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  • 1
    Online Resource
    Online Resource
    Wiley ; 2021
    In:  European Journal of Neurology Vol. 28, No. 7 ( 2021-07), p. 2174-2184
    In: European Journal of Neurology, Wiley, Vol. 28, No. 7 ( 2021-07), p. 2174-2184
    Abstract: Mortality is known to be markedly increased in people with dementia. However, the association between multiple chronic conditions and mortality in dementia is not well clarified. The aim of this study was to investigate the impact of somatic and psychiatric diseases on mortality in dementia compared with the general elderly population. Methods Using a cohort study design, nationwide registry data from 2006 to 2015 on dementia and psychiatric and somatic comorbidities defined by the Charlson Comorbidity Index (CCI) were linked. Impact of chronic conditions was assessed according to mortality rate ratios (MRRs) in all Danish residents aged ≥65 years with and without dementia. Results Our population comprised 1,518,917 people, of whom 114,109 people were registered with dementia. The MRRs was 2.70 (95% confidence interval 2.68, 2.72) in people with dementia after adjusting for sex, age, calendar year, and comorbidities. MRRs increased with higher CCI score, and when comparing people with a similar comorbidity load, MRRs were significantly higher for people with dementia. Conclusions The comorbidity load was associated with increased mortality in both people with and without dementia. Mortality in dementia remained increased, even after adjusting for psychiatric and chronic somatic comorbidities. Our findings suggest that dementia disorders alone contribute to excess mortality, which may be further increased by comorbidities.
    Type of Medium: Online Resource
    ISSN: 1351-5101 , 1468-1331
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2020241-6
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  • 2
    In: Nature Aging, Springer Science and Business Media LLC, Vol. 1, No. 2 ( 2021-02-11), p. 226-233
    Type of Medium: Online Resource
    ISSN: 2662-8465
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 3029419-8
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  • 3
    In: Alzheimer's & Dementia, Wiley, Vol. 17, No. S10 ( 2021-12)
    Abstract: Several epidemiological studies from Taiwan, all using the same data resource, found significant associations between herpes virus infection, antiherpetic medication and dementia. We conducted a multicenter observational cohort study using health registry data from Wales, Germany, Scotland, and Denmark to investigate potential associations between antiherpetic medication and incident dementia, and also to comprehensively investigate such associations broken down according to medication type and dose, type of herpes virus, and dementia subtype. Method 2.5 million people aged 65 and older were followed up using routinely collected linked electronic health records in four separate national observational cohort studies. Exposure and outcome were classified using coded data from prescriptions and from primary and secondary care. Data were analyzed using survival analysis with time‐dependent covariates. Confounders were age, year, sex, socioeconomic status, and comorbidities. Result Results were heterogenous across cohorts (Figure 1), with a tendency for decreased dementia risk in people exposed to antiherpetic medication (Wales: HR 0.91, 95% CI 0.86 to 0.97; Denmark: HR 0.91 (0.89 to 0.93); Germany: HR 1.08 (0.98 to 1.20); Scotland: HR 0.98 (0.64 to 1.49). Associations were not affected by number of treatments, herpes diagnosis, type of dementia, or specific type of medication. People diagnosed with herpes but not exposed to antiherpetic medication were at higher dementia risk in the German cohort (HR: 1.18; 1.09 to 1.28) but not in the Welsh cohort (HR: 0.95; 0.88 to 1.02). Conclusion Results from the four large cohorts allow us to exclude any major association of short‐term exposure to antiherpetic medication with dementia. Because neither type of dementia nor type of herpes infection modified the association, the small but significant decrease in dementia incidence with antiherpetic administration mayeflect unmeasured confounding and misclassification.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2201940-6
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  • 4
    Online Resource
    Online Resource
    IOS Press ; 2021
    In:  Journal of Alzheimer's Disease Vol. 79, No. 1 ( 2021-01-05), p. 289-300
    In: Journal of Alzheimer's Disease, IOS Press, Vol. 79, No. 1 ( 2021-01-05), p. 289-300
    Abstract: Background: It remains unclear whether the increased focus on improving healthcare and providing appropriate care for people with dementia has affected mortality. Objective: To assess survival and to conduct a time trend analysis of annual mortality rate ratios (MRR) of dementia based on healthcare data from an entire national population. Methods: We assessed survival and annual MRR in all residents of Denmark ≥65 years from 1996–2015 using longitudinal registry data on dementia status and demographics. For comparison, mortality and survival were calculated for acute ischemic heart disease (IHD) and cancer. Results: The population comprised 1,999,366 people (17,541,315 person years). There were 165,716 people (529,629 person years) registered with dementia, 131,321 of whom died. From 1996–2015, the age-adjusted MRR for dementia declined (women: 2.76 to 2.05; men: 3.10 to 1.99) at a similar rate to elderly people without dementia. The sex-, age-, and calendar-year-adjusted MRR was 2.91 (95%CI: 2.90–2.93) for people with dementia. MRR declined significantly more for acute IHD and cancer. In people with dementia, the five-year survival for most age-groups was at a similar level or lower as that for acute IHD and cancer. Conclusion: Although mortality rates declined over the 20-year period, MRR stayed higher for people with dementia, while the MRR gap, compared with elderly people without dementia, remained unchanged. For the comparison, during the same period, the MRR gap narrowed between people with and without acute IHD and cancer. Consequently, initiatives for improving health and decreasing mortality in dementia are still highly relevant.
    Type of Medium: Online Resource
    ISSN: 1387-2877 , 1875-8908
    Language: Unknown
    Publisher: IOS Press
    Publication Date: 2021
    detail.hit.zdb_id: 2070772-1
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  • 5
    In: Dementia and Geriatric Cognitive Disorders, S. Karger AG, Vol. 30, No. 1 ( 2010), p. 43-50
    Abstract: 〈 i 〉 Background: 〈 /i 〉 This study aimed to determine whether there is an association between hysterectomy and dementia. 〈 i 〉 Methods: 〈 /i 〉 All female Danish residents born before 1966, alive on their 40th birthday and without a dementia diagnosis prior to 1977 (n = 2,313,388) were followed from January 1, 1977, or the age of 40, whichever came later, until dementia diagnosis, death, emigration or December 31, 2006, whichever came first. The relative risks (RR) for developing dementia in women with hysterectomy/oophorectomy compared to referent women were calculated. 〈 i 〉 Results: 〈 /i 〉 Overall, hysterectomy did not increase the risk of dementia. When stratified by age at dementia diagnosis, hysterectomy was associated with an increased risk for early-onset dementia before the age of 50: hysterectomy alone (RR = 1.38, 95% confidence interval (CI) = 1.07–1.78), with unilateral oophorectomy (RR = 2.10, 95% CI = 1.28–3.45), with bilateral oophorectomy (RR = 2.33, 95% CI = 1.44–3.77). The younger the age at hysterectomy/oophorectomy, the greater was the risk. 〈 i 〉 Conclusions: 〈 /i 〉 Although statistically significant, the association between premenopausal hysterectomy and early-onset dementia is uncertain due to study limitations. Premenopausal bilateral oophorectomy is associated with a higher risk, suggesting a dose effect of premature estrogen deficiency on dementia. The age-dependent effect suggests that the younger brain is probably more vulnerable to estrogen deficiency.
    Type of Medium: Online Resource
    ISSN: 1420-8008 , 1421-9824
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2010
    detail.hit.zdb_id: 1482186-2
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  • 6
    In: Journal of Neurology, Springer Science and Business Media LLC
    Abstract: Our aim was to identify changes in healthcare utilization prior to a young-onset Alzheimer’s disease diagnosis. Methods In a retrospective incidence density matched nested case–control study using national health registers, we examined healthcare utilization for those diagnosed with young-onset Alzheimer’s disease in Danish memory clinics during 2016–2018 compared with age- and sex-matched controls. Negative binomial regression analysis produced contact rate ratios. Results The study included 1082 young-onset Alzheimer’s disease patients and 3246 controls. In the year preceding diagnosis, we found increased contact rate ratios for all types of contacts except physiotherapy. Contact rate ratios for contacts with a general practitioner were significantly increased also  〉  1–5 and  〉  5–10 years before diagnosis. The highest contact rate ratios were for psychiatric emergency contacts (8.69, 95% CI 4.29–17.62) ≤ 1 year before diagnosis. Interpretation Results demonstrate that young-onset Alzheimer’s disease patients have increased healthcare utilization from 5 to 10 years prior to diagnosis. Awareness of specific alterations in health-seeking behaviour may help healthcare professionals provide timely diagnoses.
    Type of Medium: Online Resource
    ISSN: 0340-5354 , 1432-1459
    RVK:
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2023
    detail.hit.zdb_id: 1421299-7
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  • 7
    Online Resource
    Online Resource
    Wiley ; 2021
    In:  European Journal of Neurology Vol. 28, No. 11 ( 2021-11), p. 3603-3614
    In: European Journal of Neurology, Wiley, Vol. 28, No. 11 ( 2021-11), p. 3603-3614
    Abstract: We aimed to investigate readmission risks following infections in dementia, identify the types of infections behind the risks, and highlight the reasons for readmissions. Methods Acute inpatient hospital admissions for infections in Danish residents were included from 1 January 2000, or age 65 years. Primary outcomes were 7‐day readmissions risk ratios (RRs; risk following infection index admissions of people with dementia relative to those without dementia), risks by infection site, and reasons for readmission. Secondary outcomes were 30‐ and 90‐day readmission risks. Competing risk of death was estimated. Results Seven‐day readmission RR was increased in all age groups and was highest in the youngest patients (women RR: 1.37, 95% confidence interval [CI] 1.22–1.53; men RR: 1.23, 95% CI 1.12–1.35). RRs decreased with increasing age and longer follow‐up. The most notable common readmissions were for infections and dehydration in dementia. Conclusions We conclude that there is a substantially increased readmission risk in people with dementia than in those without dementia, particularly within 7 days, and for the youngest in the cohort. Readmission risks were higher for infection index admissions than for admissions for causes other than infection, and readmissions were mostly due to infections. Our findings highlight the burden of infections in people with dementia and call for in‐depth investigations of determinants related to readmission risks, to inform public policy and identify avenues for interventions that can decrease or prevent potentially avoidable readmissions.
    Type of Medium: Online Resource
    ISSN: 1351-5101 , 1468-1331
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2020241-6
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  • 8
    In: Alzheimer's & Dementia, Wiley, Vol. 16, No. S10 ( 2020-12)
    Abstract: The role of infections in dementia remains to date insufficiently explored. Studies have reported that pneumonia and sepsis were either an immediate cause of death or increased mortality in people with dementia. However, it is unknown whether association with mortality is long‐term and whether it is dependent on the type of infection. We aimed to investigate the association between several infections and the short‐ and long‐term mortality in people with and without dementia. Method We conducted a nationwide registry‐based prospective cohort study using data from Danish national registries. Follow up was from 1 January 2000 or the 65‐year birthday (whichever came later) until death, immigration or 31 December 2015. Primary exposure was incident dementia and a first infection post start of follow‐up. The primary outcome was all‐cause mortality. Mortality rate ratios (MRR) were calculated in all exposure groups (Dementia/Infection; Infection before or after dementia, Dementia/No Infection, No Dementia/Infection and with No Dementia/No Infection as the reference group) and stratified by sex and infection site categories. MRRs were also calculated by time since first infection and by infection site. Result A total of 1,496,436 people were followed with a total of 12,739,135 person years. A total of 575,260 people died during follow‐up (82,573 with dementia). MRR for the Dementia/Infection group (infection after dementia) was 6.52 (95% CI: 6.43 to 6.61) times higher compared with the reference group and was higher in men. MRRs for the Infection groups in all of the site categories were markedly higher in the Dementia than No Dementia group (highest ratios for sepsis and lowest for ear infections). MRRs were highest the first 30 days after onset of first infection in the Dementia group and remained higher than the No Dementia group until 10 years after first infection (similar trends in the analyzed infection site categories). Conclusion Mortality is substantially increased in people with dementia following infections of all sites. Excess mortality is both short‐ (within 30 days) and long‐term (after10 years). Our findings identify people with dementia and infections as a vulnerable group who need clinical attention.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2201940-6
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  • 9
    In: Alzheimer's & Dementia, Wiley, Vol. 19, No. S8 ( 2023-06)
    Abstract: Older adults with dementia are at an increased risk of hospitalizations with respiratory infections and death. This emphasizes the need for increased focus on preventive measures, such as influenza vaccination, in this vulnerable group. The aim of our study was to investigate whether dementia, along with other factors, is associated with likelihood of influenza vaccination among older adults as well as to estimate time trends of vaccine uptake for older adults with dementia. Method We conducted a nationwide cross‐sectional study with data from national registries on the entire Danish population aged ≥65 years. We mapped the time trends of vaccination for each vaccination season (September to August) from 2002/2003 to 2018/2019. Using multivariable logistic regression, we estimated the likelihood of vaccination in 2018/2019 for a combined measure of dementia status and living situation (home living vs. nursing home). In the same model, we estimated the effect of other potential predictors of influenza vaccination. Result The study population was 801,710 individuals in 2002/2003, and 1,122,489 in 2018/2019. In the entire elderly population vaccine uptake increased steadily from 6% in 2002/2003 to 51% in 2009/2010 and then plateaued but was 10% higher among people with dementia. Compared to home living without dementia, the likelihood of vaccination in 2018/2019 was lower for home living with dementia (OR: 0·80; 95% CI: 0·78‐0·82), while it was higher for nursing home residents both with (1·36; 95% CI:1·31‐1·41) and without dementia (1·21; 95% CI: 1·17‐1·25). Higher age, more GP contacts, higher number of drugs and CCI score were associated with higher vaccination likelihood, while lower educational level, lower residential urbanization and being unmarried were associated with lower vaccination likelihood. Conclusion Influenza vaccination coverage has remained below 60% among older adults regardless of dementia status, not reaching the WHO target of 75% immunization in this group. Home‐living older adults with dementia were 20% less likely to receive an influenza vaccination, representing an important target group for future vaccination campaigns
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2201940-6
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  • 10
    In: Alzheimer's & Dementia, Wiley
    Abstract: Proton pump inhibitors (PPIs) may increase dementia risk. However, it is currently unknown whether timing of exposure or age at dementia diagnosis influence the risk. METHODS We assessed associations between cumulative PPI use and dementia at different ages in a nationwide Danish cohort of 1,983,785 individuals aged 60 to 75 years between 2000 and 2018. RESULTS During follow‐up, there were 99,384 all‐cause dementia incidences. Incidence rate ratio (IRR) of dementia with PPI ever‐use compared with never‐use was 1.36 (95% CI, 1.29 to 1.43) for age 60 to 69 years at diagnosis, 1.12 (1.09 to 1.15) for 70 to 79 years, 1.06 (1.03 to 1.09) for 80 to 89 years, and 1.03 (0.91 to 1.17) for 90+ years. Longer treatment duration yielded increasing IRRs. For cases below 90 years, increased dementia rate was observed regardless of treatment initiation up to 〉 15 years before diagnosis. DISCUSSION Regardless of timing of treatment initiation, PPI use was associated with increased dementia rate before age 90 years. Dementia rates increased with younger age at diagnosis. HIGHLIGHTS After following 1,983,785 individuals for a median of 10 years, 99,384 developed dementia PPIs were used by 21.2% of cases and 18.9% of controls PPI use was associated with increased dementia rate regardless of time of treatment onset Magnitude of associations increased with younger age at diagnosis PPI use was not associated with dementia occurring after age 90 years
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2201940-6
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