Aulikki Nissinen

Publications (128)520.03 Total impact

• Article: The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): Study design and progress.

  Miia Kivipelto, Alina Solomon, Satu Ahtiluoto, Tiia Ngandu, Jenni Lehtisalo, Riitta Antikainen, Lars Bäckman, Tuomo Hänninen, Antti Jula, Tiina Laatikainen, [......], Francesca Mangialasche, Aulikki Nissinen, Teemu Paajanen, Satu Pajala, Markku Peltonen, Rainer Rauramaa, Anna Stigsdotter-Neely, Timo Strandberg, Jaakko Tuomilehto, Hilkka Soininen
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  ABSTRACT: BACKGROUND: Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a multi-center, randomized, controlled trial ongoing in Finland. MATERIALS: Participants (1200 individuals at risk of cognitive decline) are recruited from previous population-based non-intervention studies. Inclusion criteria are CAIDE Dementia Risk Score ≥6 and cognitive performance at the mean level or slightly lower than expected for age (but not substantial impairment) assessed with the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery. The 2-year multidomain intervention consists of: nutritional guidance; exercise; cognitive training and social activity; and management of metabolic and vascular risk factors. Persons in the control group receive regular health advice. The primary outcome is cognitive performance as measured by the modified Neuropsychological Test Battery, Stroop test, and Trail Making Test. Main secondary outcomes are: dementia (after extended follow-up); disability; depressive symptoms; vascular risk factors and outcomes; quality of life; utilization of health resources; and neuroimaging measures. RESULTS: Screening began in September 2009 and was completed in December 2011. All 1200 persons are enrolled and the intervention is ongoing as planned. Baseline clinical characteristics indicate that several vascular risk factors and unhealthy lifestyle-related factors are present, creating a window of opportunity for prevention. The intervention will be completed during 2014. CONCLUSIONS: The FINGER is at the forefront of international collaborative efforts to solve the clinical and public health problems of early identification of individuals at increased risk of late-life cognitive impairment, and of developing intervention strategies to prevent or delay the onset of cognitive impairment and dementia.
  Alzheimer's & dementia: the journal of the Alzheimer's Association 01/2013; · 5.90 Impact Factor
• Article: C-reactive protein, fibrinogen, and cardiovascular disease prediction.

  Stephen Kaptoge, Emanuele Di Angelantonio, Lisa Pennells, Angela M Wood, Ian R White, Pei Gao, Matthew Walker, Alexander Thompson, Nadeem Sarwar, Muriel Caslake, [......], Gordon D O Lowe, Nicholas J Wareham, Kay-Tee Khaw, Naveed Sattar, Chris J Packard, Vilmundur Gudnason, Paul M Ridker, Mark B Pepys, Simon G Thompson, John Danesh
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  ABSTRACT: There is debate about the value of assessing levels of C-reactive protein (CRP) and other biomarkers of inflammation for the prediction of first cardiovascular events. We analyzed data from 52 prospective studies that included 246,669 participants without a history of cardiovascular disease to investigate the value of adding CRP or fibrinogen levels to conventional risk factors for the prediction of cardiovascular risk. We calculated measures of discrimination and reclassification during follow-up and modeled the clinical implications of initiation of statin therapy after the assessment of CRP or fibrinogen. The addition of information on high-density lipoprotein cholesterol to a prognostic model for cardiovascular disease that included age, sex, smoking status, blood pressure, history of diabetes, and total cholesterol level increased the C-index, a measure of risk discrimination, by 0.0050. The further addition to this model of information on CRP or fibrinogen increased the C-index by 0.0039 and 0.0027, respectively (P<0.001), and yielded a net reclassification improvement of 1.52% and 0.83%, respectively, for the predicted 10-year risk categories of "low" (<10%), "intermediate" (10% to <20%), and "high" (≥20%) (P<0.02 for both comparisons). We estimated that among 100,000 adults 40 years of age or older, 15,025 persons would initially be classified as being at intermediate risk for a cardiovascular event if conventional risk factors alone were used to calculate risk. Assuming that statin therapy would be initiated in accordance with Adult Treatment Panel III guidelines (i.e., for persons with a predicted risk of ≥20% and for those with certain other risk factors, such as diabetes, irrespective of their 10-year predicted risk), additional targeted assessment of CRP or fibrinogen levels in the 13,199 remaining participants at intermediate risk could help prevent approximately 30 additional cardiovascular events over the course of 10 years. In a study of people without known cardiovascular disease, we estimated that under current treatment guidelines, assessment of the CRP or fibrinogen level in people at intermediate risk for a cardiovascular event could help prevent one additional event over a period of 10 years for every 400 to 500 people screened. (Funded by the British Heart Foundation and others.).
  New England Journal of Medicine 10/2012; 367(14):1310-20. · 53.30 Impact Factor
• Article: Low respiratory function increases the risk of depressive symptoms in later life in men.

  Erik J Giltay, Aulikki Nissinen, Simona Giampaoli, Frans G Zitman, Daan Kromhout
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  ABSTRACT: To assess the risk of depressive symptoms with respect to respiratory function in middle-aged men. Chronic lung diseases are associated with a high prevalence of depression, but the association of poor respiratory function with depressive symptoms has not been established in prospective population-based cohort studies. In a prospective, population-based cohort study with up to 30 years of follow-up, we included 1205 men aged 50 to 69 years from Finland (n = 663) and Italy (n = 542). Forced vital capacity (FVC) and forced expiratory flow in 0.75 sec (FEV(0.75)) in 1970 were analyzed in relationship to depressive symptoms (by Zung self-rating depression scale [SDS]) in 1985, 1990, 1995, and 2000, using multilevel regression models. Subsequent analyses were done separately in the strata with (n = 501) and without (n = 704) chronic diseases in 1970 (i.e., chronic lung diseases, cardiovascular diseases, or diabetes mellitus). Poor respiratory function was associated independently with steeper increases in depressive symptoms over time, both for FVC (p < .001) and FEV(0.75) (p = .004). In participants without chronic diseases, a standard deviation (SD) increase in FVC was associated with a 1.1-point decrease (standard error [SE] = 0.4) in Zung SDS (p = .01) and a 1.5-point decrease (SE = 0.4) (p < .001) in participants with chronic diseases (p = .27 for interaction). Low FEV(0.75) was associated with more depressive symptoms in participants with chronic diseases (1.7 SE 0.4 decrease per SD; p < .001), but not in participants without chronic diseases (0.6 SE 0.4 decrease per SD; p = .16; p = .008 for interaction). Small lung volumes were associated with an increased risk of subsequent depressive symptoms at old age, especially in persons with chronic lung diseases, cardiovascular diseases, or diabetes mellitus at baseline.
  Psychosomatic Medicine 11/2009; 72(1):53-60. · 3.97 Impact Factor
• Article: Apolipoprotein E genotype modifies the association between midlife lung function and cognitive function in old age.

  Erik J Giltay, Aulikki Nissinen, Simona Giampaoli, Daan Kromhout
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  ABSTRACT: Because poor lung function may be a risk factor for cognitive decline, we aimed to test the association of respiratory function with cognitive function and dementia later in life, as well as potential effect modification by APOE epsilon4 carrier status. In a prospective population-based cohort study, forced vital capacity and forced expiratory flow were measured around 1965 in 857 men aged 45-64 years (394 from Finland, 208 from The Netherlands, and 255 from Italy). The Mini-Mental State Examination scores around 1990, 1995 and 2000 were analyzed using multilevel regression models and the Clinical Dementia Rating score around 1990 using multinomial logistic regression analyses. Midlife lung function was positively associated with cognitive function in old age in APOE epsilon4 non-carriers, but not in carriers (p < 0.05 for interaction). In Finland and Italy, 18.6% had questionable to mild dementia and 2.8% moderate to severe dementia after 25 years of follow-up. Dementia was inversely related to midlife lung function in APOE epsilon4 non-carriers, but not in carriers (p < 0.05 for interaction). Small lung volumes were prospectively associated with an increased risk for poor cognitive function and dementia in non-carriers of the APOE epsilon4 gene.
  Dementia and Geriatric Cognitive Disorders 11/2009; 28(5):433-41. · 2.14 Impact Factor
• Article: Changes in Alcohol Consumption and Mortality in Aged Finnish Men

  Sirkka-Liisa Kivela, Aulikki Nissinen, Sven Punsar, Pekka Puska, Martti J. Karvonen
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  ABSTRACT: Drinking patterns and changes in alcohol consumption from 1974 to 1984 and associations between alcohol consumption in 1974 and ten-year mortality rates from cardiovascular, violent, cancer or all causes were studied among Finnish men born between 1900 and 1919. The overall absolute alcohol consumption was low in both 1974 and 1984. The average alcohol consumption and drinking pattern did not significantly change with increasing age, though some individual changes occured. Moderate or heavier alcohol consumption was a significant risk factor for cancer deaths among non-smoking men, but not in male smokers. Moderate or heavier alcohol consumption might also be a significant risk factor in violent death. Low, moderate or heavier alcohol consumption was not a significant risk factor for coronary deaths among the men in this rural Finnish population.
  07/2009; 21(3):245-246.
• Source

  Available from: Mikael Fogelholm

  Article: Type 2 diabetes prevention in the real world: three-year results of the GOAL lifestyle implementation trial.

  Pilvikki Absetz, Brian Oldenburg, Nelli Hankonen, Raisa Valve, Heikki Heinonen, Aulikki Nissinen, Mikael Fogelholm, Martti Talja, Antti Uutela
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  ABSTRACT: OBJECTIVE We study the effectiveness of the GOAL Lifestyle Implementation Trial at the 36-month follow-up. RESEARCH DESIGN AND METHODS Participants (n = 352, type 2 diabetes risk score FINDRISC = 16.2 +/- 3.3, BMI 32.6 +/- 5.0 kg/m(2)) received six lifestyle counseling sessions over 8 months. Measurements were at baseline, 12 months (88.6%), and 36 months (77.0%). RESULTS Statistically significant risk reduction at 12 months was maintained at 36 months in weight (-1.0 +/- 5.6 kg), BMI (-0.5 +/- 2.1 kg/m(2)), and serum total cholesterol (-0.4 +/- 1.1 mmol/l). CONCLUSIONS Maintenance of risk reduction in this "real world" trial proves the intervention's potential for significant public health impact.
  Diabetes care 05/2009; 32(8):1418-20. · 8.09 Impact Factor
• Article: Prevalence, awareness and treatment of hypertension in Finland during 1982-2007.

  Mika Kastarinen, Riitta Antikainen, Markku Peltonen, Tiina Laatikainen, Noel C Barengo, Antti Jula, Veikko Salomaa, Pekka Jousilahti, Aulikki Nissinen, Erkki Vartiainen, Jaakko Tuomilehto
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  ABSTRACT: To assess the trends in prevalence and in control of hypertension in various parts of Finland during 1982-2007. Three independent cross-sectional population surveys were conducted in 1982, 2002 and 2007 with age-stratified samples of men and women aged 25-64 years from the national population register. The total number of participants with complete blood pressure (BP) measurements was 16 775. Overall, during 1982-2007, the prevalence of hypertension (systolic BP > or = 140 mmHg and/or diastolic BP > or = 90 mmHg and/or current use of antihypertensive drug treatment) fell significantly in both sexes. In men, it fell from 63.3 to 52.1%; in women, from 48.1 to 33.6% (P < 0.001 for both sexes). However, during the past 5-year period, a decline was observed only in women in south-western Finland (P = 0.003). Furthermore, previously observed significant increases in the proportions of treated and controlled hypertensive individuals did not continue among men during 2002-2007. Despite the evident progress in all aspects of hypertension care since 1982, still in 2007, only 68% of all hypertensive individuals were aware of their condition, 52% of those who were aware were treated with antihypertensive drugs and 37% of the drug-treated patients had normal BP. Steady progress has been made in the prevention and treatment of hypertension in Finland. However, further improvements are clearly needed.
  Journal of hypertension 05/2009; 27(8):1552-9. · 4.02 Impact Factor
• Article: Respiratory function and other biological risk factors for completed suicide: 40 years of follow-up of European cohorts of the Seven Countries Study.

  Erik J Giltay, Frans G Zitman, Alessandro Menotti, Aulikki Nissinen, David R Jacobs, Hisashi Adachi, Antony Kafatos, Daan Kromhout
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  ABSTRACT: Prospective cohort studies on biological risk factors of completed suicide are scarce. We aimed to test which biological risk factors independently identify subjects at increased risk of suicidal death. In the prospective cohort of the Seven Countries Study, 5,321 middle-aged men from Finland, Serbia, Italy, and Greece were included. Completed suicide (ICD-8 codes E950-959) was assessed during 40 years of follow-up. Biological cardiovascular risk factors (including forced vital capacity [FVC] and height) were tested for their role as predictors in multivariable Cox models stratified by country. There were 4518 deaths during follow-up, with 64 from suicide (1.4%). In univariable models, only FVC and height were strongly inversely related with suicide. Socio-economic status and being unmarried were potential confounders. In multivariable models taking these confounders into account, both a low FVC (0.30 for top vs. lowest quartile; 95% CI: 0.12-0.76; P=0.006 for trend) and a low FVC/height ratio (0.37 for top vs. lowest quartile; 95% CI: 0.17-0.82; P=0.004 for trend) were strongly inversely related with completed suicide. Information on proximal causes, such as prior suicidal ideation, emotional distress and depression, was lacking at baseline. Poor respiratory function in middle-aged men was an independent risk factor for completed suicide.
  Journal of affective disorders 05/2009; 120(1-3):249-53. · 3.76 Impact Factor
• Article: Dietary factors and hypertension

  Jussi K. Huttunen, Pirjo Pietinen, Aulikki Nissinen, Pekka Puska
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  ABSTRACT: There is increasing evidence that nutritional factors are critical in the pathogenesis of essential hypertension typical for acculturated societies. These factors include sodium, potassium, calcium, alcohol, and type and level of fat in the diet. More research is needed, however, before the role of various nutrients in the prevention and treatment of hypertension will be ascertained.
  Journal of Internal Medicine 04/2009; 218(S701):72 - 82. · 5.48 Impact Factor
• Article: Cardiovascular risk factors and dementia mortality: 40 years of follow-up in the Seven Countries Study.

  Alvaro Alonso, David R Jacobs, Alessandro Menotti, Aulikki Nissinen, Anastasios Dontas, Anthony Kafatos, Daan Kromhout
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  ABSTRACT: Previous research shows that cardiovascular risk factors in mid-adulthood could increase the risk of dementia later in life, but studies with very long follow-up are still scarce. We assessed whether cardiovascular risk factors measured in midlife were associated with dementia mortality during a 40-year follow-up. 10,211 men, aged 40-59 at baseline, from 13 cohorts of the Seven Countries Study were followed for 40 years. Information on cardiovascular risk factors was obtained at baseline from questionnaires and a physical examination. Dementia death was assigned if there was any mention of dementia on the death certificate. Associations between cardiovascular risk factors and death from dementia were estimated through Cox proportional hazards models. We identified 160 dementia deaths during the follow-up. Smoking, hypercholesterolemia, high blood pressure, low forced vital capacity and previous history of cardiovascular disease at baseline were associated with a higher risk of death from dementia in the follow-up. The hazard ratio (HR) of dementia death among heavy smokers was 1.58 (95% confidence interval (CI) 1.03, 2.43) compared to non-smokers. Similarly, the HR (95% CI) among those with systolic BP>or=160 or diastolic BP>or=95 mm Hg compared to normotensives (<140/90) was 1.55 (1.02, 2.35). Individuals with the largest forced vital capacity had a lower risk of dying of dementia (HR 0.54, 95% CI 0.30, 0.98). Finally, total serum cholesterol was directly associated with higher risk of dementia mortality (p for trend=0.03). In men, cardiovascular risk factors in midlife are associated with increased risk of dementia death later in life.
  Journal of the neurological sciences 02/2009; 280(1-2):79-83. · 2.32 Impact Factor
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  Available from: Hilkka Soininen

  Article: Association between mid-life marital status and cognitive function in later life: population based cohort study.

  Krister Håkansson, Suvi Rovio, Eeva-Liisa Helkala, Anna-Riitta Vilska, Bengt Winblad, Hilkka Soininen, Aulikki Nissinen, Abdul H Mohammed, Miia Kivipelto
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  ABSTRACT: To evaluate whether mid-life marital status is related to cognitive function in later life. Prospective population based study with an average follow-up of 21 years. Kuopio and Joensuu regions in eastern Finland. 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. Alzheimer's disease and mild cognitive impairment. 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. 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.
  BMJ (Clinical research ed.). 02/2009; 339:b2462.
• Article: The effect of midlife physical activity on structural brain changes in the elderly.

  Suvi Rovio, Gabriela Spulber, Lasse J Nieminen, Eini Niskanen, Bengt Winblad, Jaakko Tuomilehto, Aulikki Nissinen, Hilkka Soininen, Miia Kivipelto
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  ABSTRACT: Physical activity has been associated with decreased dementia risk in recent studies, but the effects for structural brain changes (i.e. white matter lesions (WML) and/or brain atrophy) have remained unclear. The CAIDE participants were a random population-based sample studied in midlife and re-examined on average 21 years later (n=2000). A subpopulation (n=75; 31 control, 23 MCI, 21 dementia) was MRI scanned at the re-examination. T1-weighted images were used to investigate grey matter (GM) density, and FLAIR-images for WML rating. Persons who actively participated in physical activity at midlife tended to have larger total brain volume (β 0.12; 95% CI 0.17-1.16, p=0.10) in late-life than sedentary persons even after adjustments. GM volume was larger among the active (β 0.19; 95% CI 0.07-1.48, p=0.03), whereas the association between midlife physical activity and larger WM volume became non-significant (β 0.03; 95% CI -0.64 to 0.86, p=0.77) after full adjustments. The differences in the GM density localized mainly in frontal lobes. There was no significant association between midlife physical activity and severe WML later in life after full adjustments (OR 4.20, 95% CI 0.26-69.13, p=0.32).
  Neurobiology of aging 01/2009; 31(11):1927-36. · 5.94 Impact Factor
• Article: Homogeneity in the relationship of serum cholesterol to coronary deaths across different cultures: 40-year follow-up of the Seven Countries Study.

  Alessandro Menotti, Mariapaola Lanti, Daan Kromhout, Henry Blackburn, David Jacobs, Aulikki Nissinen, Anastasios Dontas, Antony Kafatos, Srecko Nedeljkovic, Hisashi Adachi
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  ABSTRACT: The aim was to investigate whether multivariate coefficients of serum cholesterol in the prediction of coronary heart disease (CHD) deaths were similar across different cultures in a long-term follow-up. Thirteen cohorts for a total of 10,157 men aged 40-59 years at entry, enrolled in seven countries (USA, Finland, the Netherlands, Italy, Serbia, Greece, Japan) were repeatedly examined and followed up for 40 years. Serum cholesterol measured at baseline, and then on repeated occasions, was studied, using multivariate models, in relation with the occurrence of CHD deaths during a 40-year follow-up. Homogeneity of multivariate serum cholesterol coefficients was found considering cholesterol levels at baseline, as average of up to three measurements during the first 10 years, as average of up to six measurements in 35 years, using the time-dependent technique with up to three measurements in 10 years, and with up to six measurement in 35 years. The strength of the association between serum cholesterol and CHD death seems homogeneous across different cultures characterized by different levels of serum cholesterol and different absolute risk of CHD death.
  European journal of cardiovascular prevention and rehabilitation: official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology 01/2009; 15(6):719-25. · 2.51 Impact Factor
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  Available from: Tineke van Veen

  Article: Serum cholesterol, apolipoprotein E genotype and depressive symptoms in elderly European men: the FINE study.

  Erik J Giltay, Arianne K B van Reedt Dortland, Aulikki Nissinen, Simona Giampaoli, Tineke van Veen, Frans G Zitman, Sinikka Bots, Daan Kromhout
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  ABSTRACT: Cohort and case-control studies found that lower serum total cholesterol is associated with depression. It is, however, unclear whether low cholesterol or its lipoprotein fractions are causally related to depression. Using a Mendelian randomization design, the potential association between apolipoprotein E (APOE) genotype (affecting lifetime cholesterol levels) and depressive symptoms was studied. In the longitudinal Finland, Italy, the Netherlands Elderly (FINE) Study 1089 men were included in 1985. The 435 men from Finland, 418 men from The Netherlands, and 236 men from Italy (aged 65-84 years) were free of myocardial infarction, stroke, diabetes mellitus and cancer at all time points. They were prospectively studied around 1985 (n=658), 1990 (n=668), 1995 (n=327), and 2000 (n=82). Associations between serum cholesterol, lipoprotein fractions and APOE genotype, with depressive symptoms (by Zung self-rating depression scale [SDS]) were analyzed using multilevel regression models. Serum total cholesterol was inversely associated with the Zung SDS (-0.61 points per 1 mmol/L increase in cholesterol; 95% confidence interval: -1.05 to -0.17; P=0.007), after adjustment for country, age, body mass index, smoking, and alcohol intake. However, none of the cholesterol lipoprotein fractions were associated with the Zung SDS. The APOE genotypes epsilon4/4, epsilon4/3; epsilon3/3; epsilon4/2, and epsilon3/2 or epsilon2/2 were associated with decreasing levels of serum total and LDL cholesterol (Ps<0.001), but not with increasing depressive symptoms (P=0.67). APOE genotype was assessed through protein isoforms and not actual DNA-based typing. There was a modest inverse relationship between depression scores and serum total cholesterol in elderly men, but no associations with lipoprotein fractions or with the APOE genotype.
  Journal of affective disorders 12/2008; 115(3):471-7. · 3.76 Impact Factor
• Article: The association of depression with cardiovascular mortality is partly explained by health status. The FINE Study.

  Marjolein H Kamphuis, Mirjam I Geerlings, Simona Giampaoli, Aulikki Nissinen, Diederick E Grobbee, Daan Kromhout
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  ABSTRACT: Depression is associated with an increased risk of cardiovascular diseases (CVD) and cardiovascular mortality. We investigated to what extent subjective health status explained the apparent association between depressive symptoms and cardiovascular mortality in older European men. Data were used from the population-based prospective Finland, Italy and the Netherlands Elderly (FINE) Study. Depressive symptoms were measured with the Zung Self-rating Depression Scale in 909 men, aged 70-90 years, free of CVD and diabetes in 1990. Subjective health status was estimated with a single question on self-rated health and with a standardized questionnaire about activities of daily living. Cardiovascular mortality was determined during ten years of follow-up. At baseline, poor self-rated health and more disability in activities of daily living were both associated with more depressive symptoms using multiple linear regression analysis. Prospectively men who reported to be unhealthy or with moderate to severe disability had an approximately 2.5 times higher risk of cardiovascular mortality using Cox regression analysis. An increase in depressive symptoms by one standard deviation was associated with an increased risk of cardiovascular mortality (HR 1.37; 95% CI 1.21-1.56). A substantial part of this association was explained by self-rated health and disability (proportion explained 0.32; 95% CI 0.09-0.55). However, a significant risk of depressive symptoms on cardiovascular mortality remained (HR 1.25; 95% CI 1.09-1.43) after adjustment for subjective health status. Health status is based on subjective measures. In older men, subjective health status explains a considerable part of the association between depression and risk of cardiovascular mortality.
  Journal of affective disorders 09/2008; 114(1-3):184-92. · 3.76 Impact Factor
• Article: Fat intake at midlife and cognitive impairment later in life: a population-based CAIDE study.

  Marjo H Eskelinen, Tiia Ngandu, Eeva-Liisa Helkala, Jaakko Tuomilehto, Aulikki Nissinen, Hilkka Soininen, Miia Kivipelto
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  ABSTRACT: To investigate the association of midlife dietary fat intake to cognitive performance, and to the occurrence of clinical mild cognitive impairment (MCI) later in life in a non-demented population. A longitudinal population-based study. Populations of Kuopio and Joensuu, Eastern Finland. Participants of the CAIDE study were derived from random, population-based samples studied at midlife (1972, 1977, 1982 or 1987). After an average follow-up of 21 years, a total of 1449 (72%) individuals aged 65-80 years participated in the re-examination in 1998. Altogether 82 (5.7%) people were diagnosed as having MCI. Dietary information was collected with a structured questionnaire and an interview at midlife. MCI, global cognitive and executive functions, episodic, semantic and prospective memory and psychomotor speed. Abundant saturated fat (SFA) intake from milk products and spreads at midlife was associated with poorer global cognitive function and prospective memory and with an increased risk of MCI (OR 2.36, 95% CI 1.17-4.74) after adjusting for demographic and vascular factors, other fats and ApoE. On the contrary, high intake of polyunsaturated fatty acids (PUFA) was associated with better semantic memory. Also frequent fish consumption was associated with better global cognitive function and semantic memory. Further, higher PUFA-SFA ratio was associated with better psychomotor speed and executive function. Our data suggests that dietary fat intake at midlife affects cognitive performance and occurrence of MCI later in life. The impact of dietary interventions needs to be tested in clinical trials.
  International Journal of Geriatric Psychiatry 07/2008; 23(7):741-7. · 2.42 Impact Factor
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  Available from: gnmhealthcare.com

  Article: Lifestyle- and diet-related factors in late-life depression--a 5-year follow-up of elderly European men: the FINE study.

  Sinikka Bots, Marja Tijhuis, Simona Giampaoli, Daan Kromhout, Aulikki Nissinen
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  ABSTRACT: Late-life depression is one of the main health problems among elderly populations and a key element of healthy ageing. Causal relationships of lifestyle- and diet-related factors in late-life depression are unclear. This study investigates prospective associations of lifestyle- and diet-related factors with development of categorically defined late-life depression in a well-documented population of elderly European men. Altogether 526 not-demented and not-depressed European men aged 70-89 at baseline were included in the analyses. The association of lifestyle-related and dietary factors with development of categorically defined depression (> =48/80 on the Zung Self-rating Depression Scale) was assessed in a follow-up of 5 years. Eleven percent (n=59) of the men developed depression during follow-up. An independent association with development of depression was found for baseline depressive status [Odds Ratio (OR) 1.19, 95% Confidence Interval (CI): 1.10-1.28, p<0.001], a decline in serum total cholesterol level between study years (OR 1.76, 95%CI: 1.01-3.04, p=0.045), physical activity (OR 0.97, 95%CI: 0.94-1.00, p=0.022) and moderate alcohol intake (OR 0.35, 95%CI: 0.14-0.87, p=0.023) but not for dietary factors. This study of a well-documented population of elderly European men confirms that physical activity and moderate alcohol consumption may protect against depression in the old-old. Our results are the first to suggest that a decline in serum cholesterol level may predict development of late-life depression. As the effects of age, medication and incipient cognitive decline could not be entirely ruled out; this finding must be interpreted with care.
  International Journal of Geriatric Psychiatry 05/2008; 23(5):478-84. · 2.42 Impact Factor
• Article: Apolipoprotein E epsilon4 magnifies lifestyle risks for dementia: a population-based study.

  Miia Kivipelto, Suvi Rovio, Tiia Ngandu, Ingemar Kåreholt, Marjo Eskelinen, Bengt Winblad, Vladimir Hachinski, Angel Cedazo-Minguez, Hilkka Soininen, Jaakko Tuomilehto, Aulikki Nissinen
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  ABSTRACT: The risk of dementia and Alzheimer's disease (AD) probably results from an interaction between genetic and environmental factors. The aim of this study was to investigate the effects and putative interactions between the apoE epsilon4 allele and lifestyle related risk factors for dementia and AD. Participants of the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study were derived from random, population-based samples previously studied in 1972, 1977, 1982 or 1987. After an average follow-up of 21 years, 1449 individuals (72.5%) aged 65-79 years were re-examined in 1998. The apoE epsilon4 allele was an independent risk factor for dementia/AD even after adjustments for sociodemographic, lifestyle and vascular factors (odds ratio [OR]=2.83, 95% confidence interval [CI]=1.61-4.97). Physical inactivity, alcohol drinking and smoking increased the risk of dementia/AD particularly among the apoE epsilon4 carriers. Furthermore, low-moderate intake of polyunsaturated, and moderate-high intake of saturated fats were associated with an increased risk of dementia/AD more pronouncedly among apoE epsilon4 carriers. Composite effect of the lifestyle factors was particularly seen among the epsilon4 carriers (OR=11.42, 95% CI=1.94-67.07 in the 4th quartile). Physical inactivity, dietary fat intake, alcohol drinking and smoking at midlife are associated with the risk of dementia and AD, especially among the apoE epsilon4 carriers. The apoE epsilon4 carriers may be more vulnerable to environmental factors, and thus, lifestyle interventions may greatly modify dementia risk particularly among the genetically susceptible individuals.
  Journal of Cellular and Molecular Medicine 04/2008; 12(6B):2762-71. · 4.13 Impact Factor
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  Available from: Merja Hallikainen

  Article: MRI of hippocampus and entorhinal cortex in mild cognitive impairment: a follow-up study.

  Tero Tapiola, Corina Pennanen, Mia Tapiola, Susanna Tervo, Miia Kivipelto, Tuomo Hänninen, Maija Pihlajamäki, Mikko P Laakso, Merja Hallikainen, Anne Hämäläinen, Matti Vanhanen, Eeva-Liisa Helkala, Ritva Vanninen, Aulikki Nissinen, Roberta Rossi, Giovanni B Frisoni, Hilkka Soininen
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  ABSTRACT: The concept of mild cognitive impairment (MCI) has been proposed to represent a transitional stage between normal aging and dementia. We studied the predictive value of the MRI-derived volumes of medial temporal lobe (MTL) structures, white matter lesions (WML), neuropsychological tests, and Apolipoprotein E (APOE) genotype on conversion of MCI to dementia and AD. The study included 60 subjects with MCI identified from population cohorts. During the mean follow-up period of 34 months, 13 patients had progressed to dementia (9 to Alzheimer's disease (AD)). In Cox regression analysis the baseline volumes of the right hippocampus, the right entorhinal cortex and CDR sum of boxes predicted the progression of MCI to dementia during the follow-up. In a bivariate analysis, only the baseline volumes of entorhinal cortex predicted conversion of MCI to AD. The Mini-Mental State Examination (MMSE) score at baseline, WML load, or APOE genotype were not significant predictors of progression. The MTL volumetry helps in identifying among the MCI subjects a group, which is at high risk for developing AD.
  Neurobiology of aging 02/2008; 29(1):31-8. · 5.94 Impact Factor
• Article: The effects of lifestyle intervention for hypertension on low back pain: a randomized controlled trial.

  Riikka Mattila, Antti Malmivaara, Mika Kastarinen, Sirkka-Liisa Kivelä, Aulikki Nissinen
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  ABSTRACT: Randomized controlled trial. To assess the effects of a lifestyle intervention for hypertension on low back pain. According to prospective etiologic studies, a causal association exists between certain lifestyle factors and low back pain. These factors are similar to those that elevate the risk for hypertension. Nevertheless, no randomized controlled trial has assessed effectiveness of lifestyle intervention for the treatment of hypertension on the prevalence of low back pain. A total of 731 hypertensive employees from 45 worksites were assigned to multidisciplinary lifestyle interventions for hypertension in a rehabilitation center or to routine care in occupational or primary healthcare services during 12 months. Questionnaire data on low back pain were used to assess the effects of the intervention on the extent of low back pain and disability. The changes in prevalence and duration of low back pain, and related disability did not differ between the 2 groups, although there were favorable changes in some risk factors, such as body weight and physical inactivity. Subgroup analyses among patients with moderately heavy or heavy work showed that the prevalence of low back pain during the previous 12 months decreased more in the intervention than in the control group. Multidisciplinary lifestyle intervention aimed to reduce hypertension is not effective at reducing prevalence of low back pain or disability. However, in the subgroup of persons doing moderate or heavy work, the intervention seemed to reduce prevalence of low back pain during the 1-year follow-up.
  Spine 01/2008; 32(26):2943-7. · 2.08 Impact Factor