Cristin-prosjekt-ID: 2512310
Sist endret: 19. oktober 2021, 10:54

Cristin-prosjekt-ID: 2512310
Sist endret: 19. oktober 2021, 10:54
Prosjekt

Changing lives, changing brains

prosjektleder

Bjørn Heine Strand
ved Folkehelseinstituttet

prosjekteier / koordinerende forskningsansvarlig enhet

  • Folkehelseinstituttet

Finansiering

  • TotalbudsjettNOK 30.000.000
  • National Institutes of Health
    Prosjektkode: R01AG069109-01

Klassifisering

Vitenskapsdisipliner

Helsefag

Emneord

Livsløpsanalyse • Sosioøkonomiske ulikheter • Kognisjon • Demens • Arbeid og familie

HRCS-helsekategori

  • Nevrologisk
  • Mental helse

HRCS-forskningsaktivitet

  • 2.3 Psykologiske, sosiale og økonomiske faktorer
  • 4.4 Befolkningsundersøkelser

Kategorier

Prosjektkategori

  • Anvendt forskning

Tidsramme

Aktivt
Start: 1. juli 2020 Slutt: 30. juni 2025

Beskrivelse Beskrivelse

Tittel

Changing lives, changing brains

Populærvitenskapelig sammendrag

We will study life-course effects of and interactions between family and work in adulthood for risk of Alzheimer’s disease and related dementias (ADRD) and cognitive impairment in older adults. This will be done by exploiting the exceptional Norwegian HUNT (Nord-Trondelag Health Study) dataset, a large ongoing prospective population level study that includes cohorts born 1900 – 1960 (including more than 11700 participants aged 70+ years), combined with Norwegian national registry data. Family patterns have fundamentally changed in Western countries in the second half of the 20th century, with more childlessness, partnership disruptions, cohabitation and “patchwork”-families (following (re-) partnering with own children and step-children). This project will study the joint effect of changing family and work dynamics on risk of ADRD.

Vitenskapelig sammendrag

The prevalence of Alzheimer’s disease and related dementias (ADRD) is projected to triple by 2050. Currently, there is no known effective medical treatment for ADRD. Prevention through behavioral changes affecting ADRD risk is therefore of utmost importance. Rapid changes that characterize modern family life and work are two critical domains that likely impact ADRD risk. However, these effects remain relatively understudied due to the scarcity of data suited to such investigation. A shift to “modern” family structures and work tasks have occurred relatively early in Norway, and unique data availability allows these changes to be studied prospectively to predict coming changes in ADRD in the US and other countries. We will study life-course effects of and interactions between family and work in adulthood for risk of ADRD and cognitive impairment in older adults. This will be done by exploiting the exceptional Norwegian HUNT (Nord-Trondelag Health Study) dataset, a large ongoing prospective population level study that includes cohorts born 1900 – 1960 (including more than 11700 participants aged 70+ years), combined with Norwegian national registry data. Family patterns have fundamentally changed in Western countries in the second half of the 20th century, with more childlessness, partnership disruptions, cohabitation and “patchwork”-families (following (re-) partnering with own children and step-children). Data available previously could not assess the consequences of new family patterns on ADRD and cognition. Family formation influences and is influenced by economic and social resources and may, in turn, affect ADRD. Important employment parameters have also changed, with e.g., greater levels of economic activity for women and a shift in the content of work towards more cognitively demanding job tasks, and less physical and repetitive work. However, job opportunities among low skilled populations have worsened over the 20th century. This polarization may have important effects, including reducing cognition for the least stable, physically demanding, and cognitively understimulating jobs, while improving cognition among those with more stimulating work. This project will study the joint effect of changing family and work dynamics on risk of ADRD.

Metode

The central data component for our analyses is a comprehensive, population-based registry dataset from the HUNT study that includes individual level histories on occupation, education, health, social security, demographics, and various forms of social support. Because of its root in the Norwegian civil registry system, these data entail several strengths that make it exceptionally suitable for long-term cohort analyses: Firm knowledge of the population denominator, knowledge of the reasons for refusal and attrition, options for levels and localization of participation (at test station, at home, at nursing homes), coverage of sociodemographic features by the comprehensive HUNT-protocol and linkage to multiple Norwegian civil registries. This provides extensive longitudinal family and work histories along with relevant socioeconomic and contextual information. HUNT also includes institutionalized individuals and individuals with reduced capacity to consent; measurement of risk and compensatory factors across the life course by merging with previous HUNT study waves and linkage to registries, core elements and assessment methods can be compared with other Western study populations, and, finally, the ability to include biobank results in the analyses. 

HUNT4 70+ includes nearly 10,000 persons aged 70+. In addition to the usual HUNT protocol, the participants in HUNT4 70+ (H4 70+) were assessed for cognitive impairment and ADRD, physical function, function in daily life and oral health. The HUNT4 70+ participants were assessed at a test station, their home or a nursing home. In total, 9,943 persons are included in HUNT4 70+, 4,076 in the age group 70-74, 2,625 in 75-79, 1,613 in 80-84, 964 in 85-89, 513 in 90-94, 133 in 94-99 and 19 in ≥100.

Cognitive tests and level of subjective cognitive decline were used in HUNT4 to determine who went on to have a structured interview with the closest caregiver. All dementia diagnoses are determined by medical doctors specialized in neurology, psychiatry, or geriatrics, and who also have broad experience in research. All data from HUNT participants are screened independently by at least two medical doctors. In cases where no consensus on the ADRD diagnosis is reached, a third specialist is consulted. Individuals are categorized as either no cognitive impairment, subjective cognitive impairment, mild cognitive impairment (MCI) (DSM (Diagnostic and Statistical Manual of Mental Disorders 5th edition) criteria) or ADRD (DSM 5 criteria). Those with MCI are diagnosed as either amnestic or non–amnestic. In addition to Alzheimer’s Disease diagnoses, vascular dementia, Lewy body dementia, Parkinson dementia, fronto-temporal dementia, mixed dementia, unspecified dementia and other specified dementia (DSM 5 criteria) are diagnosed.

We will employ a variety of Norwegian registry data (all linked to HUNT) available from different sources. This includes individuals who are not part of HUNT, or just participating in some of the HUNT study waves. The linkage will take place at the individual level, which allows one to obtain health information from primary and specialist health care records as well as mortality data, socioeconomic and geographic information, military data, occupation data, vital statistics, education, taxes and social security data. 

We will analyze the association between marriage trajectories and work histories and the cognitive outcome in older adulthood outcome using regression methods, as well as mediation analysis. Furthermore, we will calculate cumulative exposure (for example persons years married), and regressing this cumulative exposure on the outcome, controlling for confounders, as we have done previously. We will use inverse probability weighting (IPW) to “adjust” for bias that due to loss from follow-up. 

prosjektdeltakere

prosjektleder
Aktiv cristin-person

Bjørn Heine Strand

  • Tilknyttet:
    Prosjektleder
    ved Folkehelseinstituttet

Yaakov Stern

  • Tilknyttet:
    Lokalt ansvarlig
    ved Columbia University in the City of New York

Jordan Weiss

  • Tilknyttet:
    Prosjektdeltaker
    ved University of Pennsylvania

Catherine E Bowen

  • Tilknyttet:
    Prosjektdeltaker
    ved University of Pennsylvania

Eric Bonsang

  • Tilknyttet:
    Prosjektdeltaker
    ved Université Paris Dauphine
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