established by an expert panel that considered data from a standardized assessment protocol blinded for 7MS and SKT results. RESULTS: Subjects were diagnosed with mild dementia (n = 69) or no dementia (n = 26). Sensitivity for 7MS was 71%, specificity 73% and LR+ was 2.6. Sensitivity for SKT was 65%, specificity 65% and LR+ was 1.9. CONCLUSION: Sensitivity, specificity and LR+ for 7MS and SKT were unacceptably low in this outpatient sample.

Differences in health-related quality of life between older nursing home residents without cognitive impairment and the general population of Norway.

AIM: To advance the understanding of health-related quality of life among older nursing home residents by assessing their health-related quality of life and comparing this with norms from the general population. METHODS: The study used a two-group cross-sectional comparative design. The samples comprised 227 nursing home residents aged 65-102 years with at least six months' residence and a representative population sample of 1137 Norwegian citizens aged 65-102 years. All nursing home residents had a Clinical Dementia Rating Scale score > or =0.5 and were capable of conversing. The respondents provided demographic information and were surveyed using the SF-36 Health Survey. We used univariate and multivariate linear models to identify possible differences in health-related quality of life between the nursing home residents and the general population, controlled for age, sex, marital status and education. RESULTS: After adjustment for age, group, sex, marital status and education, the nursing home residents scored significantly higher on bodily pain and on physical and emotional role limitation and significantly lower on the other SF-36 subscales, except social functioning, with the largest differences for physical functioning (mean nursing home 23.2 and mean general population 62.9). The general population scores on all subscales generally increased with increasing education but not among the nursing home residents. CONCLUSIONS: The mean SF-36 scale scores differed markedly between the nursing home residents and the general population, with the nursing home residents generally scoring lower. The association with background variables known to be related to health-related quality of life differed between the groups. Healthcare professionals should increase attention to health-related quality of life among nursing home residents, periodically assess health-related quality of life and consider interventions that may improve health-related quality of life in older institutionalised populations. RELEVANCE TO CLINICAL PRACTICE: This study highlights the role of nurses and other health professionals in ensuring that nursing home residents have opportunities to improve their health-related quality of life.

Stopping antipsychotic drug therapy in demented nursing home patients: a randomized, placebo-controlled study--the Bergen District Nursing Home Study (BEDNURS).

BACKGROUND: Despite modest efficacy, unpredictable individual utility, and a high rate of adverse effects, behavioural and psychological symptoms of dementia (BPSD) are common determinants for antipsychotic drug therapy in nursing home patients. AIMS: To explore the impact on BPSD of stopping long-term antipsychotic treatment in nursing home patients with dementia. METHODS: Fifty-five patients (43 women; mean age 84.1) taking haloperidol, risperidone, or olanzapine for BPSD were randomly assigned to cessation (intervention group, n=27) or continued treatment with antipsychotic drugs (reference group, n=28) for 4 consecutive weeks. The Neuropsychiatric Inventory (NPI) Questionnaire was used to examine changes in behavioural and psychological symptoms. RESULTS: By study completion, 23 of the 27 intervention group patients were still off antipsychotics. Symptom scores (NPI) remained stable or even improved in 42 patients (intervention group, 18 out of 27; reference group, 24 out of 28; p=0.18). As compared to patients with stable or improved symptom scores, patients with behavioural deterioration after antipsychotic cessation used higher daily drug doses at baseline (p=0.42). CONCLUSION: A large share of elderly nursing home patients on long-term treatment with antipsychotics for BPSD, do well without this treatment. Standardized symptom evaluations and drug cessation attempts should therefore be undertaken at regular intervals.

Measuring body mass index (BMI) in nursing home residents: the usefulness of measurement of arm span.

OBJECTIVE: To study whether arm span can be used as substitute for measurement of height in nursing home patients for calculating body mass index (BMI). DESIGN: Explanatory observational study. SETTING: Assessment of 35 nursing home residents admitted to long-term stay in a nursing home. MAIN OUTCOME MEASURES: Correlation between measured height and arm span and of BMI based on both measures. RESULTS: Measured height and arm span, and BMI calculated from either measure were significantly correlated, r(s)=0.75, p <0.001 and r(s)=0.89, p <0.001, respectively. The ratios of measured height and arm span and between BMIs based on height or arm span are close to 1, but the dispersion is rather large. CONCLUSION: Arm span is a reliable substitute for measurement of height in nursing home patients. In persons with severe height reduction, arm-span-based BMI is probably more accurate than conventional height-based BMI.

Diagnosing dementia -- ICD-10 not so bad after all: a comparison between dementia criteria according to DSM-IV and ICD-10.

BACKGROUND: The discrepancy between results of diagnosing dementia with ICD-10 and DSM-IV has been shown by several studies. Our aim was to show that the two diagnostic systems are more or less alike if ICD-10 is interpreted in the way we believe is in the intention of the ICD-10 authors. METHODS: Two hundred and seven patients consecutively referred patients and their caregivers were interviewed and the patients were clinically examined. Algorithms using criteria for the World health Organization's International classification of Diseases, 10(th) revision (ICD-10) and the American Psychiatric Association's, the fourth edition (DSM-IV) were followed to diagnose dementia. RESULTS: A diagnosis of dementia was made for 198 patients and there was 100% agreement (kappa = 1,0) between ICD-10 and DSM-IV diagnosis. CONCLUSION: In the ICD-10 criteria 'decline in other cognitive abilities such as abstraction, judgement, problem solving' has been interpreted in a way that all the above executive functions must be impaired for diagnosing dementia. According to our interpretation these are meant to be examples of functions which may be compromised in demented patients.The results of our study demonstrate that this interpretation of ICD-10 has shown that the authors of ICD-10 and DSM-IV have succeeded in harmonising the two systems. However, the ICD-10 criteria are phrased in a way that leaves much to individual interpretation. WHO has to define the ICD criteria in such a way that there is uniformity in its interpretation.

Cognitive performance among the elderly and dietary fish intake: the Hordaland Health Study.

BACKGROUND: Increasing evidence suggests that cognitive impairment and dementia in older subjects might be influenced by a diet including seafood. OBJECTIVE: The objective was to examine the cross-sectional relation between intake of different amounts of various seafood (fish and fish products) and cognitive performance. DESIGN: The subjects (n = 2031 subjects; 55% women), aged 70-74 y, were recruited from the general population in Western Norway and underwent cognitive testing. A cognitive test battery included the Kendrick Object Learning Test, Trail Making Test (part A), modified versions of the Digit Symbol Test, Block Design, Mini-Mental State Examination, and Controlled Oral Word Association Test. Poor cognitive performance was defined as a score in the highest decile for the Trail Making Test and in the lowest decile for all other tests. RESULTS: Subjects whose mean daily intake of fish and fish products was >/=10 g/d (n = 1951) had significantly better mean test scores and a lower prevalence of poor cognitive performance than did those whose intake was <10 g/d (n = 80). The associations between total intake of seafood and cognition were strongly dose-dependent; the maximum effect was observed at an intake of approximately 75 g/d. Most cognitive functions were influenced by fish intake. The effect was more pronounced for nonprocessed lean fish and fatty fish. CONCLUSIONS: In the elderly, a diet high in fish and fish products is associated with better cognitive performance in a dose-dependent manner.

Seven minute screen performance in a normal elderly sample.

BACKGROUND AND OBJECTIVE: The Seven Minute Screen (7MS) is a brief cognitive case-finding instrument for dementia. The test is composed of four subtests that assess performance with regard to orientation, memory, visuospatial ability and language. The objective of this study was to describe 7MS performance in a normal sample of people aged 65 years and older. METHOD: The subjects were 66 Norwegian community-dwellers who met selection criteria modified from the Mayo Older American Normative Studies standard. Mean age was 73.2 years, age range was 65-93 years, and mean Mini-Mental State Examination score was 29.06, range 26-30. RESULTS: Analysis of the 7MS subtests revealed relatively modest influence of age, education and gender on test performance. The composite 7MS performance scores were associated with education. Normal performance was expressed as means, standard deviations and percentile values for the age groups 65-74 years and 75 + years. CONCLUSION: 7MS performance is described for a normal sample. These data have the potential to increase the clinicians' ability to interpret 7MS test results.