Carina Wattmo - Academia.edu (original) (raw)

Papers by Carina Wattmo

Research paper thumbnail of Cerebrospinal Fluid Biomarker Levels as Markers for Nursing Home Placement and Survival Time in Alzheimer’s Disease

Current Alzheimer Research

Background: Cerebrospinal fluid (CSF) biomarkers are associated with conversion from mild cogniti... more Background: Cerebrospinal fluid (CSF) biomarkers are associated with conversion from mild cognitive impairment to Alzheimer’s disease (AD), but their predictive value for later end-points has been less evaluated with inconsistent results. Objective: We investigated potential relationships between CSF amyloid-β1-42 (Aβ42), phosphorylat- ed tau (P-tau), and total tau (T-tau) with time to nursing home placement (NHP) and life expectan- cy after diagnosis. Methods: This prospective observational study included 129 outpatients clinically diagnosed with mild-to-moderate AD who underwent a lumbar puncture. The CSF biomarkers were analysed with xMAP technology. Dates of institutionalisation and death were recorded. Results : After 20 years of follow-up, 123 patients (95%) were deceased. The participants with ab- normal P-tau and T-tau (A+ T+ (N)+) died earlier than those with normal P-tau/abnormal T-tau (A+ T- (N)+) (mean, 80.5 vs. 85.4 years). Linear associations were demonstrated between ...

Research paper thumbnail of Cerebro-spinal fluid biomarker levels: phosphorylated tau (T) and total tau (N) as markers for rate of progression in Alzheimer’s disease

BMC Neurology

Background We investigated the potential associations between cerebro-spinal fluid (CSF) levels o... more Background We investigated the potential associations between cerebro-spinal fluid (CSF) levels of phosphorylated tau (P-tau) and total tau (T-tau) with short-term response to cholinesterase inhibitor (ChEI) treatment, longitudinal outcome and progression rates in Alzheimer’s disease (AD). Methods This prospective, observational study included 129 participants clinically diagnosed with mild-to-moderate AD, who underwent a lumbar puncture. The CSF biomarkers amyloid-β1–42 (Aβ42), P-tau and T-tau were analysed with xMAP technology. Cognitive, global, instrumental and basic activities of daily living (ADL) capacities at the start of ChEI therapy and semi-annually over 3 years were evaluated. Results All patients had abnormal Aβ42 (A+). Fifty-eight individuals (45%) exhibited normal P-tau and T-tau (A+ T– (N)–), 12 (9%) abnormal P-tau/normal T-tau (A+ T+ (N)–), 17 (13%) normal P-tau/abnormal T-tau (A+ T– (N)+) and 42 (33%) abnormal P-tau and T-tau (A+ T+ (N)+). The participants with A+ ...

Research paper thumbnail of Prognostic Regression Models of Life Expectancy After Diagnosis of Alzheimer’s Disease: A 20-YEAR Follow-Up

Research paper thumbnail of Survival among the older adults with clinical signs of Lewy body dementia in 40 Swedish nursing homes: a 6-year follow-up study

BMJ Open

ObjectivesTo investigate survival among elderly residents of Swedish nursing homes (NHs), with sp... more ObjectivesTo investigate survival among elderly residents of Swedish nursing homes (NHs), with specific focus on those with two or more signs of Lewy body dementia (LBD).DesignProspective observational study.SettingNHs in Malmö, the third largest city in Sweden.ParticipantsThe study population was older adults (aged ≥65 years) living in the 40 NHs in Malmö. Clinical data were collected with a customised questionnaire assessing core clinical LBD signs. Patients were categorised based on 0–1 or 2–4 LBD signs. The head nurse at each NH collected the study data: LBD questionnaires, electronic medication lists and electronic medical records from 2012 to 2013.Main outcome measures80-month mortality.ResultsFive hundred and fifty-eight (96%) of the residents were deceased at follow-up; among these, mean (95% CI) overall survival time was 29 (28–31) months. Mean survival differed between the LBD groups; those with 0–1 LBD signs lived 8 months longer than those with 2–4 LBD signs. Mortality r...

Research paper thumbnail of The Course and End-Points of Alzheimer’s Disease According to Sociodemographics, Apolipoprotein e Genotype and Cognitive Ability

Alzheimer's & Dementia

The course and end-points of Alzheimer's disease according to sociodemographics, apolipoprotein E... more The course and end-points of Alzheimer's disease according to sociodemographics, apolipoprotein E genotype and cognitive ability.

Research paper thumbnail of Psychotropic and anti-dementia treatment in elderly persons with clinical signs of dementia with Lewy bodies: a cross-sectional study in 40 nursing homes in Sweden

BMC Geriatrics

Background: Elderly persons with a dementia diagnosis often suffer from different neuropsychiatri... more Background: Elderly persons with a dementia diagnosis often suffer from different neuropsychiatric symptoms (NPS) such as delusions, hallucinations, depression, anxiety, irritability and agitation. Currently, the medical treatment for NPS consists mostly of psychotropic medication such as hypnotics/sedatives, anxiolytics and antipsychotics. In elderly persons with dementia, usage of antipsychotics is less appropriate because of the risk of side effects such as parkinsonism, rapid cognitive decline, cerebrovascular events and finally mortality. Furthermore, elderly persons with dementia with Lewy bodies (DLB) are often hypersensitive to antipsychotics with numerous serious adverse events such as somnolence, sedation, extra-pyramidal symptoms, delirium and increased mortality. The aim of this study was to investigate the usage of psychotropics with a focus on antipsychotics and anti-dementia medication (according to the Anatomical Therapeutic Chemical Classification System) in elderly persons with clinical signs of DLB living in dementia nursing homes (NHs) in Sweden. Methods: Between 2012 and 2013, we applied a specially designed questionnaire that covered the clinical DLB features according to the consensus criteria of DLB. We also collected computerized medical lists from the Swedish National Medication Dispensing System from the same period. All dementia NHs (n = 40) in Malmö, the third largest city in Sweden, were covered. Of 650 eligible residents, 610 (94%) were included with 576 medical lists. The mean age was 86 years and 76% were women. Results: Treatment with antipsychotics was seen in 22% of residents, hypnotics/sedatives in 41%, antidepressants in 50% and anxiolytics in 58%. We also found an increasing usage of antipsychotics from 25% to 43% in residents with the increasing number of DLB features. Anti-dementia medications were found in 45% of the elderly with a dementia diagnosis. However, residents with two or more DLB features had less anti-dementia medication (37%) than the rest of the dementia-diagnosed NH residents (62-69%). Conclusions: Residents with 2-4 DLB clinical features in Swedish NHs receive an unfavourable medical treatment with high antipsychotic usage and insufficient anti-dementia medication. These findings show the importance of identifying elderly persons with DLB features more effectively and improving the collaboration with nursing care to provide better medical prescription.

Research paper thumbnail of Cholinesterase Inhibitor Therapy Does Not Affect Time Spent in Nursing Homes in Patients with Alzheimer's Disease

Alzheimer's & Dementia

Women cared for their spouses with Alzheimer's disease (AD) at home longer than did men. The situ... more Women cared for their spouses with Alzheimer's disease (AD) at home longer than did men. The situation of these female informal caregivers needs attention and possibly support. There was no indication that any aspects of cholinesterase inhibitor (ChEI) therapy (drug agent, dosage, or duration of treatment) altered the survival time in nursing homes (NHs). BACKGROUND An increased knowledge of factors that affect the time spent in NHs for AD patients treated with ChEIs is important for clinicians and community-based services. The length of stay in NHs might be influenced by factors such as sociodemographic characteristics, rate of AD progression, impairment in activities of daily living (ADL), and concomitant disorders. Whether different aspects of ChEI therapy (drug agent, dose, or treatment duration) influence survival time in NHs has not been previously investigated. We aimed to study the relationship between the aforementioned potential predictors and time spent in NHs.

Research paper thumbnail of Early-versus Late-Onset Alzheimer Disease: Long-Term Functional Outcomes, Nursing Home Placement, and Risk Factors for Rate of Progression

Dementia and geriatric cognitive disorders extra

Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We... more Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We, therefore, investigated risk factors for progression in activities of daily living (ADL) and nursing home placement (NHP) in cholinesterase inhibitor (ChEI)-treated patients with early-onset AD (EOAD) versus late-onset AD (LOAD). This 3-year, prospective, observational, multicenter study included 1,017 participants with mild-to-moderate AD; 143 had EOAD (onset <65 years) and 874 LOAD (onset ≥65 years). Possible sociodemographic and clinical factors that could affect functional outcome and NHP were analyzed using mixed-effects models and logistic regression, respectively. Younger individuals exhibited longer illness duration before AD diagnosis, whereas 6-month functional response to ChEI therapy, 3-year changes in ADL capacities, time from diagnosis to NHP, and survival time in nursing homes were similar between the groups. In LOAD, a higher ChEI dose, no antidepressant use, and low...

Research paper thumbnail of Early- versus late-onset Alzheimer's disease in clinical practice: cognitive and global outcomes over 3 years

Alzheimer's research & therapy, Jan 31, 2017

Whether age at onset influences Alzheimer's disease (AD) progression and the effectiveness of... more Whether age at onset influences Alzheimer's disease (AD) progression and the effectiveness of cholinesterase inhibitor (ChEI) therapy is not clear. We aimed to compare longitudinal cognitive and global outcomes in ChEI-treated patients with early-onset Alzheimer's disease (EOAD) versus late-onset Alzheimer's disease (LOAD) in clinical practice. This 3-year, prospective, observational, multicentre study included 1017 participants with mild to moderate AD; 143 had EOAD (age at onset < 65 years) and 874 had LOAD (age at onset ≥ 65 years). At baseline and semi-annually, patients were assessed using cognitive, global and activities of daily living (ADL) scales, and the dose of ChEI was recorded. Potential predictors of decline were analysed using mixed-effects models. Six-month response to ChEI therapy and long-term prognosis in cognitive and global performance were similar between the age-at-onset groups. However, deterioration was significantly faster when using the Alzh...

Research paper thumbnail of Cholinesterase inhibitors do not alter the length of stay in nursing homes among patients with Alzheimer's disease: a prospective, observational study of factors affecting survival time from admission to death

BMC neurology, Jan 31, 2016

The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by soc... more The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by sociodemographic/clinical characteristics, rate of disease progression, and use of specific medications and community-based services. Whether different aspects of cholinesterase inhibitor (ChEI) therapy modify time spent in NHs is unclear. Therefore, we examined the relationship between these potential predictors and survival time in NHs. This prospective, multicenter study of ChEI treatment in clinical practice included 220 deceased patients clinically diagnosed with mild-to-moderate AD who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) performance, ChEI dose, and amount of services used/week were evaluated every 6 months over 3 years. Dates of nursing-home placement (NHP) and death were recorded. Variables that determined survival time in NHs were analyzed using general linear models. The mean survival time in NHs was 4.06 years (men, 2.78 years; wom...

Research paper thumbnail of Response to the Letter From Abid Iraqi, MD, CMD and Terry Hughes, RN, CS

Journal of the American Medical Directors Association, 2017

Research paper thumbnail of Prevalence of Dementia With Lewy Body Symptoms: A Cross-Sectional Study in 40 Swedish Nursing Homes

Journal of the American Medical Directors Association, 2016

To investigate and establish the prevalence of dementia with Lewy body (DLB) symptoms in all nurs... more To investigate and establish the prevalence of dementia with Lewy body (DLB) symptoms in all nursing home (NH) residents in Malmö, the third largest city in Sweden. DLB is a neurocognitive disorder with core features, such as parkinsonism, visual hallucinations, and fluctuating cognition/excessive daytime sleepiness, and supportive features, such as rapid eye movement sleep behavior disorder. DLB is often misdiagnosed and unrecognized in elderly individuals. A questionnaire, designed to cover the main DLB symptoms, according to consensus criteria from the third report of the DLB Consortium from 2005, was distributed in 40 NHs. The questionnaires were completed by the nursing staff after receiving specifically designed teaching. Medication lists were collected from the Swedish national medication dispensing system. Nursing homes. Of 650 eligible residents, 620 (96%) were included. The mean age was 86.0 ± 7.5 years; 467 (75%) were women. We found a prevalence of 16% of 2 or more main symptoms of DLB in the NH residents. However, when a wider more inclusive parkinsonism variable was used, the prevalence of DLB symptoms increased to 20%. We conclude that elderly with 2 or more DLB symptoms may constitute between 16% and 20% of all residents in NHs. This emphasizes the importance of identification of DLB and guides clinicians to deliver appropriate treatment for this fragile patient group.

Research paper thumbnail of Mild versus Moderate Stage of Alzheimer’s Disease—Three-year Outcomes of Cholinesterase Inhibitor Therapy in a Routine Clinical Setting

Research paper thumbnail of Early- versus late-onset Alzheimer's disease: 3-year outcomes of cholinesterase inhibitor treatment in routine clinical practice

F1000posters, Feb 3, 2015

This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed th... more This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed that more sensitive cognitive measures, such as ADAS-cog, are required to detect a potentially faster decline among patients with early-onset AD. Despite better functional performance and fewer concomitant medications at the start of ChEI treatment, patients with early-onset AD had a similar rate of deterioration in ADL and need for institutionalization compared with the late-onset group. This emphasizes the clinical importance of functional assessments, even among younger patients. The possibility that younger individuals live longer after a diagnosis of AD raises questions about the need to provide 24 h care adapted specifically to this group.

Research paper thumbnail of Various outcomes of cholinesterase inhibitor treatment influence survival of patients with Alzheimer's disease

F1000posters, Mar 26, 2015

This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed th... more This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed that more sensitive cognitive measures, such as ADAS-cog, are required to detect a potentially faster decline among patients with early-onset AD. Despite better functional performance and fewer concomitant medications at the start of ChEI treatment, patients with early-onset AD had a similar rate of deterioration in ADL and need for institutionalization compared with the late-onset group. This emphasizes the clinical importance of functional assessments, even among younger patients. The possibility that younger individuals live longer after a diagnosis of AD raises questions about the need to provide 24 h care adapted specifically to this group.

Research paper thumbnail of Two-year outcome of Galantamine treatment in Alzheimer’s disease in a routine clinical setting

Conclusion Long-term galantamine treatment in a routine clinical setting resulted in a positive e... more Conclusion Long-term galantamine treatment in a routine clinical setting resulted in a positive effect in cognitive tests compared to historical controls and mathematical models. After 2 years of treatment a positive global outcome was observed in half of the patients. Dropout was less than expected.

Research paper thumbnail of Alzheimer's disease - Safety and dropout in long-term galantamine treatment in a routine clinical setting

New Trends in Alzheimer and Parkinson Related Disorders Adpd 2007, 2007

Research paper thumbnail of Activities of daily living - Outcome during two years in galantamine treated Alzheimer patients

New Trends in Alzheimer and Parkinson Related Disorders Adpd 2007, 2007

Research paper thumbnail of Plasma concentration of galantamine - influence of dose and body mass index in Alzheimer's disease

F1000posters, May 21, 2015

Plasma concentration of galantamine in Alzheimer's disease-influence of dose and body mass index ... more Plasma concentration of galantamine in Alzheimer's disease-influence of dose and body mass index Background and objectives Patients with Alzheimer's disease (AD) are at present treated with galantamine without actual knowledge of plasma concentration levels. The aim of this presentation is to analyse the relationship between galantamine plasma concentration, dose, demographic factors and body mass index (BMI).

Research paper thumbnail of Three-year outcome of Galantamine treatment in Alzheimer's disease in a routine clinical setting

F1000posters, May 21, 2015

Conclusion Long-term galantamine treatment in a routine clinical setting was safe and resulted in... more Conclusion Long-term galantamine treatment in a routine clinical setting was safe and resulted in a positive effect in cognitive tests compared to historical controls and mathematical models. After 3 years of treatment a positive global outcome was observed in more than 40% of the patients. Dropout was less than expected.

Research paper thumbnail of Cerebrospinal Fluid Biomarker Levels as Markers for Nursing Home Placement and Survival Time in Alzheimer’s Disease

Current Alzheimer Research

Background: Cerebrospinal fluid (CSF) biomarkers are associated with conversion from mild cogniti... more Background: Cerebrospinal fluid (CSF) biomarkers are associated with conversion from mild cognitive impairment to Alzheimer’s disease (AD), but their predictive value for later end-points has been less evaluated with inconsistent results. Objective: We investigated potential relationships between CSF amyloid-β1-42 (Aβ42), phosphorylat- ed tau (P-tau), and total tau (T-tau) with time to nursing home placement (NHP) and life expectan- cy after diagnosis. Methods: This prospective observational study included 129 outpatients clinically diagnosed with mild-to-moderate AD who underwent a lumbar puncture. The CSF biomarkers were analysed with xMAP technology. Dates of institutionalisation and death were recorded. Results : After 20 years of follow-up, 123 patients (95%) were deceased. The participants with ab- normal P-tau and T-tau (A+ T+ (N)+) died earlier than those with normal P-tau/abnormal T-tau (A+ T- (N)+) (mean, 80.5 vs. 85.4 years). Linear associations were demonstrated between ...

Research paper thumbnail of Cerebro-spinal fluid biomarker levels: phosphorylated tau (T) and total tau (N) as markers for rate of progression in Alzheimer’s disease

BMC Neurology

Background We investigated the potential associations between cerebro-spinal fluid (CSF) levels o... more Background We investigated the potential associations between cerebro-spinal fluid (CSF) levels of phosphorylated tau (P-tau) and total tau (T-tau) with short-term response to cholinesterase inhibitor (ChEI) treatment, longitudinal outcome and progression rates in Alzheimer’s disease (AD). Methods This prospective, observational study included 129 participants clinically diagnosed with mild-to-moderate AD, who underwent a lumbar puncture. The CSF biomarkers amyloid-β1–42 (Aβ42), P-tau and T-tau were analysed with xMAP technology. Cognitive, global, instrumental and basic activities of daily living (ADL) capacities at the start of ChEI therapy and semi-annually over 3 years were evaluated. Results All patients had abnormal Aβ42 (A+). Fifty-eight individuals (45%) exhibited normal P-tau and T-tau (A+ T– (N)–), 12 (9%) abnormal P-tau/normal T-tau (A+ T+ (N)–), 17 (13%) normal P-tau/abnormal T-tau (A+ T– (N)+) and 42 (33%) abnormal P-tau and T-tau (A+ T+ (N)+). The participants with A+ ...

Research paper thumbnail of Prognostic Regression Models of Life Expectancy After Diagnosis of Alzheimer’s Disease: A 20-YEAR Follow-Up

Research paper thumbnail of Survival among the older adults with clinical signs of Lewy body dementia in 40 Swedish nursing homes: a 6-year follow-up study

BMJ Open

ObjectivesTo investigate survival among elderly residents of Swedish nursing homes (NHs), with sp... more ObjectivesTo investigate survival among elderly residents of Swedish nursing homes (NHs), with specific focus on those with two or more signs of Lewy body dementia (LBD).DesignProspective observational study.SettingNHs in Malmö, the third largest city in Sweden.ParticipantsThe study population was older adults (aged ≥65 years) living in the 40 NHs in Malmö. Clinical data were collected with a customised questionnaire assessing core clinical LBD signs. Patients were categorised based on 0–1 or 2–4 LBD signs. The head nurse at each NH collected the study data: LBD questionnaires, electronic medication lists and electronic medical records from 2012 to 2013.Main outcome measures80-month mortality.ResultsFive hundred and fifty-eight (96%) of the residents were deceased at follow-up; among these, mean (95% CI) overall survival time was 29 (28–31) months. Mean survival differed between the LBD groups; those with 0–1 LBD signs lived 8 months longer than those with 2–4 LBD signs. Mortality r...

Research paper thumbnail of The Course and End-Points of Alzheimer’s Disease According to Sociodemographics, Apolipoprotein e Genotype and Cognitive Ability

Alzheimer's & Dementia

The course and end-points of Alzheimer's disease according to sociodemographics, apolipoprotein E... more The course and end-points of Alzheimer's disease according to sociodemographics, apolipoprotein E genotype and cognitive ability.

Research paper thumbnail of Psychotropic and anti-dementia treatment in elderly persons with clinical signs of dementia with Lewy bodies: a cross-sectional study in 40 nursing homes in Sweden

BMC Geriatrics

Background: Elderly persons with a dementia diagnosis often suffer from different neuropsychiatri... more Background: Elderly persons with a dementia diagnosis often suffer from different neuropsychiatric symptoms (NPS) such as delusions, hallucinations, depression, anxiety, irritability and agitation. Currently, the medical treatment for NPS consists mostly of psychotropic medication such as hypnotics/sedatives, anxiolytics and antipsychotics. In elderly persons with dementia, usage of antipsychotics is less appropriate because of the risk of side effects such as parkinsonism, rapid cognitive decline, cerebrovascular events and finally mortality. Furthermore, elderly persons with dementia with Lewy bodies (DLB) are often hypersensitive to antipsychotics with numerous serious adverse events such as somnolence, sedation, extra-pyramidal symptoms, delirium and increased mortality. The aim of this study was to investigate the usage of psychotropics with a focus on antipsychotics and anti-dementia medication (according to the Anatomical Therapeutic Chemical Classification System) in elderly persons with clinical signs of DLB living in dementia nursing homes (NHs) in Sweden. Methods: Between 2012 and 2013, we applied a specially designed questionnaire that covered the clinical DLB features according to the consensus criteria of DLB. We also collected computerized medical lists from the Swedish National Medication Dispensing System from the same period. All dementia NHs (n = 40) in Malmö, the third largest city in Sweden, were covered. Of 650 eligible residents, 610 (94%) were included with 576 medical lists. The mean age was 86 years and 76% were women. Results: Treatment with antipsychotics was seen in 22% of residents, hypnotics/sedatives in 41%, antidepressants in 50% and anxiolytics in 58%. We also found an increasing usage of antipsychotics from 25% to 43% in residents with the increasing number of DLB features. Anti-dementia medications were found in 45% of the elderly with a dementia diagnosis. However, residents with two or more DLB features had less anti-dementia medication (37%) than the rest of the dementia-diagnosed NH residents (62-69%). Conclusions: Residents with 2-4 DLB clinical features in Swedish NHs receive an unfavourable medical treatment with high antipsychotic usage and insufficient anti-dementia medication. These findings show the importance of identifying elderly persons with DLB features more effectively and improving the collaboration with nursing care to provide better medical prescription.

Research paper thumbnail of Cholinesterase Inhibitor Therapy Does Not Affect Time Spent in Nursing Homes in Patients with Alzheimer's Disease

Alzheimer's & Dementia

Women cared for their spouses with Alzheimer's disease (AD) at home longer than did men. The situ... more Women cared for their spouses with Alzheimer's disease (AD) at home longer than did men. The situation of these female informal caregivers needs attention and possibly support. There was no indication that any aspects of cholinesterase inhibitor (ChEI) therapy (drug agent, dosage, or duration of treatment) altered the survival time in nursing homes (NHs). BACKGROUND An increased knowledge of factors that affect the time spent in NHs for AD patients treated with ChEIs is important for clinicians and community-based services. The length of stay in NHs might be influenced by factors such as sociodemographic characteristics, rate of AD progression, impairment in activities of daily living (ADL), and concomitant disorders. Whether different aspects of ChEI therapy (drug agent, dose, or treatment duration) influence survival time in NHs has not been previously investigated. We aimed to study the relationship between the aforementioned potential predictors and time spent in NHs.

Research paper thumbnail of Early-versus Late-Onset Alzheimer Disease: Long-Term Functional Outcomes, Nursing Home Placement, and Risk Factors for Rate of Progression

Dementia and geriatric cognitive disorders extra

Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We... more Whether age at onset influences functional deterioration in Alzheimer disease (AD) is unclear. We, therefore, investigated risk factors for progression in activities of daily living (ADL) and nursing home placement (NHP) in cholinesterase inhibitor (ChEI)-treated patients with early-onset AD (EOAD) versus late-onset AD (LOAD). This 3-year, prospective, observational, multicenter study included 1,017 participants with mild-to-moderate AD; 143 had EOAD (onset <65 years) and 874 LOAD (onset ≥65 years). Possible sociodemographic and clinical factors that could affect functional outcome and NHP were analyzed using mixed-effects models and logistic regression, respectively. Younger individuals exhibited longer illness duration before AD diagnosis, whereas 6-month functional response to ChEI therapy, 3-year changes in ADL capacities, time from diagnosis to NHP, and survival time in nursing homes were similar between the groups. In LOAD, a higher ChEI dose, no antidepressant use, and low...

Research paper thumbnail of Early- versus late-onset Alzheimer's disease in clinical practice: cognitive and global outcomes over 3 years

Alzheimer's research & therapy, Jan 31, 2017

Whether age at onset influences Alzheimer's disease (AD) progression and the effectiveness of... more Whether age at onset influences Alzheimer's disease (AD) progression and the effectiveness of cholinesterase inhibitor (ChEI) therapy is not clear. We aimed to compare longitudinal cognitive and global outcomes in ChEI-treated patients with early-onset Alzheimer's disease (EOAD) versus late-onset Alzheimer's disease (LOAD) in clinical practice. This 3-year, prospective, observational, multicentre study included 1017 participants with mild to moderate AD; 143 had EOAD (age at onset < 65 years) and 874 had LOAD (age at onset ≥ 65 years). At baseline and semi-annually, patients were assessed using cognitive, global and activities of daily living (ADL) scales, and the dose of ChEI was recorded. Potential predictors of decline were analysed using mixed-effects models. Six-month response to ChEI therapy and long-term prognosis in cognitive and global performance were similar between the age-at-onset groups. However, deterioration was significantly faster when using the Alzh...

Research paper thumbnail of Cholinesterase inhibitors do not alter the length of stay in nursing homes among patients with Alzheimer's disease: a prospective, observational study of factors affecting survival time from admission to death

BMC neurology, Jan 31, 2016

The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by soc... more The survival time in nursing homes (NHs) in Alzheimer's disease (AD) might be affected by sociodemographic/clinical characteristics, rate of disease progression, and use of specific medications and community-based services. Whether different aspects of cholinesterase inhibitor (ChEI) therapy modify time spent in NHs is unclear. Therefore, we examined the relationship between these potential predictors and survival time in NHs. This prospective, multicenter study of ChEI treatment in clinical practice included 220 deceased patients clinically diagnosed with mild-to-moderate AD who were admitted to NHs during the study. Cognitive and activities of daily living (ADL) performance, ChEI dose, and amount of services used/week were evaluated every 6 months over 3 years. Dates of nursing-home placement (NHP) and death were recorded. Variables that determined survival time in NHs were analyzed using general linear models. The mean survival time in NHs was 4.06 years (men, 2.78 years; wom...

Research paper thumbnail of Response to the Letter From Abid Iraqi, MD, CMD and Terry Hughes, RN, CS

Journal of the American Medical Directors Association, 2017

Research paper thumbnail of Prevalence of Dementia With Lewy Body Symptoms: A Cross-Sectional Study in 40 Swedish Nursing Homes

Journal of the American Medical Directors Association, 2016

To investigate and establish the prevalence of dementia with Lewy body (DLB) symptoms in all nurs... more To investigate and establish the prevalence of dementia with Lewy body (DLB) symptoms in all nursing home (NH) residents in Malmö, the third largest city in Sweden. DLB is a neurocognitive disorder with core features, such as parkinsonism, visual hallucinations, and fluctuating cognition/excessive daytime sleepiness, and supportive features, such as rapid eye movement sleep behavior disorder. DLB is often misdiagnosed and unrecognized in elderly individuals. A questionnaire, designed to cover the main DLB symptoms, according to consensus criteria from the third report of the DLB Consortium from 2005, was distributed in 40 NHs. The questionnaires were completed by the nursing staff after receiving specifically designed teaching. Medication lists were collected from the Swedish national medication dispensing system. Nursing homes. Of 650 eligible residents, 620 (96%) were included. The mean age was 86.0 ± 7.5 years; 467 (75%) were women. We found a prevalence of 16% of 2 or more main symptoms of DLB in the NH residents. However, when a wider more inclusive parkinsonism variable was used, the prevalence of DLB symptoms increased to 20%. We conclude that elderly with 2 or more DLB symptoms may constitute between 16% and 20% of all residents in NHs. This emphasizes the importance of identification of DLB and guides clinicians to deliver appropriate treatment for this fragile patient group.

Research paper thumbnail of Mild versus Moderate Stage of Alzheimer’s Disease—Three-year Outcomes of Cholinesterase Inhibitor Therapy in a Routine Clinical Setting

Research paper thumbnail of Early- versus late-onset Alzheimer's disease: 3-year outcomes of cholinesterase inhibitor treatment in routine clinical practice

F1000posters, Feb 3, 2015

This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed th... more This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed that more sensitive cognitive measures, such as ADAS-cog, are required to detect a potentially faster decline among patients with early-onset AD. Despite better functional performance and fewer concomitant medications at the start of ChEI treatment, patients with early-onset AD had a similar rate of deterioration in ADL and need for institutionalization compared with the late-onset group. This emphasizes the clinical importance of functional assessments, even among younger patients. The possibility that younger individuals live longer after a diagnosis of AD raises questions about the need to provide 24 h care adapted specifically to this group.

Research paper thumbnail of Various outcomes of cholinesterase inhibitor treatment influence survival of patients with Alzheimer's disease

F1000posters, Mar 26, 2015

This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed th... more This Alzheimer's disease (AD) study, which was performed in a routine clinical setting, showed that more sensitive cognitive measures, such as ADAS-cog, are required to detect a potentially faster decline among patients with early-onset AD. Despite better functional performance and fewer concomitant medications at the start of ChEI treatment, patients with early-onset AD had a similar rate of deterioration in ADL and need for institutionalization compared with the late-onset group. This emphasizes the clinical importance of functional assessments, even among younger patients. The possibility that younger individuals live longer after a diagnosis of AD raises questions about the need to provide 24 h care adapted specifically to this group.

Research paper thumbnail of Two-year outcome of Galantamine treatment in Alzheimer’s disease in a routine clinical setting

Conclusion Long-term galantamine treatment in a routine clinical setting resulted in a positive e... more Conclusion Long-term galantamine treatment in a routine clinical setting resulted in a positive effect in cognitive tests compared to historical controls and mathematical models. After 2 years of treatment a positive global outcome was observed in half of the patients. Dropout was less than expected.

Research paper thumbnail of Alzheimer's disease - Safety and dropout in long-term galantamine treatment in a routine clinical setting

New Trends in Alzheimer and Parkinson Related Disorders Adpd 2007, 2007

Research paper thumbnail of Activities of daily living - Outcome during two years in galantamine treated Alzheimer patients

New Trends in Alzheimer and Parkinson Related Disorders Adpd 2007, 2007

Research paper thumbnail of Plasma concentration of galantamine - influence of dose and body mass index in Alzheimer's disease

F1000posters, May 21, 2015

Plasma concentration of galantamine in Alzheimer's disease-influence of dose and body mass index ... more Plasma concentration of galantamine in Alzheimer's disease-influence of dose and body mass index Background and objectives Patients with Alzheimer's disease (AD) are at present treated with galantamine without actual knowledge of plasma concentration levels. The aim of this presentation is to analyse the relationship between galantamine plasma concentration, dose, demographic factors and body mass index (BMI).

Research paper thumbnail of Three-year outcome of Galantamine treatment in Alzheimer's disease in a routine clinical setting

F1000posters, May 21, 2015

Conclusion Long-term galantamine treatment in a routine clinical setting was safe and resulted in... more Conclusion Long-term galantamine treatment in a routine clinical setting was safe and resulted in a positive effect in cognitive tests compared to historical controls and mathematical models. After 3 years of treatment a positive global outcome was observed in more than 40% of the patients. Dropout was less than expected.