Publications
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Skudal, Hilde Kristin; Lorentzen, Åslaug Rudjord; Stenstad, Tore; Paulsen, Else Quist; Fevang, Børre & Jaioun, Keson
[Show all 10 contributors for this article]
(2026).
Long-term patient-reported neurocognitive and functional outcomes after tick-borne encephalitis: a prospective controlled multicenter cohort study.
Journal of Neurology.
ISSN 0340-5354.
273.
doi:
10.1007/s00415-026-14095-3.
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Objective To characterize cognitive symptoms the first year after tick-borne encephalitis (TBE). Methods We conducted a controlled, multicenter cohort study of 109 hospitalized patients ≥16 years with confirmed TBE in Norway. At 3 and 12 months after admission, patients completed BRIEF-A (Global Executive Composite (GEC) and subscales), Everyday Memory Questionnaire-Revised (EMQ-R), and Rivermead Post-Concussion Symptoms Questionnaire (RPQ), assessing executive functioning, memory, and post-TBE symptoms (higher scores indicate more difficulties). The primary outcomes were within-patient change in questionnaire scores from 3 to 12 months, and 12-month scores in patients compared to controls. The secondary outcomes were BRIEF-A subscale scores and proportion with clinically significant impairment. Covariates included in the analyses were age, sex, comorbidities, acute disease severity, anxiety, and depression. Results There were no significant changes from 3 to 12 months. At 12 months, scores were within the normal range, but patients had higher EMQ-R and RPQ than controls ( p <0.001). BRIEF-A GECs did not differ, but patients had higher working memory subscale scores ( p =0.002). These differences persisted after adjustment for anxiety and depression. Clinically significant impairment was more frequent in patients (odds ratios 2.29–8.19). Comorbidities, acute disease burden, anxiety, depression and female sex were associated with unfavorable 12 month outcome. Conclusion TBE patients have an overall good one-year prognosis, but a minority—characterized by higher acute disease burden and comorbidities—have persistent cognitive difficulties that may warrant follow-up. Anxiety and depression were related to unfavorable prognosis but did not account for the cognitive differences between patients and controls.
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Ringstad, Ingrid Beate; Skovlund, Eva; Santervas, Leonor Roa; Kersten, Hege; Fjeld, Katrine Gahre & Hove, Lene Hystad
[Show all 9 contributors for this article]
(2026).
Association Between Anticholinergic Burden and Dry Mouth Severity in Acutely Ill Older Adults.
Drugs & Aging.
ISSN 1170-229X.
43(4),
p. 361–371.
doi:
10.1007/s40266-026-01286-w.
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Background: Dry mouth is a common and burdensome condition in older adults and its severity may increase with use of anticholinergic medications. The aims were to describe anticholinergic medication use among acutely ill older adults, examine the association between anticholinergic burden and dry mouth severity using the composite Dry Mouth Severity Points (DMSP) measure and investigate whether the association differs by sex.
Methods: Patients ≥70 years admitted to Oslo municipal inpatient acute care unit were eligible. Anticholinergic burden (ACB) was assessed using the ACB calculator and classified as 0, lower (ACB = 1-2) or high (ACB = ≥ 3). Dry mouth severity was quantified with DMSP, range 0-4, assigning one point for each indicator above cut-off: General Xerostomia Question ≥ 3, Summated Xerostomia Inventory ≥ 11, Clinical Oral Dryness Score ≥ 6 and unstimulated whole saliva secretion rate ≤ 0.1 mL/min. Associations were examined with ordinal logistic regression.
Results: Of 382 examined patients, 256 (mean age 84 ± 7 years, 70% women) had complete data. Mean [standard deviation (SD)] ACB score was 2.0 (1.7); 18% had ACB = 0, 50% had ACB = 1-2 and 32% had ACB = ≥ 3. DMSP scores of 0, 1, 2 and ≥ 3 were present in 29%, 36%, 23% and 12%, respectively. Compared with patients with ACB = 0, those with ACB = 1-2 [odds ratio (OR) = 2.06, 95% confidence interval (CI) 1.07-3.97) and ACB = ≥ 3 (OR = 2.25, 95% CI 1.09-4.63) had higher odds of more severe dry mouth. Women had significantly higher ACB and DMSP scores than men.
Conclusions: Even lower anticholinergic burden was associated with greater dry mouth severity, highlighting the need for early recognition and proactive management in acutely ill older adults.
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Nilsson, Per Rasmus; Myklebust, Tor Åge; Næss-Andresen, Thomas Fredrik; Bernklev, Tomm; Kersten, Hege & Haug, Erik Skaaheim
(2026).
In pathological T2-prostate cancers a positive surgical margin is associated with adverse psychological outcomes.
Scandinavian Journal of Urology.
ISSN 2168-1805.
61,
p. 15–21.
doi:
10.2340/sju.v61.45306.
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Objective: A positive surgical margin (PSM) after radical prostatectomy (RP) is considered an adverse surgical feature, but the clinical implications have been debated. Further motive to aim for negative margins (NSM) may be patient anxiety due to PSM, but studies on psychological consequences are lacking. We explored associations between psychological factors and PSM on a consecutive group of men after RP.
Material and methods: Men with suspected prostate cancer were invited to a study on psychological factors. Patient reported outcome measurement questionnaires were collected before diagnosis, and at 6, 12 and 24 months from those who underwent RP. Multivariable mixed models and post hoc pairwise comparisons were used to explore associations between PSM and psychological outcomes.
Results: In total, 387 men had RP and 94 (24%) had PSM. General psychological outcomes were not associated with margin status. At 12 months, men with PSM considered their personal risk of recurrence 6% (30% vs. 24%) points higher and had clinical fear of recurrence (FoR) 14% (47% vs. 33%) more often than men with NSM. In adjusted and stratified analyses, men with pathological (p-)T2-stage and NSM had less FoR than the rest of the sample. In pT3-disease, PSM had no additional impact on FoR. A limitation was the small size of the pT2 group with PSM and the lack of information on how patients were informed.
Conclusions: After RP, PSM was associated with higher FoR, particularly in men with pT2-cancer. Improved counselling and further research into causes and mitigation of FoR, is warranted.
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Kersten, Hege; Barca, Maria Lage; Eldholm, Rannveig Sakshaug; Persson, Karin Ester Torun; Hvidsten, Lara H. Thomasgaard & Jaioun, Keson
[Show all 9 contributors for this article]
(2026).
Potentially inappropriate medications related to two-year progression of mild cognitive impairment and dementia.
European Journal of Clinical Pharmacology.
ISSN 0031-6970.
82.
doi:
10.1007/s00228-025-03977-6.
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Purpose
To document use and impact of potentially inappropriate medications on two-year progression of dementia in individuals with cognitive declines.
Methods
A retrospective study of 397 patients with Mild Cognitive Impairment (MCI) or dementia diagnosed and followed-up in outpatient memory clinics in Norway during 2009 − 18. Beers (2019)- and STOPP-2 criteria were used to identify Potentially Inappropriate Medications (PIMcogs) in individuals with cognitive impairments at baseline and two-year-follow-up. PIMcog use in terms of dementia severity, cognitive function, and neuropsychiatric and depressive symptoms were analyzed in regression models.
Results
The prevalence of PIMcogs increased from 16% at baseline to 23% at follow-up. PIMcog users were more likely to be women (63.5%), and they used more drugs, with a median of 5 drugs at baseline and 4 drugs at follow-up, compared to non-users who had a median of 3 used drugs at both time points. PIMcog users had higher median Neuropsychiatric Inventory severity sum scores (6 [3.0–11.0] versus 4.0 [2.0–7.0]) and median Cornell Scale for Depression in Dementia scores (6.5 [3.0–11.0] versus 4.0 [1.0–7.0]) compared to non-users at follow-up (p ≤ 0.002). PIMcog users exhibited more severe dementia, with a Clinical Dementia Rate-Sum of Boxes (CDR-SB) score of 7.0 (4.0–13.0) compared to 6.0 (3.5–10.0) in non-users. The median annual increase in CDR-SB was one unit, and PIMcog use at follow-up was significantly associated with more rapid progression of dementia severity.
Conclusion
Faster dementia progression was documented among PIMcog users although, the prevalence of PIMcogs was generally low in Norwegian memory clinic patients with cognitive impairments.
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Skudal, Hilde Kristin; Stenstad, Tore; Lorentzen, Åslaug Rudjord; Paulsen, Else Quist; Egeland, Jens & Fevang, Børre
[Show all 12 contributors for this article]
(2025).
Tick-borne encephalitis in Norway: A cohort study of clinical course and health-related quality of life at three- and twelve-month follow-up.
European Journal of Clinical Microbiology and Infectious Diseases.
ISSN 0934-9723.
doi:
10.1007/s10096-025-05341-z.
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Purpose: Knowledge of tick-borne encephalitis (TBE) prognosis is limited. This study aimed to describe the disease course in the first year and assess one-year outcomes, focusing on clinical recovery and health-related quality of life (HR-QoL).
Methods: In this cohort study, we recruited hospitalized patients ≥ 16 years with confirmed TBE from hospitals in Norway’s endemic area. A composite clinical score consisting of variables on symptoms and neurological findings was scored at baseline (during hospitalization), 3- and 12 months. HR-QoL at 12 months was measured using RAND 36-item short form health survey and compared to the Norwegian reference population.
Results: Among the 93 patients included, clinical improvement from baseline to 3 months was 68%, increasing to 77% by 12 months. The proportion of patients with symptoms or neurological findings influencing daily life was 98% at baseline, 52% at 3 months, and 41% at 12 months. 14% required inpatient rehabilitation, and 4/56 (7%) of active workers were on full-time sick leave at 12 months. Severe disease and comorbidities were linked to poorer outcomes. Most common symptoms influencing daily life at 12 months were fatigue (28%), concentration issues (13%) memory and sleep difficulties (12% each), while 8% had clinical findings where impaired balance and tremor dominated. Patients scored lower in physical health and social functioning regarding HR-QoL than reference population.
Conclusion: Most improvements occur during the first three months; however, 41% of patients experience ongoing complaints at 12 months, impacting HR-QoL regarding physical health. Severe disease and comorbidities correlate with poorer prognoses.
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Sarjomaa, Marjut Anneli; Berg, Kristine Karlsrud; Jaioun, Keson; Tveten, Yngvar; Kersten, Hege & Reiso, Harald
[Show all 12 contributors for this article]
(2025).
SARS-CoV-2-specific humoral immunity in a Norwegian cohort between 2020 and 2023.
BMC Medicine.
23,
p. 1–14.
doi:
10.1186/s12916-025-04171-2.
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Background: We have previously reported on natural humoral immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a Norwegian cohort between 2020 and 2021. In this study, we evaluated long-term humoral (including vaccination-induced) immunity in the same cohort and assessed predictors of high antibody levels against spike protein, as well as the persistence of antibodies against the virus spike and nucleocapsid proteins.
Methods: Vaccination data and antibody levels against the spike and nucleocapsid proteins were collected at 12 (only in infected participants) and 24 months (in both infected and uninfected participants) after the participants’ first polymerase chain reaction (PCR) tests for the virus. Antibody levels against spike protein at 24 months were categorized as high or low based on the 50th percentile. Possible predictors of high antibody levels against spike protein were examined using univariate and multivariate logistic regression models.
Results: Of 1119 original participants (400 PCR + and 719 PCR −), 574 responded to our questionnaires and were invited to antibody measurements (median age: 51 years; women: 59%). Vaccination data showed that 11% were fully immunized, and 85% were booster-immunized at 24 months. Antibody levels were evaluated in 72% (287/400) of the PCR + participants at 12 months and 58% (233/400) at 24 months. At 12 and 24 months, we observed that 97% (278/287) and 100% (233/233), respectively, still had antibodies against the spike protein, and 86% (248/287) and 95% (221/233), respectively, against the nucleocapsid protein. Antibody levels were also evaluated in 34% (247/719) of those in the PCR − group, which revealed that 99.5% and 69% had detectable antibodies against spike and nucleocapsid proteins, respectively, at 24 months. Irrespective of pre-vaccination SARS-CoV-2 infection status, the boosterimmunized participants were 3.7 × more likely to have high antibody levels against spike protein vs the non-boosterimmunized ones. Those aged > 60 years had the highest median antibody levels against the spike protein and were more likely to be booster-immunized.
Conclusions: Our findings highlight the benefits of booster vaccinations for humoral immune responses. Long-term
antibody levels against the SARS-CoV-2 spike protein were higher in booster-immunized participants vs the nonbooster-
immunized, irrespective of pre-vaccination infection status.
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Mathiesen, Liv; Blix, Hege Salvesen; Molden, Espen; Kersten, Hege; Trapnes, Elin & Bergan, Stein
[Show all 7 contributors for this article]
(2024).
Erfaringsbasert master i klinisk farmasi – en kartleggingsstudie.
Norsk Farmaceutisk Tidsskrift (NFT).
ISSN 0029-1935.
p. 32–36.
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Hensikt
Kartlegge bakgrunn for farmasøyter som har gjennomført minst halve det erfaringsbaserte masterprogrammet i klinisk farmasi ved Farmasøytisk institutt, Universitetet i Oslo. Kartlegge i hvilken grad arbeidsoppgavene har endret seg for de som har fullført utdanningen.
Materiale og metode
Deskriptiv nettbasert spørreskjemaundersøkelse med spørsmål knyttet til demografi, grunnutdanningen i farmasi, det erfaringsbaserte masterprogrammet og arbeidsoppgaver. Farmasøyter som hadde fullført minst tre av seks emner i masterprogrammet, kunne inkluderes, og 92 farmasøyter ble invitert til å delta.
Resultater
82 farmasøyter (88 %) besvarte undersøkelsen, hvorav 53 hadde gjennomført hele utdanningen, og 29 farmasøyter hadde gjennomført minst halve utdanningen. Blant respondentene som hadde fullført masterprogrammet, hadde en signifikant høyere andel 5-årig farmasiutdanning (master i farmasi eller cand.pharm.) (p < 0,01) og jobbet i sykehus med klinisk farmasøytiske oppgaver før de startet på masterprogrammet (p = 0,04), sammenliknet med de som var underveis i utdanningen. Blant de som hadde fullført masterprogrammet, svarte 93 % at de hadde jobbet med klinisk farmasøytiske oppgaver etter utdanningen. Det var 70 % som for tiden utførte klinisk farmasøytiske arbeidsoppgaver, sammenliknet med 62 % før oppstart. 43 % hadde vært involvert i kliniske forskningsprosjekter etter endt utdanning.
Konklusjon
Blant de som var i ferd med å gjennomføre videreutdanningen var det flere med bachelorgrad og færre med erfaring som klinisk farmasøyt enn i gruppen som hadde fullført. Ni av ti farmasøyter som hadde gjennomført hele videreutdanningen, har hatt klinisk arbeidsoppgaver etterpå, mens seks av ti hadde slike oppgaver før utdanningen. Nesten halvparten hadde vært involvert i kliniske forskningsprosjekter.
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Sarjomaa, Marjut Anneli; Zhang, Chi; Tveten, Yngvar; Kersten, Hege; Reiso, Harald & Eikeland, Randi
[Show all 14 contributors for this article]
(2024).
Risk factors for SARS-CoV-2 infection: A test-negative case-control study with additional population controls in Norway.
BMJ Open.
14(1),
p. 1–11.
doi:
10.1136/bmjopen-2023-073766.
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Objectives This study aims to assess risk factors for
SARS-CoV-2 infection by combined design; first comparing
positive cases to negative controls as determined by PCR testing and then comparing these two groups to an additional prepandemic population control group.
Design and setting
Test-negative design (TND), multicentre case–control study with additional population controls in South-Eastern Norway.
Participants
Adults who underwent SARS-CoV-2 PCR testing between February and December 2020. PCR-positive cases, PCR-negative controls and additional age-matched population controls.
Primary outcome measures
The associations between various risk factors based on self- reported questionnaire and SARS-CoV-2 infection comparing PCR-positive cases and PCR-negative controls. Using subgroup analysis, the risk factors for both PCR-positive and PCR-negative participants were compared with a population control
group.
Results
In total, 400 PCR-positive cases, 719 PCR-negative controls and 14 509 population controls were included. Male sex was associated with the risk of SARS-CoV-2 infection only in the TND study (OR 1.9, 95% CI 1.4 to 2.6), but not when PCR-positive cases were compared with population controls (OR 1.2, 95% CI 0.9. to 1.5). Some factors were positively (asthma, wood heating) or negatively (hypertension) associated with SARS-CoV-2 infection when PCR-positive cases were compared with population controls, but lacked convincing association in the TND study. Smoking was negatively associated with the risk of SARS-CoV-2 infection in both analyses (OR 0.5, 95% CI 0.3 to 0.8 and OR 0.6, 95% CI 0.4 to 0.8).
Conclusions
Male sex was a possible risk factor for SARS-CoV-2 infection only in the TND study, whereas smoking was negatively associated with SARS-CoV-2 infection in both the TND study and when using population controls. Several factors were associated with SARS-CoV-2 infection when PCR-positive cases were compared with population controls, but not in the TND study, highlighting the strength of combining case–control study designs during the pandemic.
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Skudal, Hilde Kristin; Lorentzen, Åslaug Rudjord; Stenstad, Tore; Paulsen, Else Quist; Egeland, Jens & Fevang, Børre
[Show all 13 contributors for this article]
(2024).
Clinical characteristics and factors affecting disease severity in hospitalized tick-borne encephalitis patients in Norway from 2018 to 2022.
European Journal of Clinical Microbiology and Infectious Diseases.
ISSN 0934-9723.
43(7),
p. 1355–1366.
doi:
10.1007/s10096-024-04855-2.
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Purpose To describe the clinical characteristics and factors associated with disease severity in a Norwegian cohort of hospitalized patients with tick-borne encephalitis (TBE). Methods This observational multicenter study included hospitalized patients with TBE in the endemic area in the southeastern region of Norway from 2018 to 2022. Clinical signs and findings from laboratory tests, EEG, CT and MRI scans were recorded. Patient characteristics were compared among those with mild, moderate, and severe TBE, and factors associated with disease severity were identified. Results Nearly all eligible patients were included in the final cohort (153/189 participants, 81%). The median age was 56 years, 63% were men, and 7% were vaccinated against TBE; no participants were fully vaccinated. TBE presented as mild (meningeal) disease in 31% of patients and as moderate or severe (encephalitic) disease in 54% and 14% of patients, respectively. We found that 46% of the patients had a monophasic course, 64% had hyponatremia, and 7% presented with central nervous system (CNS) symptoms without pleocytosis in cerebrospinal fluid (CSF). Dysesthesia, a symptom previously not described, was reported in 10% of the patients. Most objective findings were related to the CNS. Preexisting comorbidities, CRP and CSF protein levels were predictors of more severe disease. Conclusion This novel presentation of a large Norwegian cohort supports TBE as a serious disease in the southeastern region of Norway. The majority of hospitalized patients presented with encephalitis, and fewer presented with meningitis. Comorbidities, CRP and CSF protein levels were associated with more severe disease.
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Nilsson, Per Rasmus; Næss-Andresen, Thomas Fredrik; Myklebust, Tor Åge; Bernklev, Tomm; Kersten, Hege & Haug, Erik Skaaheim
(2024).
The association between pre-diagnostic levels of psychological distress and adverse effects after radical prostatectomy.
BJUI Compass.
5(5),
p. 616–625.
doi:
10.1002/bco2.334.
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Objectives: To prospectively analyse the associations between pre-diagnostic levels of anxiety and depression and patient-reported urinary and sexual adverse effects after radical prostatectomy in a population-based setting.
Patients and Methods: In three Norwegian county hospitals, men referred with a suspicion of prostate cancer were asked to fill out a patient-reported outcome measurement (PROM) questionnaire prior to prostate biopsy. Those who later underwent radical prostatectomy were stratified into three distress groups according to their Hopkins Symptom Checklist 5-score. Additional PROM questionnaires, including the EPIC-26 to measure adverse effects, were collected at 6 and 12 months postoperatively. Multivariable mixed models were estimated and post hoc pairwise comparisons performed to explore differences in adverse effects between distress groups.
Results: A total of 416 men were included at baseline and of those, 365 (88%)returned questionnaires at 6 months and 360 (87%) at 12 months. After adjusting for confounders, men with high distress at baseline had worse urinary incontinence
domain score (58.9 vs. 66.8, p = 0.028), more urinary bother (64.7 vs. 73.6, p = 0.04) and a higher risk of using incontinence pads (70.6% vs. 54.2%, p = 0.034) at 6 months
than those with low distress. There was no difference in the sexual domain scores between distress groups postoperatively, but the high-distress group expressed more sexual bother (24.9 vs. 37.5, p = 0.015) and the intermediate-distress group had a greater probability of using sexual medications or devices (63.8% vs. 50.0%, p = 0.015) than the low-distress group at 6 months. At 12 months scores generally improved slightly and differences between distress groups were less evident.
Conclusion: Men with higher levels of anxiety and depression before prostate biopsy report more urinary and sexual adverse effects after radical prostatectomy. This should be considered both in treatment decision-making and during follow-up after radical prostatectomy.
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Helvik, Anne-Sofie; Hvidsten, Lara H. Thomasgaard; Engedal, Knut; Kersten, Hege; Dourado, Marcia Cristina Nascimento & Johannessen, Aud
(2023).
Living with young-onset dementia in the family – a mixed method study.
Aging & Mental Health.
ISSN 1360-7863.
28(2),
p. 254–261.
doi:
10.1080/13607863.2023.2243585.
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Background: Studies on disease-related obstructions experienced in everyday life of younger people with dementia (YOD ≤ 65 years) and their families are encouraged. Aim: To explore how the family carers experience six predefined topics that influence the everyday life and needs of persons with YOD. Method: A quantitative and a qualitative study including family carers of persons with young-onset Alzheimer’s dementia (AD) and frontotemporal dementia (FTD). Seventy-four informants responded to the Camberwell Assessment of Needs in the Elderly (CANE) and individual interviews were conducted with 13 informants. Results: Family carers of persons with YOD reported few unmet needs in the CANE assessment. Needs related to behavior and close relationships were reported significantly more frequent (p < 0.1) in persons with FTD than in persons with AD. From the qualitative data, six main themes were emphasized: daily activities turned upside down, involuntary loss of previous social network, losing close relationship, but maintaining a friendship with the spouse, unpredictable behavior adds burdens to a changing life, health and life risks, and economic insecurity for future life and caring costs. Conclusion: Whilst family carers quantitatively reported unmet needs, the individual interviews reported several major difficulties in everyday life.
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Wang-Hansen, Marte Sofie; Kersten, Hege; Benth, Jurate Saltyte & Wyller, Torgeir Bruun
(2022).
The association between geriatric treatment and 30-day readmission risk among medical inpatients aged ≥75 years with multimorbidity.
PLOS ONE.
17(1).
doi:
10.1371/journal.pone.0262340.
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Background: Readmission to hospital is frequent among older patients and reported as a post-discharge adverse outcome. The effect of treatment in a geriatric ward for acutely admitted older patients on mortality and function is well established, but less is known about the possible influence of such treatment on the risk of readmission, particularly in the oldest and most vulnerable patients. Our aim was to assess the risk for early readmission for multimorbid patients > 75 years treated in a geriatric ward compared to medical wards and to identify risk factors for 30-day readmissions.
Methods: Prospective cohort study of patients acutely admitted to a medical department at a Norwegian regional hospital. Eligible patients were community-dwelling, multimorbid, receiving home care services, and aged 75+. Patients were consecutively included in the period from 1 April to 31 October 2012. Clinical data were retrieved from the referral letter and medical records.
Results: We included 227 patients with a mean (SD) age of 86.0 (5.7) years, 134 (59%) were female and 59 (26%) were readmitted within 30 days after discharge. We found no statistically significant difference in readmission rate between patients treated in a geriatric ward versus other medical wards. In adjusted Cox proportional hazards regression analyses, lower age (hazard ratio (95% confidence interval) 0.95 (0.91-0.99) per year), female gender (2.17 (1.15-4.00)) and higher MMSE score (1.03 (1.00-1.06) per point) were significant risk factors for readmission.
Conclusions: Lower age, female gender and higher cognitive function were the main risk factors for 30-day readmission to hospital among old patients with multimorbidity. We found no impact of geriatric care on the readmission rate.
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Flemmen, Heidi Øyen; Simonsen, Cecilia Smith; Broch, Line; Brunborg, Cathrine; Berg-Hansen, Pål & Moen, Stine Marit
[Show all 8 contributors for this article]
(2022).
The influence of socioeconomic factors on access to disease modifying treatment in a Norwegian multiple sclerosis cohort.
Multiple Sclerosis and Related Disorders.
ISSN 2211-0348.
61,
p. 1–10.
doi:
10.1016/j.msard.2022.103759.
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Objective: Several studies report an impact of socioeconomic factors on access to disease modifying treatment (DMT) in multiple sclerosis (MS), with a trend of less access to more deprived persons. We investigated the impact of socioeconomic status (SES) on access to treatment in a well-defined Norwegian MS cohort.
Methods: This is a study of a population-based Norwegian MS cohort. We collected detailed information on disease development, progression, and DMT administered. Socioeconomic data was obtained from Statistics Norway and a questionnaire.
Results: We included 1314 persons with relapsing remitting MS at the prevalence date 01/01/2018. The population ever treated with DMTs is younger at onset, has shorter time from onset to diagnosis and lower expanded disability status score (EDSS) at diagnosis. The persons with MS (pwMS) with the highest levels of education, and those who are married are more likely to be ever treated with DMT. In the subgroup treated with a high efficacy DMT as a first drug, the pwMS are younger at prevalence date (39.9 years (SD 12.1)) compared with those who are not treated with a high efficacy DMT as first drug (43.8 years (SD 10.3)). The subgroup treated with a high efficacy DMT as a first drug has a 0.5 point higher EDSS at diagnosis compared to those not treated with a high efficacy DMT as a first drug. The level of education, household income and marital status are inversely related to access to high efficacy DMT as a first drug. None of the above differences persist when analyzing the subgroup diagnosed within the last six years (2012-2017).
Conclusions: Since 2012, the pwMS in this Norwegian cohort are treated equally with DMT in terms of different measures of socioeconomic position.
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Sarjomaa, Marjut Anneli; Diep, Lien My; Zhang, Chi; Tveten, Yngvar; Reiso, Harald & Thilesen, Carina
[Show all 14 contributors for this article]
(2022).
SARS-CoV-2 antibody persistence after five and twelve months: A cohort study from South-Eastern Norway.
PLOS ONE.
17(8),
p. 1–15.
doi:
10.1371/journal.pone.0264667.
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Objectives: To assess total antibody levels against Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS CoV-2) spike protein up to 12 months after Coronavirus Disease (COVID-19) infection in non-vaccinated individuals and the possible predictors of antibody persistence.
Methods: This is the first part of a prospective multi-centre cohort study.
Participants: The study included SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) positive and negative participants in South-Eastern Norway from February to December 2020. Possible predictors of SARS-CoV-2 total antibody persistence was assessed. The SARS-CoV-2 total antibody levels against spike protein were measured three to five months after PCR in 391 PCR-positive and 703 PCR-negative participants; 212 PCR-positive participants were included in follow-up measurements at 10 to 12 months. The participants completed a questionnaire including information about symptoms, comorbidities, allergies, body mass index (BMI), and hospitalisation.
Primary outcome: The SARS-CoV-2 total antibody levels against spike protein three to five and 10 to 12 months after PCR positive tests.
Results: SARS-CoV-2 total antibodies against spike protein were present in 366 (94%) non-vaccinated PCR-positive participants after three to five months, compared with nine (1%) PCR-negative participants. After 10 to 12 months, antibodies were present in 204 (96%) non-vaccinated PCR-positive participants. Of the PCR-positive participants, 369 (94%) were not hospitalised. The mean age of the PCR-positive participants was 48 years (SD 15, range 20-85) and 50% of them were male. BMI ≥ 25 kg/m2 was positively associated with decreased antibody levels (OR 2.34, 95% CI 1.06 to 5.42). Participants with higher age and self-reported initial fever with chills or sweating were less likely to have decreased antibody levels (age: OR 0.97, 95% CI 0.94 to 0.99; fever: OR 0.33, 95% CI 0.13 to 0.75).
Conclusion: Our results indicate that the level of SARS-CoV-2 total antibodies against spike protein persists for the vast majority of non-vaccinated PCR-positive persons at least 10 to 12 months after mild COVID-19.
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Flemmen, Heidi Øyen; Simonsen, Cecilia Smith; Broch, Line; Brunborg, Cathrine; Berg-Hansen, Pål & Moen, Stine Marit
[Show all 8 contributors for this article]
(2021).
Maternal education has significant influence on progression in multiple sclerosis.
Multiple Sclerosis and Related Disorders.
ISSN 2211-0348.
53,
p. 1–10.
doi:
10.1016/j.msard.2021.103052.
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Objective: The identification of potential risk factors for disease severity is of great importance in the treatment of multiple sclerosis. The influence of socioeconomic status on progression in multiple sclerosis (MS) is sparsely investigated. Our aim was to investigate how socioeconomic status in adolescence influences disease progression in later life.
Methods: A total of 1598 patients with multiple sclerosis from a well-defined population in Norway were included. Detailed information on disease progression, measured by expanded disability status scale (EDSS) and multiple sclerosis severity score (MSSS), were combined with data on socioeconomic factors. We used residency and parental level of education at patients' age 16 and exposure to second-hand smoking as a measure of socioeconomic status in adolescence, adjusting for the same variables as well as use of disease modifying treatments at prevalence date 01.01.18.
Results: High maternal level of education at patients' age 16 was significantly associated with less pronounced disease progression measured by MSSS (β-coefficient -0.58, p = 0.015), younger age and lower EDSS at disease onset, and shorter time from onset to diagnosis. No significant associations were found for paternal education level and MSSS. The use of any disease modifying treatment before prevalence date was significantly associated with disease progression (β-coefficient -0.49, p=0.004), while residence, current and second-hand smoking were not.
Conclusion: This study on a population-based, real-world cohort shows that the parental level of education has a significant impact on a timely diagnosis of MS. In addition to disease modifying treatment, maternal level of education also had an impact on disease progression in later life.
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Sandvik, Miriam Kristine; Watne, Leiv; Brugård, Anniken; Wang-Hansen, Marte Sofie & Kersten, Hege
(2021).
Association between psychotropic drug use and handgrip strength in older hospitalized patients.
European Geriatric Medicine.
ISSN 1878-7649.
12(6),
p. 1213–1220.
doi:
10.1007/s41999-021-00511-6.
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Purpose: Handgrip strength is an indicator of frailty and longevity in older adults. The association between psychotropic drug use and handgrip strength in older hospitalized patients was investigated in this study.
Methods: A total of 488 patients were included in this retrospective cross-sectional study, 333 women and 155 men, from two different cohorts of older (mean age 84 years) hospitalized in-patients. We used multiple linear regression models to explore the association between psychotropic drug use and handgrip strength. We adjusted for factors known to affect handgrip strength: Age, gender, body mass index (BMI) and comorbidity (Charlson comorbidity index).
Results: Both unadjusted and adjusted analyses showed that psychotropic drug use was associated with handgrip strength (β = - 0.183, p
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Nilsson, Rasmus; Næss-Andresen, Thomas Fredrik; Myklebust, Tor Åge; Bernklev, Tomm; Kersten, Hege & Haug, Erik Skaaheim
(2021).
Fear of Recurrence in Prostate Cancer Patients: A Cross-sectional Study After Radical Prostatectomy or Active Surveillance.
European Urology Open Science.
ISSN 2666-1691.
25,
p. 44–51.
doi:
10.1016/j.euros.2021.01.002.
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Background: Fear of recurrence (FoR) is a distressing consequence of cancer. Little
is known about the prevalence of FoR in different treatment groups and factors
associated with FoR among prostate cancer (PCa) survivors.
Objective: To investigate the prevalence of high FoR among PCa survivors after
radical prostatectomy (RP) or under active surveillance (AS) and to explore clinical
and psychological factors potentially associated with FoR.
Design, setting, and participants: This is a retrospective cross-sectional study of
606 patients with PCa, treated with either RP (n = 442) or AS (n = 164) at two
Norwegian regional hospitals. The 440 patients (73%) who gave consent to participate
were invited in 2017 to complete a questionnaire measuring FoR, self-rated
health, adverse effects, and psychological factors at a mean of 4.1 yr (standard
deviation 1.7) after their treatment decision. Clinical data were retrieved from
medical records.
Outcome measurements and statistical analysis: FoR was measured using the
Concerns About Recurrence Questionnaire, with high FoR defined as a sum score
of ≥12 points (range 0–40). Using multivariable logistic regression analyses, factors
associated with high FoR were identified.
Results and limitations: One-third of the participants had high FoR; scores were
higher in the AS group and in the RP group with treatment failure. Younger age was
significantly associated with high FoR in the AS group, while high prostate-specific
antigen at diagnosis, biochemical recurrence, positive surgical margin, higher fatigue, and a type D personality were significantly associated with high FoR in the
RP group.
Conclusions: At 4 yr after a diagnosis of PCa, high FoR was common, especially
among AS patients and among RP patients with treatment failure.
Patient summary: In this study, we examined fear that their disease will return or
progress among prostate cancer survivors. We found that such fear was common,
especially among young patients under active surveillance and among radical
prostatectomy patients with treatment failure or with certain psychological
features.
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Flemmen, Heidi Øyen; Simonsen, Cecilia Smith; Berg-Hansen, Pål; Moen, Stine Marit; Kersten, Hege & Heldal, Kristian
[Show all 7 contributors for this article]
(2020).
Prevalence of multiple sclerosis in rural and urban districts in Telemark county, Norway.
Multiple Sclerosis and Related Disorders.
ISSN 2211-0348.
45.
doi:
10.1016/j.msard.2020.102352.
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Objective: To explore the trends in prevalence and incidence of multiple sclerosis (MS) in Telemark, Norway (latitude 58.7-60.3˚N), over the past two decades, with focus on differences between rural and urban areas.
Methods: Data from all patients with a confirmed diagnosis of MS in Telemark since 1993 were prospectively recorded and collected in a retrospective chart review. Prevalence estimates on January 1st 1999, 2009 and 2019, and incidence rates at five-year intervals between 1999 and 2018 were calculated and all results were adjusted to the European Standard Population. The study population was divided into urban and rural residency using a Norwegian governmental index.
Results: We registered 579 patients with MS in Telemark between 1999 and 2019. The adjusted prevalence estimates for January 1st 1999, 2009 and 2019 were 105.8/105, 177.1/105 and 260.6/105, respectively. In 2019, the prevalence estimates were 250.4/105 in urban and 316.2 /105 in rural areas. Between 1999 and 2018, the yearly incidence increased from 8.4/105 to 14.4/105.
Conclusions: The prevalence of MS in Telemark is among the highest ever reported in Norway, consistent with an increasing incidence in the county over the past twenty years. The even higher prevalence in the rural areas is unlikely to be explained by possible risk factors like latitude, exposure to sunlight and diet. Further studies on differences between urban and rural areas are required to reveal possible new risk factors.
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Nilsson, Per Rasmus; Dahl, Alv A; Bernklev, Tomm; Kersten, Hege & Haug, Erik S.
(2020).
Work status and work ability after radical prostatectomy or active surveillance for prostate cancer.
Scandinavian Journal of Urology.
ISSN 2168-1805.
54(3),
p. 194–200.
doi:
10.1080/21681805.2020.1750473.
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Romskaug, Rita; Wyller, Torgeir Bruun; Straand, Jørund; Kersten, Hege & Molden, Espen
(2020).
Prescribed Doses of CYP2D6-Metabolized Drugs and Hemodynamic Responses in Relation to CYP2D6 Genotype Among Older Patients Exposed to Polypharmacy.
Drugs & Aging.
ISSN 1170-229X.
37(6),
p. 425–433.
doi:
10.1007/s40266-020-00763-0.
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Background: Many drugs with dose-dependent effects on hemodynamic variables are metabolized by cytochrome P450 2D6 (CYP2D6). The aim of this study was to compare prescribed dosages and hemodynamic responses of such drugs in relation to pharmacogenetic variability in CYP2D6 metabolism among patients aged ≥ 70 years exposed to polypharmacy. Materials and methods: We included 173 patients with detailed information about drug use. The patients were retrospectively subjected to CYP2D6 genotyping, which comprised the most common variant alleles encoding reduced, absent, or increased CYP2D6 metabolism. In order to compare dosages across different CYP2D6-metabolized drugs, all prescribed daily doses were harmonized to the 'percent of a daily defined dose' (DDD). The mean harmonized DDD was compared between genotype-predicted normal metabolizers (NMs) and patients with reduced or absent CYP2D6 enzyme activity, defined as intermediate or poor metabolizers (IMs/PMs). Blood pressure, pulse, and patient proportions with orthostatism and bradycardia were also compared between genotype subgroups. Results: The genotype-predicted phenotype subgroups comprised 79 NMs (45.7%), 75 IMs (43.4%), and 16 PMs (9.2%). There were no differences in dosing of CYP2D6 substrates between NMs and IMs/PMs (p = 0.76). A higher proportion of CYP2D6 IMs/PMs experienced orthostatism (p = 0.03), while there were no significant subgroup differences for the other hemodynamic variables. Conclusion: In this real-life clinical setting of patients aged ≥ 70 years, dosing of CYP2D6 substrates were not adjusted according to genotype-predicted CYP2D6 metabolism. The increased occurrence of orthostatism in patients with reduced/absent CYP2D6 metabolism may indicate that individualized dosing based on genotype has the potential to prevent adverse effects in these vulnerable patients.
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Hvidsten, Lara H. Thomasgaard; Engedal, Knut; Selbæk, Geir; Wyller, Torgeir Bruun; Benth, Jurate Saltyte & Kersten, Hege
(2019).
Quality of Life of Family Carers of Persons with Young-Onset Dementia: A Nordic Two-Year Observational Multicenter.
PLOS ONE.
14(7).
doi:
10.1371/journal.pone.0219859.
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Objectives
To identify factors associated with QOL in carers of persons with young-onset Alzheimer’s (AD) and frontotemporal dementia (FTD) and explore development in QOL over a two-year period.
Methods
Eighty-eight family carers of community-dwelling people with young-onset AD (n = 50) and FTD (n = 38) recruited from Nordic memory clinics. Carer QOL was assessed using the Quality of Life–Alzheimer’s Disease questionnaire. Carer burden was assessed by the Relatives’ Stress scale and depressive symptoms by the Montgomery-Åsberg Depression Rating Scale. Factors associated with QOL in YOD and development in QOL over time were explored with growth mixture model trajectories and mixed model analyses.
Results
We identified two carer groups of persons with YOD following trajectories with better (n = 53) versus poorer (n = 30) QOL. Carers who reported more burden at baseline had greater odds of belonging to the poorer QOL group (OR 1.1 (1.0–1.2), p = 0.004). Analyses of the development in QOL showed a significant decline in QOL–AD scores among the AD-carers from baseline to two-year follow-up (p = 0.044), while the score remained stable among the FTD-carers. The FTD-carer group had significantly higher mean QOL–AD scores at one- and two-year follow-up (p = 0.022 and 0.045, respectively). However, the difference between the two groups regarding time trend was non-significant. Poorer QOL was associated with increased carer burden (p = 0.01), more depressive symptoms (p = 0.024), and being male carer (p = 0.038).
Conclusion
Higher care burden, more depressive symptoms, and being a male carer was associated with poorer QOL in family carers for persons with YOD. Carers of persons with AD may experience greater challenges in preserving QOL compared to carers of persons with FTD.
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Hvidsten, Lara H. Thomasgaard; Engedal, Knut; Selbæk, Geir; Wyller, Torgeir Bruun; Benth, Jurate Saltyte & Kersten, Hege
(2019).
Quality of Life in People with Young-Onset Dementia: A Nordic Two-Year Observational Multicenter Study.
Journal of Alzheimer's Disease.
ISSN 1387-2877.
67(1),
p. 197–210.
doi:
10.3233/JAD-180479.
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Background:Cross-sectional studies of quality of life (QOL) of people with young-onset dementia show diverging results. Objective:To identify factors associated with QOL in people with young-onset Alzheimer’s (AD) and frontotemporal dementia (FTD) and explore development in QOL over a two-year period, including differences between the two subtypes. Methods:A two-year cohort study of 88 community-dwelling people with young-onset AD and FTD recruited from Nordic memory clinics. QOL was assessed using the proxy version of the Quality of Life – Alzheimer’s Disease questionnaire, dementia severity was rated with the Clinical Dementia Rating scale, depressive symptoms by the Cornell Scale for Depression in Dementia, awareness with the Reed anosognosia scale, and needs using the Camberwell Assessment of Needs in the Elderly questionnaire. Factors associated with QOL and development in QOL over time were explored with growth mixture model trajectories and mixed model analyses. Results:We identified two groups of people following trajectories with better (n = 35) versus poorer (n = 53) QOL. People with more depressive symptoms at baseline had higher odds of belonging to poorer QOL group, OR 1.2 (CI 1.1; 1.5, p = 0.011). Having Alzheimer’s disease was associated with significantly better QOL (p = 0.047 at baseline, p = 0.009 at T1 and p = 0.033 at T2). Increasing number of unmet needs was significantly associated with poorer QOL at baseline (p = 0.007), but not later in follow-up. Conclusion:Early assessment and treatment based on dementia subtype, depression, and individual needs may enhance quality of life in young-onset dementia. Keywords: Alzheimer’s disease, depression, frontotemporal dementia, quality of life, young-onset
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Romskaug, Rita; Skovlund, Eva; Straand, Jørund; Molden, Espen; Kersten, Hege & Pitkala, Kaisu H
[Show all 8 contributors for this article]
(2019).
Effect of clinical geriatric assessments and collaborative medication reviews by geriatrician and family physician for improving health-related quality of life in home-dwelling older patients receiving polypharmacy: a cluster randomized clinical trial.
JAMA Internal Medicine.
ISSN 2168-6106.
doi:
10.1001/jamainternmed.2019.5096.
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Importance: Polypharmacy and inappropriate drug regimens are major health concerns among older adults. Various interventions focused on medication optimization strategies have been carried out, but the effect on patient-relevant outcomes remains uncertain. Objective: To investigate the effect of clinical geriatric assessments and collaborative medication reviews by geriatrician and family physician (FP) on health-related quality of life and other patient-relevant outcomes in home-dwelling older patients receiving polypharmacy. Design, Setting, and Participants: Cluster randomized, single-blind, clinical trial. Norwegian FPs were recruited from March 17, 2015, to March 16, 2017, to participate in the trial with their eligible patients. Participants were home-dwelling patients 70 years or older, using at least 7 medications regularly, and having their medications administered by the home nursing service. Patients in the control group received usual care. Randomization occurred at the FP level. A modified intent-to-treat analysis was used. Intervention: The intervention consisted of 3 main parts: (1) clinical geriatric assessment of the patients combined with a thorough review of their medications; (2) a meeting between the geriatrician and the FP; and (3) clinical follow-up. Main Outcomes and Measures: The primary outcome was health-related quality of life as assessed by the 15D instrument (score range, 0-1; higher scores indicate better quality of life, with a minimum clinically important change of ±0.015) at week 16. Secondary outcomes included changes in medication appropriateness, physical and cognitive functioning, use of health services, and mortality. Results: Among 174 patients (mean [SD] age, 83.3 [7.3] years; 67.8% women; 87 randomized to the intervention group and 87 randomized to the control [usual care] group) in 70 FP clusters (36 intervention and 34 control), 158 (90.8%) completed the trial. The mean (SD) 15D instrument score at baseline was 0.708 (0.121) in the intervention group and 0.714 (0.113) in the control group. At week 16, the mean (SD) 15D instrument score was 0.698 (0.164) in the intervention group and 0.655 (0.184) in the control group, with an estimated between-group difference of 0.045 (95% CI, 0.004-0.086; P = .03). Several secondary outcomes were also in favor of the intervention. There were more drug withdrawals, reduced dosages, and new drug regimens started in the intervention group. Conclusions and Relevance: This study’s findings indicate that, among older patients exposed to polypharmacy, clinical geriatric assessments and collaborative medication reviews carried out by a geriatrician in cooperation with the patient’s FP can result in positive effects on health-related quality of life.
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Hvidsten, Lara H. Thomasgaard; Engedal, Knut; Selbæk, Geir; Wyller, Torgeir Bruun; Benth, Jurate Saltyte & Bruvik, Frøydis Kristine
[Show all 7 contributors for this article]
(2019).
Quality of life of family carers of persons with young-onset compared to late-onset dementia.
Aging & Mental Health.
ISSN 1360-7863.
24(9),
p. 1394–1401.
doi:
10.1080/13607863.2019.1617245.
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Abstract OBJECTIVES: To compare quality of life (QOL) of family carers of persons with young- (YOD) to late-onset dementia (LOD). METHODS: This was a cross-sectional comparison of 88 carers of persons with YOD and 100 carers of persons with LOD. The Quality of Life - Alzheimer's Disease questionnaire (QOL-AD) was used to measure QOL of both carers and persons with dementia. Depressive symptoms were measured by the Geriatric Depression Scale (GDS) for carers and the Cornell Scale for Depression in Dementia for persons with dementia. Care burden was measured by the Relatives' Stress Scale. Activities of Daily Living (ADL) of the persons with dementia were assessed using the total score from the Lawton & Brody Instrumental-ADL scale and the Physical Self-Maintenance Scale. Multiple linear regression models with interactions between covariates and group (YOD versus LOD) were estimated. RESULTS: The QOL-AD scores of YOD-carers were significantly poorer compared to LOD-carers (mean difference 2.5 (95% CI 0.7; 4.3), p = 0.006). Poorer QOL of carers was associated with more depressive symptoms (mean QOL-AD change -0.5 (-0.6; -0.3), p < 0.001), but with no difference between the two groups. In contrast to LOD, QOL of carers of people with YOD was also significantly associated with symptom duration (p = 0.002), depressive symptoms of the persons with dementia (p = 0.030), ADL (p = 0.001), and carer burden (p = 0.002). CONCLUSION: YOD-carers reported significantly poorer QOL compared to LOD-carers. QOL was significantly associated with depressive symptoms in carers of both groups.
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Wang-Hansen, Marte Sofie; Wyller, Torgeir Bruun; Hvidsten, Lara H. Thomasgaard & Kersten, Hege
(2019).
Can screening tools for potentially inappropriate prescriptions in older adults prevent serious adverse drug events?
European Journal of Clinical Pharmacology.
ISSN 0031-6970.
75(5),
p. 627–637.
doi:
10.1007/s00228-019-02624-1.
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Purpose The purpose of the study is to identify and explore risk factors of serious adverse drug events (SADE) and SADE-related admissions in acutely hospitalized multimorbid older adults and assess whether these could have been prevented by adherence to the prescription tools Screening Tool of Older Persons’ Prescriptions (STOPP) and The Norwegian General Practice (NORGEP) criteria. Methods Cross-sectional study of acutely admitted patients to a medical department in a Norwegian regional hospital. Eligible patients were community-dwelling, receiving home care services, and aged 75+, with ≥ 3 chronic diseases. Medications and information regarding the admission were retrieved from the referral letter and medical records, while an expert panel identified SADE using the Common Terminology Criteria for Adverse Events and SADE-related admissions. Results We included 232 patients. Mean (SD) age was 86 (5.7) years, 137 (59%) were female, 121 (52%) used 5–9 drugs whereas 65 (28%) used ≥ 10. We identified SADEs in 72 (31%) of the patients, and in 49 (68%) of these cases, the SADE was considered to cause the hospital admission. A low body mass index (BMI) and a high Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score were independent risk factors for SADEs. Among the SADEs identified, 32 (44%) and 11 (15%) were preventable by adherence to STOPP and NORGEP, respectively. Conclusions We found a high prevalence of SADE leading to hospitalization. Risk factors for SADE were high CIRS-G and low BMI. STOPP identified more SADEs than NORGEP, but adherence to the prescription tools could only to a limited degree prevent SADEs in this patient group.
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Hvidsten, Lara H. Thomasgaard; Engedal, Knut; Selbæk, Geir; Wyller, Torgeir Bruun; Bruvik, Frøydis Kristine & Kersten, Hege
(2018).
Quality of Life in People with Young-Onset Alzheimer’s Dementia and Frontotemporal Dementia.
Dementia and Geriatric Cognitive Disorders.
ISSN 1420-8008.
45(1-2),
p. 91–104.
doi:
10.1159/000487263.
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Barca, Maria Lage; Persson, Karin; Eldholm, Rannveig Sakshaug; Benth, Jurate Saltyte; Kersten, Hege & Knapskog, Anne Brita
[Show all 9 contributors for this article]
(2017).
Trajectories of depressive symptoms and their relationship to the progression of dementia.
Journal of Affective Disorders.
ISSN 0165-0327.
222,
p. 146–152.
doi:
10.1016/j.jad.2017.07.008.
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Background
The relationship between progression of Alzheimer's disease and depression and its underlying mechanisms has scarcely been studied.
Methods
A sample of 282 outpatients with Alzheimer's disease (AD; 105 with amnestic AD and 177 with Alzheimer's dementia) from Norway were followed up for an average of two years. Assessment included Cornell Scale for Depression in Dementia and Clinical Dementia Rating Scale (CDR) at baseline and follow-up to examine the relationship between AD and depression. Additionally, MRI of the brain, CSF dementia biomarkers and APOE status were assessed at baseline. Progression of dementia was defined as the difference between CDR sum of boxes at follow-up and baseline (CDR-SB change). Trajectories of depressive symptoms on the Cornell Scale were identified using growth mixture modeling. Differences between the trajectories in regard to patients’ characteristics were investigated.
Results
Three distinct trajectories of depressive symptoms were identified: 231 (82.8%) of the patients had stable low-average scores on the Cornell Scale (Class 1); 11 (3.9%) had high and decreasing scores (Class 2); and 37 (13.3%) had moderate and increasing scores (Class 3). All classes had average probabilities over 80%, and confidence intervals were non-overlapping. The only significant characteristic associated with membership in class 3 was CDR-SB change.
Limitations
Not all patients screened for participation were included in the study, but the included and non-included patients did not differ significantly. Some patients with amnestic MCI might have been misdiagnosed.
Conclusion
A more rapid progression of dementia was found in a group of patients with increasing depressive symptoms.
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Eldholm, Rannveig Sakshaug; Barca, Maria Lage; Persson, Karin; Knapskog, Anne Brita; Kersten, Hege & Engedal, Knut
[Show all 10 contributors for this article]
(2017).
Progression of Alzheimer's disease: A longitudinal study in Norwegian memory clinics.
Journal of Alzheimer's Disease.
ISSN 1387-2877.
61(3),
p. 1221–1232.
doi:
10.3233/JAD-170436.
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Background: The course of Alzheimer’s disease (AD) varies considerably between individuals. There is limited evidence on factors important for disease progression. Objective: The primary aim was to study the progression of AD, as measured by the Clinical Dementia Rating Scale Sum of Boxes (CDR-SB). Secondary aims were to investigate whether baseline characteristics are important for differences in progression, and to examine the correlation between progression assessed using three different instruments: CDR-SB (0–18), the cognitive test Mini-Mental State Examination (MMSE, 0–30), and the functional measure Instrumental Activities of Daily Living (IADL, 0-1). Methods: The Progression of AD and Resource use (PADR) study is a longitudinal observational study in three Norwegian memory clinics. Results: In total, 282 AD patients (mean age 73.3 years, 54% female) were followed for mean 24 (16–37) months. The mean annual increase in CDR-SB was 1.6 (SD 1.8), the mean decrease in MMSE score 1.9 (SD 2.6), and the mean decrease in IADL score 0.13 (SD 0.14). Of the 282 patients, 132 (46.8%) progressed slowly, with less than 1 point yearly increase in CDR-SB. Cognitive test results at baseline predicted progression rate, and together with age, ApoE, history of hypertension, and drug use could explain 17% of the variance in progression rate. The strongest correlation of change was found between CDR-SB and IADL scores, the weakest between MMSE and IADL scores. Conclusion: Progression rate varied considerably among AD patients; about half of the patients progressed slowly. Cognitive test results at baseline were predictors of progression rate.
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Hvidsten, Lara Hisami Thomasgaard; Engedal, Knut; Selbæk, Geir; Wyller, Torgeir Bruun; Høgh, Peter & Snaedal, Jon
[Show all 9 contributors for this article]
(2015).
Young Onset Dementia study - A Prospective Cohort Study of Quality of Life and Specific Needs in Persons with Young Onset Dementia and their Families.
Journal of Clinical Trials.
5(1).
doi:
10.4172/2167-0870.1000204.
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Background: Young-Onset Dementia (YOD) causes challenges and concerns that are likely to affect quality of life and generate specific needs for health care, which may be different from what is observed in late onset dementia. The knowledge about the impact of YOD, in particular Fronto Temporal Dementia (FTD), on the affected families is scarce, and previous studies have underscored the importance of differentiating between diagnostic subgroups of YOD in future research. Accordingly, the aims of this study are to identify and compare factors influencing quality of life between persons with young onset FTD and Alzheimer’s Dementia (AD) and their families as the condition progresses. An additional aim is to compare the use of health care services among younger and older persons with dementia, and to
investigate the life-stage specific needs for health care services in persons with YOD.
Methods/Design: This is a two-year observational Nordic multicentre cohort study of community-dwelling persons with YOD and their families. Two diagnostic subgroups, each consisting of 75 dyads with AD and 75 dyads with FTD with symptom debut <65 years, will be included, and compared with a control group consisting of 100 older persons with dementia and onset >70 years. Participants are recruited from nine Nordic memory clinics.
Comprehensive assessments are made at baseline, 12 and 24 months, supplemented with telephone follow-ups at 6 and 18 months. Primary outcome measure is Quality of life measured by Quality of Life in Alzheimer’s Disease (QoL-AD) and EuroQol-5D (EQ-5D). Secondary outcome measures are needs for health care services measured by Camberwell Assessment of Needs in the Elderly (CANE) and Resource Utilization in Dementia Lite (RUD Lite). The
inclusion period is from February 2014 to February 2015, with follow-up data collection until February 2017.
Conclusion: The sample size, the outcome measures, and the explanatory factors chosen in this study will provide new knowledge of quality of life in families with young onset FTD and AD, and contribute to tailoring the health care services to the life stage-specific needs of families with YOD.
ClinicalTrials.gov identifier: NCT02055092
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Kersten, Hege
(2015).
Legemiddelbruk relatert til demensutvikling.
Norsk Farmaceutisk Tidsskrift (NFT).
ISSN 0029-1935.
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Kersten, Hege; Hvidsten, Lara H. Thomasgaard; Gløersen, Gløer; Wyller, Torgeir Bruun & Wang-Hansen, Marte Sofie
(2015).
Clinical impact of potentially inappropriate medications during hospitalization of acutely ill older patients with multimorbidity.
Scandinavian Journal of Primary Health Care.
ISSN 0281-3432.
33(4),
p. 243–251.
doi:
10.3109/02813432.2015.1084766.
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Kersten, Hege; Wyller, Torgeir Bruun & Molden, Espen
(2014).
Association between inherited CYP2D6/2C19 phenotypes and anticholinergic measures in elderly patients using anticholinergic drugs.
Therapeutic Drug Monitoring.
ISSN 0163-4356.
36(1),
p. 125–130.
doi:
10.1097/FTD.0b013e31829da990.
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Nesset, Magnar; Kersten, Hege & Ulstein, Ingun
(2014).
Brief Tests such as the Clock Drawing Test or Cognistat Can Be Useful Predictors of Conversion from MCI to Dementia in the Clinical Assessment of Outpatients.
Dementia and Geriatric Cognitive Disorders Extra.
4(2),
p. 263–270.
doi:
10.1159/000363734.
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Kersten, Hege & Wyller, Torgeir Bruun
(2014).
Anticholinergic Drug Burden in Older People's Brain - How well is it Measured?
Basic & Clinical Pharmacology & Toxicology.
ISSN 1742-7835.
114(2),
p. 151–159.
doi:
10.1111/bcpt.12140.
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Kersten, Hege; Molden, Espen; Tolo, Inga Kristin; Skovlund, Eva; Engedal, Knut Arne & Wyller, Torgeir Bruun
(2013).
Cognitive Effects of Reducing Anticholinergic Drug Burden in a Frail Elderly Population: A Randomized Controlled Trial.
The journals of gerontology. Series A, Biological sciences and medical sciences.
ISSN 1079-5006.
68(3),
p. 271–278.
doi:
10.1093/gerona/gls176.
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Kersten, Hege; Molden, Espen; Willumsen, Tiril; Engedal, Knut Arne & Wyller, Torgeir Bruun
(2013).
Higher anticholinergic drug scale (ADS) scores are associated with peripheral but not cognitive markers of cholinergic blockade. Cross sectional data from 21 Norwegian nursing homes.
British Journal of Clinical Pharmacology.
ISSN 0306-5251.
75(3),
p. 842–849.
doi:
10.1111/j.1365-2125.2012.04411.x.
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Jakobsen, Stine Mjåvatn; Kersten, Hege & Molden, Espen
(2011).
Evaluation of brain anticholinergic activities of urinary spasmolytic drugs using a high-throughput radio receptor bioassay.
Journal of The American Geriatrics Society.
ISSN 0002-8614.
59(3),
p. 501–505.
doi:
10.1111/j.1532-5415.2010.03307.x.
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Kersten, Hege; Ruths, Sabine & Wyller, Torgeir Bruun
(2009).
Farmakoterapi i sykehjem.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
129(17),
p. 1732–1735.
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Kersten, Hege; Vaksvik, Tonje Marie Bø; Romskaug, Rita; Wyller, Torgeir Bruun; Jaioun, Keson & Botteri, Edoardo
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(2026).
One year pre-diagnostic prevalence and associated factors of polypharmacy and potentially inappropriate medication use in community-dwelling adults with mild cognitive impairment or dementia in Norway (2014–2024): A registered report protocol.
doi:
10.1371/journal.pone.0356275.
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Background People with cognitive impairment frequently have multiple comorbidities, and polypharmacy is highly prevalent, affecting nearly half of individuals with mild cognitive impairment and dementia. The use of potentially inappropriate medications (PIMs), including those specifically problematic for cognitive impairment (PIMcog), increases with the total number of medications and may exacerbate cognitive symptoms or increase the risk of adverse drug events. However, the prevalence of polypharmacy and PIMcog use among patients diagnosed with MCI or dementia in Norwegian specialist outpatient clinics has not been described. Methods We will conduct a retrospective cohort study linking national health registries to estimate the prevalence of polypharmacy and PIMcog use in the year prior to diagnosis of mild cognitive impairment or dementia. Data from the Norwegian Registry of Persons Assessed for Cognitive Symptoms will be linked to dispensing data from the Norwegian Prescribed Drug Registry and comorbidity data from the Norwegian Patient Registry. The study population will include all patients diagnosed with mild cognitive impairment or dementia in Norwegian specialist outpatient clinics from 2014 to 2024. We will estimate the twelve-month prevalence of polypharmacy and PIMcog use preceding diagnosis, compare sociodemographic and clinical characteristics between PIMcog users and non-users, and identify factors associated with PIMcog use. Expected impact By describing the one-year prevalence and patterns of polypharmacy and PIMcog use and associated factors prior to mild cognitive impairment and dementia diagnosis, the findings may inform targeted deprescribing interventions and safer prescribing strategies for individuals with cognitive impairment.
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Eldholm, Rannveig Sakshaug; Barca, Maria Lage; Persson, Karin Ester Torun; Knapskog, Anne Brita; Kersten, Hege & Skovlund, Eva
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(2018).
Do vascular risk factors and vascular diseases influence disease progression in Alzheimer's disease?
Foredrag som ledd i felles symposium med tittelen "Biomarkers and clinical factors in mild cognitive impairment and dementia - a multicenter study" holdt av forskningsgruppen bak studien Progression of Alzheimer's Disease and Resource use (PADR).
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Romskaug, Rita; Molden, Espen; Straand, Jørund; Kersten, Hege; Skovlund, Eva & Pitkala, Kaisu H
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(2017).
Cooperation between geriatricians and general practitioners for improved pharmacotherapy in home-dwelling elderly people receiving polypharmacy - the COOP Study: Study protocol for a cluster randomised controlled trial.
Trials.
18(1).
doi:
10.1186/s13063-017-1900-0.
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Background: Polypharmacy and inappropriate drug use is associated with negative health outcomes among older people. Various interventions for improving drug treatment have been evaluated, but the majority of studies are limited by the use of surrogate outcomes or suboptimal design. Thus, the potential for clinically significant improvements from different interventions is still unclear. The main objective of this study is therefore to evaluate the effect upon patient-relevant endpoints of a cooperation between geriatricians and general practitioners on complex drug regimens in home-dwelling elderly people. Methods: This is a cluster randomised, single-blind, controlled trial where general practitioners are invited to participate with patients from their lists. The patients must be 70 years or older, use at least seven different medications and have their medications administered by the home nursing service. We plan to recruit 200 patients, with randomisation at physician level. The intervention consists of three main parts: (1) clinical geriatric assessment of the patient, combined with a thorough review of their medications; (2) a meeting between the geriatrician and general practitioner, where the two physicians combine their competence and knowledge and discuss the drug list systematically; (3) clinical follow-up, depending on the medication changes that have been done. The study period is 24 weeks, and the patients are assessed at baseline, 16 and 24 weeks. The primary outcome measure is health-related quality of life according to the 15D instrument. Secondary outcome measures include physical and cognitive functioning, medication appropriateness, falls, carer burden, use of health services (hospital or nursing home admissions, use of home nursing services) and mortality. Discussion: Our choice of patient-relevant outcome measures will hopefully provide new knowledge on the potential for clinical improvements after performing comprehensive medication reviews in home-dwelling elderly people receiving polypharmacy. Trial registration ClinicalTrials.gov, NCT02379455. Registered on 27 February 2015.
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Hvidsten, Lara H. Thomasgaard; Engedal, Knut; Selbæk, Geir; Wyller, Torgeir Bruun & Kersten, Hege
(2016).
Cognitive characteristics in persons with young onset Alzheimer’s Disease and Frontotemporal Dementia in Nordic Memory Clinics.
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Hvidsten, Lara H. Thomasgaard; Wyller, Torgeir Bruun; Selbæk, Geir; Engedal, Knut & Kersten, Hege
(2015).
Cognitive Characteristics in Persons with Young Onset Alzheimer’s Disease and Frontotemporal Dementia in Norwegian Memory Clinics Study Population.
European Geriatric Medicine.
ISSN 1878-7649.
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Kersten, Hege; Hvidsten, Lara H. Thomasgaard; Wyller, Torgeir Bruun; Selbæk, Geir & Engedal, Knut
(2015).
Cognitive Characteristics in Persons with Young Onset Alzheimer’s Disease and Frontotemporal Dementia in Norwegian Memory Clinics Study Population.
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Hvidsten, Lara H. Thomasgaard; Engedal, Knut; Selbæk, Geir; Wyller, Torgeir Bruun & Kersten, Hege
(2015).
Kognitive karakteristika hos yngre med demens i norske hukommelsesklinikker - Alzheimers demens og frontotemporallappsdemens.
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Kersten, Hege; Wyller, Torgeir Bruun & Molden, Espen
(2012).
Elevated serum anticholinergic activity in CYP 2D6 poor metabolizers.
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Kersten, Hege; Wyller, Torgeir Bruun & Ruths, Sabine
(2008).
Medication reviews in Norwegian nursing home residents showed different quality of the drug treatments.
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Kersten, Hege & Wyller, Torgeir Bruun
(2013).
Reducing anticholinergic burden in a frail elderly population: Translating the inappropriateness of anticholinergic drugs into patient-related outcomes.
Universitetet i Oslo.
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Published
Aug. 17, 2023 3:12 PM
- Last modified
Aug. 17, 2023 3:12 PM
