Depression in relation to sex and gender expression among Swedish septuagenarians-Results from the H70 study.

OBJECTIVE: Little is known about the role of gender expression (femininity, masculinity, or androgyny) in relation to sex differences in depression. This study tested if gender expression was associated with depression and burden of depressive symptoms in a 70-year-old population. METHODS: A cross-sectional population-based sample of 70-year-olds from The Gothenburg H70 Birth Cohort Study (n = 1203) was examined in 2014-16. Data were collected using psychiatric examinations and structured questionnaires, including the Positive-Negative Sex-Role Inventory to assess gender expression. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders criteria, and symptom burden was assessed with Montgomery Åsberg Depression Rating Scale (MADRS). RESULTS: Gender expression was related to MADRS score and depression diagnosis. In fully adjusted models, feminine traits with low social desirability (FEM-) were associated with a higher MADRS score (R2 0.16; B 0.16; CI 0.1-0.2), while androgyny (t ratio) (R2 0.12; B 0.42; CI 0.1-0.7) and masculine traits with high social desirability (MAS+) (R2 0.13; B -0.06; CI -0.1--0.01) were associated with a lower MADRS score. Also, feminine traits with low social desirability (FEM-) were positively associated with depression (OR 1.04; CI 1.01-1.1). No associations between depression and masculinity or androgyny were observed in adjusted models. There were no interactions between sex and gender expression in relation to depression or MADRS score, indicating that the effects of gender expression were similar in men and women. CONCLUSIONS: We found that gender expression was associated to both depression and burden of depressive symptoms. More specifically, we found that femininity was associated to higher levels of depression, irrespective of biological sex. In addition, masculinity and androgyny were associated with lower levels of depression. These results highlight the importance of taking gender expression into consideration when studying sex differences in depression among older populations in future studies.

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.

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.

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.

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.

Long-term Risk of Neuropsychiatric Disease After Exposure to Infection In Utero.

Importance: The developmental origins of mental illness are incompletely understood. Although the development of autism and schizophrenia are linked to infections during fetal life, it is unknown whether more common psychiatric conditions such as depression might begin in utero. Objective: To estimate the risk of psychopathologic conditions imparted from fetal exposure to any maternal infection while hospitalized during pregnancy. Design, Setting, and Participants: A total of 1 791 520 Swedish children born between January 1, 1973, and December 31, 2014, were observed for up to 41 years using linked population-based registries. Children were excluded if they were born too late to contribute person-time, died before being at risk for the outcome, or were missing particular model data. Infection and psychiatric diagnoses were derived using codes from hospitalizations. Directed acyclic graphs were developed from a systematic literature review to determine Cox proportional hazards regression models for risk of psychopathologic conditions in the children. Results were evaluated using probabilistic and simple bias analyses. Statistical analysis was conducted from February 10 to October 17, 2018. Exposures: Hospitalization during pregnancy with any maternal infection, severe maternal infection, and urinary tract infection. Main Outcomes and Measures: Inpatient diagnosis of autism, depression, bipolar disorder, or psychosis among offspring. Results: A total of 1 791 520 Swedish-born children (48.6% females and 51.4% males) were observed from birth up to age 41 years, with a total of 32 125 813 person-years. Within the directed acyclic graph framework of assumptions, fetal exposure to any maternal infection increased the risk of an inpatient diagnosis in the child of autism (hazard ratio [HR], 1.79; 95% CI, 1.34-2.40) or depression (HR, 1.24; 95% CI, 1.08-1.42). Effect estimates for autism and depression were similar following a severe maternal infection (autism: HR, 1.81; 95% CI, 1.18-2.78; depression: HR, 1.24; 95% CI, 0.88-1.73) or urinary tract infection (autism: HR, 1.89; 95% CI, 1.23-2.90; depression: HR, 1.30; 95% CI, 1.04-1.61) and were robust to moderate unknown confounding. Within the directed acyclic graph framework of assumptions, the relationship between infection and depression was vulnerable to bias from loss to follow-up, but separate data from the Swedish Death Registry demonstrated increased risk of suicide among individuals exposed to pregnancy infection. No evidence was found for increased risk of bipolar disorder or psychosis among children exposed to infection in utero. Conclusions and Relevance: These findings suggest that fetal exposure to a maternal infection while hospitalized increased the risk for autism and depression, but not bipolar or psychosis, during the child's life. These results emphasize the importance of avoiding infections during pregnancy, which may impart subtle fetal brain injuries contributing to development of autism and depression.

Cognitive and physical activity and dementia: A 44-year longitudinal population study of women.

OBJECTIVE: To investigate whether cognitive and physical activities in midlife are associated with reduced risk of dementia and dementia subtypes in women followed for 44 years. METHODS: A population-based sample of 800 women aged 38-54 years (mean age 47 years) was followed from 1968 to 2012. Cognitive (artistic, intellectual, manual, religious, and club) and physical activity were assessed at baseline. During follow-up, dementia (n = 194), Alzheimer disease (n = 102), vascular dementia (n = 27), mixed dementia (n = 41), and dementia with cerebrovascular disease (n = 81) were diagnosed according to established criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. Cox regression models were used with adjustment for age, education, socioeconomic status, hypertension, body mass index, cigarette smoking, diabetes mellitus, angina pectoris, stress, and major depression. RESULTS: We found that cognitive activity in midlife was associated with a reduced risk of total dementia (hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.49-0.89) and Alzheimer disease (HR 0.54; 95% CI 0.36-0.82) during follow-up. Physical activity in midlife was associated with a reduced risk of mixed dementia (HR 0.43; 95% CI 0.22-0.86) and dementia with cerebrovascular disease (HR 0.47; 95% CI 0.28-0.78). The results were similar after excluding those who developed dementia before 1990 (n = 21), except that physical activity was then also associated with reduced risk of total dementia (HR 0.67; 95% CI 0.46-0.99). CONCLUSION: Our findings suggests that midlife cognitive and physical activities are independently associated with reduced risk of dementia and dementia subtypes. The results indicate that these midlife activities may have a role in preserving cognitive health in old age.

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.

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.

Do later-born birth cohorts of septuagenarians sleep better? A prospective population-based study of two birth cohorts of 70-year-olds.

Study Objectives: To investigate birth cohort differences in the prevalence of insomnia from ages 70 to 79. Methods: Data were drawn from population-based samples of two cohorts of septuagenarians; the early-born 1901-07-cohort, who took part in psychiatric examinations between 1971 and 1986 (n = 681), and the later-born 1930-cohort examined between 2000 and 2010 (n = 943). Examinations were conducted at ages 70, 75, and 79. Criteria for insomnia were identical across cohorts and included sleep dissatisfaction accompanied with complaints of difficulty initiating or maintaining sleep. Associations were analyzed with logistic growth curve models. Results: The later-born cohort had lower odds for insomnia at age 70 (OR = 0.52, 95% CI: 0.32-0.87) compared with the earlier born cohort. Age was not related to insomnia as a main effect but we found an interaction between age and birth cohort (OR = 1.14, 95% CI: 1.08-1.21); insomnia increased with age in the later but not in the early-born cohort. Women had higher odds for insomnia compared with men (OR = 3.10, 95% CI: 2.02-4.74), and there was an interaction between sex and birth cohort (OR = 0.51, 95% CI: 0.30-0.88; there were larger cohort differences among women than among men and less sex differences in the later than in the earlier born cohort. Also, there were no significant differences between the cohorts in taking sleep medications. Conclusions: Our findings provide evidence of improved self-reported sleep in later-born cohorts of septuagenarians, but the difference diminished with age. The prevalence of self-reported insomnia was greater in women than in men, but sex differences were less pronounced in the later-born cohort.

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.

Increased Risk of Dementia in Subjective Cognitive Decline if CT Brain Changes are Present.

BACKGROUND: Subjective cognitive decline (SCD) has low predictive value for incident dementia. OBJECTIVES: We examined whether CT detectable brain changes add predictive value to SCD in a population sample with high scores on the Mini-Mental State Examination. METHODS: Subjective reports of memory and executive function were gathered in a non-demented population sample ≥70 years (n = 921). CT-brain was performed at baseline (n = 626). Brain atrophy, infarcts, and white matter lesions (WMLs) were classified using visual ratings. Dementia incidence was evaluated periodically during 12 years. RESULTS: The prevalence of SCD was 32.5% among individuals without dementia. During follow-up, 151 individuals (16.4%) developed dementia. The risk of dementia was increased in SCD, and increased further with WMLs and cortical atrophy present. However, the positive predictive values for incident dementia were low, 25% in SCD and 41% in SCD with WMLs and cortical atrophy. CONCLUSION: Our observations add clinical value to the use of SCD and CT to select relevant populations for interventions against dementia, but more stringent screening methods are necessary to reach individuals at risk.

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.

A 10-Year Follow-Up of Adiposity and Dementia in Swedish Adults Aged 70 Years and Older.

BACKGROUND: Adiposity measured in mid- or late-life and estimated using anthropometric measures such as body mass index (BMI) and waist-to-hip ratio (WHR), or metabolic markers such as blood leptin and adiponectin levels, is associated with late-onset dementia risk. However, during later life, this association may reverse and aging- and dementia-related processes may differentially affect adiposity measures. OBJECTIVE: We explored associations of concurrent BMI, WHR, and blood leptin and high molecular weight adiponectin levels with dementia occurrence. METHODS: 924 Swedish community-dwelling elderly without dementia, aged 70 years and older, systematically-sampled by birth day and birth year population-based in the Gothenburg city region of Sweden. The Gothenburg Birth Cohort Studies are designed for evaluating risk and protective factors for dementia. All dementias diagnosed after age 70 for 10 years were identified. Multivariable logistic regression models were used to predict dementia occurrence between 2000-2005, 2005-2010, and 2000-2010 after excluding prevalent baseline (year 2000) dementias. Baseline levels of BMI, WHR, leptin, and adiponectin were used. RESULTS: Within 5 years of baseline, low BMI (<20 kg/m2) was associated with higher odds of dementia compared to those in the healthy BMI category (≥ 20-24.9 kg/m2). Compared to the lowest quartile, leptin levels in the second quartile were associated with lower odds of dementia in women (p < 0.05). CONCLUSION: In late-life, anthropometric and metabolic adiposity measures appear to be differentially associated with dementia risk. While BMI and leptin levels are highly positively correlated, our results show that their association with dementia at age ≥70 years, is asynchronous. These data suggest that with aging, the complexity of the adiposity exposure may increase and suggests metabolic dysregulation. Additional studies are needed to better understand this complexity.

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.

Low Cerebrospinal Fluid Aß42 and Aß40 are Related to White Matter Lesions in Cognitively Normal Elderly.

BACKGROUND: Low cerebrospinal fluid (CSF) levels of Aß42 may be the earliest manifestation of Alzheimer's disease (AD). Knowledge on how CSF Aß interacts with different brain pathologies early in the disease process is limited. We examined how CSF Aß markers relate to brain atrophy and white matter lesions (WMLs) in octogenarians with and without dementia to explore the earliest pathogenetic pathways of AD in the oldest old. OBJECTIVE: To study CSF amyloid biomarkers in relation to brain atrophy and WMLs in 85-year-olds with and without dementia. METHODS: 53 octogenarians took part in neuropsychiatric examinations and underwent both a lumbar puncture and a brain CT scan. CSF levels of Aß42 and Aß40 were examined in relation to cerebral atrophy and WMLs. Dementia was diagnosed. RESULTS: In 85-year-olds without dementia, lower levels of both CSF Aß42 and CSF Aß40 were associated with WMLs. CSF Aß42 also correlated with measures of central atrophy, but not with cortical atrophy. In participants with dementia, lower CSF levels of Aß42 were related to frontal, temporal, and parietal cortical atrophy but not to WMLs. CONCLUSIONS: Our findings may suggest that there is an interrelationship between Aß and subcortical WMLs in older persons without dementia. After onset of dementia, low CSF Aß42, probably representing amyloid deposition in plaques, is associated with cortical atrophy. WMLs may be an earlier manifestation of Aß deposition than cortical degeneration.

Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women.

OBJECTIVE: To investigate whether greater cardiovascular fitness in midlife is associated with decreased dementia risk in women followed up for 44 years. METHODS: A population-based sample of 1,462 women 38 to 60 years of age was examined in 1968. Of these, a systematic subsample comprising 191 women completed a stepwise-increased maximal ergometer cycling test to evaluate cardiovascular fitness. Subsequent examinations of dementia incidence were done in 1974, 1980, 1992, 2000, 2005, and 2009. Dementia was diagnosed according to DSM-III-R criteria on the basis of information from neuropsychiatric examinations, informant interviews, hospital records, and registry data up to 2012. Cox regressions were performed with adjustment for socioeconomic, lifestyle, and medical confounders. RESULTS: Compared with medium fitness, the adjusted hazard ratio for all-cause dementia during the 44-year follow-up was 0.12 (95% confidence interval [CI] 0.03-0.54) among those with high fitness and 1.41 (95% CI 0.72-2.79) among those with low fitness. High fitness delayed age at dementia onset by 9.5 years and time to dementia onset by 5 years compared to medium fitness. CONCLUSIONS: Among Swedish women, a high cardiovascular fitness in midlife was associated with a decreased risk of subsequent dementia. Promotion of a high cardiovascular fitness may be included in strategies to mitigate or prevent dementia. Findings are not causal, and future research needs to focus on whether improved fitness could have positive effects on dementia risk and when during the life course a high cardiovascular fitness is most important.

Genetic Variation in FOXO3 is Associated with Self-Rated Health in a Population-Based Sample of Older Individuals.

Self-rated health (SRH) strongly predicts mortality. Twin studies estimate that genetic factors account for a substantial part of the variability in SRH. Variations in the gene FOXO3 (forkhead box O3), and in genes located at the APOE (apoplipoprotein E) locus, are associated with longevity. This study explores the relationship between SRH and genetic variation related to longevity, in a population-based cohort of older individuals. SRH was assessed among 1,520 individuals aged 75-87, and five single nucleotide polymorphisms (SNPs), in APOE, TOMM40 (translocase of outer mitochondrial membrane 40 homolog), and FOXO3 were genotyped. Two SNPs (rs10457180 and rs2802292) in FOXO3 were associated with SRH (OR = 2.18 [CI: 1.27-3.76], p = .005 and OR = 1.63 [CI: 1.11-2.40], p = .013), while no associations were found with SNPs in APOE and TOMM40. Several factors, such as depression, cardiovascular disease (CVD), and diabetes, were related to SRH, but the only factor that had any influence on the association with FOXO3 was CVD. Still, after including CVD as a covariate, the associations between FOXO3 SNPs and SRH remained significant. Our results suggest that FOXO3 is related to SRH in older individuals. This relationship seems to be influenced by CVD, but not by mental and cognitive status.

Decreasing prevalence of dementia in 85-year olds examined 22 years apart: the influence of education and stroke.

Individuals aged 80 years and older constitute the fastest growing segment of the population worldwide, leading to an expected increase in dementia cases. Education level and treatment of vascular risk factors has increased during the last decades. We examined whether this has influenced the prevalence of dementia according to DSM-III-R using population-based samples of 85-year-olds (N = 1065) examined with identical methods 1986-87 and 2008-10. The prevalence of dementia was 29.8% in 1986-87 and 21.7% in 2008-10 (OR 0.66; 95%-CI: 0.50-0.86). The decline was mainly observed for vascular dementia. The proportion with more than basic education (25.2% and 57.7%), and the prevalence of stroke (20% and 30%) increased, but the odds ratio for dementia with stroke decreased from 4.3 to 1.8 (interaction stroke*birth cohort; p = 0.008). In a logistic regression, education (OR 0.70; 95%-CI 0.51-0.96), stroke (OR 3.78; 95%-CI 2.28-6.29), interaction stroke*birth cohort (OR 0.50; 95%-CI 0.26-0.97), but not birth cohort (OR 0.98; 95%-CI 0.68-1.41), were related to prevalence of dementia. Thus, the decline in dementia prevalence was mainly explained by higher education and lower odds for dementia with stroke in later born birth cohorts. The findings may be related to an increased cognitive reserve and better treatment of stroke in later-born cohorts.

Sex differences in time trends of blood pressure among Swedish septuagenarians examined three decades apart: a longitudinal population study.

OBJECTIVE: The aim of this study was to analyze the influence of birth cohort, sex and age on the trajectories of SBP and DBP in two birth cohorts of 70-year-olds, examined 3 decades apart and followed up at ages 75 and 79-80 years. METHODS: Two population samples of 70-year-olds from Gothenburg, Sweden, were examined. The first, born in 1901-1902, was examined in 1971-1972 (n = 973). The second, born in 1930, was examined in 2000 (n = 509). Both samples were re-examined at ages 75 and 79-80 years. RESULTS: We found that SBP and DBP were considerably lower in septuagenarian men and women born 1930 compared with those born 1901-1902, also when adjusting for antihypertensive treatment in different ways. The decline was especially pronounced in women. Blood pressure was higher in women than in men in the 1970s, whereas there were no sex differences in the 2000s. The age-related decline in SBP started earlier and was more accentuated in those born in 1930 than in those born in 1901-1902. CONCLUSION: Blood pressure decreased, and the age-related decline in SBP started earlier in septuagenarians examined in the 2000s compared with those examined in the 1970s. The decrease was especially pronounced in women and diminished the sex differences. Antihypertensive treatment only partly explained our findings, suggesting that other mostly unknown factors played an important role.