Reproductive period and dementia: A 44-year longitudinal population study of Swedish women.

INTRODUCTION: Longitudinal studies examining the effect of endogenous estrogens on dementia risk are needed to understand why women have higher dementia incidence than men after age 85. METHODS: A population-based sample of women with natural menopause (N = 1364) from Gothenburg, Sweden, was followed from 1968-2012. Information on endogenous estrogens (age at menarche and menopause, number of pregnancies, and months of breastfeeding) was obtained from interviews in 1968-1992. Dementia was diagnosed according to established criteria based on information from neuropsychiatric examinations and close informant interviews. RESULTS: We found that longer reproductive period was associated with increased risk of dementia (hazard ratio [HR] per year 1.06, 95% confidence interval [CI] 1.03-1.20) and Alzheimer's disease (AD) (1.06, 1.02-1.11), particularly for those with dementia (1.10, 1.04-1.17) and AD (1.15, 1.06-1.26) onset after age 85. DISCUSSION: These results may explain why women have higher dementia incidence compared to men after age 85, the age with the highest number of dementia cases.

Amyloid ß42 and Total Tau Levels in Cerebrospinal Fluid Associate with Survival in an 85-Year-Old Population-Based Cohort Followed until Death.

BACKGROUND: Dementia of Alzheimer's type (AD) is related to decreased survival. It is not clear whether also biological markers of AD are related to mortality. Low levels of amyloid beta-42 (Aß42) and high levels of total tau (T-tau) protein in cerebrospinal fluid (CSF) are established biomarkers for AD. OBJECTIVE: Our aim was to investigate whether levels of Aß42 and T-tau are associated with survival among octogenarians independently of dementia status. METHODS: Sixty-five 85-year-olds underwent lumbar puncture and were followed with repeated neuropsychiatric examinations until death. RESULTS: Lower CSF Aß42 (p = 0.010) and higher CSF T-tau (p = 0.005) at the age of 85 were associated with lower survival independently of dementia status at baseline and follow-up. Low CSF Aß42 and high CSF T-tau were also related to baseline dementia at the age of 85 years, and lower CSF Aß42 with increased dementia incidence during the first 3 years of follow-up. CONCLUSIONS: Biological markers of AD are associated with mortality in octogenarians. The reason for this needs further study. Our findings highlight the importance to consider the competing risk of death when evaluating biological markers of AD in the very old.

The Gothenburg H70 Birth cohort study 2014-16: design, methods and study population.

To improve health care for older persons, we need to learn more about ageing, e.g. identify protective factors and early markers for diseases. The Gothenburg H70 Birth Cohort Studies (the H70 studies) are multidisciplinary epidemiological studies examining representative birth cohorts of older populations in Gothenburg, Sweden. So far, six birth cohorts of 70-year-olds have been examined over time, and examinations have been virtually identical between studies. This paper describes the study procedures for the baseline examination of the Birth cohort 1944, conducted in 2014-16. In this study, all men and women born 1944 on specific dates, and registered as residents in Gothenburg, were eligible for participation (n = 1839). A total of 1203 (response rate 72.2%; 559 men and 644 women; mean age 70.5 years) agreed to participate in the study. The study comprised sampling of blood and cerebrospinal fluid, psychiatric, cognitive, and physical health examinations, examinations of genetics and family history, use of medications, social factors, functional ability and disability, physical fitness and activity, body composition, lung function, audiological and ophthalmological examinations, diet, brain imaging, as well as a close informant interview, and qualitative studies. As in previous examinations, data collection serves as a basis for future longitudinal follow-up examinations. The research gained from the H70 studies has clinical relevance in relation to prevention, early diagnosis, clinical course, experience of illness, understanding pathogenesis and prognosis. Results will increase our understanding of ageing and inform service development, which may lead to enhanced quality of care for older persons.

Is the prevalence of psychosis in the very old decreasing? A comparison of 85-year-olds born 22 years apart.

OBJECTIVE: To elucidate whether there is a decrease of psychotic symptoms in 85-years-olds without dementia and if factors associated with psychotic symptoms have changed, we studied two birth cohorts of 85-year-olds born 22 years apart. METHODS: Every second, 85-year-olds in Gothenburg, Sweden was invited to neuropsychiatric examinations in 1986 to 1987 (participation 63.1%, N = 494) and in 2008 to 2010 (60.5%, N = 571). A close informant was interviewed by a psychiatrist or a research psychologist. RESULTS: The prevalence of psychotic symptoms in 85-years-olds without dementia decreased from 10.1% in 1986 to 1987 to 3.2% in 2008 to 2010 (P < .001). Disability in daily life (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.1-4.5), depressed mood (OR, 3.9; 95% CI, 2.1-7.1), irritability (OR, 3.6; 95% CI, 1.2-10.5), and suicidal ideation (OR, 4.1; 95% CI, 2.1-8.0) were associated with psychotic symptoms in both cohorts. Mean mini-mental state examination (MMSE) score was lower in those with psychotic symptom compared with those with no psychotic symptoms (Cohort 1986-1987, 26.4 vs 27.8, Cohort 2008-2009, 26.1 vs 27.7, t value -4.24, Pr > t < 0.001). CONCLUSION: The prevalence of psychotic symptoms decreased between 1986 to 1987 and 2008 to 2010 among 85-years-olds without dementia. These symptoms were associated with broad psychopathology, worse performance in cognitive testing, and with disability of daily life in both cohorts.

Changes in the expression of worries, anxiety, and generalized anxiety disorder with increasing age: A population study of 70 to 85-year-olds.

OBJECTIVES: The prevalence of generalized anxiety disorder (GAD) is supposed to decrease with age. Reasons suggested include that emotional control increases and that anxiety and worry are expressed differently in older adults. The aim of this study was to examine how the expression of anxiety and worry changes with age and how this influences diagnoses in current classification systems. METHOD: Semistructured psychiatric examinations were performed in population-based samples of 70- (n = 562), 75- (n = 770), 79/80- (n = 603), and 85-year-olds (n = 433). Individuals with dementia were excluded. GAD was diagnosed according to DSM-5 (DSM5 GAD) and ICD-10 (ICD10 GAD) criteria. Individual symptoms were assessed according to severity and frequency. Functioning was measured with Global Assessment of Functioning (GAF). RESULTS: The prevalence of clinical anxiety, autonomic arousal, muscle tension, and irritability decreased with age, while that of worry and fatigue increased. Concentration difficulties and sleep disturbances remained stable. The prevalence of ICD10 GAD tended to decrease, while that of DSM5 GAD did not change with age. Core symptoms and diagnoses of GAD were related to lower GAF scores. However, in those with autonomic arousal and ICD10 GAD, GAF scores increased with age. CONCLUSIONS: The prevalence of ICD10 GAD tended to decrease with increasing age while the prevalence of DSM5 GAD remained stable. This difference was partly due to a decreased frequency of severe anxiety and autonomic arousal symptoms, and that worries increased, suggesting changes in the expression of GAD with increasing age.

Agreement between self-reports, proxy-reports and the National Patient Register regarding diagnoses of cardiovascular disorders and diabetes mellitus in a population-based sample of 80-year-olds.

BACKGROUND: cognitive impairment is common among older adults, necessitating the use of collateral sources in epidemiological studies involving this age group. The objective of this study was to evaluate agreement between self- and proxy-reports of cardiovascular disorders and diabetes mellitus in a population-based sample of 80-year-olds. Further, both self- and proxy-reports were compared with hospital register data. METHODS: data were obtained from the Gothenburg H70 Birth Cohort Studies in Sweden. The study had a cross-sectional design and information was collected through semi-structured interviews in 2009-2012 from participants born in 1930 (N = 419) and their proxy informants. The National Patient Register provided diagnoses registered during hospital stays. Agreement was measured with Kappa values (K). RESULTS: agreement between self- and proxy-reports was substantial for diabetes mellitus (K = 0.79), atrial fibrillation (K = 0.61), myocardial infarction (K = 0.75), angina pectoris (K = 0.73) and hypertension (K = 0.62), and fair for intermittent claudication (K = 0.38) and heart failure (K = 0.40). Compared to the National Patient Register, a large proportion of those with a hospital discharge diagnosis were also self- and proxy-reported. CONCLUSIONS: proxy informants can be an important source of information, at least for well-defined conditions such as myocardial infarction, angina pectoris and diabetes mellitus.

Increased Alcohol Consumption Among Swedish 70-Year-Olds 1976 to 2016: Analysis of Data from The Gothenburg H70 Birth Cohort Studies, Sweden.

BACKGROUND: The older adult population is increasing worldwide, as is the number of older adults who consume alcohol. Although there is a growing body of research on alcohol consumption among older people, few studies focus on changes in at-risk consumption over time across well-defined birth cohorts of older adults. METHODS: This study used a serial cross-sectional design in order to compare alcohol consumption patterns among birth cohorts of Swedish 70-year-olds (total n = 2,268) examined in 1976 to 1977 (n = 393), 1992 to 1993 (n = 248), 2000 to 2002 (n = 458), and 2014 to 2016 (n = 1,169). Participants took part in a multidisciplinary study on health and aging. Face-to-face interviews were conducted by healthcare professionals. Protocols regarding alcohol consumption were similar for all cohorts. The volume of weekly alcohol consumption was estimated during the past month. At-risk consumption was defined as ≥100 g alcohol/wk corresponding roughly to the National Institute on Alcohol Abuse and Alcoholism definition of heavy consumption. RESULTS: The proportion of at-risk consumers among men increased from 16.1% in 1976 to 1977 to 29.9% in 2000 to 2002 (p = 0.001) and 45.3% in 2014 to 2016 (p < 0.001). In women, proportions were low in 1976 to 1977 (0.5%) and 1992 to 1993 (2.0%; p = 0.134), but increased to 9.5% in 2000 to 2002 (p < 0.001) and 24.3% in 2014 to 2016 (p < 0.001). The male:female ratio regarding consumption of ≥100 g/wk decreased from 32.2:1 in 1976 to 1977 to 3.1:1 in 2000 to 2002 to 1.9:1 in 2014 to 2016. Spirit consumption decreased dramatically among men during the study period, while women reported very low spirit consumption at all examinations. Wine consumption increased in both sexes between 2000 to 2002 and 2014 to 2016. Beer consumption increased among men between 2000 to 2002 and 2014 to 2016. CONCLUSIONS: Recent cohorts of 70-year-olds in Sweden report significantly higher levels of alcohol consumption than previous cohorts. There was a dramatic increase in at-risk consumption among 70-year-olds from the 1970s to the mid-2010s, and this was particularly pronounced among women.

Depressive spectrum states in a population-based cohort of 70-year olds followed over 9 years.

OBJECTIVE: Depression may be understood as a spectrum of more or less symptomatic states. Little is known about the long-term course of these states in older populations. We examined the prevalence and course of depressive states of different severity in a Swedish population sample of older people followed over 9 years. METHODS: A population-based sample of 70-year olds without dementia (N = 563, response rate 71.1%) underwent a psychiatric examination; 450 survivors without dementia were reexamined at ages 75 and/or 79 years. Three depressive spectrum states were defined: major depression (MD), minor depression (MIND), and subsyndromal depression (SSD). RESULTS: The cumulative 9-year prevalence of any depressive spectrum state was 55.3% (MD 9.3%, MIND 27.6%, SSD 30.9%). The cross-sectional prevalence increased with age, especially for MIND and SSD. Among those with baseline MD and MIND, 75.0% and 66.7%, respectively, had MD or MIND during follow-up. Among those with SSD, 47.2% had SSD also during follow-up and 36.1% had MD or MIND. Among those with MD during follow-up, 63.1% were in a depressive spectrum state at baseline. The corresponding proportion was 30% for those with MIND (but no MD) during follow-up. CONCLUSION: In this population-based sample, over half experienced some degree of depression during their eighth decade of life. The findings give some support for the validity of a depressive spectrum in older adults. Most new episodes of major depression occurred in people who were in a depressive spectrum state already at baseline, which may have implications for late-life depression prevention strategies.

Increased risk for dementia both before and after stroke: A population-based study in women followed over 44 years.

INTRODUCTION: Longitudinal studies are needed to understand the long-term associations between stroke and dementia. METHODS: A population sample of 1460 women without stroke or dementia at baseline was followed over 44 years, from 1968 to 2012. Information on stroke and dementia was obtained from neuropsychiatric examinations, key-informant interviews, hospital registry, and medical records. RESULTS: During 44 years follow-up, 362 women developed stroke and 325, dementia. The age-specific incidence of the two disorders was similar. The incidence of dementia was higher in those with stroke than among those without (33.7% vs. 18.5%; age-adjusted hazard ratio 1.44, 95% confidence interval 1.15-1.81). The increased risk of dementia started already 5 years before stroke, was highest 1 year after stroke, and continued more than 11 years after stroke. DISCUSSION: There is an increased risk for dementia both before and after stroke. This has implications for understanding the relation between the two disorders and for prevention of dementia and stroke.

The ACE Gene Is Associated with Late-Life Major Depression and Age at Dementia Onset in a Population-Based Cohort.

OBJECTIVE: Depression and dementia in the elderly have been suggested to share similar risk factors and pathogenetic background, and recently the authors reported that the APOEɛ4 allele is a risk factor for both disorders in the general population. The aim of the present study was to examine the influence of the well-known polymorphisms rs1799752 in the angiotensin-converting enzyme (ACE) and rs5186 in the angiotensin receptor II type 1 (AGTR1) on late-life depression and dementia in a population-based Swedish cohort of older individuals followed over 12 years. METHODS: In 2000-2001, 900 individuals underwent neuropsychiatric and neuropsychological examinations. Follow-up evaluations were performed in 2005-2006 and 2009-2010, and register data on dementia to 2012 were included. Cross-sectional associations between genotypes/alleles and depression and dementia at baseline and between genotypes/alleles and depression on at least one occasion during the study period and dementia onset to 2012 were investigated. RESULTS: As previously found for rs1799752 in ACE, rs5186 in AGTR1 was associated with dementia at baseline (OR: 3.25 [CI: 1.42-7.06], z = 2.90, p = 0.004). These associations became substantially weaker, or disappeared, when dementia onset to 2012 was included. For rs1799752 this could be explained by a significant association with age at onset (mean: 79.5 [SD: 6.45] years for risk-genotype carriers and 81.7 [SD: 7.12] years for carriers of other genotypes, b = -2.43, t = -2.38, df = 192, p = 0.02). When individuals with major depression on at least one occasion were analyzed, a significant association (OR: 2.14 [95% CI: 1.13-4.20], z = 2.28, p = 0.02), remaining after exclusion of dementia, with rs1799752 in ACE was found. CONCLUSION: In this population-based sample of older individuals, genetic variations in ACE seem to be important both for late-life major depression and dementia.

Time Trends in Murray's Psychogenic Needs over Three Decades in Swedish 75-Year-Olds.

BACKGROUND: While time trends in personality traits have been suggested in younger cohorts, little is known regarding this issue in older adults. OBJECTIVE: To test for birth cohort changes in psychogenic needs according to Murray's theory of personality in two birth cohorts of 75-year-olds born 1901-1902 and 1930. METHODS: Two population-based birth cohorts were examined at the age of 75 years in 1976-1977 and in 2005-2006. Psychogenic needs according to Murray were measured with the Cesarec-Marke Personality Schedule (CMPS), a Swedish version of the Edwards Personal Preference Schedule. Scores on the CMPS subscales (achievement, affiliation, aggression, defence of status, guilt feelings, dominance, exhibition, autonomy, nurturance, order, succorance, and acquiescence) were compared between cohorts. RESULTS: Achievement, exhibition, dominance, aggression, affiliation, and succorance scores were higher, and order and acquiescence scores lower, in the more recent birth cohort of 75-year-olds. Women scored lower than men on exhibition and dominance, and higher on defence of status, guilt feelings, affiliation, nurturance, and succorance. Interaction effects between cohort and sex were found for achievement (women scored lower than men in 1976-1977 but not in 2005-2006), order (the lower scores in 2005-2006 were more accentuated among men), and acquiescence (increased in men and decreased in women). CONCLUSION: The later-born birth cohort scored higher on self-centred traits, such as more dominant, competitive, and exhibitive traits as well as the need to be taken care of and have friends around, but it scored lower on the need for order. The gap between men and women regarding achievement decreased, possibly reflecting women's more prominent role in society.

Mortality and risk of dementia in normal-pressure hydrocephalus: A population study.

INTRODUCTION: We examined mortality, dementia, and progression of hydrocephalic symptoms among untreated individuals with idiopathic normal-pressure hydrocephalus (iNPH) in a population-based sample. METHODS: A total of 1235 persons were examined between 1986 and 2012. Shunted individuals were excluded. We examined 53 persons with hydrocephalic ventricular enlargement (probable iNPH: n = 24, asymptomatic or possible iNPH: n = 29). Comparisons were made with individuals without hydrocephalic ventricular enlargement. RESULTS: The 5-year mortality was 87.5% among those with probable iNPH. The hazard ratio (HR) for death was 3.8 (95% confidence interval [CI]: 2.5-6.0) for probable iNPH. Those with possible iNPH and asymptomatic hydrocephalic ventricular enlargement had increased risk of developing dementia, HR 2.8 (95% CI: 1.5-5.2). Only two individuals with hydrocephalic ventricular enlargement remained asymptomatic. DISCUSSION: In the present sample, persons with clinical and imaging signs of iNPH had excess mortality and an increased risk of dementia. The data also suggest that radiological signs of iNPH might be more important than previously supposed.

DSM-IV and DSM-5 Prevalence of Social Anxiety Disorder in a Population Sample of Older People.

OBJECTIVES: To examine the prevalence of social anxiety disorders (SAD) with (DSM-IV) and without (DSM-5) the person's own assessment that the fear was unreasonable, in a population sample of older adults. Further, to determine whether clinical and sociodemographic correlates of SAD differ depending on the criteria applied. DESIGN: Cross-sectional. SETTING: General population in Gothenburg, Sweden. PARTICIPANTS: A random population-based sample of 75- and 85-year olds (N = 1200) without dementia. MEASUREMENTS: Psychiatric research nurses carried out a semi-structured psychiatric examination including the Comprehensive Psychopathological Rating Scale. DSM-IV SAD was diagnosed with the Mini International Neuropsychiatric Interview. SAD was diagnosed according to DSM-IV and DSM-5 criteria. The 6-month duration criterion in DSM-5 was not applied because of lack of information. Other assessments included the Global Assessment of Functioning (GAF), the Brief Scale for Anxiety (BSA), and the Montgomery Åsberg Depression Rating Scale (MADRS). RESULTS: The 1-month prevalence of SAD was 2.5% (N = 30) when the unreasonable fear criterion was defined in accordance with DSM-IV and 5.1% (N = 61) when the DSM-5 criterion was applied. Clinical correlates (GAF, MADRS, and BSA) were worse in SAD cases identified by either procedure compared with all others, and ratings for those reporting unreasonable fear suggested greater (albeit nonsignificant) overall psychopathology. CONCLUSIONS: Shifting the judgment of how reasonable the fear was, from the individual to the clinician, doubled the prevalence of SAD. This indicates that the DSM-5 version might increase prevalence rates of SAD in the general population. Further studies strictly applying all DSM-5 criteria are needed in order to confirm these findings.

NINE-YEAR FOLLOW-UP OF SPECIFIC PHOBIA IN A POPULATION SAMPLE OF OLDER PEOPLE.

BACKGROUND: Little is known about the long-term course of specific phobia (SP) in the general population. We examined the prevalence and course of SP and subthreshold fears in an older population followed over 9 years. METHOD: A psychiatric examination was performed in a population-based sample of 558 70-year-olds, among whom 303 dementia-free survivors were followed up at both ages 75 and 79. Fears were rated with respect to level of anxiety and social or other consequences. DSM-IV SP was diagnosed when fears were associated with prominent anxiety and had social or other consequences. All other fears were labeled subthreshold fears. RESULTS: The prevalence of SP declined from 9.9% at age 70 to 4.0% at age 79. The reason was that the prevalence of fears associated with prominent anxiety (mandatory in the diagnosis) decreased whereas the prevalence of fears that gave social or other consequences remained stable. A total of 14.5% of the population had SP at least once during the study. Among these, 11.4% had SP and 65.9% had specific fear at all three examinations. CONCLUSION: The prevalence of fears associated with prominent anxiety decreased with age, resulting in an overall decline in the prevalence of SP. SP seems to be a fluctuating disorder, and in most cases an exacerbation of chronic subthreshold fears.

Cognitive Function in Older Suicide Attempters and a Population-Based Comparison Group.

OBJECTIVE: The aim was to compare cognitive function in older suicide attempters with a population-based comparison group. METHODS: Hospitalized suicide attempters aged 70 years and older were assessed cognitively at baseline (n = 99) and 1-year follow-up (n = 59). Depression symptoms were rated with the Montgomery-Åsberg Depression Rating Scale (MADRS). Results of cognitive assessments in attempters were compared with results in nonattempter comparison subjects (n = 115) selected among participants in our population-based health studies to yield a similar distribution of MADRS scores. RESULTS: Suicide attempters scored lower on Mini-Mental State Examination (MMSE) than comparison persons. Among attempters, the mean MMSE score was lower in those with medically serious attempts. Attempters displayed poorer performance on tests of pentagon drawing and abstract thinking compared to comparison persons, and the results remained also after exclusion of those with medically serious attempts. At 1-year follow-up, significant improvement in MADRS scores was observed in the attempters. No evidence of improvement could be shown regarding cognitive deficits. CONCLUSION: Older suicide attempters may have cognitive deficits, which may in part be related to the attempt itself. This needs to be taken into account when designing intervention strategies.

Effect of diagnostic criteria on prevalence of frontotemporal dementia in the elderly.

BACKGROUND: Frontotemporal dementia (FTD) is believed to be rare in the elderly, and the influence of different criteria on the prevalence of FTD is unclear. METHODS: Population-based samples of 70- to 95-year-olds (n = 2462) in Gothenburg, Sweden, underwent neuropsychiatric examinations. Behavioral variant FTD (bvFTD) was diagnosed according to the International Behavioural Variant FTD Criteria Consortium (FTDC), the Frontotemporal Lobe Degeneration Consensus criteria, and the Lund-Manchester Research Criteria. A subset (n = 1074) underwent computerized tomography (CT) of the brain. RESULTS: The prevalence of bvFTD varied between 0.2% and 0.5% at age 70 to 79 years, between 2.5% and 3.6% at age 80 to 89 years, and between 1.7% and 2.2% at age 90 to 95 years. The agreement between different criteria was low to moderate (κ = 0.20-0.42). Among those with bvFTD according to FTDC, 93.3% had frontal and/or temporal lobar atrophy on CT, compared with 12.6% of those without bvFTD (P < .001). CONCLUSIONS: The prevalence of bvFTD was higher than expected in this population. To a large extent, different criteria captured different individuals.

Higher CSF interleukin-6 and CSF interleukin-8 in current depression in older women. Results from a population-based sample.

OBJECTIVE: The literature regarding cerebrospinal fluid (CSF) cytokines in geriatric depression is sparse. The aim of this study was to examine associations between CSF interleukin-6 (IL-6), interleukin-8 (IL-8) and depression in a population-based sample of older women who were followed for 17 years. METHODS: 86 dementia-free women aged 70-84 years who participated in the Prospective Population Study of Women in Gothenburg, Sweden took part in a lumbar puncture in 1992-3. CSF IL-6 and CSF IL-8 were measured. Psychiatric symptoms were rated with the Comprehensive Psychopathological Rating Scale at baseline and at three subsequent face-to-face examinations. Depression (major or minor) was diagnosed in accordance with DSM-IV/DSM-IV research criteria. RESULTS: At baseline, women with ongoing major (n=10) or minor depression (n=9) had higher levels of CSF IL-6 (p=0.008) and CSF IL-8 (p=0.007) compared with those without depression (n=67). Higher CSF IL-8 was related to higher MADRS score (p=0.003). New cases of depression were observed in 9 women during follow-ups. No associations between CSF cytokine levels and future depression could be shown in women without depression at baseline. CONCLUSION: Higher levels of CSF IL-6 and IL-8 were associated with current depression in this population-based sample. CSF IL-6 and CSF IL-8 may play a role in depression in late life.

Physical activity, weight status, diabetes and dementia: a 34-year follow-up of the population study of women in Gothenburg.

BACKGROUND: There is evidence of a synergistic interaction between obesity and sedentary lifestyle with respect to diabetes. Although diabetes is a known risk factor for dementia, it is unclear if both diseases have common aetiologies. METHODS: A community-based sample of 1,448 Swedish women, aged 38-60 years and free of diabetes and dementia in 1968, was followed by means of up to 5 examinations spread over 34 years. 9.6% of all women developed diabetes and 11.4% developed dementia (over 40,000 person-years of follow-up for each disease). Cox proportional hazard regression was used to assess the influence of selected risk factors on both diseases, and the relation between diabetes and dementia. RESULTS: Comparing risk factors for incident diabetes and dementia, both diseases showed a synergistic association with obesity combined with a low level of leisure time physical activity [hazard ratio (HR) for interaction = 2.7, 95% confidence interval (CI) = 1.2-6.3 for diabetes and HR = 3.3, 95% CI = 1.1-9.9 for dementia]. Development of diabetes doubled the risk for subsequent dementia (HR = 2.2, 95% CI = 1.1-4.4), which was slightly reduced upon adjustment for common risk factors. CONCLUSIONS: Shared risk factors suggest a similar aetiology for diabetes and dementia and partially explain the association between diseases.

Determinants of sexual activity in four birth cohorts of Swedish 70-year-olds examined 1971-2001.

INTRODUCTION: Knowledge about determinants of sexual activity in older adults in the general population is limited. Human senescence has been delayed by a decade, and people are reaching old age in better health. AIM: The aim of this study was to investigate determinants of sexual activity in four birth cohorts of non-demented 70-year-olds examined in 1971-1977 and 1992-2001. MAIN OUTCOME MEASURE: The main outcome measure was sexual activity (defined as intercourse) during the past year. METHODS: The study is based on cross-sectional data from four population samples of 70-year-olds from Gothenburg, Sweden (N = 1,407) systematically sampled from the Swedish population register. RESULTS: In the time periods 1971-1972 and 2000-2001, sexual activity among men increased from 47% to 66%, and in women from 12% to 34%. Sexual activity was related to positive attitude toward sexuality, sexual debut before age 20, having a very happy relationship, having a physically and mentally healthy partner, self-reported good global health, interviewer-rated good mental health, being married/cohabiting, satisfaction with sleep, and drinking alcohol more than three times a week. Having an older partner, diabetes mellitus, coronary heart disease, higher physical health-sum score, and depression were related to less sexual activity. Interaction effects for birth cohort, with stronger positive associations in 1971-1972, were found for positive attitude toward sexuality, strong desire at age 20-30, premarital sexuality, having a younger partner, self-reported good global health, interviewer-rated good global mental health, overweight, and satisfaction with sleep. Having an older partner and depression showed stronger negative associations in the 1970s. Physical health-sum score showed a stronger negative association in 1992-2001. CONCLUSIONS: We found that determinants of sexual activity in older people are numerous and varied, and change over time. It is thus important that health professionals and others take a holistic approach when dealing with sexual problems in older adults. Sexual aging should be part of health care and medical education. Clinicians should be trained to ask older patients about sexual concerns.

Prevalence of obsessive-compulsive disorder in relation to depression and cognition in an elderly population.

OBJECTIVES: We examined the 1-month prevalence of obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) not fulfilling OCD criteria in relation to sex, age, social and mental function, comorbid depression, and cognitive functioning in an elderly nondemented population. SETTINGS AND PARTICIPANTS: Population-based sample (N = 900), stratified into two age groups: 70-year-olds (335 women and 224 men) and those aged 78 and above (341 women). MEASUREMENTS: Semi-structured interviews. Psychiatric symptoms were assessed with the Comprehensive Psychopathological Rating Scale and Mini-International Neuropsychiatric Interview, mental and social function with the GAF-scale, memory function with the Word Recall Task and general cognition with MMSE. OCD and Depression were diagnosed according to DSM-IV. RESULTS: The one-month prevalence of OCD was 2.9%; a further 21% had OCS. Among 70-year-olds, the prevalence of OCD was 1.3% in men and 4.5% in women. Depression was more common among those with OCD (34.6%) than among those with (12.7%) and without (8.0%) OCS. GAF-score was lower among those with OCD (74.8) and OCS (82.9) compared with individuals without obsessions and compulsions (88.2). The association between OCD and GAF-score remained after adjustment for age, sex, and depression. The OCD subgroup with checking behavior had more memory and concentration problems and did worse on Word Recall Task than other groups in our sample. CONCLUSIONS: We found that OCD and OCS are common among the elderly. Both conditions are related to depression and poorer mental and social functioning. Physicians who meet elderly patients need to be aware of OCD as it is potentially treatable.