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  • 1.
    Durgunoglu, Aydin
    et al.
    Dep of Psychology, University of Minnesota, Duluth, USA.
    Håkansson, Krister
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Education, Psychology and Sport Science.
    Baguma, Peter
    Department of Organisational and Social Psychology, Institute of Psychology, Makerere University, Uganda.
    Crossing borders with technology in a university course2010Conference paper (Refereed)
  • 2.
    Feng, Lei
    et al.
    Yong Loo Lin School of Medicine, Singapore.
    Ng, Xue-Ting
    National University of Singapore, Singapore.
    Yap, Philip
    Khoo Teck Puat Hospital, Singapore.
    Li, Jialiang
    National University of Singapore, Singapore.
    Lee, Tih-Shih
    Duke-NUS Graduate Medical School, Singapore.
    Håkansson, Krister
    Karolinska Institutet, Sweden.
    Kua, Ee-Heok
    Yong Loo Lin School of Medicine, Singapore.
    Ng, Tze-Pin
    Yong Loo Lin School of Medicine, Singapore.
    Marital Status and Cognitive Impairment among Community-Dwelling Chinese Older Adults: The Role of Gender and Social Engagement2014In: Dementia and geriatric cognitive disorders extra, E-ISSN 1664-5464, Vol. 4, no 3, p. 375-384, article id 25473404Article in journal (Refereed)
    Abstract [en]

    Aims: To examine the association between marital status and cognitive impairment among community-dwelling Chinese older adults. Methods: We analyzed data from 2,498 Chinese aged 55 and older from the Singapore Longitudinal Aging Study cohort. Cognitive impair- ment was defined as a Mini-Mental State Examination total score of 23 or below. Odds ratios of associations were reported and adjusted for potential confounders in logistic regression models. Results: The prevalence of cognitive impairment was 12.2% (n = 306). Being single was associated with about 2.5 times increased odds of cognitive impairment compared to be- ing married (adjusted OR = 2.53, 95% CI: 1.41–4.55). The association between marital status and cognitive impairment was much stronger in men compared to that in women, and was indeed statistically significant only for men. Among the single and widowed persons social engagement was associated with a lower risk of cognitive impairment. Compared with sub- jects in the lowest tertile of social engagement scores, the odds of having cognitive impair- ment was lowered by 50% for subjects in the second and the third tertile. Conclusion: Being single or widowed was associated with higher odds of cognitive impairment compared to be- ing married in a cohort of older Chinese men but not women.

  • 3.
    Hageskog, Carl-Axel
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Education. Idrottsvetenskap.
    Håkansson, Krister
    Växjö University, Faculty of Humanities and Social Sciences, School of Education. Idrottsvetenskap.
    Idrott och vetenskap2006In: Inkast. Idrottsforskning vid Växjö universitet, Växjö University Press , 2006, p. 185-198Chapter in book (Other (popular science, discussion, etc.))
  • 4.
    Hagman, Göran
    et al.
    Karolinska Institutet.
    Solomon, Alina
    University of Eastern Finland, Kuopio, Finland.
    Kårehult, Ingemar
    Karolinska Institutet.
    Vuorinen, Miika
    University of Eastern Finland, Kuopio, Finland.
    Håkansson, Krister
    Karolinska Institutet.
    Soininen, Hilkka
    University of Eastern Finland, Kuopio, Finland.
    Kivipelto, Miia
    Karolinska Institutet.
    Midlife hopelessness and white matter lesions two decades later: A population-based study2010In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 7, no 4, Supplement, p. 595-595Article in journal (Other academic)
    Abstract [en]

    Background: Hopelessness has been associated with increased cardiovas- cular disease mortality and morbidity, subclinical atherosclerosis and meta- bolic syndrome. This study investigates the relation between midlife hopelessness and white matter lesions (WMLs) 20 years later in a Finnish population of men and women. Methods: Participants of the Cardiovascular Risk Factors, Aging and Incidence of Dementia (CAIDE) study in Finland were derived from random, population-based samples previously surveyed in 1972,1977, 1982 or 1987. In 1998, 1449 (73%) individuals aged 65-79 years participated in the re-examination. A subgroup (n1⁄4112, including 39 dementia cases, 31 mild cognitive impairment (MCI) cases and 42 con- trols) underwent 1.5T MRI scanning at re-examination, and WMLs were as- sessed from FLAIR-images using a semi-quantitative visual rating scale. Hopelessness was measured by 2 questionnaire items (expectations about future and reaching goals). Results: Subjects with increased hopelessness had a significantly higher risk of developing more severe WMLs two de- cades later. OR (95% CI) was 4.35 (1.36-13.46) in ordinal regression anal- yses adjusted for age, sex education, follow-up time, presence of the APOEe4 allele, systolic blood pressure, BMI, history of stroke, heart infarct, smoking and level of midlife leisure physical activity. Conclusions: Higher levels of hopelessness at midlife seem to be related to more severe WMLs later in life. Since WMLs may contribute to late-life cognitive impairment, lifestyle management of midlife vascular risk factors (which also increase the risk of dementia and cognitive impairment) may have better effects if people’s expectations are more thoroughly discussed.

  • 5.
    Håkansson, Krister
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    Cons and Pros of Epidemiological Versus Experimental Approaches to Answer Questions About Risk and Protective Factors for Alzheimer’s Disease: A Personal Journey2018In: SAGE Research Methods Cases, London: Sage Publications, 2018, p. 1-17Chapter in book (Refereed)
    Abstract [en]

    This text is a personal account of the research process that led to a dissertation about the long-term relevance of social and emotional factors for cognitive health. It describes how research ideas and methodological concerns developed out of the first results where people who had lived alone, especially after being widowed already in midlife, had a high risk increase for Alzheimer’s disease over two decades later. A second study investigated the associations between feelings of hopelessness in midlife and cognitive health in later life. Both of these studies used an epidemiological association approach with logistic regression as the main statistical method, including adjustments for several relevant variables. To address the methodological concerns in the epidemiological association approach, primarily the risk of reverse causation and confounding variables, a subsequent study applied a randomized control experimental design. In this study, the effects on brain-derived neurotrophic factor levels from different types of activities were measured in healthy elderly persons through a within-subject cross-over design. The case study illustrates the compromises that had to be made through this methodological shift in relation to the original research question—compromises in terms of real-life outcomes and exposures in exchange for experimental control and establishment of causality. The relative merits and limitations of three main approaches are finally summarized in light of these experiences: experimental studies on animals and on humans and epidemiological associations in humans. The examples are from research on dementia, but should be relevant for many other research questions.

  • 6.
    Håkansson, Krister
    Växjö University, Faculty of Humanities and Social Sciences, School of Education.
    O2-07-01: Unmarried Life: Paving the way for dementia?2008In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 4, no 4, Supplement, p. T146-Article in journal (Other academic)
    Abstract [en]

    Background: Although social networks and activities have recently been suggested to protect against dementia, few long-term follow-up studies exist. The main purpose of our study was to evaluate whether midlife marital status is related to late-life cognitive function. Methods: Participants of the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study were derived from random, population-based samples previously studied. After an average follow-up of 21 years, 1449 individuals (73%) aged 65 to 79 years were re-examined in 1998. At re-examination 139 persons were diagnosed with some form of cognitive impairment: 82 of those with mild cognitive impairment (MCI) and 48 with Alzheimer's disease (AD)). The relation between midlife marital status and cognitive impairment was analyzed with adjustments for a number of other midlife factors, including education, BMI, cholesterol, blood pressure, occupation, physical activity, smoking habits and depression. Adjustments were also made for ApoE status, age at follow-up and gender. Results: Persons living with a partner in midlife were significantly less likely to show cognitive impairment compared to all other categories (single, separated or widowed). The highest risk increase was found for those widowed at midlife and still so at the follow-up (N=105). For Alzheimers disease specifically, the risk increase was almost eight-fold for this group compared to those married both at midlife and still so at late-life. Progressive adjustments for possible confounders did not weaken the associations. Conclusions: Living in a partner relation may imply cognitive and social challenges with a protective effect against cognitive impairment. Involvement of other factors is however suggested by the specific risk increase for widowed in relation to singles. Possible selection bias behind the strongly increased cognitive impairment risk for those widowed at midlife, in relation to the married group, seems unlikely. The long-term prospective design should also preclude any reverse causation effects behind the results.

  • 7.
    Håkansson, Krister
    Karolinska Institutet.
    The role of socio-emotional factors for cognitive health in later life2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    With increasing life expectancies in most parts of the world, the prevalence of dementia and other age-related chronic diseases is growing. Several factors affect future projections and are discussed in this thesis, including possible limits to a continued growth of life expectancy. A related question is to what extent healthy ageing per se affects cognitive functions in old persons. Previous studies have generally exaggerated ageing effects on cognition, by applying study designs that did not account for common confounders, such as birth cohort differences, and the effects of terminal decline and subclinical dementia. In contrast to healthy ageing, dementia neuropathologies dramatically reduce cognitive performance, and proposed mechanisms behind dementia are briefly discussed with focus on Alzheimer’s disease (AD), on the role of genetic factors and on life course exposures. Three studies (study 1-3) investigated how cohabitant status and feelings of loneliness and hopelessness in midlife were associated with cognitive health in later life. Neurotrophic factors could potentially be involved in the biological mechanisms behind these and other associations between life-style factors and cognitive health. The fourth study aimed to explore how levels of brain-derived neurotrophic factor (BDNF), measured in serum, were affected by performing different activities; physical exercise, cognitive training, and mindfulness.

    THE FOUR STUDIES

    Study 1-3 were epidemiological association studies based on the Cardiovascular Risk Factor, Ageing and Dementia (CAIDE) Study, a population based cohort study on 1511 persons in eastern Finland, who at baseline were 50.4 years. Two re-examinations have been performed in the CAIDE Study, in 1998 when the participants were between 65 and 80 years, and between 2005-2008, averagely 25.3 years after the baseline examinations. The first two studies were based on the 1409 persons who fully participated in the first re-examination and the third study on the 1511 persons who participated in one or both re-examinations. In the first two studies logistic regression was the main statistical method with any cognitive impairment versus no cognitive impairment as outcome. In addition we performed analyses with mild cognitive impairment and Alzheimer’s disease as separate outcomes. In Study 1 and 2 we also analysed how apolipoprotein epsilon 4 (ApoE4) status affected the associations with Alzheimer’s disease. The statistical method in Study 3 was survival model analysis (Kaplan-Meyer and Cox regression) and the outcome variable was dementia, without subtyping. We compared the results from the analysis on the 1511 participants with the results when we used the total sample (by including register linked data on dementia diagnoses). We adjusted the associations for several potential confounding variables in all three studies.

    In Study 4 we used 19 elderly healthy volunteers who were between 65 and 80 years (mean = 70.8 years). They performed three different activities during 35 minutes on separate occasions, i.e. a within-subject cross-over experimental design where we randomized the order of the three conditions between the participants. We sampled blood from a suitable

    lower arm vein directly before and after each activity session and in addition at 20 and 60 minutes after the session had ended. After the serum had been analysed for BDNF levels, we used repeated measures ANOVA to calculate the differences in the effect of BDNF levels between the three conditions.

    MAIN RESULTS

    We found that living alone in midlife was associated with approximately a doubled risk of cognitive impairment during the re-examination. Among the non-cohabitants the risk increase was especially high for persons who were widowed in midlife and who had continued to live alone until the re-examination (odds ratio (OR) 7.67, 95% confidence interval (CI) 1.6 – 40.0). Feelings of loneliness were common both among cohabitants and non-cohabitants, but we found that such feelings were only associated with an increased dementia risk if these persons had also been living alone. Feelings of hopelessness in midlife, but not at follow-up, were associated with increased risk of cognitive impairment at the re-examination, especially of Alzheimer’s disease (OR 2.90, CI 1.4 – 5.9). When we adjusted the association from midlife also for depression and hopelessness at the re-examination, this association was still statistically significant. Participants with a diagnosis of cognitive impairment had higher feelings of hopelessness at the re-examination, compared to the cognitively healthy group, but this difference between the groups existed already when they were in midlife. When we stratified the participants with reference to ApoE4 status, we found that participants who were also ApoE4 carriers had a dramatically increased risk of Alzheimer’s disease compared to non-carriers without feelings of hopelessness, even after final adjustment for depression (OR 6.48, CI 2.4 –17.5). A similar stratification for ApoE4 status in Study 1 showed an even more dramatic increase in the association for persons who had lost their partner (widowed or divorced/separated) if they in addition were ApoE4 carriers.

    In Study 4 we found that physical exercise, but not cognitive training or mindfulness, led to a statistically significant increase in BDNF levels of around 25%, compared to baseline. We also found that the individual differences in BDNF levels after the physical exercise correlated with working memory performance, measured on a separate occasion.

    CONCLUSIONS

    Social and emotional factors can have long-term consequences for cognitive health in later life. The long follow-up time in Study 1-3 suggests that the associations we found with dementia could reflect a causal, rather than a prodromal, relation. As other studies have found a range of adverse ill health consequences from both living alone and from depressive feelings, a possible mechanism behind the associations we found could be related to a systemic biological impact, and that the specific ill health outcome could be a result of individual vulnerability where genetic dispositions could play an important role. This conclusion seems consistent with the dramatic risk increases we found for AD when ApoE4

    status was combined with the social factor of living alone and with the emotional dimension of hopelessness. At the micro level, as synaptic dysfunction and loss is characteristic of Alzheimer’s disease, and as BDNF has a central role for synaptogenesis, impaired BDNF functionality could play a role in the development of Alzheimer’s disease. More research is needed to further explore the role of BDNF in Alzheimer’s disease and if the disease can be prevented, or the disease process halted, by activities that stimulate BDNF expression in the brain.

  • 8.
    Håkansson, Krister
    Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences. Psykologi.
    Unmarried Life - Paving the Way for Dementia?2008Conference paper (Refereed)
    Abstract [en]

    Background:

    Although social networks and activities have recently been suggested to protect against dementia, few long-term follow-up studies exist. The main purpose of our study was to evaluate whether midlife marital status is related to late-life cognitive function.

    Methods:

    Participants of the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study were derived from random, population-based samples previously studied. After an average follow-up of 21 years, 1449 individuals (73%) aged 65 to 79 years were re-examined in 1998. At re-examination 139 persons were diagnosed with some form of cognitive impairment: 82 of those with mild cognitive impairment (MCI) and 48 with Alzheimer’s disease (AD)). The relation between midlife marital status and cognitive impairment was analyzed with adjustments for a number of other midlife factors, including education, BMI, cholesterol, blood pressure, occupation, physical activity, smoking habits and depression. Adjustments were also made for ApoE status, age at follow-up and gender.

    Results:

    Persons living with a partner in midlife were significantly less likely to show cognitive impairment compared to all other categories (single, separated or widowed). The highest risk increase was found for those widowed at midlife and still so at the follow-up (N=105). For Alzheimers disease specifically, the risk increase was almost eight-fold for this group compared to those married both at midlife and still so at late-life. Progressive adjustments for possible confounders did not weaken the associations.

    Conclusions:

    Living in a partner relation may imply cognitive and social challenges with a protective effect against cognitive impairment. Involvement of other factors is however suggested by the specific risk increase for widowed in relation to singles. Possible selection bias behind the strongly increased cognitive impairment risk for those widowed at midlife, in relation to the married group, seems unlikely. The long-term prospective design should also preclude any reverse causation effects behind the results.

  • 9.
    Håkansson, Krister
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences.
    Durgunoglu, Aydin
    Baguma, Peter
    Experiential learning in cyberspace:  Using Internet to connect students from different cultures in a course on cross-cultural Psychology2009Conference paper (Refereed)
    Abstract [en]

    In this paper we will present a pilot project where three universities on different continents (Africa, America and Europe) collaborated to offer a joint course on cross- cultural Psychology. Both students and teachers were evenly distributed between the universities and all interaction took place through a distance education platform. The course was structured to facilitate interaction between students from the different continents in a virtual international class room and thereby to add an experiential dimension to the theoretical contents of the course. To tentatively evaluate if a course of this kind could affect students attitudes a test on ethnocentrism was distributed before and after the course. Students evaluations of the different tools that were used are presented along with their evaluations of the course as a whole and their suggestions for future courses.

    Of the different learning tools that were used, the Discussion tool was most appreciated. Group projects, were students from different countries had to coordinate their efforts to solve problems, collect data and present joint solutions, was the most difficult to manage. Different time zones and difficulties in establishing efficient intra group communication seem to have been the main obstacles. No general effect on ethnocentric values was found, but a higher degree of involvement in the course was related to decreased ethnocentrism, as measured by us.

    We conclude that modern distance education platforms have a great potential in connecting students and teachers in different parts of the world to enhance learning and intercultural understanding, but that the cultural differences also present a challenge for the teachers to plan and arrange such a course in a way that takes these cultural differences into account along with the different societal and economical conditions in the countries that are represented.

  • 10.
    Håkansson, Krister
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Education. Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences. Idrottsavdelningen.
    Hageskog, Carl-Axel
    Växjö University, Faculty of Humanities and Social Sciences, School of Education. Idrottsavdelningen.
    Framgångsrik Coaching: Kan "vetenskaplighet" vara ett användbart instrument?2006In: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 15, no 4, p. 46-51Article in journal (Other academic)
  • 11.
    Håkansson, Krister
    et al.
    Karolinska Institutet.
    Helkala, Eeva-Liisa
    University of Kuopio,, Kuopio, Finland.
    Soininen, Hilkka
    University of Kuopio,, Kuopio, Finland.
    Nissinen, Aulikki
    National Institute for Health and Welfare, Helsinki, Finland.
    Mohammed, Abdul K. H.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Education, Psychology and Sport Science. Karolinska institutet.
    Winblad, Bengt
    Karolinska Institutet.
    Kivipelto, Miia
    Karolinska Institutet.
    Perceived marital problems in midlife are associated with cognitive health in later life2010In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 7, no 4, Supplement, p. 595-595Article in journal (Other academic)
  • 12.
    Håkansson, Krister
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Education, Psychology and Sport Science.
    Helkala, E.L.
    University of Eastern Finland, Kuopio.
    Soininen, H.
    University of Eastern Finland, Kuopio.
    Nissinen, A.
    National Institute for Health and Welfare, Helsinki.
    Winblad, B.
    Karolinska Institutet.
    Mohammed, Abdul K. H.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Education, Psychology and Sport Science.
    Kivipelto, M.
    Karolinska Institutet.
    Depressive signs in midlife: A risk factor for cognitive impairment in later life?2010In: International Conference on Alzheimer's Disease (ICAD) 2010, Chicago, USA: Alzheimer's Association , 2010Conference paper (Refereed)
    Abstract [en]

    Background: Although depression has been associated with dementia, the nature of this relation is still unclear. Establishing causality from previous studies has been complicated by the typical use of a short follow-up and participants aged over 70 already at baseline. The main purpose of this study was to evaluate if depressive signs already in midlife are related to cognitive impairment in later life. Methods: Participants were derived from random, population-based samples previously investigated in 1972, 1977, 1982, or 1987. Their mean age at baseline was 50.4 years (SD 6.0). After an average follow-up of 21 years, 1449 individuals (73%) aged 65 to 79 years were re-examined in 1998. At the re-examination some form of cognitive impairment was diagnosed in 139 of the participants: 82 with mild cognitive impairment and 57 with dementia (48 of these with Alzheimer’s disease). Signs of depression were estimated through responses to three questions concerning the perception of a hopeless future, impossible life goals and loneliness. The relation between depressive signs in midlife and cognitive impairment in later life was analyzed with logistic regression with adjustments for age, gender, apolipoprotein e4 status and a number of midlife health and lifestyle indicators, including blood pressure, cholesterol and marital status. Results: Depressive signs in midlife, as measured in this study, were significantly related to general cognitive impairment in later life, but also separately to both mild cognitive impairment and Alzheimer’s disease. When dichotomized into high versus low levels of depressive signs the odds ratios were 2.19 (1.1 to 4.3) for mild cognitive impairment and 3.81 (1.3 to 11.5) for Alzheimer’s disease. Significant associations were also found between the separate measures of hopelessness and loneliness on the one hand and the separate outcomes of mild cognitive impairment and Alzheimer’s disease on the other. Conclusions: The results support a causal relation between depressive signs relatively early in life and cognitive function in later life. Clinical relevance includes the long-term health implications of depressive signs in midlife also for the risk of dementia.

  • 13.
    Håkansson, Krister
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet ; Stockholm University.
    Ledreux, Aurelie
    Karolinska Institutet ; Medical University of South Carolina, USA.
    Daffner, Kirk
    Harvard Medical School, USA.
    Terjestam, Yvonne
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Bergman, Patrick
    Linnaeus University, Faculty of Social Sciences, Department of Sport Science.
    Carlsson, Roger
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    Kivipelto, Miia
    Karolinska Institutet.
    Granholm, Ann-Charlotte
    Medical University of South Carolina, USA.
    Mohammed, Abdul K. H.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology.
    BDNF Responses in Healthy Older Persons to 35 Minutes of Physical Exercise, Cognitive Training, and Mindfulness: Associations with Working Memory Function2017In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 55, no 2, p. 645-657Article in journal (Refereed)
    Abstract [en]

    Brain-derived neurotrophic factor (BDNF) has a central role in brain plasticity by mediating changes in cortical thickness and synaptic density in response to physical activity and environmental enrichment. Previous studies suggest that physical exercise can augment BDNF levels, both in serum and the brain, but no other study has examined how different types of activities compare with physical exercise in their ability to affect BDNF levels. By using a balanced cross over experimental design, we exposed nineteen healthy older adults to 35-minute sessions of physical exercise, cognitive training, and mindfulness practice, and compared the resulting changes in mature BDNF levels between the three activities. We show that a single bout of physical exercise has significantly larger impact on serum BDNF levels than either cognitive training or mindfulness practice in the same persons. This is the first study on immediate BDNF effects of physical activity in older healthy humans and also the first study to demonstrate an association between serum BDNF responsivity to acute physical exercise and working memory function. We conclude that the BDNF increase we found after physical exercise more probably has a peripheral than a central origin, but that the association between post-intervention BDNF levels and cognitive function could have implications for BDNF responsivity in serum as a potential marker of cognitive health.

  • 14.
    Håkansson, Krister
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska institutet.
    Ngandu, Tiia
    National Institute for Health and Welfare, Finland.
    Kivipelto, Miia
    Karolinska Institutet;University of Eastern Finland, Finland.
    The Patient with Cognitive Impairment2018In: Treatable and Potentially Preventable Dementias / [ed] Hachinsky, Vladimir, New York: Cambridge University Press, 2018, p. 52-80Chapter in book (Refereed)
  • 15.
    Håkansson, Krister
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences. Karolinska Institutet.
    Rovio, Suvi
    Karolinska Institutet.
    Helkala, Eeva-Liisa
    University of Kuopio, Finland.
    Vilska, Anna-Riitta
    Savonia University of Applied Sciences, Kuopio, Finland.
    Winblad, Bengt
    Karolinska Institutet.
    Soininen, Hilkka
    University of Kuopio, Finland.
    Nissinen, Aulikki
    Mohammed, Abdul K. H.
    Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences. Karolinska institutet.
    Kivipelto, Miia
    Karolinska institutet / University of Kuopio, Finland.
    Association between mid-life marital status and cognitive function in later life: population based cohort study2009In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 339, no July, p. Article number: b2462-Article in journal (Refereed)
    Abstract [en]

    Objectives To evaluate whether mid-life marital status is related to cognitive function in later life. Design Prospective population based study with an average follow-up of 21 years. Setting Kuopio and Joensuu regions in eastern Finland. Participants Participants were derived from random, population based samples previously investigated in 1972, 1977, 1982, or 1987; 1449 individuals (73%), aged 65-79, underwent re-examination in 1998. Main outcome measures Alzheimer's disease and mild cognitive impairment. Results People cohabiting with a partner in mid-life (mean age 50.4) were less likely than all other categories (single, separated, or widowed) to show cognitive impairment later in life at ages 65-79. Those widowed or divorced in mid-life and still so at follow-up had three times the risk compared with married or cohabiting people. Those widowed both at mid-life and later life had an odds ratio of 7.67 (1.6 to 40.0) for Alzheimer's disease compared with married or cohabiting people. The highest increased risk for Alzheimer's disease was in carriers of the apolipoprotein E e4 allele who lost their partner before mid-life and were still widowed or divorced at follow-up. The progressive entering of several adjustment variables from mid-life did not alter these associations. Conclusions Living in a relationship with a partner might imply cognitive and social challenges that have a protective effect against cognitive impairment later in life, consistent with the brain reserve hypothesis. The specific increased risk for widowed and divorced people compared with single people indicates that other factors are needed to explain parts of the results. A sociogenetic disease model might explain the dramatic increase in risk of Alzheimer's disease for widowed apolipoprotein E e4 carriers.

  • 16.
    Håkansson, Krister
    et al.
    Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences.
    Sjöstrand, Glenn
    Växjö University, Faculty of Humanities and Social Sciences, School of Social Sciences.
    Villanueva, Cesar
    Universidad Iberoamericana, Mexico City, Mexico..
    New Perspectives in International Cooperation in Higher Education:: Empirical Report from Two Transatlantic Educational Projects.2005In: Democracy and Culture in the Transatlantic World / [ed] Wallin C. & Silander D., Växjö: Växjö University Press , 2005Chapter in book (Other academic)
  • 17.
    Håkansson, Krister
    et al.
    Karolinska Institutet.
    Soininen, Hilkka
    Eastern University of Finland.
    Winblad, Bengt
    Kivipelto, Miia
    Karolinska Institutet.
    Feelings of Hopelessness in Midlife and Cognitive Health in Later Life: A Prospective Population-Based Cohort Study.2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 10, p. 1-16, article id e0140261Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several studies have found depression and depressive feelings to be associated with subsequent dementia. As dementias typically have a long preclinical development phase, it has been difficult to determine whether depression and depressive feelings reflect a concurrent underlying dementia disease, rather than playing a causative role. Our aim was to investigate hopelessness, one dimension of depressive feelings, and evaluate the likelihood of a prodromal versus a causative role of hopelessness feelings in dementia development.

    METHODS: We invited a random sample of 2000 survivors from a representative population in Eastern Finland, originally investigated in midlife between 1972 and 1987, for re-examination an average of 21 years later. The age of the 1449 persons who accepted the invitation was between 39 and 64 years (mean 50.4 years) in midlife and between 65 and 80 (mean 71.3) at follow-up. To measure feelings of hopelessness in midlife and at follow-up, the participants indicated their level of agreement to two statements about their own possible future. We used logistic regression to investigate the association between the combined scores from these two items and cognitive health at follow-up, while adjusting for several health and life-style variables from midlife and for apolipoprotein E4 (ApoE4) status, depression and hopelessness feelings at follow-up. We compared the associations with late-life cognitive health when feelings of hopelessness were either measured in midlife or at the follow-up. In addition we analyzed the changes in hopelessness scores from midlife to follow-up in participants who were either cognitively healthy or impaired at follow-up.

    RESULTS: We found higher levels of hopelessness in midlife, but not at follow-up, to be associated with cognitive impairment at follow-up; the adjusted odds ratio for each step of the five-level hopelessness scale was 1.30 (95% confidence interval 1.11-1.51) for any cognitive impairment and 1.37 (1.05-1.78) for Alzheimer's disease. These associations remained significant also after the final adjustments for depressive feelings and for hopelessness at follow-up. The individual changes in hopelessness scores between midlife and follow-up were not systematically related to cognitive health at the follow-up.

    CONCLUSION: Our results suggest that feelings of hopelessness already in midlife may have long-term implications for cognitive health and increase the risk of Alzheimer's disease in later life.

  • 18.
    Håkansson, Krister
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Education, Psychology and Sport Science. Karolinska Institutet.
    Soininen, Hilkka
    University of Eastern Finland.
    Winblad, Bengt
    Karolinska Institutet.
    Mohammed, Abdul K. H.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Education, Psychology and Sport Science.
    Kivipelto, Miia
    Karolinska Institutet.
    Feelings of hopelessness in midlife are associated with dementia risk in later life2012In: 12th International Stockholm/Springfield Symposium on Advances in Alzheimer Therapy, 2012, p. 165-165Conference paper (Other academic)
    Abstract [en]

    Background: Although an association between depressive feelings and dementia has been estab- lished previously, the nature of this relation remains unclear. Establishing causality has been com- plicated by the typical use of a short follow-up and aged participants already at baseline. The aim with this study was to investigate the association between feelings of hopelessness in midlife and cognitive impairment in later life.

    Methods: From a representative population in Eastern Finland, originally investigated between 1972-1987, a random sample of 2000 survivors was invited for re-examination in 1998, averagely 21 years later. The mean age of the 1449 persons who accepted the invitation was 50.4 (range 39-64) at baseline and 71.3 years (range 65-80) at follow-up. Baseline scores of hopelessness were related to cognitive status at follow-up, mainly through logistic regression. Adjustments were made for age, years of education, gender, APOE4 and a number of health and life style factors at baseline. In addition we analyzed differences in hopelessness scores between baseline and follow-up within the different outcome groups.

    Results: Participants with high levels of hopelessness at midlife had more than a doubled risk of cognitive impairment in later life as expressed by an odds ratio of 2.24 (1.4-3.6), even higher spe- cifically for Alzheimers disease. Persons with high levels of hopelessness at midlife and who in addition carried the apolipoprotein allele 4 (ApoE ε4) had a highly elevated risk of Alzheimers dis- ease. There were no significant differences in levels of hopelessness between baseline and follow-up within any of the outcome groups.

    Conclusions: The results confirm previous studies showing elevated scores of depressive feelings in persons diagnosed with dementia, compared to cognitively healthy persons. On the other hand, the results also suggest that the major portion of this difference could have existed already decades before the dementia diagnosis; Carrying feelings of hopelessness in midlife may have long-term implications for cognitive health in later life. 

    Background: Although an association between depressive feelings and dementia has been estab- lished previously, the nature of this relation remains unclear. Establishing causality has been com- plicated by the typical use of a short follow-up and aged participants already at baseline. The aim with this study was to investigate the association between feelings of hopelessness in midlife and cognitive impairment in later life.

    Methods: From a representative population in Eastern Finland, originally investigated between 1972-1987, a random sample of 2000 survivors was invited for re-examination in 1998, averagely 21 years later. The mean age of the 1449 persons who accepted the invitation was 50.4 (range 39-64) at baseline and 71.3 years (range 65-80) at follow-up. Baseline scores of hopelessness were related to cognitive status at follow-up, mainly through logistic regression. Adjustments were made for age, years of education, gender, APOE4 and a number of health and life style factors at baseline. In addition we analyzed differences in hopelessness scores between baseline and follow-up within the different outcome groups.

    Results: Participants with high levels of hopelessness at midlife had more than a doubled risk of cognitive impairment in later life as expressed by an odds ratio of 2.24 (1.4-3.6), even higher spe- cifically for Alzheimers disease. Persons with high levels of hopelessness at midlife and who in addition carried the apolipoprotein allele 4 (ApoE ε4) had a highly elevated risk of Alzheimers dis- ease. There were no significant differences in levels of hopelessness between baseline and follow-up within any of the outcome groups.

    Conclusions: The results confirm previous studies showing elevated scores of depressive feelings in persons diagnosed with dementia, compared to cognitively healthy persons. On the other hand, the results also suggest that the major portion of this difference could have existed already decades before the dementia diagnosis; Carrying feelings of hopelessness in midlife may have long-term implications for cognitive health in later life. 

  • 19.
    Kivipelto, Miia
    et al.
    Karolinska Institutet ; Karolinska University Hospital ; University of Eastern Finland, Finland.
    Håkansson, Krister
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    A Rare Success against Alzheimer's2017In: Scientific American, ISSN 0036-8733, E-ISSN 1946-7087, Vol. 316, no 4, p. 32-37Article in journal (Other academic)
    Abstract [en]
    • Two hundred experimental drugs intended to treat Alzheimer's disease have failed in the past 30 years. Without new therapies, the number of patients worldwide will increase dramatically by 2050.
    • A ray of hope has come recently from a clinical trial that showed that dementia's cognitive impairment might be prevented by paying close attention to various health factors.
    • Participants in the study who followed a regimen of health-related steps registered improvements on cognitive measures such as memory and mental-processing speed.
    • Results of this research suffice for health care professionals to begin making a series of recommendations to patients on diet, exercise and levels of social engagement that may help prevent dementia.
  • 20.
    Kivipelto, Miia
    et al.
    Karolinska Institutet.
    Solomon, Alina
    Karolinska Institutet.
    Håkansson, Krister
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    Till Klarhet med Alzheimer2013In: Äldre i Centrum. Tidskrift för aktuell äldreforskning., ISSN 1653-3585, Vol. 27, no 4, p. 13-15Article, review/survey (Other academic)
  • 21.
    Kivipelto, Miia
    et al.
    Karolinska Institutet.
    Solomon, Alina
    Karolinska institutet / Östra Finlands universitet i Kuopio.
    Ngandu, Tiia
    National Institute for Health and Welfare, Helsinki.
    Håkansson, Krister
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    Winblad, Bengt
    Karolinska Institutet.
    Fokus på tidig diagnos och förebyggande i Alzheimer forskning2013In: Finska Läkaresällskapets Handlingar, ISSN 0015-2501, Vol. 173, no 2, p. 11-19Article, review/survey (Refereed)
    Abstract [en]

    Focus on early diagnosis and prevention in Alzheimer studies/research

    Alzheimer’s disease has been identified with dementia. Recent diagnostic criteria help to identify it be- fore dementia development, which offers hope for finding efficient drugs and preventive interventions. In addition to age and genetics, epidemiological studies have revealed modifiable risks such as vascular, lifestyle, and psychosocial factors. . Steps have already taken place, moving from observation to inter- vention in large multifactorial studies in which risk factors and mechanisms are targeted simultane- ously. The Finnish geriatric programme FINGER is part of the European Dementia Prevention Initiative (EDPI), together with two studies in France and the Netherlands. These will all aid in formulating lifestyle recommendations for preventing/delaying cognitive decline and dementia. 

  • 22.
    Prohovnik, Isak
    et al.
    University of Lund.
    Håkansson, Krister
    University of Lund.
    Risberg, Jarl
    University of Lund.
    Observations on the functional significance of regional cerebral blood flow in "resting" normal subjects.1980In: Neuropsychologia, ISSN 0028-3932, E-ISSN 1873-3514, Vol. 18, no 2, p. 203-17Article in journal (Refereed)
    Abstract [en]

    Regional Cerebral Blood Flow (rCBF) of 16 cortical regions was measured bilaterally in 22 healthy adults, with 4–8 repeated measurements per individual. All measurements were done during “rest”, i.e. with minimal external stimulation, by the Xe-133 inhalation method. The data are presented to serve as normal controls for research and clinical work, but more importantly because of their significance for neuropsychological theory. Some rCBF variance is shown to be meaningfully related to handedness, habituation processes, biological rhythms and possibly to regional lateral dominance. Further data and discussion relate to the possible role of frontal lobe structures during non-task-oriented cognition. Finally, data are interpreted as showing that regional functional coupling across the midline, in this situation, is inversely related to the characteristic level-of-processing associated with each area.

  • 23.
    Simon, Sharon S.
    et al.
    Harvard Med Sch, USA.
    Tusch, Erich S.
    Harvard Med Sch, USA.
    Feng, Nicole C.
    Harvard Med Sch, USA.
    Håkansson, Krister
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    Mohammed, Abdul K. H.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    Daffner, Kirk R.
    Harvard Med Sch, USA.
    Is Computerized Working Memory Training Effective in Healthy Older Adults?: Evidence from a Multi-Site, Randomized Controlled Trial2018In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 65, no 3, p. 931-949Article in journal (Refereed)
    Abstract [en]

    Background: Developing effective interventions to attenuate age-related cognitive decline and prevent or delay the onset of dementia are major public health goals. Computerized cognitive training (CCT) has been marketed increasingly to older adults, but its efficacy remains unclear. Working memory (WM), a key determinant of higher order cognitive abilities, is susceptible to age-related decline and a relevant target for CCT in elders. Objective: To evaluate the efficacy of CCT focused on WM compared to an active control condition in healthy older adults. Methods: Eighty-two cognitively normal adults from two sites (USA and Sweden) were randomly assigned to Cogmed Adaptive or Non-Adaptive (active control) CCT groups. Training was performed in participants' homes, five days per week over five weeks. Changes in the performance of the Cogmed trained tasks, and in five neuropsychological tests (Trail Making Test Part A and Part B, Digit Symbol, Controlled Oral Word Association Test and Semantic Fluency) were used as outcome measures. Results: The groups were comparable at baseline. The Adaptive group showed robust gains in the trained tasks, and there was a time-by-group interaction for the Digit Symbol test, with significant improvement only after Adaptive training. In addition, the magnitude of the intervention effect was similar at both sites. Conclusion: Home-based CCT Adaptive WM training appears more effective than Non-Adaptive training in older adults from different cultural backgrounds. We present evidence of improvement in trained tasks and on a demanding untrained task dependent upon WM and processing speed. The benefits over the active control group suggest that the Adaptive CCT gains were linked to providing a continuously challenging level of WM difficulty.

  • 24.
    Sindi, Shireen
    et al.
    Karolinska Institutet.
    Håkansson, Krister
    Linnaeus University, Faculty of Health and Life Sciences, Department of Psychology. Karolinska Institutet.
    Hagman, Göran
    Karolinska Institutet.
    Kulmala, Jenni
    Eastern University of Finland.
    Soininen, Hilkka
    Eastern University of Finland.
    Kareholt, Ingemar
    Karolinska Institutet.
    Solomon, Alina
    Karolinska Institutet.
    Kivipelto, Miia
    Karolinska Institutet.
    Mid-life work-related stress increases dementia risk in late-life: The CAIDE 30-year study2014In: Alzheimer's & Dementia, ISSN 1552-5260, E-ISSN 1552-5279, Vol. 10, no 4, Supplement, p. P746-Article in journal (Other academic)
    Abstract [en]

    Background: The associations between work-related stress and various health outcomes in mid-life are well documented, yet less is known about the effects on late-life cognitive process and dementia. The current study investigated the associations between work-related stress in mid-life and the development of cognitive impairment and Alzheimer’s disease in late-life. Methods: The data was derived from the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) study; a prospective cohort study. Participants were randomly selected from four independent population-based samples that completed cardiovascular surveys. First baseline examinations occurred when participants were 50 years old on average, in 1972, 1977, 1982, or 1987. A random sample of 2,000 individ- uals was selected for re-examinations (carried out in 1998 and 2005-2008), where 1,511 subjects participated in at least one re-examination. The re- examinations included an extensive neuropsychological and cognitive assessment. Follow-up time was on average 28 (S.E.M. 1⁄4 0.17) years. Work-related stress comprised the total score of two questions adminis- tered in mid-life. The questions asked participants to rate their stress related to meeting demands at work, and constant hurry at work. Groups were categorized so that those with high or medium levels of stress were compared to those with low levels or no work-related stress. Results: High levels of work-related stress in mid-life were associated with higher

    risk of cognitive impairment (where participants with cognitive impair- ment and dementia were compared to the group with no cognitive impair- ment) [odds ratio (OR), 1.5; 95% confidence interval (CI), 1.1-2.1], and Alzheimer’s disease [OR, 2.1; CI, 1.1-3.9], when assessed at the first or second follow-up. Results remained significant after adjusting for age, ed- ucation, marital status, chronic health conditions, apolipoprotein E ε 4 allele (APOE ε 4), measures of hopelessness and loneliness. Conclusions: High levels of mid-life work-related stress predict the risk of developing dementia in late-life. The evidence suggests that individuals experiencing high levels of work-related stress form an important at-risk population. Preventive interventions are needed for this population in order to post- pone or prevent the development of cognitive impairment and Alzheimer’s disease. 

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