Low Seroprevalence among Undetected COVID-19 Cases, Faroe Islands, November 2020.

We conducted a second nationwide severe acute respiratory syndrome coronavirus 2 seroprevalence study in the Faroe Islands during November 2020. We found crude seroprevalence was 0.3% and prevalence was 0.4% after adjusting for test sensitivity and specificity. This low seroprevalence supports the prevention strategies used in the Faroe Islands.

The Faroese Septuagenarians cohort: A comparison of well-being before and during the COVID-19 pandemic among older home-dwelling Faroese.

AIMS: Despite success in avoiding morbidity and mortality in the oldest members of the population during the COVID-19 pandemic, the crisis may have affected the well-being of older adults, for example due to social distancing measures. The aim of this study was to examine the well-being of older Faroese by conducting a direct comparison of well-being indicators on the same group of elderly people before and during the COVID-19 pandemic. METHODS: Data were collected from 227 home-dwelling adults aged 82-86 years from the Faroese Septuagenarians cohort. The pre-COVID-19 period was from December 2017 to January 2019, and the COVID-19 period was from 8 June to 15 July 2020. Three aspects of well-being were assessed: loneliness, self-rated health and quality of life (WHOQOL-BREF). RESULTS: During the COVID-19 pandemic, there were significant increases in loneliness (21.8% vs. 6.8%; p<0.001) and in worse self-rated health compared to the previous year (37.2% vs. 19.0%; p<0.001). In terms of quality of life, the domains of overall quality of life (74.33±14.96 vs. 71.88±15.21; p=0.04) and physical health (73.81±17.11 vs. 71.66±17.37; p=0.03) deteriorated. On the other hand, the domains of social relationships (78.87±16.52 vs. 85.81±13.35; p<0.001), environment (82.49±10.78 vs. 87.06±7.88; p<0.001) and psychological health (77.07±11.52 vs. 80.53±10.89; p<0.001) improved during the pandemic. CONCLUSIONS: Our findings suggest that attention should be directed to loneliness and physical well-being amongst home-dwelling old adults, despite the elderly showed resilience and improved psychological health, social relations and environment domains in a quality of life assessment during the COVID-19 pandemic.

Blood Harmane (1-Methyl-9H-Pyrido[3,4-b]indole) and Mercury in Essential Tremor: A Population-Based, Environmental Epidemiology Study in the Faroe Islands.

BACKGROUND: Essential tremor (ET) is among the most prevalent neurological diseases. Its environmental determinants are poorly understood. Harmane (1-methyl-9H-pyrido[3, 4-b]indole), a dietary tremor-producing neurotoxin, has been linked to ET in a few studies in New York and Madrid. Mercury, also a tremor-producing neurotoxin, has not been studied in ET. The Faroe Islands have been the focus of epidemiological investigations of numerous neurological disorders. OBJECTIVE: In this population-based, case-control study, we directly measured blood harmane concentrations (HA) and blood mercury concentrations (Hg) in ET cases and controls. METHODS: In total, 1,328 Faroese adults were screened; 26 ET cases were identified whose (HA) and (Hg) were compared to 197 controls. RESULTS: Although there were no statistically significant differences between diagnostic groups, median (HA) was 2.7× higher in definite ET (4.13 g-10/mL) and 1.5× higher in probable ET (2.28 g-10/mL) than controls (1.53 g-10/mL). Small sample size was a limitation. For definite ET versus controls, p = 0.126. (Hg) were similar between groups. CONCLUSIONS: We demonstrated marginally elevated (HA) in definite and probable ET. These data are similar to those previously published and possibly extend etiological links between this neurotoxin and ET to a third locale. The study did not support a link between mercury and ET.

Prevalence of Essential Tremor in the Faroe Islands: A Population-Based Study.

BACKGROUND: No studies of the prevalence of one of the most common movement disorders, essential tremor (ET), have been undertaken in the Faroe Islands. Given the potential for founder effects in the Islands, and the highly genetic nature of ET, the Faroe Islands provide a particularly interesting setting in which to study the prevalence of ET. OBJECTIVE: To estimate the prevalence of ET and study its characteristics. METHODS: We used a 2-phase, population-based design, screening 1,328 randomly selected Faroese individuals aged ≥40 years. A subsample of 282 individuals who had returned the spirals and questionnaire was selected to participate in an in-person clinical evaluation. Tremor was systematically quantified by a senior movement disorder neurologist with particular specialization in tremor using a reliable and valid clinical rating scale followed by the application of rigorous diagnostic criteria used by tremor investigators internationally. RESULTS: The overall crude prevalence was 2.9%. The age-adjusted prevalence was 3.1%. There was an age-associated rise in prevalence; by age ≥70, prevalence reached 4.8%. Twenty six of 27 (96.2%) were previously undiagnosed. CONCLUSIONS: This is the first population-based study of the prevalence of ET in the Faroe Islands. The estimated prevalence was similar to studies using the same or comparable methodologies.

High Prevalence of Dystonia in the Faroe Islands: A Population-Based Study.

BACKGROUND: There are fewer than 5 population-based studies of dystonia worldwide. Only one utilized a movement disorders neurologist. Given the potential for founder effects, and the highly genetic nature of dystonia, the Faroe Islands provide a particularly interesting setting to study the prevalence of dystonia. OBJECTIVE: To estimate the prevalence of dystonia. METHODS: We used a 2-phase, population-based design, screening 1,334 randomly selected Faroese individuals aged ≥40 years from which a subsample of 227 participated in an in-person clinical evaluation. Dystonia was assessed by 2 movement disorder neurologists using videotaped examinations. RESULTS: Two of 227 (0.88%, 95% CI -0.33 to 2.09%) were diagnosed with cervical or segmental dystonia. An unusual form of thumb flexion dystonia was noted in 75 more, yielding a combined prevalence of 33.92% (95% CI 27.73-40.11%). CONCLUSIONS: The prevalence of cervical or segmental dystonia was as high as in one prior population-based study using similar methods. Furthermore, an unusual form of thumb flexion dystonia was uncovered, which yielded an extraordinarily high prevalence of dystonia in this population. Although our methods likely contributed to more complete capture of subtle dystonia, founder effects are highly likely to have been an additional major contributor to these findings.

10-Year Cognitive Change in the Faroese Septuagenarian Cohort and Impact of Sociodemographic, Lifestyle, and Health Factors.

OBJECTIVES: To investigate cognitive change in multiple cognitive domains in a population-based cohort of 713 Faroese older adults. METHODS: Participants were cognitively tested at baseline (70-74 years) and re-evaluated after 10 years. Changes in cognitive performance and the impact of sociodemographic factors, lifestyle, and health conditions were analysed using mixed-effect models. Participants free from dementia were studied in separate analyses. RESULTS: A significant decline over 10 years was observed in most of the neuropsychological tests. People living in rural areas, married or cohabiting people, people without professional education, slightly older persons, smokers, teetotalers, and people with heart disease and abnormal electrocardiogram (ECG) had a steeper decline in cognitive ability. Conflicting results were found for sex and people with myocardial infarction (MI). DISCUSSION: There are modifiable factors that contribute to cognitive decline which should be addressed in future public health efforts.

10-Year Follow-up of the Original Faroese Septuagenarian Cohort: Focus on Frailty and Association With All-cause Mortality.

Little is known about the health status of Faroese people reaching high age. The purpose of this study was to elucidate the health status of older adults in a small-scale society with emphasis on frailty and all-cause mortality. In this 10-year follow-up study, 347 Faroese citizens aged 80 to 84 from the Faroese Septuagenarian cohort participated. A detailed health examination was conducted, in addition to self-reported questionnaire. We constructed a 40-item Frailty Index (FI) to assess frailty. Survival and mortality risks were analyzed using Kaplan-Meier curves and Cox proportional hazard model. Median FI score was 0.28 ranging from 0.09 to 0.7; 71 (21%) individuals were least frail, 244 (67%) moderately frail, and 41 (12%) were most frail. Frailty and sex were statistically significantly associated with mortality; being male was associated with hazard ratio (HR) of 4.05 [CI 1.73, 9.48], and being most frail with HR of 6.2 [CI 1.84, 21.3]. Classification of octogenarians as least/moderately frail may be an opportunity to initiate interventions to prevent or delay frailty in this population stratum.

Clinical characteristics of the Omicron variant - results from a Nationwide Symptoms Survey in the Faroe Islands.

OBJECTIVES: Omicron appears to lead to a milder illness for patients compared with previous COVID-19 variants. However, not all infected with Omicron would describe their illness as mild. In this study, we investigate the experienced severity and symptoms of the Omicron variant. METHODS: We conducted a nationwide cross-sectional study, including 5036 individuals of all ages, consisting of reverse transcription-polymerase chain reaction confirmed SARS-CoV-2 cases from 1 January to 31 January 2022 (n = 4506) and a control group without SARS-COV-2 infection in December 2021 or January 2022 (n = 530). Omicron was dominant during this period. Cases were asked about their acute symptoms and answered a web-based questionnaire 10-30 days after their positive test while controls were asked about symptoms during the past week. RESULTS: Among cases, 97% reported at least one symptom during the acute phase compared with 79% of controls. Just over half the cases assessed their illness as asymptomatic or mild, whereas 46% assessed their illness as moderate or severe. Children reported fewer symptoms and less severe illnesses than adults (P <0.001). The largest risk differences (RDs) between adult cases and controls due to symptoms were observed for fever (RD = 60.6%, confidence interval [CI] 57.4-63.6), fatigue (RD = 49.6%, CI 44.1-54.7), and chills (RD = 48.8%, CI 43.8-53.2). CONCLUSION: Most of those infected with Omicron experience symptoms, and the Omicron variant appears to lead to less severe disease. However, this does not mean that all the infected experience an Omicron infection as mild. The unprecedented rate of Omicron infections worldwide leads to urgent questions about the rate of long COVID after Omicron infections.

Meat Consumption and Meat Cooking Practices in Essential Tremor: A Population-Based Study in the Faroe Islands.

Background: Elevated tissue levels of the tremor-producing neurotoxin, harmane, have been detected in patients with essential tremor (ET) in the USA and Spain. Recently, a study in the Faroe Islands similarly noted an elevation in blood harmane concentrations in probable and definite ET cases. The underlying mechanism is not understood. Possible mechanisms include increased dietary consumption (esp. through cooked meats), impaired metabolism, or increased endogenous production of harmane. To investigate this issue further, we conducted a population-based study in the Faroe Islands to examine meat consumption and meat cooking practices in ET cases and controls. Methods: 1,328 Faroese adults were screened for tremor and 27 ET cases were identified. Meat consumption and meat cooking practices were compared to 200 controls. Detailed data were collected via questionnaires regarding current meat consumption for 14 meat types and meat cooking doneness for 8 meat types. Data were also available on blood harmane concentrations. Results: Current meat consumption was similar in ET cases and controls in 12 out of 14 meat types, with no differences observed after a Bonferroni correction in any meat type; no difference was observed when stratified by gender. No difference was observed in meat doneness between ET cases and controls. Blood harmane concentrations were not correlated with dietary data. Discussion: This is the first population-based study of harmane-linked dietary factors in ET. The study suggests the observed difference in blood harmane in ET is not driven by dietary differences and is likely due to other mechanisms (e.g., impaired metabolism).

Tremor in normal adults: A population-based study of 1158 adults in the Faroe Islands.

There are virtually no population-based data on tremor in normal individuals. Using a population-based sample of 1158 normal adults ages 40-98 years in the Faroe Islands, we characterized the extent of normal action tremor across age and gender strata. Participants drew two Archimedes spirals with each hand, and tremor was systematically quantified by a senior movement disorder neurologist using a reliable and valid ordinal rating scale (ratings = 0-3). Tremor was nearly universal - 1145 (98.9%) participants had a total mean spiral score > 0. Older age was associated with more tremor (p < .001) and spiral scores were higher in males than females (p < .001). The proportion of individuals with a spiral rating ≥ 1.5 (i.e., more than mild tremor) was low (1.8% - 8.5%); however, this value reached 19.6% in left-hand spirals of males ≥70 years old. In this population-based study of more than one thousand normal adults, the vast bulk (i.e., 98.9%) had tremor on spiral drawing. In general, the tremor was mild. The proportion of individuals with tremor above the mild range varied across age and gender strata. These extensive data may be used as a gold standard for defining normal levels of tremor within adult populations.

Involuntary Thumb Flexion on Neurological Examination: An Unusual Form of Upper Limb Dystonia in the Faroe Islands.

Background: The prevalence of dystonia varies worldwide. A prior report suggested a high prevalence of focal dystonia in the Faroese population, possibly reflecting a founder effect. During standardized neurological examination as part of an ongoing neuroepidemiologic study in the Faroe Islands, we noted an unusual phenomenon of thumb flexion during repetitive hand movements in a subset of subjects and sought to define its phenomenology. Methods: We requested commentary from a panel of dystonia experts regarding the phenomenology of the movements. These experts reviewed the videotaped neurological examination. Results: Among the experts, dystonia was the leading diagnosis. Alternate causes were considered, but deemed less likely. Discussion: Diagnosis of dystonia requires careful clinical assessment and consideration of associated features. We report a novel form of dystonia, not previously described to our knowledge, in this isolated population. Further studies of dystonia prevalence in the Faroe Islands are merited to characterize its burden in this population and its specific clinical characteristics.