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  • 1.
    Bai, Ge
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Szwajda, Agnieszka
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Wang, Yunzhang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Li, Xia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Bower, Hannah
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Karlsson, Ida K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; School of Health and Welfare, Institute of Gerontology and Aging Research Network—Jönköping (ARN-J), Jönköping University, Sweden.
    Johansson, Boo
    Department of Psychology, Centre for Ageing and Health (AgeCap), University of Gothenburg, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hägg, Sara
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Frailty trajectories in three longitudinal studies of aging: Is the level or the rate of change more predictive of mortality?2021In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 50, no 6, p. 2174-2182Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: frailty shows an upward trajectory with age, and higher levels increase the risk of mortality. However, it is less known whether the shape of frailty trajectories differs by age at death or whether the rate of change in frailty is associated with mortality.

    OBJECTIVES: to assess population frailty trajectories by age at death and to analyse whether the current level of the frailty index (FI) i.e. the most recent measurement or the person-specific rate of change is more predictive of mortality.

    METHODS: 3,689 individuals from three population-based cohorts with up to 15 repeated measurements of the Rockwood frailty index were analysed. The FI trajectories were assessed by stratifying the sample into four age-at-death groups: <70, 70-80, 80-90 and >90 years. Generalised survival models were used in the survival analysis.

    RESULTS: the FI trajectories by age at death showed that those who died at <70 years had a steadily increasing trajectory throughout the 40 years before death, whereas those who died at the oldest ages only accrued deficits from age ~75 onwards. Higher level of FI was independently associated with increased risk of mortality (hazard ratio 1.68, 95% confidence interval 1.47-1.91), whereas the rate of change was no longer significant after accounting for the current FI level. The effect of the FI level did not weaken with time elapsed since the last measurement.

    CONCLUSIONS: Frailty trajectories differ as a function of age-at-death category. The current level of FI is a stronger marker for risk stratification than the rate of change.

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  • 2.
    Beam, Christopher R.
    et al.
    Department of Psychology, University of Southern California, Los Angeles, CA, United States.
    Luczak, Susan E.
    Department of Psychology, University of Southern California, Los Angeles, CA, United States.
    Panizzon, Matthew S.
    Department of Psychiatry and Center for Behavior Genetics of Aging, University of California San Diego, CA, United States.
    Reynolds, Chandra A.
    Department of Psychology, University of California Riverside, CA, United States.
    Christensen, Kaare
    Danish Twin Registry, University of Southern Denmark, Odense, Denmark.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Elman, Jeremy A.
    Department of Psychiatry and Center for Behavior Genetics of Aging, University of California San Diego, CA, United States.
    Franz, Carol E.
    Department of Psychiatry and Center for Behavior Genetics of Aging, University of California San Diego, CA, United States.
    Kremen, William S.
    Department of Psychiatry and Center for Behavior Genetics of Aging, University of California San Diego, CA, United States.
    Lee, Teresa
    Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia.
    Nygaard, Marianne
    Danish Twin Registry, University of Southern Denmark, Odense, Denmark.
    Sachdev, Perminder S.
    Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia.
    Whitfield, Keith E.
    Department of Psychology, University of Nevada Las Vegas, NV, United States.
    Pedersen, Nancy L.
    Department of Psychology, University of Southern California, Los Angeles, CA, United States ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden ; Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States.
    Estimating Likelihood of Dementia in the Absence of Diagnostic Data: A Latent Dementia Index in 10 Genetically Informed Studies2022In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 90, no 3, p. 1187-1201Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Epidemiological research on dementia is hampered by differences across studies in how dementia is classified, especially where clinical diagnoses of dementia may not be available. OBJECTIVE: We apply structural equation modeling to estimate dementia likelihood across heterogeneous samples within a multi-study consortium and use the twin design of the sample to validate the results. METHODS: Using 10 twin studies, we implement a latent variable approach that aligns different tests available in each study to assess cognitive, memory, and functional ability. The model separates general cognitive ability from components indicative of dementia. We examine the validity of this continuous latent dementia index (LDI). We then identify cut-off points along the LDI distributions in each study and align them across studies to distinguish individuals with and without probable dementia. Finally, we validate the LDI by determining its heritability and estimating genetic and environmental correlations between the LDI and clinically diagnosed dementia where available. RESULTS: Results indicate that coordinated estimation of LDI across 10 studies has validity against clinically diagnosed dementia. The LDI can be fit to heterogeneous sets of memory, other cognitive, and functional ability variables to extract a score reflective of likelihood of dementia that can be interpreted similarly across studies despite diverse study designs and sampling characteristics. Finally, the same genetic sources of variance strongly contribute to both the LDI and clinical diagnosis. CONCLUSION: This latent dementia indicator approach may serve as a model for other research consortia confronted with similar data integration challenges.

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  • 3.
    Bogl, Leonie H.
    et al.
    Institute for Molecular Medicine FIMM, University of Helsinki, Finland ; Department of Public Health, University of Helsinki, Finland.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network–Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Kaprio, Jaakko
    Institute for Molecular Medicine FIMM, University of Helsinki, Finland ; Department of Public Health, University of Helsinki, Finland.
    Does the sex of one’s co-twin affect height and BMI in adulthood?: A study of dizygotic adult twins from 31 cohorts2017In: Biology of Sex Differences, ISSN 2042-6410, Vol. 8, no 1, article id 14Article in journal (Refereed)
    Abstract [en]

    Background: The comparison of traits in twins from opposite-sex (OS) and same-sex (SS) dizygotic twin pairs is considered a proxy measure of prenatal hormone exposure. To examine possible prenatal hormonal influences on anthropometric traits, we compared mean height, body mass index (BMI) and the prevalence of being overweight or obese between men and women from OS and SS dizygotic twin pairs.

    Methods: The data were derived from COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) database, and included 68,494 SS and 53,808 OS dizygotic twin individuals above the age of 20 years from 31 twin cohorts representing 19 countries. Zygosity was determined by questionnaires or DNA genotyping depending on the study. Multiple regression and logistic regression models adjusted for cohort, age and birth year with the twin type as a predictor were carried out to compare height and BMI in twins from OS pairs with those from SS pairs and to calculate the adjusted odds ratios and 95% confidence intervals for being overweight or obese.

    Results: OS females were, on average, 0.31 cm (95% confidence interval (CI): 0.20, 0.41) taller than SS females. OS males were also, on average, taller than SS males, but this difference was only 0.14 cm (95% CI: 0.02, 0.27). Mean BMI and the prevalence of overweight or obesity did not differ between males and females from SS and OS twin pairs. The statistically significant differences between OS and SS twins for height were small and appeared to reflect our large sample size rather than meaningful differences of public health relevance.

    Conclusions: We found no evidence to support the hypothesis that prenatal hormonal exposure or postnatal socialization (i.e., having grown up with a twin of the opposite sex) has a major impact on height and BMI in adulthood.

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  • 4.
    Bokenberger, Kathleen
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sjölander, Arvid
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; School of Health and Welfare, Institute of Gerontology, Jönköping University, Sweden.
    Karlsson, Ida K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Åkerstedt, Torbjörn
    Stress Research Institute, Stockholm University, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy Lee
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, USA.
    Shift work and risk of incident dementia: a study of two population-based cohorts2018In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 33, no 10, p. 977-987Article in journal (Refereed)
    Abstract [en]

    This study aimed to investigate the association between shift work and incident dementia in two population-based cohorts from the Swedish Twin Registry (STR). The STR-1973 sample included 13,283 participants born 1926–1943 who received a mailed questionnaire in 1973 that asked about status (ever/never) and duration (years) of shift work employment. The Screening Across the Lifespan Twin (SALT) sample included 41,199 participants born 1900–1958 who participated in a telephone interview in 1998–2002 that asked about night work status and duration. Dementia diagnoses came from Swedish patient registers. Cox proportional-hazards regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI). Potential confounders such as age, sex, education, diabetes, cardiovascular disease and stroke were included in adjusted models. In genotyped subsamples (n = 2977 in STR-1973; n = 10,366 in SALT), APOE ε4 status was considered in models. A total of 983 (7.4%) and 1979 (4.8%) dementia cases were identified after a median of 41.2 and 14.1 years follow-up in the STR-1973 and SALT sample, respectively. Ever shift work (HR 1.36, 95% CI 1.15–1.60) and night work (HR 1.12, 95% CI 1.01–1.23) were associated with higher dementia incidence. Modest dose-response associations were observed, where longer duration shift work and night work predicted increased dementia risk. Among APOE ε4 carriers, individuals exposed to ≥ 20 years of shift work and night work had increased dementia risk compared to day workers. Findings indicate that shift work, including night shift work, compared to non-shift jobs is associated with increased dementia incidence. Confirmation of findings is needed. 

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  • 5.
    Bokenberger, Kathleen
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ström, Peter
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Johansson, Anna L. V.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Åkerstedt, Torbjörn
    Stress Research Institute, Stockholm University, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Association between sleep characteristics and incident dementia accounting for baseline cognitive status: A prospective population-based study2017In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 72, no 1, p. 134-139Article in journal (Refereed)
    Abstract [en]

    Background: While research has shown that sleep disorders are prevalent among people with dementia, the temporal relationship is unclear. We investigated whether atypical sleep characteristics were associated with incident dementia while accounting for baseline cognitive functioning.

    Methods: Screening Across the Lifespan Twin Study (SALT) participants were 11,247 individuals from the Swedish Twin Registry who were at least 65 years at baseline (1998-2002). Sleep and baseline cognitive functioning were assessed via the SALT telephone screening interview. Data on dementia diagnoses came from national health registers. Cox regression was performed to estimate hazard ratios (HR) for dementia.

    Results: After 17 years of follow-up, 1,850 dementia cases were identified. Short (≤ 6 hours) and extended (> 9 hours) time-in-bed (TIB) compared to the middle reference group (HR=1.40, 95% CI=1.06-1.85, HR=1.11, 95% CI=1.00-1.24, respectively) and rising at 8:00AM or later compared to earlier rising (HR=1.12, 95% CI=1.01-1.24) were associated with higher dementia incidence. Bedtime, sleep quality, restorative sleep, and heavy snoring were not significant predictors. Findings stratified by baseline cognitive status indicated that the association between short TIB and dementia remained in those cognitively intact at the start.

    Conclusions: Short and extended TIB as well as delayed rising among older adults predicted increased dementia incidence in the following 17 years. The pattern of findings suggests that extended TIB and late rising represent prodromal features whereas short TIB appeared to be a risk factor for dementia.

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  • 6.
    Bokenberger, Kathleen
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ström, Peter
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Åkerstedt, Torbjörn
    Stress Research Institute, Stockholm University, Sweden ; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles CA, USA.
    Shift work and cognitive aging: A longitudinal study2017In: Scandinavian Journal of Work, Environment and Health, ISSN 0355-3140, E-ISSN 1795-990X, Vol. 43, no 5, p. 485-493Article in journal (Refereed)
    Abstract [en]

    Objectives The few studies of shift work and late life cognitive functioning have yielded mixed findings. The aim of the present study is to estimate the association between shift-work experience and change in cognitive performance before and after retirement age among older adults who were gainfully employed.

    Methods Five hundred and ninety five participants with no dementia were followed up for a mean of 17.6 standard deviation (SD) 8.8 years from a Swedish population-based sample. Participants had self-reported information on any type of shift-work experience (ever/never) in 1984 and measures of cognitive performance (verbal, spatial, memory, processing speed, and general cognitive ability) from up to 9 waves of cognitive assessments during 1986–2012. Night work history (ever/never) from 1998–2002 was available from a subsample (N=320). Early adult cognitive test scores were available for 77 men.

    Results In latent growth curve modeling, there were no main effects of "any-type" or night shift work on the mean scores or rate of change in any of the cognitive domains. An interaction effect between any-type shift work and education on cognitive performance at retirement was noted. Lower-educated shift workers performed better on cognitive tests than lower-educated day workers at retirement. Sensitivity analyses, however, indicated that the interactions appeared to be driven by selection effects. Lower-educated day workers demonstrated poorer cognitive ability in early adulthood than lower-educated shift workers, who may have selected jobs entailing higher cognitive demand.

    Conclusion There was no difference in late-life cognitive aging between individuals with a history of working shifts compared to those who had typical day work schedules during midlife.

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  • 7.
    Bravell, Marie Ernsth
    et al.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Finkel, Deborah
    Department of Psychology, Indiana University Southeast, USA.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, USA.
    Hallgren, Jenny
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, USA.
    Motor functioning differentially predicts mortality in men and women2017In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 72, p. 6-11Article in journal (Refereed)
    Abstract [en]

    Introduction

    Research indicates gender differences in functional performance at advanced ages, but little is known about their impact on longevity for men and women.

    Objective

    To derive a set of motor function factors from a battery of functional performance measures and examine their associations with mortality, incorporating possible gender interactions.

    Method

    Analyses were performed on the longitudinal Swedish Adoption/Twin Study of Aging (SATSA) including twenty-four assessments of motor function up to six times over a 19-year period. Three motor factors were derived from several factor analyses; fine motor, balance/upper strength, and flexibility. A latent growth curve model was used to capture longitudinal age changes in the motor factors and generated estimates of intercept at age 70 (I), rates of change before (S1) and after age 70 (S2) for each factor. Cox regression models were used to determine how gender in interaction with the motor factors was related to mortality.

    Results

    Females demonstrated lower functional performance in all motor functions relative to men. Cox regression survival analyses demonstrated that both balance/upper strength, and fine motor function were significantly related to mortality. Gender specific analyses revealed that this was true for women only. For men, none of the motor factors were related to mortality.

    Conclusion

    Women demonstrated more difficulties in all functioning facets, and only among women were motor functioning (balance/upper strength and fine motor function) associated with mortality. These results provide evidence for the importance of considering motor functioning, and foremost observed gender differences when planning for individualized treatment and rehabilitation.

  • 8.
    Dahl, Anna
    Institute of Gerontology, School of Health Sciences, Jönköping University.
    Body mass index, cognitive ability, and dementia: prospective associations and methodological issues in late life2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aims of the present study were to investigate the association between overweight and cognitive ability and dementia, and to evaluate the usefulness of self-reported body mass index (BMI) in late life and various data sources commonly used in epidemiological studies to identify persons with dementia. Data were drawn from three population-based studies: the Swedish Adoption/Twin Study of Aging (SATSA), Aging in Women and Men: A Longitudinal Study of Gender Differences in Health Behaviour and Health among Elderly (the Gender Study), and the Finnish Lieto Study. In Study I, the agreement between self-reported and measured BMI over time was evaluated among 774 men and women, ages 40 to 88 years at baseline (mean age 63.9) participating in both the questionnaire phase and in-person testing of SATSA. Latent growth curve (LGC) modeling showed a small but significant increase between self-reported and measured BMI (0.02 kg/m2/y) over time, which would probably not affect the results if self-reported BMI were used as a continuous variable in longitudinal research. In Study II, the agreement between dementia diagnoses from various sources and dementia diagnoses set at a consensus conference was evaluated. Among the 498 elderly people ages 70 to 81 at baseline (mean age 74.5) enrolled in the Gender Study, 87 were diagnosed with dementia during an eight-year period. Review of medical records and nurse evaluations yielded the highest sensitivity (0.83 and 0.80, respectively) and a high specificity (0.98 and 0.96), indicating that these sources might be good proxies of dementia, while data extraction from the Swedish Inpatient Discharge Registry underestimated the prevalence of dementia (sensitivity 0.26). In Study III, the association between being overweight in midlife and cognitive ability in late life was examined in SATSA. The 781 participants ages 25 to 63 at baseline (mean age 41.6) in 1963 or 1973 self-reported their height and weight. From 1986 until 2002, they were assessed five times using a cognitive test battery. LGC models showed that people with higher midlife BMI scores had significantly lower cognitive ability and a significantly steeper decline than their thinner counterparts, an association that persisted when those who developed dementia during the study period were excluded from the analysis. This finding indicates that being overweight might affect cognitive ability independently of dementia. In Study IV, the association between BMI and dementia risk in older persons was described among 605 persons without dementia and ages 65 to 92 at baseline (mean age 70.8) in the Lieto Study. Among these, 86 persons were diagnosed with dementia during eight years of follow-up. Cox regression analyses indicated that for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio = 0.92, 95% confidence interval = 0.87–0.97) and the association remained significant when individuals who developed dementia during the first four years of follow-up were excluded from the analyses. This result suggests that low BMI scores are present almost a decade before clinical dementia onset.

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  • 9.
    Dahl, Anna
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Berg, Stig
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Nilsson, Sven E.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Identification of dementia in epidemiological research: A study on the usefulness of various data sources2007In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 19, no 5, p. 381-389Article in journal (Refereed)
    Abstract [en]

    Background and aims: Prevalence and incidence ratios of dementia in epidemiological studies vary according to the data source used. Medical records, cognitive tests, and registry information are sources frequently used to differentiate dementia from normal aging. The aim of the present study was to compare the identification of dementia from these different sources with that from consensus diagnosis. 

    Methods: 498 elderly people (age range 70–81 at baseline) enrolled in a Swedish population-based longitudinal twin study (Gender) were evaluated on physical and mental health and interviewed for their socio-demographic background three times during an eight-year period. Reviews of medical records and the Swedish Discharge Registry (DR) were conducted. The 10th percentile was used to differentiate between dementia and non-dementia in all cognitive tests. Scores of 24 or below on the Mini-Mental State Examination (MMSE) (range 1–30) indicated dementia. A consensus conference diagnosed dementia on the basis of total information. The consensus diagnosis was used as the gold standard. 

    Results: MMSE scores (sensitivity 64%, specificity 96%, kappa 0.65) and the review of medical records (sensitivity 57%, specificity 99%, kappa 0.65) were good sources for dementia identification. The precision of medical records increased when recordings of cognitive impairment were included (sensitivity 83%, specificity 98%, kappa 0.84). The discharge registry had low sensitivity (26%) and kappa coefficient (0.31). 

    Conclusions: The present study shows that both review of medical records and MMSE scores are good although not perfect identifiers of dementia. The discharge registry is an uncertain source of dementia identification.

  • 10.
    Dahl, Anna
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Hassing, Linda B.
    Department of Psychology, University of Gothenburg, Sweden.
    Fransson, Eleonor
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Berg, Stig
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Gatz, Margrete
    Department of Psychology, University of Southern California, Los Angeles, USA ; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, USA.
    Pedersen, Nancy L.
    Department of Psychology, University of Southern California, Los Angeles, USA ; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Being overweight in midlife is associated with lower cognitive ability and steeper cognitive decline in late life2010In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 65A, no 1, p. 57-62Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although an increasing body of evidence links being overweight in midlife with an increased risk for dementia in late life, no studies have examined the association between being overweight in midlife and cognitive ability in late life. Our aim was to examine the association between being overweight in midlife as measured by body mass index (BMI) and cognitive ability assessed over time. METHODS: Participants in the Swedish Adoption/Twin Study Aging were derived from a population-based sample. The participants completed baseline surveys in 1963 or 1973 (mean age 41.6 years, range 25-63 years). The surveys included questions about height, weight, diseases, and lifestyle factors. Beginning in 1986, the same individuals were assessed on neuropsychological tests every 3 years (except in 1995) until 2002. During the study period, 781 individuals who were 50 years and older (60% women) had at least one complete neuropsychological assessment. A composite score of general cognitive ability was derived from the cognitive test battery for each measurement occasion. RESULTS: Latent growth curve models adjusted for twinness showed that persons with higher midlife BMI scores had significantly lower general cognitive ability and significantly steeper longitudinal decline than their thinner counterparts. The association did not change substantially when persons who developed dementia during the study period were excluded from the analysis. CONCLUSIONS: Higher midlife BMI scores precede lower general cognitive ability and steeper cognitive decline in both men and women. The association does not seem to be mediated by an increased risk for dementia

  • 11.
    Dahl, Anna K.
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Hassing, Linda B.
    Department of Psychology, University of Gothenburg, Sweden.
    Fransson, Eleonor I.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Agreement between self-reported and measured height, weight and body mass index in old age: a longitudinal study with 20 years of follow-up2010In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 39, no 4, p. 445-451Article in journal (Refereed)
    Abstract [en]

    Background: self-reported body mass index (BMI) based on self-reported height and weight is a widely used measure of adiposity in epidemiological research. Knowledge about the accuracy of these measures in late life is scarce.

    Objective: the study aimed to evaluate the accuracy and changes in accuracy of self-reported height, weight and BMI calculated from self-reported height and weight in late life.

    Design: a longitudinal population-based study with five times of follow-up was conducted.

    Participants: seven hundred seventy-four community-living men and women, aged 40–88 at baseline (mean age 63.9), included in The Swedish Adoption/Twin Study of Aging.

    Methods: participants self-reported their height and weight in a questionnaire, and height and weight were measured by experienced research nurses at an in-person testing five times during a 20-year period. BMI was calculated as weight (kilogramme)/height (metre)2.

    Results: latent growth curve modelling showed an increase in the mean difference between self-reported and measured values over time for height (0.038 cm/year) and BMI (0.016 kg/m2/year), but not for weight.

    Conclusions: there is a very small increase in the mean difference between self-reported and measured BMI with ageing, which probably would not affect the results when self-reported BMI is used as a continuous variable in longitudinal studies.

  • 12.
    Dahl, Anna K.
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Löppönen, Minna
    Department of Family Medicine, University of Turku, Finland ; Härkätie Health Centre, Finland.
    Isoaho, Raimo
    Department of Family Medicine, University of Turku, Finland ; Nordic School of Public Health, Gothenburg, Sweden.
    Berg, Stig
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Kivelä, Sirkka-Liisa
    Department of Family Medicine, University of Turku, Finland ; Satakunta Central Hospital, Satakunta, Finland ; Unit of Family Medicine, Turku University Hospital, Finland.
    Overweight and obesity in old age are not associated with greater dementia risk2008In: Journal of The American Geriatrics Society, ISSN 0002-8614, E-ISSN 1532-5415, Vol. 56, no 12, p. 2261-2266Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To describe the association between body mass index (BMI) and dementia risk in older persons.

    DESIGN: Prospective population‐based study, with 8 years of follow‐up.

    SETTING: The municipality of Lieto, Finland, 1990/91 and 1998/99.

    PARTICIPANTS: Six hundred five men and women without dementia aged 65 to 92 at baseline (mean age 70.8).

    MEASUREMENTS: Weight and height were measured at baseline and at the 8‐year follow‐up. Dementia was clinically assessed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.

    RESULTS: Eighty‐six persons were diagnosed with dementia. Cox regression analyses, adjusted for age, sex, education, cardiovascular diseases, smoking, and alcohol use, indicated that, for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio (HR)=0.92, 95% confidence interval (CI)=0.87–0.97). This association remained significant when individuals who developed dementia early during the first 4 years of follow‐up were excluded from the analyses (HR=0.93, 95% CI=0.86–0.99). Women with high BMI scores had a lower dementia risk (HR=0.90, 95% CI=0.84–0.96). Men with high BMI scores also tended to have a lower dementia risk, although the association did not reach significance (HR=0.95, 95% CI=0.84–1.07).

    CONCLUSION: Older persons with higher BMI scores have less dementia risk than their counterparts with lower BMI scores. High BMI scores in late life should not necessarily be considered to be a risk factor for dementia.

  • 13.
    Dahl Aslan, Anna
    Hälsohögskolan i Jönköping.
    Psykologiskt åldrande2020In: Äldre och åldrande: grundbok i gerontologi / [ed] Marie Ernsth Bravell; Lena Östlund, Malmö: Gleerups Utbildning AB, 2020, 3, p. 209-236Chapter in book (Other academic)
  • 14.
    Dahl Aslan, Anna K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology, School of Health Sciences, Jönköping, Sweden.
    Starr, John M.
    Geriatric Medicine, University of Edinburgh, Royal Victoria Hospital, Edinburgh, UK ; Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, UK.
    Pattie, Alison
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, UK.
    Deary, Ian
    Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, UK.
    Cognitive consequences of overweight and obesity in the ninth decade of life?2015In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 44, no 1, p. 59-65Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: the association between late-life obesity and late-life cognitive abilities is poorly understood. We studied the association between body mass index (BMI) and cognitive change in longitudinal population-based study spanning over the ninth decade of life.

    SUBJECTS/METHODS: in total, 475 participants free of dementia at baseline from the Lothian Birth Cohort 1921 (mean age: 79.1 years, SD: 0.6) were included. Height and weight were assessed at baseline. BMI was calculated as kg/m(2). Cognitive abilities were assessed at age ∼11 years and at age ∼79, ∼83, ∼87 and ∼90 years.

    RESULTS: latent growth models showed that men being overweight and obese had a 0.65 (SD: 0.3) and 1.10 (SD: 0.5) points less steep decline in general cognitive ability (as measured by the Moray House Test) for each year than people of normal weight. These associations were to some extent confounded by childhood intelligence. No other association between BMI and cognition was significant, either for men or women. People who were obese in old age had significantly lower childhood intelligence (m = 43.6, SD: 1.3) than people who were normal in weight (m = 47.0, SD: 0.8) and persons being overweight (m = 47.5, SD: 0.8), F (472, 3) = 3.2, P = 0.043.

    CONCLUSIONS: the current study shows weak or no evidence for an association between BMI in old age and cognitive function, especially not when childhood intelligence is controlled for. Lower intelligence at the age of 11 years predicted obesity at the age of 79 years.

  • 15.
    Dybjer, Elin
    et al.
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Engström, Gunnar
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Nilsson, Erik D.
    Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Nägga, Katarina
    Clinical Memory Research Unit, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden ; Department of Acute Internal Medicine and Geriatrics, Linköping University, Sweden.
    Nilsson, Peter M.
    Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
    Hassing, Linda B.
    Department of Psychology, University of Gothenburg, Sweden ; Centre for Ageing and Health, University of Gothenburg, Sweden.
    Type 1 diabetes, cognitive ability and incidence of cardiovascular disease and death over 60 years of follow-up time in men2022In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 39, no 8, article id e14806Article in journal (Refereed)
    Abstract [en]

    Aims: There are few cohorts of type 1 diabetes that follow individuals over more than half a century in terms of health outcomes. The aim of this study was to examine associations between type 1 diabetes, diagnosed before age 18, and long-term morbidity and mortality, and to investigate whether cognitive ability plays a role in long-term morbidity and mortality risk. Methods: In a Swedish cohort, 120 men with type 1 diabetes and 469 without type 1 diabetes were followed between 18 and 77 years of age as regards morbidity and mortality outcomes, and impact of cognitive ability at military conscription for the outcomes. In Cox regression analyses and Kaplan-Meier analyses with log-rank tests, associations between diabetes and cognitive ability respectively, and outcomes (mortality, cardiovascular morbidity and diabetes complications) were investigated. Results: Men with type 1 diabetes suffered from dramatically higher mortality (HR 4.62, 95% CI: 3.56–5.60), cardiovascular mortality (HR 5.60, 95% CI: 3.27–9.57), and cardiovascular events (HR 3.97, 95% CI: 2.79–5.64) compared to men without diabetes. Higher cognitive ability at military conscription was associated with lower mortality in men without diabetes, but was not associated with any outcome in men with diabetes. Conclusions: In this historical cohort study with 60 years of follow-up time and a less effective treatment of diabetes than today, mortality rates and cardiovascular outcomes were high for men with type 1 diabetes. Morbidity or mortality did not differ between those that had low to normal or high cognitive ability among men with type 1 diabetes.

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  • 16.
    Emery, Charles F.
    et al.
    Departments of Psychology and Internal Medicine, Institute for Behavioral Medicine Research, Ohio State University, Columbus, OH, United States.
    Finkel, Deborah
    Department of Psychology, Indiana University Southeast, New Albany, IN, United States ; Institute for Gerontology Jönköping University, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Karolinska Institutet, Stockholm, Sweden.
    Bidirectional associations between body mass and bodily pain among middle-aged and older adults2022In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 163, no 10, p. 2061-2067Article in journal (Refereed)
    Abstract [en]

    Higher body mass and obesity are associated with bodily pain, and rates of chronic pain increase among older adults. Most past studies are cross-sectional, precluding determination of the temporal relationship between body mass and pain. A longitudinal study of body mass and pain among middle-aged adults found that higher body mass index (BMI) led to greater lower back pain. No longitudinal study of BMI and pain has been conducted among adults older than 70 years. This study used dual change score models to determine the directional relationship between BMI and bodily pain in a sample of middle-aged and older adults. Participants (n = 1889) from the Swedish Twin Registry (baseline age range 40-93 years) completed at least 1 nurse assessment of BMI and self-report ratings of pain interference and joint pain. Pain interference was not associated with BMI, but joint pain was analyzed in univariate and bivariate models, with dual change score models modeling the relationship of BMI and joint pain across age, both independently and as part of bivariate relationships. The results indicated a reciprocal relationship between BMI and joint pain, but joint pain generally led to changes in BMI. In addition, the relationship changed with age, until approximately age 80 years, increasing joint pain contributed to higher BMI, but after that time increasing joint pain contributed to lower BMI. In addition, sex differences in the relationship between BMI and pain appeared after age 70 years. Thus, joint pain contributes to changes in BMI among middle-aged and older adults, but the relationship may change by age and sex.

  • 17.
    Emery, Charles F.
    et al.
    Department of Psychology, Ohio State University, Columbus, USA.
    Finkel, Deborah
    Department of Psychology, Indiana University Southeast, New Albany, USA ; Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Gatz, Margaret
    Department of Psychology, University of Southern California, Los Angeles, USA ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Evidence of bi-directional associations between depressive symptoms and body mass among older adults2020In: The journals of gerontology. Series B, Psychological sciences and social sciences, ISSN 1079-5014, E-ISSN 1758-5368, Vol. 75, no 8, p. 1689-1698Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Body fat, measured with body mass index (BMI), and obesity are associated with depressive symptoms. Among younger adults there is stronger evidence of obesity leading to depressive symptoms than of depressive symptoms leading to obesity, but the temporal relationship is unknown among older adults. This study utilized dual-change-score models (DCSMs) to determine the directional relationship between body mass and depressive symptoms among older adults.

    METHOD: Participants (n=1743) from the Swedish Twin Registry (baseline age range 50-96 years) completed at least one assessment of BMI (nurse measurement of height and weight) and the Center for Epidemiologic Studies-Depression scale (CESD). More than half the sample completed three or more assessments, scheduled at intervals of 2-4 years. DCSMs modeled the relationship of BMI and CESD across age, both independently and as part of bivariate relationships.

    RESULTS: Depressive symptoms contributed to subsequent changes in BMI after age 70, while BMI contributed to subsequent changes in depressive symptoms after age 82. Thus, there is a reciprocal relationship that may change with age. The effect was more pronounced for women.

    DISCUSSION: The association of BMI and depressive symptoms is bi-directional among older adults, and it appears to be affected by both age and sex.

  • 18.
    Emmesjö, Lina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Patients’ and next of kin’s expectations and experiences of a mobile integrated care model with a home health care physician – a qualitative thematic study2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 921Article in journal (Refereed)
    Abstract [en]

    Background

    The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients’ and next of kin’s experiences of integrated care is however lacking, motivating exploration.

    Method

    A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later.

    Results

    The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making.

    Conclusion

    Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.

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  • 19.
    Ericsson, Malin
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundholm, Cecilia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fors, Stefan
    Aging Research Center, Karolinska Institutet & Stockholm University, Sweden.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute for Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Zavala, Catalina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, United States.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, United States.
    Childhood social class and cognitive aging in the Swedish Adoption/Twin Study of Aging2017In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 114, no 27, p. 7001-7006Article in journal (Refereed)
    Abstract [en]

    In this report we analyzed genetically informative data to investigate within-person change and between-person differences in late-life cognitive abilities as a function of childhood social class. We used data from nine testing occasions spanning 28 y in the Swedish Adoption/Twin Study of Aging and parental social class based on the Swedish socioeconomic index. Cognitive ability included a general factor and the four domains of verbal, fluid, memory, and perceptual speed. Latent growth curve models of the longitudinal data tested whether level and change in cognitive performance differed as a function of childhood social class. Between-within twin-pair analyses were performed on twins reared apart to assess familial confounding. Childhood social class was significantly associated with mean-level cognitive performance at age 65 y, but not with rate of cognitive change. The association decreased in magnitude but remained significant after adjustments for level of education and the degree to which the rearing family was supportive toward education. A between-pair effect of childhood social class was significant in all cognitive domains, whereas within-pair estimates were attenuated, indicating genetic confounding. Thus, childhood social class is important for cognitive performance in adulthood on a population level, but the association is largely attributable to genetic influences.

  • 20.
    Ericsson, Malin
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Johansson, Anna L. V.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Cancer Registry of Norway, Oslo, Norway.
    Fors, Stefan
    Aging Research Center, Karolinska Institutet & Stockholm University, Solna, Sweden.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute for Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Life-course socioeconomic differences and social mobility in preventable and non-preventable mortality: a study of Swedish twins2019In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 48, no 5, p. 1701-1709Article in journal (Refereed)
    Abstract [en]

    Background

    Despite advances in life expectancy, low socioeconomic status is associated with a shorter lifespan. This study was conducted to investigate socioeconomic differences in mortality by comparing preventable with non-preventable causes of death in 39 506 participants from the Swedish Twin Registry born before 1935.

    Methods

    Childhood social class, own education, own social class and social mobility were used as separate indicators of socioeconomic status. These data were linked to the Swedish Cause of Death Register. Cause of death was categorized as preventable or non-preventable mortality according to indicators presented in the Avoidable Mortality in the European Union (AMIEHS) atlas. Using Cox proportional hazard models, we tested the association between the socioeconomic measures and all-cause mortality, preventable mortality and non-preventable mortality. Additional co-twin control analyses indicated whether the associations reflected genetic confounding.

    Results

    The social gradient for mortality was most prominent for the adult socioeconomic measures. There was a social gradient in both preventable mortality and non-preventable mortality, but with an indication of a moderately stronger effect in preventable causes of death. In analyses of social mobility, those who experienced life-time low socioeconomic status (SES) or downward social mobility had an increased mortality risk compared with those with life-time high SES and upward social mobility. Adjustments for genetic confounding did not change the observed associations for education, social class or social mobility and mortality. In the co-twin control analyses of reared-apart twins, the association between childhood social class and mortality weakened, indicating possible genetic influences on this association.

    Conclusions

    Our results indicate that there is an association between low adult socioeconomic status and increased mortality independent of genetic endowment. Thus, we do not find support for indirect social selection as the basis for mortality inequalities in Sweden

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  • 21.
    Finkel, Deborah
    et al.
    Department of Psychology, Indiana University Southeast, New Albany, Indiana ; Institute of Gerontology and Aging Research Network-Jönköping (ARN-J), Jönköping University, Sweden.
    Zavala, Catalina
    Department of Psychology, University of Southern California, Los Angeles, California.
    Franz, Carol E.
    Department of Psychology, University of California, San Diego, California.
    Pahlen, Shandell
    Department of Psychology, University of California, Riverside, California.
    Gatz, Margaret
    Center for Economic and Social Research, University of Southern California, Los Angeles, California.
    Pedersen, Nancy L.
    Department of Psychology, University of Southern California, Los Angeles, California ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Finch, Brian K.
    Department of Sociology and Spatial Sciences, University of Southern California, Los Angeles, California.
    Dahl Aslan, Anna K.
    Institute of Gerontology and Aging Research Network-Jönköping (ARN-J), Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Catts, Vibeke S.
    Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, Australia.
    Ericsson, Malin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Krueger, Robert F.
    Department of Psychology, University of Minnesota, Minneapolis, Minnesota.
    Martin, Nicholas G.
    Genetic Epidemiology, QIMR Berghofer Medical Research Institute, Brisbane, Australia.
    Mohan, Adith
    Centre for Healthy Brain Ageing, School of Psychiatry, Faculty of Medicine, UNSW Sydney, Kensington, Australia.
    Mosing, Miriam A.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden ; Melbourne School of Psychological Sciences, University of Melbourne, Australia.
    Prescott, Carol A.
    Department of Psychology, University of Southern California, Los Angeles, California.
    Whitfield, Keith E.
    Department of Psychology, University of Nevada Las Vegas, Las Vegas, Nevada.
    Financial strain moderates genetic influences on self-rated health: support for diathesis–stress model of gene–environment interplay2022In: Biodemography and Social Biology, ISSN 1948-5565, E-ISSN 1948-5573, Vol. 67, no 1, p. 58-70Article in journal (Refereed)
    Abstract [en]

    Data from the Interplay of Genes and Environment across Multiple Studies (IGEMS) consortium were used to examine predictions of different models of gene-by-environment interaction to understand how genetic variance in self-rated health (SRH) varies at different levels of financial strain. A total of 11,359 individuals from 10 twin studies in Australia, Sweden, and the United States contributed relevant data, including 2,074 monozygotic and 2,623 dizygotic twin pairs. Age ranged from 22 to 98 years, with a mean age of 61.05 (SD = 13.24). A factor model was used to create a harmonized measure of financial strain across studies and items. Twin analyses of genetic and environmental variance for SRH incorporating age, age2, sex, and financial strain moderators indicated significant financial strain moderation of genetic influences on self-rated health. Moderation results did not differ across sex or country. Genetic variance for SRH increased as financial strain increased, matching the predictions of the diathesis–stress and social comparison models for components of variance. Under these models, environmental improvements would be expected to reduce genetically based health disparities.

  • 22.
    Hallgren, Jenny
    et al.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Risk factors for hospital readmission among Swedish older adults2018In: European Geriatric Medicine, ISSN 1878-7649, E-ISSN 1878-7657, Vol. 9, no 5, p. 603-611Article in journal (Refereed)
    Abstract [en]

    Introduction 

    Hospital readmissions of older persons are common and often associated with complex health problems. The objectives were to analyze risk factors for readmission within 30 days from hospital discharge.

    Methods

    A prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/ Twin Study of Aging (SATSA) was conducted. During 9 years of follow-up, information on hospitalizations, readmissions and associated diagnoses were obtained from national registers. Logistic regression models controlling for age and sex were conducted to analyze risk factors for readmissions.

    Results

    Of the 772 participants, [mean age 69.7 (±11.1), 84 (63%)] were hospitalized and among these 208 (43%) had one or several readmissions within 30 days during the follow-up period. Most of the readmissions (57%) occurred within the frst week; mean days from hospital discharge to readmission was 7.9 (±6.2). The most common causes of admission and readmission were cardiovascular diseases and tumors. Only 8% of the readmissions were regarded as avoidable admissions. In a multivariate logistic regression, falling within the last 12 months (OR 0.57, p=0.039) and being a male (OR 1.84, p=0.006) increased the risk of readmission.

    Conclusions

    Most older persons that are readmitted return to hospital within the frst week after discharge. Experiencing a fall was a particular risk factor of readmission. Preventive actions should preferably take place already at the hospital to reduce the numbers of readmission. Still, it should be remembered that most readmissions were considered to be necessary.

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  • 23.
    Hallgren, Jenny
    et al.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Ernsth Bravell, Marie
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Josephson, Iréne
    Region Jönköping County, Jönköping, Sweden ; The Jönköping Academy for Improvement of Health and Welfare, School of Health Sciences, Jönköping University, Sweden.
    In Hospital We Trust: Experiences of older peoples' decision to seek hospital care2015In: Geriatric Nursing, ISSN 0197-4572, E-ISSN 1528-3984, Vol. 36, no 4, p. 306-311Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to explore how older people experience and perceive decisions to seek hospital care while receiving home health care. Twenty-two Swedish older persons were interviewed about their experiences of decision to seek hospital while receiving home health care. The interviews were analyzed using qualitative content analysis. The findings consist of one interpretative theme describing an overall confidence in hospital staff to deliver both medical and psychosocial health care, In Hospital We Trust, with three underlying categories: Superior Health Care, People's Worries, and Biomedical Needs. Findings indicate a need for establishing confidence and ensuring sufficient qualifications, both medical and psychological, in home health care staff to meet the needs of older people. Understanding older peoples' arguments for seeking hospital care may have implications for how home care staff address individuals' perceived needs. Fulfillment of perceived health needs may reduce avoidable hospitalizations and consequently improve quality of life.

  • 24.
    Hallgren, Jenny
    et al.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Regional Development Council of Jönköping County, Sweden.
    Ernsth Bravell, Marie
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Mölstad, Sigvard
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Östgren, Carl Johan
    Department of Medical and Health Sciences, Linköping University, Sweden.
    Midlöv, Patrik
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Factors associated with increased hospitalisation risk among nursing home residents in Sweden: a prospective study with a three-year follow-up2016In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 11, no 2, p. 130-139Article in journal (Refereed)
    Abstract [en]

    Background

    Hospitalisation of nursing home residents might lead to deteriorating health.

    Aim

    To evaluate physical and psychological factors associated with hospitalisation risk among nursing home residents.DesignProspective study with three years of follow-up.

    Methods

    Four hundred and twenty-nine Swedish nursing home residents, ages 65–101 years, from 11 nursing homes in three municipalities were followed during three years. The participants' physical and psychological status was assessed at baseline. A Cox proportional hazards model was used to evaluate factors associated with hospitalisation risk using STATA.

    Results

    Of the 429 participants, 196 (45.7%) were hospitalised at least once during the three-year follow-up period, and 109 (25.4%) during the first six months of the study. The most common causes of hospitalisation were cardiovascular diseases or complications due to falls. A Cox regression model showed that residents who have had previous falls (P < 0.001), are malnourished (P < 0.001), use a greater number of drugs (P < 0.001) and have more diseases (P < 0.001), are at an increased risk of hospitalisation.

    Conclusion

    Nursing home residents are frequently hospitalised, often due to falls or cardiovascular diseases. Study results underscore the relationships between malnutrition, previous falls, greater numbers of drugs and diseases and higher risk of hospitalisation.

    Implications for practice

    Preventive interventions aimed at malnutrition and falls at the nursing home could potentially reduce the number of hospitalisations. With improved education and support to nurses concerning risk assessment at the nursing homes, it may be possible to reduce the numbers of avoidable hospitalisation among nursing home residents and in the long run improve quality of life and reduce suffering.

  • 25.
    Hallgren, Jenny
    et al.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Fransson, Eleonor I.
    Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kåreholt, Ingemar
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of Southern California, Riverside, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Factors associated with hospitalization risk among community living middle aged and older persons: Results from the Swedish Adoption/Twin Study of Aging (SATSA)2016In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 66, p. 102-108Article in journal (Refereed)
    Abstract [en]

    The aims of the present study were to: (1) describe and compare individual characteristics of hospitalized and not hospitalized community living persons, and (2) to determine factors that are associated with hospitalization risk over time. We conducted a prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA). A total of 772 Swedes (mean age at baseline 69.7 years, range 46–103, 59.8% females) answered a postal questionnaire about physical and psychological health, personality and socioeconomic factors. During nine years of follow-up, information on hospitalizations and associated diagnoses were obtained from national registers. Results show that 484 persons (63%) had at least one hospital admission during the follow-up period. The most common causes of admission were cardiovascular diseases (25%) and tumors (22%). Cox proportional hazard regression models controlling for age, sex and dependency within twin pairs, showed that higher age (HR = 1.02, p < 0.001) and more support from relatives (HR = 1.09, p = 0.028) were associated with increased risk of hospitalization, while marital status (unmarried (HR = 0.75, p = 0.033) and widow/widower (HR = 0.69, p < 0.001)) and support from friends (HR = 0.93, p = 0.029) were associated with lower risk of hospitalization. Social factors were important for hospitalization risk even when medical factors were controlled for in the analyses. Number of diseases was not a risk in the final regression model. Hospitalization risk was also different for women and men and within different age groups. We believe that these results might be used in future interventions targeting health care utilization.

  • 26.
    Hallgren, Jenny
    et al.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden.
    Fransson, Eleonor I.
    Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Sweden ; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, USA.
    Finkel, Deborah
    School of Social Sciences, Indiana University Southeast, New Albany, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cognitive trajectories in relation to hospitalization among older Swedish adults2018In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 74, p. 9-14Article in journal (Refereed)
    Abstract [en]

    Introduction

    Research indicate that cognitive impairment might be related to hospitalization, but little is known about these effects over time.

    Objective

    To assess cognitive change before and after hospitalization among older adults in a population-based longitudinal study with up to 25 years of follow-up.

    Method

    A longitudinal study on 828 community living men and women aged 50–86 from the Swedish Adoption/Twin Study of Ageing (SATSA) were linked to The Swedish National Inpatient Register. Up to 8 assessments of cognitive performance (general cognitive ability, verbal, spatial/fluid, memory, and processing speed) from 1986 to 2010 were available. Latent growth curve modelling was used to assess the association between cognitive performance and hospitalization including spline models to analyse cognitive trajectories pre- and post-hospitalization.

    Results

    A total of 735 persons (89%) had at least one hospital admission during the follow-up. Mean age at first hospitalization was 70.2 (±9.3) years. Persons who were hospitalized exhibited a lower mean level of cognitive performance in general ability, processing speed and spatial/fluid ability compared with those who were not hospitalized. The two-slope models revealed steeper cognitive decline before hospitalization than after among those with at least one hospitalization event, as compared to non-hospitalized persons who showed steeper cognitive decline after the centering age of 70 years.

    Conclusions

    Persons being hospitalized in late life have lower cognitive performance across all assessed domains. The results indicate that the main decline occurs before the hospitalization, and not after. This might indicate that when you get treatment you also benefit cognitively.

  • 27.
    Hovlin, Lina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Jönköping, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Mutual trust is a prerequisite for nurses’ sense of safety and work satisfaction – Mobile Integrated Care Model: A qualitative interview study2023In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 43, no 1, p. 1-8Article in journal (Refereed)
    Abstract [en]

    An increasing number of older persons have complex health care needs. This, along with the organizational principle of remaining at home, emphasizes the need to develop collaborations among organizations caring for older persons. A health care model developed in Sweden, the Mobile Integrated Care Model aims to promote work in teams across organizations. The aim of the study was to describe nurses’ experiences in working and providing health care in the Mobile Integrated Care Model in the home with home health care physicians. Semi-structured interviews were conducted with 18 nurses and analyzed through qualitative content analysis. The method was compliant with the COREQ checklist. A mutually trusting collaboration with physicians, which formed person-centered care, created work satisfaction for the nurses. Working within the Mobile Integrated Care Model was negatively impacted by being employed by different organizations, lack of time to provide health care, and physicians’ person-centered work abilities.

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  • 28.
    Hovlin, Lina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden.
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA.
    The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study2022In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 22, no 1, article id 554Article in journal (Refereed)
    Abstract [en]

    Background: An increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person’s home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care.

    Methods: A phenomenographic qualitative study design, with semi-structured interviews using an interview guide.

    Results: Working within Mobile Integrated Care Model was a different way of working as a physician. The physicians’ role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients’ homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making.

    Conclusions: The home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other’s medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model. 

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  • 29.
    Jelenkovic, Aline
    et al.
    Department of Social Research, University of Helsinki, Finland ; Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country, Leioa, Spain.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network - Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Silventoinen, Karri
    Department of Social Research, University of Helsinki, Finland ; Osaka University Graduate School of Medicine, Osaka University, Japan.
    Genetic and environmental influences on adult human height across birth cohorts from 1886 to 19942016In: eLIFE, E-ISSN 2050-084X, Vol. 5, article id e20320Article in journal (Refereed)
    Abstract [en]

    Human height variation is determined by genetic and environmental factors, but it remains unclear whether their influences differ across birth-year cohorts. We conducted an individual-based pooled analysis of 40 twin cohorts including 143,390 complete twin pairs born 1886–1994. Although genetic variance showed a generally increasing trend across the birth-year cohorts, heritability estimates (0.69-0.84 in men and 0.53-0.78 in women) did not present any clear pattern of secular changes. Comparing geographic-cultural regions (Europe, North America and Australia, and East Asia), total height variance was greatest in North America and Australia and lowest in East Asia, but no clear pattern in the heritability estimates across the birth-year cohorts emerged. Our findings do not support the hypothesis that heritability of height is lower in populations with low living standards than in affluent populations, nor that heritability of height will increase within a population as living standards improve.

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  • 30.
    Jelenkovic, Aline
    et al.
    Department of Social Research, University of Helsinki, Finland ; Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, Leioa, Spain.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology, School of Health Sciences, Jönköping University, Sweden.
    Silventoinen, Karri
    Department of Social Research, University of Helsinki, Finland ; Osaka University Graduate School of Medicine, Osaka University, Japan.
    Zygosity Differences in Height and Body Mass Index of Twins From Infancy to Old Age: A Study of the CODATwins Project2015In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 18, no 5, p. 557-570Article in journal (Refereed)
    Abstract [en]

    A trend toward greater body size in dizygotic (DZ) than in monozygotic (MZ) twins has been suggested by some but not all studies, and this difference may also vary by age. We analyzed zygosity differences in mean values and variances of height and body mass index (BMI) among male and female twins from infancy to old age. Data were derived from an international database of 54 twin cohorts participating in the COllaborative project of Development of Anthropometrical measures in Twins (CODATwins), and included 842,951 height and BMI measurements from twins aged 1 to 102 years. The results showed that DZ twins were consistently taller than MZ twins, with differences of up to 2.0 cm in childhood and adolescence and up to 0.9 cm in adulthood. Similarly, a greater mean BMI of up to 0.3 kg/m2 in childhood and adolescence and up to 0.2 kg/m2 in adulthood was observed in DZ twins, although the pattern was less consistent. DZ twins presented up to 1.7% greater height and 1.9% greater BMI than MZ twins; these percentage differences were largest in middle and late childhood and decreased with age in both sexes. The variance of height was similar in MZ and DZ twins at most ages. In contrast, the variance of BMI was significantly higher in DZ than in MZ twins, particularly in childhood. In conclusion, DZ twins were generally taller and had greater BMI than MZ twins, but the differences decreased with age in both sexes.

  • 31.
    Johansson, Linda
    et al.
    Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Finkel, Deborah
    Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden / Department of Psychology, Indiana University Southeast, New Albany, IN, United States.
    Lannering, Christina
    Region Jönköping County, Futurum, Ryhov, Jönköping, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden / Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Andersson-Gäre, Boel
    Region Jönköping County, Futurum, Ryhov, Jönköping, Sweden / Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Sweden.
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Lindmark, Ulrika
    Department of Natural Science and Biomedicine, School of Health and Welfare, Centre for Oral Health and Aging Research Network – Jönköping (ARN-J), Jönköping University, Sweden.
    Bravell, Marie E.
    Institute of Gerontology, Aging Research Network – Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Using aggregated data from Swedish national quality registries as tools to describe health conditions of older adults with complex needs2021In: Aging Clinical and Experimental Research, ISSN 1594-0667, E-ISSN 1720-8319, Vol. 33, no 5, p. 1297-1306Article in journal (Refereed)
    Abstract [en]

    Background: Combining National Quality Registries (NQRs) with existing National Health Registries (NHRs) might make it possible to get a wider picture of older adults health situation. The aim was to examine the feasibility of aggregating data across different NQRs and existing NHRs to explore the possibility to investigate trajectories and patterns of disease and care, specifically for the most ill older adults. Method: A Swedish twin population (N = 44,816) was linked to nine NQRs and four NHRs. A descriptive mixed-method study was performed. A manifest content analysis identified which health parameters were collected from each NQR. Factor analysis identified patterns in representation across NQRs. Two case studies illustrated individual trajectories of care by using NQRs and NHRs. Results: About 36% of the population was registered in one or more NQRs. NQRs included 1849 variables that were sorted into 13 categories with extensive overlap across the NQRs. Health and function variables were identified, but few social or cognitive variables. Even though most individuals demonstrated unique patterns of multi-morbidities, factor analysis identified three clusters of representation in the NQRs with sufficient sample sizes for future investigations. The two cases illustrated the possibility of following patterns of disease and trajectories of care. Conclusions: NQRs seem to be a significant source for collecting data about a population that may be underrepresented in most research on aging because of their age and poor health. However, NQRs are primarily disease related, and further development of the registries to maximize coverage and utility is needed. 

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  • 32.
    Karlsson, Ida K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Ericsson, Malin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Wang, Yunzhang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hägg, Sara
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, United States.
    Epigenome-wide association study of level and change in cognitive abilities from midlife through late life2021In: Clinical Epigenetics, ISSN 1868-7075, Vol. 13, no 1, article id 85Article in journal (Refereed)
    Abstract [en]

    Background: Epigenetic mechanisms are important in aging and may be involved in late-life changes in cognitive abilities. We conducted an epigenome-wide association study of leukocyte DNA methylation in relation to level and change in cognitive abilities, from midlife through late life in 535 Swedish twins. Results: Methylation levels were measured with the Infinium Human Methylation 450 K or Infinium MethylationEPIC array, and all sites passing quality control on both arrays were selected for analysis (n = 250,816). Empirical Bayes estimates of individual intercept (age 65), linear, and quadratic change were obtained from latent growth curve models of cognitive traits and used as outcomes in linear regression models. Significant sites (p &lt; 2.4 × 10–7) were followed up in between-within twin pair models adjusting for familial confounding and full-growth modeling. We identified six significant associations between DNA methylation and level of cognitive abilities at age 65: cg18064256 (PPP1R13L) with processing speed and spatial ability; cg04549090 (NRXN3) with spatial ability; cg09988380 (POGZ), cg25651129 (-), and cg08011941 (ENTPD8) with working memory. The genes are involved in neuroinflammation, neuropsychiatric disorders, and ATP metabolism. Within-pair associations were approximately half that of between-pair associations across all sites. In full-growth curve models, associations between DNA methylation and cognitive level at age 65 were of small effect sizes, and associations between DNA methylation and longitudinal change in cognitive abilities of very small effect sizes. Conclusions: Leukocyte DNA methylation was associated with level, but not change in cognitive abilities. The associations were substantially attenuated in within-pair analyses, indicating they are influenced in part by genetic factors. 

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  • 33.
    Karlsson, Ida K.
    et al.
    Institute of Gerontology and Aging Research Network—Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ericsson, Malin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Wang, Yunzhang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hägg, Sara
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, CA, USA.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, CA, USA.
    Dahl Aslan, Anna K.
    Institute of Gerontology and Aging Research Network—Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Replicating associations between DNA methylation and body mass index in a longitudinal sample of older twins2020In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497, Vol. 44, no 6, p. 1397-1405Article in journal (Refereed)
    Abstract [en]

    Background:

    There is an important interplay between epigenetic factors and body weight, and previous work has identified ten sites where DNA methylation is robustly associated with body mass index (BMI) cross-sectionally. However, interpretation of the associations is complicated by the substantial changes in BMI often occurring in late-life, and the fact that methylation is often driven by genetic variation. This study therefore investigated the longitudinal association between these ten sites and BMI from midlife to late-life, and whether associations persist after controlling for genetic factors.

    Methods:

    We used data from 535 individuals (mean age 68) in the Swedish Adoption/Twin Study of Aging (SATSA) with longitudinal measures of both DNA methylation from blood samples and BMI, spanning up to 20 years. Methylation levels were measured with the Infinium Human Methylation 450K or Infinium MethylationEpic array, with seven of the ten sites passing quality control. Latent growth curve models were applied to investigate longitudinal associations between methylation and BMI, and between–within models to study associations within twin pairs, thus adjusting for genetic factors.

    Results:

    Baseline DNA methylation levels at five of the seven sites were associated with BMI level at age 65 (cg00574958 [CPT1A]; cg11024682 [SREBF1]), and/or change (cg06192883 [MYO5C]; cg06946797 [RMI2]; cg08857797 [VPS25]). For four of the five sites, the associations remained comparable within twin pairs. However, the effects of cg06192883 were substantially attenuated within pairs. No change in DNA methylation was detected for any of the seven evaluated sites.

    Conclusion:

    Five of the seven sites investigated were associated with late-life level and/or change in BMI. The effects for four of the sites remained similar when examined within twin pairs, indicating that the associations are mainly environmentally driven. However, the substantial attenuation in the association between cg06192883 and late-life BMI within pairs points to the importance of genetic factors in this association.

  • 34.
    Karlsson, Ida K.
    et al.
    Institute of Gerontology and Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA.
    Arpawong, Thalida Em
    Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Institute of Gerontology and Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    The dynamic association between body mass index and cognition from midlife through late-life, and the effect of sex and genetic influences2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1Article in journal (Refereed)
    Abstract [en]

    Body mass index (BMI) is associated with cognitive abilities, but the nature of the relationship remains largely unexplored. We aimed to investigate the bidirectional relationship from midlife through late-life, while considering sex differences and genetic predisposition to higher BMI. We used data from 23,892 individuals of European ancestry from the Health and Retirement Study, with longitudinal data on BMI and three established cognitive indices: mental status, episodic memory, and their sum, called total cognition. To investigate the dynamic relationship between BMI and cognitive abilities, we applied dual change score models of change from age 50 through 89, with a breakpoint at age 65 or 70. Models were further stratified by sex and genetic predisposition to higher BMI using tertiles of a polygenic score for BMI (PGSBMI). We demonstrated bidirectional effects between BMI and all three cognitive indices, with higher BMI contributing to steeper decline in cognitive abilities in both midlife and late-life, and higher cognitive abilities contributing to less decline in BMI in late-life. The effects of BMI on change in cognitive abilities were more evident in men compared to women, and among those in the lowest tertile of the PGSBMI compared to those in the highest tertile, while the effects of cognition on BMI were similar across groups. In conclusion, these findings highlight a reciprocal relationship between BMI and cognitive abilities, indicating that the negative effects of a higher BMI persist from midlife through late-life, and that weight-loss in late-life may be driven by cognitive decline.

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  • 35.
    Karlsson, Ida K.
    et al.
    Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lehto, Kelli
    National Institute for Health Development, Tallinn, Estonia ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Psychology, University of Southern California, Los Angeles, CA, United States ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Dahl Aslan, Anna K.
    Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Age-dependent effects of body mass index across the adult life span on the risk of dementia: A cohort study with a genetic approach2020In: BMC Medicine, E-ISSN 1741-7015, Vol. 18, no 1, article id 131Article in journal (Refereed)
    Abstract [en]

    Background: While a high body mass index (BMI) in midlife is associated with higher risk of dementia, high BMI in late-life may be associated with lower risk. This study combined genetic designs with longitudinal data to achieve a better understanding of this paradox. Methods: We used longitudinal data from 22,156 individuals in the Swedish Twin Registry (STR) and 25,698 from the Health and Retirement Study (HRS). The STR sample had information about BMI from early adulthood through late-life, and the HRS sample from age 50 through late-life. Survival analysis was applied to investigate age-specific associations between BMI and dementia risk. To examine if the associations are influenced by genetic susceptibility to higher BMI, an interaction between BMI and a polygenic score for BMI (PGSBMI) was included in the models and results stratified into those with genetic predisposition to low, medium, and higher BMI. In the STR, co-twin control models were applied to adjust for familial factors beyond those captured by the PGSBMI. Results: At age 35-49, 5 units higher BMI was associated with 15% (95% CI 7-24%) higher risk of dementia in the STR. There was a significant interaction (p = 0.04) between BMI and the PGSBMI, and the association present only among those with genetic predisposition to low BMI (HR 1.38, 95% CI 1.08-1.78). Co-twin control analyses indicated genetic influences. After age 80, 5 units higher BMI was associated with 10-11% lower risk of dementia in both samples. There was a significant interaction between late-life BMI and the PGSBMI in the STR (p = 0.01), but not the HRS, with the inverse association present only among those with a high PGSBMI (HR 0.70, 95% CI 0.52-0.94). No genetic influences were evident from co-twin control models of late-life BMI. Conclusions: Not only does the association between BMI and dementia differ depending on age at BMI measurement, but also the effect of genetic influences. In STR, the associations were only present among those with a BMI in opposite direction of their genetic predisposition, indicating that the association between BMI and dementia across the life course might be driven by environmental factors and hence likely modifiable. © 2020 The Author(s).

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  • 36.
    Karlsson, Ida K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network–Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Zhan, Yiqiang
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Center for Economic and Social Research, University of Southern California, Los Angeles, California, USA.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, California, USA.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network–Jönköping(ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Change in cognition and body mass index in relation to preclinical dementia2021In: Alzheimer’s & Dementia: Translational Research & Clinical Interventions, E-ISSN 2352-8737, Vol. 7, no 1, article id e12176Article in journal (Refereed)
    Abstract [en]

    Introduction: To study if declining cognition drives weight loss in preclinical dementia, we examined the longitudinal association between body mass index (BMI) and cognitive abilities in individuals who did or did not later develop dementia.

    Methods: Using data from individuals spanning age 50 to 89, we applied dual change score models separately in individuals who remained cognitively intact (n = 1498) and those who were diagnosed with dementia within 5 years of last assessment (n = 459).

    Results: Among the cognitively intact, there was a bidirectional association: Stable BMI predicted stable cognition and vice versa. Among individuals who were subsequently diagnosed with dementia, the association was unidirectional: Higher BMI predicted declining cognition but cognition did not predict change in BMI.

    Discussion: Although BMI and cognition stabilized each other when cognitive functioning was intact, this buffering effect was missing in the preclinical dementia phase. This finding indicates that weight loss in preclinical dementia is not driven by declining cognition.

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  • 37.
    Karlsson, Ida K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Zhan, Yiqiang
    School of Public Health, Sun Yat-Sen University, Shenzhen, China.
    Wang, Yunzhang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Li, Xia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hägg, Sara
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Center for Economic and Social Research, University of Southern California, Los Angeles, United States.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, United States.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Adiposity and the risk of dementia: mediating effects from inflammation and lipid levels2022In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 37, no 12, p. 1261-1271Article in journal (Refereed)
    Abstract [en]

    While midlife adiposity is a risk factor for dementia, adiposity in late-life appears to be associated with lower risk. What drives the associations is poorly understood, especially the inverse association in late-life. Using results from genome-wide association studies, we identified inflammation and lipid metabolism as biological pathways involved in both adiposity and dementia. To test if these factors mediate the effect of midlife and/or late-life adiposity on dementia, we then used cohort data from the Swedish Twin Registry, with measures of adiposity and potential mediators taken in midlife (age 40–64, n = 5999) or late-life (age 65–90, n = 7257). Associations between body-mass index (BMI), waist-hip ratio (WHR), C-reactive protein (CRP), lipid levels, and dementia were tested in survival and mediation analyses. Age was used as the underlying time scale, and sex and education included as covariates in all models. Fasting status was included as a covariate in models of lipids. One standard deviation (SD) higher WHR in midlife was associated with 25% (95% CI 2–52%) higher dementia risk, with slight attenuation when adjusting for BMI. No evidence of mediation through CRP or lipid levels was present. After age 65, one SD higher BMI, but not WHR, was associated with 8% (95% CI 1–14%) lower dementia risk. The association was partly mediated by higher CRP, and suppressed when high-density lipoprotein levels were low. In conclusion, the negative effects of midlife adiposity on dementia risk were driven directly by factors associated with body fat distribution, with no evidence of mediation through inflammation or lipid levels. There was an inverse association between late-life adiposity and dementia risk, especially where the body’s inflammatory response and lipid homeostasis is intact. 

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  • 38.
    Ler, Peggy
    et al.
    Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Li, Xia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hassing, Linda B.
    Department of Psychology and Centre for Ageing and Health, University of Gothenburg, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, University of California - Riverside, CA, USA.
    Finkel, Deborah
    Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Psychology, Indiana University Southeast, New Albany, IN, United States.
    Karlsson, Ida K.
    Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Aging Research Network-Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Independent and joint effects of body mass index and metabolic health in mid- and late-life on all-cause mortality: a cohort study from the Swedish Twin Registry with a mean follow-up of 13 Years2022In: BMC Public Health, E-ISSN 1471-2458, Vol. 22, no 1, article id 718Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is robust evidence that in midlife, higher body mass index (BMI) and metabolic syndrome (MetS), which often co-exist, are associated with increased mortality risk. However, late-life findings are inconclusive, and few studies have examined how metabolic health status (MHS) affects the BMI-mortality association in different age categories. We, therefore, aimed to investigate how mid- and late-life BMI and MHS interact to affect the risk of mortality. METHODS: This cohort study included 12,467 participants from the Swedish Twin Registry, with height, weight, and MHS measures from 1958-2008 and mortality data linked through 2020. We applied Cox proportional hazard regression with age as a timescale to examine how BMI categories (normal weight, overweight, obesity) and MHS (identification of MetS determined by presence/absence of hypertension, hyperglycemia, low HDL, hypertriglyceridemia), independently and in interaction, are associated with the risk of all-cause mortality. Models were adjusted for sex, education, smoking, and cardiovascular disease. RESULTS: The midlife group included 6,252 participants with a mean age of 59.6 years (range = 44.9-65.0) and 44.1% women. The late-life group included 6,215 participants with mean age 73.1 years (65.1-95.3) and 46.6% women. In independent effect models, metabolically unhealthy status in midlife increased mortality risks by 31% [hazard ratio 1.31; 95% confidence interval 1.12-1.53] and in late-life, by 18% (1.18;1.10-1.26) relative to metabolically healthy individuals. Midlife obesity increased the mortality risks by 30% (1.30;1.06-1.60) and late-life obesity by 15% (1.15; 1.04-1.27) relative to normal weight. In joint models, the BMI estimates were attenuated while those of MHS were less affected. Models including BMI-MHS categories revealed that, compared to metabolically healthy normal weight, the metabolically unhealthy obesity group had increased mortality risks by 53% (1.53;1.19-1.96) in midlife, and across all BMI categories in late-life (normal weight 1.12; 1.01-1.25, overweight 1.10;1.01-1.21, obesity 1.31;1.15-1.49). Mortality risk was decreased by 9% (0.91; 0.83-0.99) among those with metabolically healthy overweight in late-life. CONCLUSIONS: MHS strongly influenced the BMI-mortality association, such that individuals who were metabolically healthy with overweight or obesity in mid- or late-life did not carry excess risks of mortality. Being metabolically unhealthy had a higher risk of mortality independent of their BMI. 

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  • 39.
    Ler, Peggy
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Ojalehto, Elsa
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Zhan, Yiqiang
    School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China.
    Finkel, Deborah
    Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States ; School of Health and Welfare, Jönkoping University, Sweden.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Karlsson, Ida K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Conversions between metabolically unhealthy and healthy obesity from midlife to late-life2023In: International Journal of Obesity, ISSN 0307-0565, E-ISSN 1476-5497Article in journal (Refereed)
    Abstract [en]

    Introduction: Metabolically healthy obesity may be a transient phenotype, but studies with long follow-up, especially covering late-life, are lacking. We describe conversions between cross-categories of body mass index (BMI) and metabolic health in 786 Swedish twins with up to 27 years of follow-up, from midlife to late-life. Methods: Metabolic health was defined as the absence of metabolic syndrome (MetS). We first visualized conversions between BMI-metabolic health phenotypes in 100 individuals with measurements available at ages 50–64, 65–79, and ≥80. Next, we modeled conversion in metabolic health status by BMI category in the full sample using Cox proportional hazards regression. Results: The proportion of individuals with MetS and with overweight or obesity increased with age. However, one-fifth maintained a metabolically healthy overweight or obesity across all three age categories. Among those metabolically healthy at baseline, 59% converted to MetS during follow-up. Conversions occurred 56% more often among individuals with metabolically healthy obesity, but not overweight, compared to normal weight. Among those with MetS at baseline, 60% regained metabolic health during follow-up, with no difference between BMI categories. Conclusions: Conversions between metabolically healthy and unhealthy status occurred in both directions in all BMI categories. While conversions to MetS were more common among individuals with obesity, many individuals maintained or regained metabolic health during follow-up. 

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  • 40.
    Ler, Peggy
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Stockholm, Sweden.
    Ploner, Alexander
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Stockholm, Sweden.
    Finkel, Deborah
    Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States ; Institute of Gerontology, Jönköping University, Sweden.
    Reynolds, Chandra A.
    Institute for Behavioral Genetics, University of Colorado Boulder, United States.
    Zhan, Yiqiang
    School of Public Health, Sun Yat-Sen University, Shenzhen Campus, Guandong, Shenzhen, China.
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Stockholm, Sweden ; Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, University of Tampere, Finland.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Karlsson, Ida K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Stockholm, Sweden.
    Interplay of body mass index and metabolic syndrome: association with physiological age from midlife to late-life2024In: GeroScience, ISSN 2509-2715, Vol. 46, no 2, p. 2605-2617Article in journal (Refereed)
    Abstract [en]

    Obesity and metabolic syndrome (MetS) share common pathophysiological characteristics with aging. To better understand their interplay, we examined how body mass index (BMI) and MetS jointly associate with physiological age, and if the associations changed from midlife to late-life. We used longitudinal data from 1,825 Swedish twins. Physiological age was measured as frailty index (FI) and functional aging index (FAI) and modeled independently in linear mixed-effects models adjusted for chronological age, sex, education, and smoking. We assessed curvilinear associations of BMI and chronological age with physiological age, and interactions between BMI, MetS, and chronological age. We found a significant three-way interaction between BMI, MetS, and chronological age on FI (p-interaction = 0·006), not FAI. Consequently, we stratified FI analyses by age: < 65, 65–85, and ≥ 85 years, and modeled FAI across ages. Except for FI at ages ≥ 85, BMI had U-shaped associations with FI and FAI, where BMI around 26-28 kg/m2 was associated with the lowest physiological age. MetS was associated with higher FI and FAI, except for FI at ages < 65, and modified the BMI-FI association at ages 65–85 (p-interaction = 0·02), whereby the association between higher BMI levels and FI was stronger in individuals with MetS. Age modified the MetS-FI association in ages ≥ 85, such that it was stronger at higher ages (p-interaction = 0·01). Low BMI, high BMI, and metabolic syndrome were associated with higher physiological age, contributing to overall health status among older individuals and potentially accelerating aging. 

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  • 41.
    Marseglia, Anna
    et al.
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fratiglioni, Laura
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden ; Stockholm Gerontology Research Center, Sweden.
    Santoni, Giola
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, California.
    Xu, Weili
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden ; Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, China.
    Cognitive Trajectories of Older Adults With Prediabetes and Diabetes: A Population-Based Cohort Study2018In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 73, no 3, p. 400-406Article in journal (Refereed)
    Abstract [en]

    Background Diabetes has been linked to dementia risk; however, the cognitive trajectories in older adults with diabetes remain unclear. We aimed to investigate the effect of prediabetes and diabetes on cognitive trajectories among cognitively intact older adults in a long-term follow-up study.

    Methods Within the Swedish Adoption/Twin Study of Aging, 793 cognitively intact older adults aged ≥50 were identified at baseline and followed for up to 23 years. Based on standardized scores from 11 cognitive tests, administered at baseline and up to seven follow-ups, four cognitive domains (verbal abilities, spatial/fluid, memory, perceptual speed) were identified by principal-component analysis. Prediabetes was defined according to blood glucose levels in diabetes-free participants. Diabetes was ascertained based on self-report, hypoglycemic medication use and blood glucose levels. Data were analyzed with linear mixed-effect models adjusting for potential confounders.

    Results At baseline, 68 participants (8.6%) had prediabetes and 45 (5.7%) had diabetes. Compared to diabetes-free individuals, people with diabetes had a steeper decline over time in perceptual speed and verbal abilities. The annual declines in these domains were greater than the annual decline in memory. Prediabetes was associated with lower performance in memory in middle-age, but also associated with a less steep memory decline over the follow-up.

    Conclusions Diabetes is associated with a faster decline in perceptual speed and verbal abilities, while prediabetes is associated with lower memory performance in middle-age. However, the detrimental effects of hyperglycemia seem to not affect memory over time.

  • 42.
    Ojalehto, Elsa
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Zhan, Yiqiang
    School of Public Health (Shenzhen), Sun Yat-Sen University, China.
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Faculty of Social Sciences, Unit of Health Sciences and Gerontology Research Center, University of Tampere, Finland.
    Reynolds, Chandra A.
    Department of Psychology, University of California, Riverside, United States.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Karlsson, Ida K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Genetically and environmentally predicted obesity in relation to cardiovascular disease: a nationwide cohort study2023In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 58, article id 101943Article in journal (Refereed)
    Abstract [en]

    Background: Evidence indicates that the adverse health effects of obesity differ between genetically and environmentally influenced obesity. We examined differences in the association between obesity and cardiovascular disease (CVD) between individuals with a genetically predicted low, medium, or high body mass index (BMI). Methods: We used cohort data from Swedish twins born before 1959 who had BMI measured between the ages of 40–64 years (midlife) or at the age of 65 years or later (late-life), or both, and prospective CVD information from nationwide register linkage through 2016. A polygenic score for BMI (PGSBMI) was used to define genetically predicted BMI. Individuals missing BMI or covariate data, or diagnosed with CVD at first BMI measure, were excluded, leaving an analysis sample of 17,988 individuals. We applied Cox proportional hazard models to examine the association between BMI category and incident CVD, stratified by the PGSBMI. Co-twin control models were applied to adjust for genetic influences not captured by the PGSBMI. Findings: Between 1984 and 2010, the 17,988 participants were enrolled in sub-studies of the Swedish Twin Registry. Midlife obesity was associated with a higher risk of CVD across all PGSBMI categories, but the association was stronger with genetically predicted lower BMI (hazard ratio from 1.55 to 2.08 for those with high and low PGSBMI, respectively). Within monozygotic twin pairs, the association did not differ by genetically predicted BMI, indicating genetic confounding not captured by the PGSBMI. Results were similar when obesity was measured in late-life, but suffered from low power. Interpretation: Obesity was associated with CVD regardless of PGSBMI category, but obesity influenced by genetic predisposition (genetically predicted high BMI) was less harmful than obesity influenced by environmental factors (obesity despite genetically predicted low BMI). However, additional genetic factors, not captured by the PGSBMI, still influence the associations. Funding: The Strategic Research Program in Epidemiology at Karolinska Institutet; Loo and Hans Osterman's Foundation; Foundation for Geriatric Diseases at Karolinska Institutet; the Swedish Research Council for Health, Working Life and Welfare; the Swedish Research Council; and the National Institutes of Health. 

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  • 43.
    Pahlen, Shandell
    et al.
    Department of Psychology, University of Minnesota, Minneapolis, United States ; Department of Psychology, University of California Riverside, Riverside, CA, USA.
    Hamdi, Nayla R.
    Department of Psychology, University of Minnesota, Minneapolis, United States.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden ; Jönköping Affiliation to School of Health and Welfare, Jönköping University, Sweden.
    Horwitz, Briana N.
    Department of Psychology, California State University Fullerton, United States.
    Panizzon, Matthew S.
    Department of Psychiatry, University of California San Diego, La Jolla, United States.
    Petersen, Inge
    The Danish Twin Register, The Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.
    Zavala, Catalina
    Department of Psychology, University of California Riverside, Riverside, CA, USA ; Department of Psychology, University of Southern California, Los Angeles, CA, USA.
    Christensen, Kaare
    The Danish Twin Register, The Danish Aging Research Center, University of Southern Denmark, Odense, Denmark.
    Finkel, Deborah G.
    Department of Psychology, Indiana University Southeast, New Albany, IN, USA.
    Franz, Carol E.
    Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, CA, USA.
    Johnson, Wendy Roy
    Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Midlothian, Scotland, UK.
    Kremen, William S.
    Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
    Krueger, Robert Frederick
    Department of Psychology, University of Minnesota, Minneapolis, United States.
    Neiderhiser, Jenaè M.
    Department of Psychology, Penn State University, University Park, PA, USA.
    Reynolds, Chandra A.
    Department of Psychology, University of California Riverside, Riverside, CA, USA.
    Pedersen, Nancy Lee
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, CA, USA.
    McGue, Matt
    Department of Psychology, University of Minnesota, Minneapolis, United States ; The Danish Twin Register, The Danish Aging Research Center, University of Southern Denmark, Odense C, Denmark.
    Age-moderation of genetic and environmental contributions to cognitive functioning in mid- and late-life for specific cognitive abilities2018In: Intelligence, ISSN 0160-2896, E-ISSN 1873-7935, Vol. 68, p. 70-81Article in journal (Refereed)
    Abstract [en]

    Age moderation of genetic and environmental contributions to Digits Forward, Digits Backward, Block Design, Symbol Digit, Vocabulary, and Synonyms was investigated in a sample of 14,534 twins aged 26 to 98 years. The Interplay of Genes and Environment across Multiple Studies (IGEMS) consortium contributed the sample, which represents nine studies from three countries (USA, Denmark, and Sweden). Average test performance was lower in successively older age groups for all tests. Significant age moderation of additive genetic, shared environmental, and non-shared environmental variance components was observed, but the pattern varied by test. The genetic contribution to phenotypic variance across age was smaller for both Digit Span tests, greater for Synonyms, and stable for Block Design and Symbol Digit. The non-shared environmental contribution was greater with age for the Digit Span tests and Block Design, while the shared environmental component was small for all tests, often more so with age. Vocabulary showed similar age-moderation patterns as Synonyms, but these effects were nonsignificant. Findings are discussed in the context of theories of cognitive aging. 

  • 44.
    Pedersen, Nancy L.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gatz, Margaret
    Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States.
    Finch, Brian K.
    Center for Economic and Social Research, University of Southern California, Los Angeles, CA, United States.
    Finkel, Deborah
    Department of Psychology, Indiana University Southeast, New Albany, IN, United States.
    Butler, David A.
    Office of Military and Veterans Health, Health and Medicine Division, National Academies of Sciences, Engineering, and Medicine, Washington, DC, United States.
    Dahl Aslan, Anna
    Institute of Gerontology and Aging Research Network – Jönköping (ARN-J) ; School of Health and Welfare, Jönköping University, Sweden.
    Franz, Carol E.
    Department of Psychiatry, University of California San Diego, San diego, CA, United States.
    Kaprio, Jaakko
    Department of Public Health,Faculty of Medicine, Institute for Molecular Medicine FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.
    Lapham, Susan
    Research and Evaluation, American Institutes for Research, Washington, DC, United States.
    McGue, Matt
    Department of Psychology, University of Minnesota, Minneapolis, MN, USA ; Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark.
    Mosing, Miriam A.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Neiderhiser, Jenae
    Department of Psychology, Penn State University, University Park, PA, United States.
    Nygaard, Marianne
    Danish Twin Registry, University of Southern Denmark, Odense C, Denmark.
    Panizzon, Matthew
    Department of Psychiatry, University of California San Diego, San diego, CA, United States.
    Prescott, Carol A.
    Department of Psychology, University of Southern California, Los Angeles, CA, United States.
    Reynolds, Chandra A.
    Department of Psychology, University of California-Riverside, Riverside, CA, United States.
    Sachdev, Perminder
    Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, NSW, Australia.
    Whitfield, Keith E.
    Department of Psychology, Wayne State University, Detroit, MI, United States.
    IGEMS: The Consortium on Interplay of Genes and Environment Across Multiple Studies - An Update2019In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 22, no 6, p. 809-816Article in journal (Refereed)
    Abstract [en]

    The Interplay of Genes and Environment across Multiple Studies (IGEMS) is a consortium of 18 twin studies from 5 different countries (Sweden, Denmark, Finland, United States, and Australia) established to explore the nature of gene-environment (GE) interplay in functioning across the adult lifespan. Fifteen of the studies are longitudinal, with follow-up as long as 59 years after baseline. The combined data from over 76,000 participants aged 14-103 at intake (including over 10,000 monozygotic and over 17,000 dizygotic twin pairs) support two primary research emphases: (1) investigation of models of GE interplay of early life adversity, and social factors at micro and macro environmental levels and with diverse outcomes, including mortality, physical functioning and psychological functioning; and (2) improved understanding of risk and protective factors for dementia by incorporating unmeasured and measured genetic factors with a wide range of exposures measured in young adulthood, midlife and later life.

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  • 45.
    Piirtola, Maarit
    et al.
    Department of Social Research, University of Helsinki, Finland ; Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network–Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Silventoinen, Karri
    Department of Social Research, University of Helsinki, Finland ; Osaka University Graduate School of Medicine, Osaka University, Japan.
    Association of current and former smoking with body mass index: A study of smoking discordant twin pairs from 21 twin cohorts2018In: PLOS ONE, E-ISSN 1932-6203, Vol. 13, no 7, article id e0200140Article in journal (Refereed)
    Abstract [en]

    Background

    Smokers tend to weigh less than never smokers, while successful quitting leads to an increase in body weight. Because smokers and non-smokers may differ in genetic and environmental family background, we analysed data from twin pairs in which the co-twins differed by their smoking behaviour to evaluate if the association between smoking and body mass index (BMI) remains after controlling for family background.

    Methods and findings

    The international CODATwins database includes information on smoking and BMI measured between 1960 and 2012 from 156,593 twin individuals 18–69 years of age. Individual-based data (230,378 measurements) and data of smoking discordant twin pairs (altogether 30,014 pairwise measurements, 36% from monozygotic [MZ] pairs) were analysed with linear fixed-effects regression models by 10-year periods. In MZ pairs, the smoking co-twin had, on average, 0.57 kg/m2 lower BMI in men (95% confidence interval (CI): 0.49, 0.70) and 0.65 kg/m2 lower BMI in women (95% CI: 0.52, 0.79) than the never smoking co-twin. Former smokers had 0.70 kg/m2 higher BMI among men (95% CI: 0.63, 0.78) and 0.62 kg/m2 higher BMI among women (95% CI: 0.51, 0.73) than their currently smoking MZ co-twins. Little difference in BMI was observed when comparing former smoking co-twins with their never smoking MZ co-twins (0.13 kg/m2, 95% CI 0.04, 0.23 among men; -0.04 kg/m2, 95% CI -0.16, 0.09 among women). The associations were similar within dizygotic pairs and when analysing twins as individuals. The observed series of cross-sectional associations were independent of sex, age, and measurement decade.

    Conclusions

    Smoking is associated with lower BMI and smoking cessation with higher BMI. However, the net effect of smoking and subsequent cessation on weight development appears to be minimal, i.e. never more than an average of 0.7 kg/m2.

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  • 46.
    Raymond, Emma
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Reynolds, Chandra A.
    Department of Psychology, the University of California at Riverside, USA.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden .
    Finkel, Deborah
    Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden ; Department of Psychology, Indiana University Southeast, New Albany, USA.
    Ericsson, Malin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Hägg, Sara
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Jylhävä, Juulia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Drivers of Frailty from Adulthood into Old Age: Results from a 27-Year Longitudinal Population-Based Study in Sweden2020In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 75, no 10, p. 1943-1950Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Frailty is a strong predictor of adverse outcomes. However, longitudinal drivers of frailty are not well understood. This study aimed at investigating the longitudinal trajectories of a frailty index (FI) from adulthood to late life and identifying the factors associated with the level and rate of change in FI. METHODS: An age-based latent growth curve analysis was performed in the Swedish Adoption/Twin Study of Aging (N = 1,842; aged 29-102 years) using data from up to 15 measurement waves across 27 years. A 42-item FI was used to measure frailty at each wave. RESULTS: A bilinear, two-slope model with a turning point at age 65 best described the age-related change in FI, showing that the increase in frailty was more than twice as fast after age 65. Underweight, obesity, female sex, overweight, being separated from one's co-twin during childhood, smoking, poor social support, and low physical activity were associated with a higher FI at age 65, with underweight having the largest effect size. When tested as time-varying covariates, underweight and higher social support were associated with a steeper increase in FI before age 65, whereas overweight and obesity were associated with less steep increase in FI after age 65. CONCLUSIONS: Factors associated with the level and rate of change in frailty are largely actionable and could provide targets for intervention. As deviations from normal weight showed the strongest associations with frailty, future public health programs could benefit from monitoring of individuals with abnormal BMI, especially those who are underweight.

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  • 47.
    Reynolds, Chandra A.
    et al.
    Department of Psychology, University of California Riverside, CA, USA.
    Gatz, Margaret
    Department of Psychology, University of Southern California, Los Angeles, CA, USA ; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Christensen, Kaare
    Epidemiology, Biostatistics and Bio-demography, Institute of Public Health, University of Southern Denmark, Odense C, Denmark ; Department of Clinical Genetics and Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.
    Christiansen, Lene
    Epidemiology, Biostatistics and Bio-demography, Institute of Public Health, University of Southern Denmark, Odense C, Denmark.
    Dahl Aslan, Anna K.
    Institute of Gerontology, School of Health and Welfare, Jönköping University, Sweden ; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Kaprio, Jaakko
    Department of Public Health & Institute for Molecular Medicine FIMM, University of Helsinki, Finland.
    Korhonen, Tellervo
    Department of Public Health, University of Helsinki, Finland ; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
    Kremen, William S.
    Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
    Krueger, Robert
    Department of Psychology, University of Minnesota, Minneapolis, MN, USA .
    McGue, Matt
    Department of Psychology, University of Minnesota, Minneapolis, MN, USA ; Epidemiology, Biostatistics and Bio-demography, Institute of Public Health, University of Southern Denmark, Odense C, Denmark.
    Neiderhiser, Jenae M.
    Department of Psychology, The Pennsylvania State University, University Park, PA, USA.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, CA, USA.
    Gene-Environment Interplay in Physical, Psychological, and Cognitive Domains in Mid to Late Adulthood: Is APOE a Variability Gene?2016In: Behavior Genetics, ISSN 0001-8244, E-ISSN 1573-3297, Vol. 46, no 1, p. 4-19Article in journal (Refereed)
    Abstract [en]

    Despite emerging interest in gene-environment interaction (GxE) effects, there is a dearth of studies evaluating its potential relevance apart from specific hypothesized environments and biometrical variance trends. Using a monozygotic within-pair approach, we evaluated evidence of G×E for body mass index (BMI), depressive symptoms, and cognition (verbal, spatial, attention, working memory, perceptual speed) in twin studies from four countries. We also evaluated whether APOE is a 'variability gene' across these measures and whether it partly represents the 'G' in G×E effects. In all three domains, G×E effects were pervasive across country and gender, with small-to-moderate effects. Age-cohort trends were generally stable for BMI and depressive symptoms; however, they were variable-with both increasing and decreasing age-cohort trends-for different cognitive measures. Results also suggested that APOE may represent a 'variability gene' for depressive symptoms and spatial reasoning, but not for BMI or other cognitive measures. Hence, additional genes are salient beyond APOE.

  • 48.
    Rizzuto, Debora
    et al.
    Department of Neurobiology, Care Sciences and Society, Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden.
    Feldman, Adina L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Karlsson, Ida K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Institute of Gerontology and Aging Research Network – Jönköping (ARN-J), School of Health and Welfare, Jönköping University, Sweden.
    Gatz, Margaret
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, California.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology, University of Southern California, Los Angeles, California.
    Detection of dementia cases in two Swedish health registers: A validation study2018In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 61, no 4, p. 1301-1310Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Population-based health registers are potential assets in epidemiological research; however, the quality of case ascertainment is crucial.

    OBJECTIVE: To compare the case ascertainment of dementia, from the National Patient Register (NPR) and the Cause of Death Register (CDR) with dementia diagnoses from six Swedish population based studies.

    METHODS: Sensitivity, specificity, and positive predictive value (PPV) of dementia identification in NPR and CDR were estimated by individual record linkage with six Swedish population based studies (n = 19,035). Time to detection in NPR was estimated using data on dementia incidence from longitudinal studies with more than two decades of follow-up.

    RESULTS: Barely half of the dementia cases were ever detected by NPR or CDR. Using data from longitudinal studies we estimated that a record with a dementia diagnosis appears in the NPR on average 5.5 years after first diagnosis. Although the ability of the registers to detect dementia cases was moderate, the ability to detect non-dementia cases was almost perfect (99%). When registers indicate that there is a dementia diagnosis, there are very few instances in which the clinicians determined the person was not demented. Indeed, PPVs were close to 90%. However, misclassification between dementia subtype diagnoses is quite common, especially in NPR.

    CONCLUSIONS: Although the overall sensitivity is low, the specificity and the positive predictive value are very high. This suggests that hospital and death registers can be used to identify dementia cases in the community, but at the cost of missing a large proportion of the cases.

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  • 49.
    Seetharaman, Shyam
    et al.
    Department of Psychology. St. Petersburg College. St. Petersburg, Florida.
    Andel, Ross
    School of Aging Studies. University of South Florida. Tampa ; International Clinical Research Center, Brno, Czech Republic.
    McEvoy, Cathy
    School of Aging Studies. University of South Florida. Tampa.
    Dahl Aslan, Anna K.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; School of Health Sciences. Jönköping University, Sweden.
    Finkel, Deborah
    Department of Psychology. Indiana University Southeast, New Albany, Indiana.
    Pedersen, Nancy L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden ; Department of Psychology. University of Southern California. Los Angeles, California.
    Blood glucose, diet-based glycemic load and cognitive aging among dementia-free older adults2015In: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 70, no 4, p. 471-479Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Although evidence indicates that Type II Diabetes is related to abnormal brain aging, the influence of elevated blood glucose on long-term cognitive change is unclear. In addition, the relationship between diet-based glycemic load and cognitive aging has not been extensively studied. The focus of this study was to investigate the influence of diet-based glycemic load and blood glucose on cognitive aging in older adults followed for up to 16 years.

    METHODS: Eight-hundred and thirty-eight cognitively healthy adults aged ≥50 years (M = 63.1, SD = 8.3) from the Swedish Adoption/Twin Study of Aging were studied. Mixed effects growth models were utilized to assess overall performance and change in general cognitive functioning, perceptual speed, memory, verbal ability, and spatial ability as a function of baseline blood glucose and diet-based glycemic load.

    RESULTS: High blood glucose was related to poorer overall performance on perceptual speed as well as greater rates of decline in general cognitive ability, perceptual speed, verbal ability, and spatial ability. Diet-based glycemic load was related to poorer overall performance in perceptual speed and spatial ability.

    CONCLUSION: Diet-based glycemic load and, in particular, elevated blood glucose appear important for cognitive performance/cognitive aging. Blood glucose control (perhaps through low glycemic load diets) may be an important target in the detection and prevention of age-related cognitive decline.

  • 50.
    Silventoinen, K.
    et al.
    Department of Social Research, Department University of Helsinki, Finland ; Center for Twin Research, Osaka University Graduate School of Medicine, Japan.
    Dahl Aslan, Anna K.
    Kaprio, J.
    Department of Public Health, University of Helsinki, Finland ; Institute for Molecular Medicine Finland FIMM, Helsinki, Finland.
    The CODATwins Project: The Current Status and Recent Findings of COllaborative Project of Development of Anthropometrical Measures in Twins2019In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 22, p. 800-808Article in journal (Refereed)
    Abstract [en]

    The COllaborative project of Development of Anthropometrical measures in Twins (CODATwins) project is a large international collaborative effort to analyze individual-level phenotype data from twins in multiple cohorts from different environments. The main objective is to study factors that modify genetic and environmental variation of height, body mass index (BMI, kg/m2) and size at birth, and additionally to address other research questions such as long-term consequences of birth size. The project started in 2013 and is open to all twin projects in the world having height and weight measures on twins with information on zygosity. Thus far, 54 twin projects from 24 countries have provided individual-level data. The CODATwins database includes 489,981 twin individuals (228,635 complete twin pairs). Since many twin cohorts have collected longitudinal data, there is a total of 1,049,785 height and weight observations. For many cohorts, we also have information on birth weight and length, own smoking behavior and own or parental education. We found that the heritability estimates of height and BMI systematically changed from infancy to old age. Remarkably, only minor differences in the heritability estimates were found across cultural–geographic regions, measurement time and birth cohort for height and BMI. In addition to genetic epidemiological studies, we looked at associations of height and BMI with education, birth weight and smoking status. Within-family analyses examined differences within same-sex and opposite-sex dizygotic twins in birth size and later development. The CODATwins project demonstrates the feasibility and value of international collaboration to address gene-by-exposure interactions that require large sample sizes and address the effects of different exposures across time, geographical regions and socioeconomic status.

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