Mapping morbidity 10 years prior to a diagnosis of young onset Alzheimer's disease.

INTRODUCTION: Early symptoms in young onset Alzheimer's disease (YOAD) may be misinterpreted, causing delayed diagnosis. This population-based study aimed to map morbidity prior to YOAD diagnosis. METHODS: In a register-based incidence density matched nested case-control study, we examined hospital-diagnosed morbidity for people diagnosed with YOAD in Danish memory clinics during 2016-2020 compared to controls in a 10-year period. Conditional logistic regression produced incidence rate ratios (IRRs). RESULTS: The study included 1745 cases and 5235 controls. YOAD patients had a higher morbidity burden in the year immediately before dementia diagnosis, for certain disorders up to 10 years before. This was especially evident for psychiatric morbidity with the highest increased IRRs throughout the entire period and IRR 1.43 (95% confidence interval 1.14-1.79) in the 5-10-years before dementia diagnosis. DISCUSSION: YOAD patients display a different pattern of morbidity up to 10 years prior to diagnosis. Awareness of specific alterations in morbidity may improve efforts toward a timely diagnosis. HIGHLIGHTS: Retrospective, nested case-control study of young onset Alzheimer's disease (YOAD). YOAD cases had a higher morbidity burden than controls. YOAD cases had a higher psychiatric morbidity burden up to 10 years before diagnosis. Altered morbidity patterns could serve as an early warning sign of YOAD.

Hospital-diagnosed sleep disorders and incident dementia: a nationwide observational cohort study.

BACKGROUND AND PURPOSE: Several smaller, community-based studies have suggested a link between sleep disorders and dementia with a focus on sleep as a modifiable risk factor for dementia. Studies on neurodegenerative diseases are prone to reverse causation, and few studies have examined the association with long follow-up time. Our aim was to explore the possible association between sleep disorders and late-onset dementia in an entire population. METHODS: In a nationwide cohort with 40-year follow-up, associations between hospital-based sleep disorder diagnoses and late-onset dementia were assessed. Incidence rate ratios (IRR) were calculated using Poisson regression. RESULTS: The cohort consisted of 1,491,276 people. Those with any sleep disorder had a 17% higher risk of dementia (IRR 1.17, 95% confidence interval [CI] 1.11-1.24) compared to people with no sleep disorder, adjusted for age, sex, calendar year, highest attained educational level at age 50, and somatic and psychiatric comorbidity. The risk of dementia was significantly increased 0-5 years after sleep disorder diagnosis (IRR 1.35, 95% CI 1.25-1.47), whilst the association after 5 years or more was non-significant (1.05, 95% CI 0.97-1.13). CONCLUSIONS: Our findings show an increased short-term risk of dementia following a hospital-based sleep disorder diagnosis, whilst weaker evidence of a long-term risk was found. This could potentially point towards sleep disorders as an early symptom of dementia. Further research is needed to distinguish sleep disorders as an early symptom of dementia, a risk factor, or both.

Prescription medication use in the 10 years prior to diagnosis of young onset Alzheimer's disease: a nationwide nested case-control study.

BACKGROUND: Patients with young onset Alzheimer's disease (YOAD) face long diagnostic delays. Prescription medication use may provide insights into early signs and symptoms, which may help facilitate timely diagnosis. METHODS: In a register-based nested case-control study, we examined medication use for everyone diagnosed with YOAD in a Danish memory clinic during 2016-2020 compared to cognitively healthy controls. Prescription medication use were grouped into 13 overall categories (alimentary tract and metabolism, blood and blood forming organs, cardiovascular system, dermatologicals, genitourinary system and sex hormones, systemic hormonal preparations, antiinfectives for systemic use, antineoplastic and immunomodulating agents, musculo-skeletal system, nervous system, antiparasitic products, respiratory system, and sensory organs). Further stratifications were done for predetermined subcategories with a use-prevalence of at least 5% in the study population. Conditional logistic regression produced odds ratios, which given the use of incidence-density matching is interpretable as incidence rate ratios (IRRs). The association between prescription medication use and subsequent YOAD diagnosis was examined in the entire 10-year study period and in three time-intervals. RESULTS: The study included 1745 YOAD cases and 5235 controls. In the main analysis, several overall categories showed significant associations with YOAD in one or more time-intervals, namely blood and blood forming organs and nervous system. Prescription medication use in the nervous system category was increased for YOAD cases compared to controls already 10->5 years prior to diagnosis (IRR 1.17, 95% CI 1.05-1.31), increasing to 1.57 (95% CI 1.39-1.78) in the year preceding diagnosis. This was largely driven by antidepressant and antipsychotic use, and especially prominent for first-time users. CONCLUSIONS: In this study, medication use in several categories was associated with YOAD. Onset of treatment-requiring psychiatric symptoms such as depression or psychosis in mid-life may serve as potential early indicators of YOAD.

Christmas article: Christmas lasts a long time, but do Christmas article writers? A bibliometric case-control study.

Introduction Christmas-themed scientific articles are becoming increasingly popular and may represent a shortcut to scientific demise due to their demand for time better spent on "serious" research. We aimed to investigate whether authorship on Christmas-themed medical articles could damage the scientific careers of authors. We hypothesized that Christmas-authorships had a negative impact on core bibliometric outcomes such as publication rates. Methods We extracted demographic and bibliometric data on first- and last authors of medical papers written for the Christmas edition of Journal of The Danish Medical Association through the years 2010-2012. These cases were compared with controls representing authors of original "serious" research papers written in the same years. We performed a negative binomial regression with the number of publications ten years after the index date (defined as the publication year of Christmas/"serious" article) as the outcome and adjusted models for sex and age. Results We found that first authors of Christmas-themed papers had a publication rate ratio (PRR) of 3.8 (95% confidence interval (CI): 1.4-12.4) in unadjusted analysis and last authors had a PRR of 0.6 (95% CI: 0.2-1.6). The associations weakened and were statistically insignificant in adjusted analyses. Conclusion Our results indicate that first authors publish more in the years following the publication of a Christmas article, although the association may be entirely driven by sex and age. Causality remains uncertain and further studies (such as RCTs) which randomize authors to produce Christmas-themed (preferably in a Santa's workshop setting) or serious articles are needed. Funding. None. Trial registration. None.

Healthcare utilization prior to a diagnosis of young-onset Alzheimer's disease: a nationwide nested case-control study.

OBJECTIVE: Our aim was to identify changes in healthcare utilization prior to a young-onset Alzheimer's disease diagnosis. METHODS: In a retrospective incidence density matched nested case-control study using national health registers, we examined healthcare utilization for those diagnosed with young-onset Alzheimer's disease in Danish memory clinics during 2016-2018 compared with age- and sex-matched controls. Negative binomial regression analysis produced contact rate ratios. RESULTS: The study included 1082 young-onset Alzheimer's disease patients and 3246 controls. In the year preceding diagnosis, we found increased contact rate ratios for all types of contacts except physiotherapy. Contact rate ratios for contacts with a general practitioner were significantly increased also > 1-5 and > 5-10 years before diagnosis. The highest contact rate ratios were for psychiatric emergency contacts (8.69, 95% CI 4.29-17.62) ≤ 1 year before diagnosis. INTERPRETATION: Results demonstrate that young-onset Alzheimer's disease patients have increased healthcare utilization from 5 to 10 years prior to diagnosis. Awareness of specific alterations in health-seeking behaviour may help healthcare professionals provide timely diagnoses.

Use of glycosylated haemoglobin as diagnostic tool in Greenland: prevalence of diagnosed diabetes mellitus.

BACKGROUND: The prevalence of undiagnosed diabetes mellitus (DM) in Greenland has been reported very high with only 30% of cases diagnosed. In 2010, glycosylated hemoglobin (A1C) was introduced as a diagnostic tool in Greenland. However, the current use of A1c is unknown as well as the current prevalence of diagnosed DM.The aim of this study was firstly to estimate the use of A1C as diagnostic tool within the first 27 months after introducing the method and secondly to estimate the age and gender specific prevalence of diagnosed DM in Greenland in 2012. METHODS: This study was perfomed as a cross-sectional register study using data from electronic medical records (EMR). To analyse the use of A1C as diagnostic tool:A sample amongst all Greenlanders at or above age 35 old was used to determine the number of individuals screened with A1C within a 27 month period, excluding those already known to have DM.To estimate the prevalence of diagnosted DM: Patients with DM were identified electronically using a statistic module run on data in the EMR. Age and gender specific prevalence was estimated using the Greenlandic population as of 1 January 2012 as the background population. RESULTS: The test sample resulted in a study group of 1008 individuals from which 2.3% (23) were excluded because they were already known to have DM. Among the remaining 985, 13.6% were tested with A1C at least once during the 27 months of observation. DM was diagnosed in 7.5% (10) of the tested persons and in 1.0% of the whole group.Regarding prevalence, a total of 920 patients with diagnosed DM were identified. The total prevalence among adults aged 20-79 years old was 2.20% (95% CI: 2.05-2.34) with no significant difference between genders. CONCLUSION: Testing for DM using A1C as diagnostic tool is used in Greenland. The prevalence of diagnosed DM in Greenland remains low although increasing. Undiagnosed DM may still be an important issue in Greenland.

[Wernicke's encephalopathy in patients with alcohol withdrawal symptoms]. / Wernickes encefalopati hos patienter med alkoholabstinenssymptomer.

INTRODUCTION: Wernicke's encephalopathy (WE) is caused by lack of thiamin. In Denmark, WE most often occurs in alcoholics. In the present study, we wanted to investigate the frequency of WE in patients hospitalized for treatment of alcohol withdrawal symptoms in a psychiatric emergency ward. MATERIAL AND METHODS: Prospective registration of symptoms and treatment regimen in all patients admitted for alcohol withdrawal treatment in the period 22.02.2007-31.08.2008. RESULTS: Symptoms of WE occurred in 52 of a total of 497 patients (11%). Ataxia of gait was the predominant symptom, succeeded by cognitive impairment, whereas ocular palsy was unusual. Patients with WE were on average administered approximately 50% more phenobarbital than patients without symptoms of WE (p < 0.01), probably reflecting a more severe withdrawal reaction. In 21 of the 52 patients with WE (41%) the preceding period of alcohol intake was shorter than 14 days. DISCUSSION: WE is a frequently occurring condition among patients treated for alcohol withdrawal symptoms in psychiatric wards. A possible pathogenetic factor is the alcohol withdrawal reaction, as cerebral hyperactivity may lead to increased thiamin consumption and thus depletion of the depots. To avoid insufficient treatment, routine administration of large doses of intravenous thiamine to all patients admitted with alcohol withdrawal symptoms should be considered.