Anna-Maija Tolppanen

• PhD, Professor (effectiveness in healthcare)
• Professor (Associate) at University of Eastern Finland

Background and objectives: Accurate diagnosis of Parkinson disease (PD) remains challenging, with variability and clinical uncertainty, especially in nonspecialized settings. Despite advancements in diagnostic criteria and biological markers, misdiagnosis continues to affect patient care and research. This study aimed to assess the long-term diagn...

Background The use of real-world data is established in post-authorization regulatory processes such as pharmacovigilance of drugs and medical devices, but is still frequently challenged in the pre-authorization phase of medicinal products. In addition, the use of real-world data, even in post-authorization steps, is constrained by the availability...

Background Pneumonia is a common cause for hospitalization and excess mortality among persons with Alzheimer’s disease (AD), but little research exists evaluating drug use as its risk factor. Objective We investigated the association between opioid use and hospital-treated pneumonia among community dwellers with AD. Methods This study was part of...

Background Helicobacter pylori ( H. pylori ) has been inconsistently associated with risk of Alzheimer disease. The exposure assessment period has often overlapped with the prodromal time of Alzheimer disease. Cognitive disorders might increase vulnerability to infectious pathogens, complicating the ascertainment of temporal relationship between H....

The age‐standardized prevalence of Parkinson's disease (PD) has increased substantially over the years and is expected to increase further. This emphasizes the need to identify modifiable risk factors of PD, which could form a logical entry point for the prevention of PD. The World Health Organization (WHO) has recommended reducing exposure to spec...

Importance Although surgery for pelvic organ prolapse (POP) is generally associated with an improvement in sexual function, knowledge on specific changes is limited. Objectives The aim of this study was to describe and compare changes in sexual activity and function during a 5-year follow-up period after POP surgery. Study Design This was a natio...

Background Multimorbidity is common in older adults and complicates diagnosing and care for this population. Objective We investigated co-occurrence patterns (clustering) of medical conditions in persons with Alzheimer’s disease (AD) and their matched controls. Methods The register-based Medication use and Alzheimer’s disease study (MEDALZ) inclu...

Introduction and hypothesis Various strategies are employed to manage stress urinary incontinence (SUI) during pelvic organ prolapse (POP) surgery. This study was aimed at facilitating shared decision-making by evaluating SUI symptom changes, staged SUI procedures, and their prognostic factors following POP surgery without concomitant SUI intervent...

Aims Persons with diabetes may have an elevated risk of Parkinson's disease (PD). Statin use could also modify the progression of PD. The aim was to study whether there is an association between statin exposure and risk of PD in persons with diabetes. Methods A nationwide, nested case–control study restricted to people with diabetes was performed...

Purpose To describe and categorize detailed components of databases in the Neurological and Mental Health Global Epidemiology Network (NeuroGEN). Methods An online 132-item questionnaire was sent to key researchers and data custodians of NeuroGEN in North America, Europe, Asia and Oceania. From the responses, we assessed data characteristics inclu...

Background: The purpose of percutaneous coronary intervention (PCI) is to relieve chest pain, improve health-related quality of life (HRQoL), or reduce the risk of cardiac adverse events and death among patients with coronary artery disease. The aim of this study was to investigate whether age is related to HRQoL improvement in patients undergoing...

The primary aim of revascularization in stable coronary artery disease (CAD) is symptom relief. The severity of symptoms is usually evaluated by the physician, not by the patient. We examined the agreement between physician- and patient-reported Canadian Cardiovascular Society (CCS) scores among patients scheduled for elective coronary angiography...

Introduction Although β2-adrenoceptor (β2AR) agonists have been associated with a lower risk of Parkinson’s disease (PD), the findings are inconclusive and may reflect confounding by indication. We studied the association between inhaled β2AR agonists and risk of PD in persons with asthma or chronic obstructive pulmonary disease (COPD). Methods Th...

In this international study, we examined the incidence of hip fractures, post-fracture treatment, and all-cause mortality following hip fractures, based on demographics, geography, and calendar year. We used patient-level healthcare data from 19 countries and regions to identify patients aged 50 years and older hospitalized with a hip fracture from...

Background Pneumonia is a very common infection in the cognitively impaired adult population, often leading to long-term deterioration, in physical and cognitive performance. Evidence is lacking on whether chronic comorbidities and drug use are risk factors for pneumonia in persons with Alzheimer’s disease (AD). The objective of this study was to i...

Background Alzheimer’s disease (AD) is a major determinant of healthcare costs and increase in the healthcare service use occur already before the AD diagnosis. However, little is known how the different diagnosis categories contribute to this increase in healthcare use. We investigated how the hospitalizations and specialized healthcare outpatient...

Background: There is mixed evidence for an association between particulate matter air pollution and Parkinson's disease despite biological plausibility. Objectives: We studied the association between particulate air pollution, its components and Parkinson's disease (PD) risk. Methods: We conducted a nested case-control study within the populat...

Background: Fall-related injuries are a major health concern among people with Parkinson's disease (PD). We compared the incidence and post-injury mortality of head injuries and traumatic brain injury (TBI) among persons with and without PD. Methods: This register-based study was conducted on the FINPARK cohort which includes 22 189 persons who...

This multinational cohort study examines the trends in relative mortality risk following dementia diagnosis in the UK, Germany, Finland, Canada (Ontario), New Zealand, South Korea, Taiwan, and Hong Kong. A common protocol was applied to population-based data of individuals aged 60+ with an incident dementia diagnosis recorded between 2000 and 2018....

Background Use of pharmacological treatments is one possible modifiable risk factor for cognitive disorders. Objective To investigate if the use of muscle relaxants is associated with the risk of Alzheimer’s disease (AD). Methods The study was performed in a nested case-control design. Altogether 70,718 community-dwelling residents of Finland who...

Background Parkinson's disease (PD) causes also visual dysfunction including decreased visual acuity, even already at the prodromal phase of disease. Still, it has been suggested that persons with PD may be less likely to be referred for cataract surgery, although early management increases the chances for successful cataract surgery. Methods Data...

Background People with Parkinson’s disease (PD) are more likely to be hospitalized and initiate antidepressant use compared to people without PD. It is not known if hospitalization increases the risk of antidepressant initiation. We studied whether a recent hospitalization associates with antidepressant initiation in people with PD. Methods A nest...

Aims: To assess the validity and completeness of the Care Register for Social Welfare among community-dwelling people with Alzheimer’s disease in Finland. Methods: The study was carried out in the Medication Use and Alzheimer’s disease (MEDALZ) study population, which includes 70,719 people who received a clinically verified diagnosis of Alzheimer’...

Background Even though surgery generally improves sexual function and alleviates dyspareunia related to pelvic organ prolapse (POP), knowledge of the long-term effects is scarce. Objective To describe changes in sexual activity and dyspareunia rates after POP surgery and to identify potential risk factors for the occurrence of dyspareunia. Design...

Objectives Antiepileptic drugs (AEDs) are frequently prescribed for persons with Alzheimer’s disease (AD), but little is known on factors associated with AED initiation in this population. We investigated whether recent hospitalization is associated with AED initiation in persons with AD. Design Nested case-control study in the nationwide register...

Introduction Previous studies have assessed antipsychotic use after Parkinson's disease (PD) diagnosis, but incident antipsychotic use before PD diagnosis is unknown. The objective is to study the incidence of antipsychotic use among community-dwelling persons with and without PD 10 years before and after the PD diagnosis. Methods The study was ba...

Background Although statin use is reported to decrease after dementia diagnosis, time to statin discontinuation and factors associated with discontinuation have not been studied in persons with Alzheimer’s disease (AD). We compared the risk of discontinuation and factors associated with discontinuation, including secondary and primary prevention in...

Purpose: Tamsulosin has been associated with dementia, but the results have been inconsistent. Concerns have been raised about using exposure assessment time too close to the outcome. We investigated the association between use of α1-adrenoceptor antagonists indicated for benign prostate hyperplasia and risk of Alzheimer's disease (AD) using diffe...

Background Although cardio- and cerebrovascular diseases are common among people with Alzheimer’s disease (AD), it is unknown how the prevalence of oral anticoagulant (OAC) use changes in relation to AD diagnosis. We investigated the prevalence of OAC use in relation to AD diagnosis in comparison to a matched cohort without AD. Methods Register-ba...

Purpose: Diabetes has been associated with increased risk of Parkinson's disease (PD). Diabetes medications have been suggested as a possible explanation, but findings have been inconsistent. More information on the role of exposure in different time windows is needed because PD has long onset. We assessed the association between use of different...

Background Generic health-related quality of life (HRQoL) and disease-specific instruments measure HRQoL from different aspects, although generic instruments often contain dimensions that reflect common symptoms. We evaluated how the change in 15D HRQoL and Canadian Cardiovascular Society (CCS) grading of angina severity correlate among coronary ar...

Objective: Psychiatric disorders have been implied as both risk factors and prodromal symptoms of Alzheimer's disease (AD). A better understanding of the history of psychiatric morbidity in people with AD may aid with understanding this relationship and highlight challenges in diagnosing AD in people with concomitant psychiatric disorders. Method...

Purpose We investigated the drug use before and after transition to automated multi-dose dispensing (MDD) service among persons with Alzheimer’s disease (AD) and compared whether the changes were similar in persons without AD. Methods The register-based Finnish nationwide MEDALZ cohort includes 70,718 community-dwelling persons diagnosed with AD d...

Background Epidemiological studies have suggested a link between rheumatoid arthritis and Parkinson’s disease (PD). Disease-modifying anti-rheumatic drugs (DMARDs) might explain this association. Objective To evaluate the association between DMARDs and risk of PD in persons with rheumatoid arthritis. Methods Nested nationwide case-control study w...

Introduction Drugs for other indications may be repurposable as disease-modifying drugs for Parkinson’s disease (PD). A systematic hypothesis-free approach can enable identification of candidates for repurposing. We applied a hypothesis-free systematic approach to identify drugs associated with lower risk of PD to discover candidates with potential...

Background Type 2 diabetes is common in persons with Alzheimer’s disease (AD). Management of diabetes in persons with AD is challenging due to changing goals of care and susceptibility to adverse drug events including hypoglycemia. The aim of this study was to investigate the prevalence of diabetes drug use from 5 years before to 5 years after the...

Objectives Antipsychotic use for neuropsychiatric symptoms in Alzheimer’s disease (AD) is common despite the increased risk of cardiovascular events and mortality. There is limited and inconsistent evidence on the possible risk of stroke. We assessed whether antipsychotic initiation increases the risk of stroke in people with a verified diagnosis o...

Background Patient-reported outcome (PRO) instruments measure health gains, including changes in health-related quality of life (HRQoL). Previous studies have assessed the reliability and relationship of multiple HRQoL instruments in search of the optimal instrument for feasible measurement of PROs. Although the 15D instrument was shown to have the...

Coronary artery disease (CAD) is a risk factor for cognitive decline. The aim of this study was to systematically review recent literature on whether coronary artery revascularizations are associated to cognitive decline and dementia. Pubmed, Scopus, and CINAHL (EBSCO) were searched systematically from January 2009 till September 2020. Studies were...

Introduction and hypothesis It is unclear how compartment of pelvic organ prolapse (POP) impacts overactive bladder (OAB) symptom severity or improvement after POP surgery. We hypothesized that anterior and apical prolapse are more strongly associated with OAB symptoms than posterior compartment prolapse. Methods A total of 2933 POP surgeries from...

Introduction Hip fractures are associated with a high burden of morbidity and mortality. Globally, there is wide variation in the incidence of hip fracture in people aged 50 years and older. Longitudinal and cross-geographical comparisons of health data can provide insights on aetiology, risk factors, and healthcare practices. However, systematic r...

Purpose To investigate the incidence of cataract surgeries in relation to Alzheimer’s disease (AD) diagnosis and to compare it with that in people without AD. Methods The MEDALZ–study includes community‐dwelling Finnish persons who received clinically verified AD diagnoses (n = 70718) during 2005–2011 and a matched comparison cohort without AD (n...

Objective To determine the risk of hip fracture in persons with Alzheimer´s disease (AD) who initiated antiepileptic drugs (AEDs). Methods In the Medication use and AD (MEDALZ) cohort of 70,719 Finnish community dwellers with clinically verified incident AD diagnosis in 2005–2011, we identified all incident users of AEDs using national Prescriptio...

Background Antidepressant use is more common in people with Parkinson’s disease (PD), but it is unknown when this difference emerges. Methods We studied the incidence of antidepressant use in six-month periods from 10 years before to 15 years after PD diagnosis in the nationwide register-based Finnish Study on Parkinson’s disease (FINPARK). This s...

Background Alzheimer’s disease (AD) is one of the leading causes of death world-wide, but little is known on the role of comorbidities on mortality among people with AD. We studied how comorbidities and age at AD diagnosis impact the survival of people with AD. Methods The Medication Use and Alzheimer’s disease (MEDALZ) cohort study included 70,71...

Objectives: Antidepressant are commonly prescribed to persons with cognitive disorders to treat depressive and other neuropsychiatric symptoms despite the inconclusive evidence on their effectiveness on this indication. We studied whether recent hospitalisation was associated with antidepressant initiation in people with Alzheimer's disease (AD)....

Objectives Antipsychotics are often prescribed to persons with cognitive impairment in the hospital, but it is not known whether recent hospital care increases the risk of antipsychotic initiation in community dwellers with Alzheimer's disease (AD). We studied whether hospital care during the previous 2 weeks is associated with antipsychotic initia...

Background: Little is known on the incidence and postoperative outcomes of revascularizations according to electivity in persons with Alzheimer's disease (AD). Methods: The Medication Use and Alzheimer's disease (MEDALZ) cohort includes 70718 community dwellers diagnosed with incident AD during 2005-2011 in Finland. For each person with AD, 1-4...

Background PD comorbid with schizophrenia has been considered rare because these diseases associate with opposite alterations in the brain dopamine system. The objective of this study was to investigate the risk of PD after a diagnosis of a schizophrenia spectrum disorder. Methods Regionally, this was a retrospective record‐based case–control stud...

Objective: To describe the major complications of pelvic organ prolapse (POP) surgery in Finland. Methods: The Finnish Pelvic Organ Prolapse Surgery Survey 2015 study is a prospective cohort of POP surgeries performed in Finland in 2015. Perioperative, postoperative, and late complications during 1 year of follow-up were compared among native ti...

Background Alzheimer’s disease (AD) is related to higher mortality but it is not entirely evident which causes of death explain this. The objective of this study was to assess the causes of death in a nationwide cohort of clinically verified AD cases and compare the causes to a matched comparison cohort without AD. Methods Cohort of all community-...

Introduction and hypothesis: Patient-reported outcome measures are fundamental tools when assessing effectiveness of treatments. The challenge lies in the interpretation: which magnitude of change in score is meaningful for the patients? The minimal important difference (MID) is defined as the smallest difference in score that patients perceive as...

Background Persons with Alzheimer’s disease (AD) are in higher risk of hip fractures (HF) than general older population and have worse prognosis after HF. Hospital stays after HF have shortened along time. We investigated the association between length of hospital stay after HF and mortality after discharge among persons with AD. Methods The MEDAL...

Aims To evaluate the correlation between three commonly used patient‐reported outcome measures, two generic and one condition‐specific instrument, in assessing the change in health‐related quality of life following pelvic organ prolapse surgery. Methods The generic health‐related quality of life measure 15‐dimensional instrument (15D), Patient Glo...

Neurological and psychiatric (mental health) disorders have a large impact on health burden globally. Cognitive disorders (including dementia) and stroke are leading causes of disability. Mental health disorders, including depression, contribute up to one-third of total years lived with disability. The Neurological and mental health Global Epidemio...

Abstract Background Hospital length of stays (LOS) for incident of hip fracture are decreasing, but it is unknown if these changes have negative impacts on vulnerable older patient populations, like those with Alzheimer’s disease (AD). We aimed to assess if persons with and without AD have different hospital LOS for hip fracture, and is the LOS ass...

Objectives We examined longitudinal associations between late‐life personality traits and cognitive impairment, dementia, and mortality in the population‐based Cardiovascular Risk Factors, Aging and Dementia (CAIDE) Study. Methods Anger expression and trait anger (State‐Trait Anger Expression Inventory), anxiety (State‐Trait Anxiety Inventory), an...

Objective To evaluate the risk of death in relation to incident antiepileptic drug (AED) use compared with nonuse in people with Alzheimer disease (AD) through the assessment in terms of duration of use, specific drugs, and main causes of death. Methods The MEDALZ (Medication Use and Alzheimer Disease) cohort study includes all Finnish persons who...

Context Type 2 diabetes has been linked with an increased risk of Alzheimer’s disease (AD). Studies on the association between metformin use and AD have reported conflicting results. Objective To investigate whether metformin use modifies the association between diabetes and incident, clinically verified AD. Design Nested case-control study. Set...

Background Parkinson’s disease is the second most common neurodegenerative disorder. Motor and non-motor symptoms seem to precede the diagnosis of Parkinson’s disease. Objective To evaluate the incidence of muscle relaxant use in community-dwelling persons with and without Parkinson’s disease from 4 years before to 4 years after the diagnosis of Pa...

The use of psychotropic drugs (antipsychotics, benzodiazepines and benzodiazepine-related drugs, and antidepressants) is common, with a prevalence estimates range of 19–29% among community dwelling older adults. These drugs are often prescribed for off-label use, including neuropsychiatric symptoms. The older adult population also has high rates of...

Background Asthma and chronic obstructive pulmonary disease (COPD) are common comorbidities in persons with Alzheimer’s disease (AD). However, pharmacotherapy of these diseases may have opposite mechanisms of action; anticholinergics in asthma/COPD and acetylcholinesterase inhibitors (AChEI) in AD. Objective To investigate whether existing asthma/...

Aims We studied the purchases of medical therapy recommended for coronary artery disease patients before and after elective revascularisation (percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG)). Methods All patients who underwent an elective PCI (N = 1557) or CABG (N = 1768) at the Heart Center, Kuopio University hospital...

Aims To evaluate the incidence of described purchases of vitamin B12 in community-dwelling persons with and without Alzheimer’s disease (AD) from 9 years before to 5 years after the diagnosis. Subject and methods We utilized register-based data from the Finnish nationwide MEDALZ (Medication use and Alzheimer’s disease) cohort, including all AD cas...

Background: Patient satisfaction and health-related quality of life are nowadays considered as the most important outcomes of pelvic organ prolapse treatment and large prospective clinical studies reporting the patient-reported surgical outcomes are needed. Objective: To evaluate the effect of female pelvic organ prolapse surgery on health-relat...

Background Hip fractures are common among persons with Alzheimer’s disease (AD), but problems in pain assessment may lead to insufficient analgesia after hospitalization. Objective We investigated the prevalence of opioid use in the 6 months after discharge from hospital care due to hip fracture among community-dwellers with and without AD. Setti...

Background/objectives: Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer's disease (AD). Design: Nationwide register-based cohort stu...

Background: Both cardiovascular diseases and Alzheimer's disease (AD) are common in aging populations. We investigated the prevalence of cardiovascular (CV) drug use in relation to AD diagnosis, and compared the prevalence to a matched cohort without AD. Methods: Point prevalence of CV drugs was counted every six months, from five years before t...

Objectives: To compare the accumulation of hospital days, a proposed proxy for overall drug safety, between antipsychotic initiators and noninitiators with Alzheimer's disease (AD). Design: Nationwide exposure-matched cohort. Setting and participants: Finnish community dwellers who received an incident AD diagnosis in 2005‒2011 (n = 70,718). F...

Objectives: We studied the determinants of high healthcare costs (highest decile of hospital care and medication costs) and cost trajectories among all community-dwellers with clinically verified Alzheimer’s disease (AD), diagnosed during 2005–2011 in Finland (N = 70,531). Methods: The analyses were done separately for hospital care costs, medicati...

Objectives: To compare the accumulation of hospital days between initiators and noninitiators of antiepileptic drugs (AEDs) among persons with Alzheimer's disease (AD). Design: Exposure-matched cohort study. Setting and participants: Persons newly diagnosed with AD in 2005-2011 (n = 70,718) and initiating AED use identified from Finnish health...

Background: Defecation symptoms are common among women with pelvic organ prolapse. However, the relationship between posterior vaginal wall prolapse and defecation symptoms remains debatable. Even though there is a plausible biomechanical rationale for posterior wall prolapse to cause obstructed defecation, previous studies have drawn contradictor...

Cell therapy is an attractive strategy for enhancing post‐stroke recovery. Different cell types and several treatment strategies have been successfully applied in animal models, but efficacy in stroke patients has not yet been confirmed. We hypothesize that the significant design differences between preclinical and clinical trials may account for t...

We investigated the association between thiazide use and the risk of low-energy fractures among community dwellers with Alzheimer’s disease. Longer use was associated with a decreased risk of low-energy fractures. This study extends the previous knowledge of reduced fracture risk of thiazides to persons with Alzheimer’s disease. Introduction To in...

Purpose To study how long antidepressants initiated after diagnoses of Alzheimer’s disease (AD) were used and factors associated with discontinuation of use among persons with Alzheimer’s disease (AD). In addition, differences in duration of use between the antidepressants groups were compared. Methods Register-based Medication use and Alzheimer’s...

Background Antiepileptic drugs (AEDs) have sedative properties which may lead to an increased risk of pneumonia. Objectives To investigate whether incident AED use is associated with an increased risk of pneumonia among community-dwelling persons with Alzheimer’s disease (AD). In addition, we determined the risk according to duration of AED use an...

Background Injuries caused by falling are a major health concern among older population. For older people, falls are the leading cause of head injuries; especially, persons with cognitive disorders have an increased risk of falling. Objective To compare the incidence of head injury and traumatic brain injury (TBI) among persons with Alzheimer’s di...

Introduction: The management of pelvic organ prolapse (POP) varies significantly between countries. The objective of this study was to describe the methods used for POP surgery in Finland and to identify the factors that affect clinicians' choice to use either a native tissue repair (NTR) or a mesh repair method. Material and methods: This prosp...

Objective To determine the prevalence of concomitant use of benzodiazepines and opioids among community‐dwelling older people with or without Alzheimer's disease (AD). An additional aim was to describe the factors associated with prolonged concomitant use, and the most commonly used combinations of these drugs. Methods This study utilized data fro...

Background It is unknown whether cognitive status or diagnosed cognitive decline affects estrogen use. Objectives We assessed how common systemic estrogen use was among community-dwellers with Alzheimer’s disease (AD) and a matched comparison cohort without AD. Methods This study included an exposure-matched cohort of all Finnish community-dwelli...

The objective of this study was to investigate whether incident opioid use is associated with an increased risk of hip fractures among community-dwelling persons with Alzheimer's disease (AD), and to assess the association in terms of duration of use and opioid strength.Among community-dwelling persons with AD diagnosed in 2010-2011 (N=23,100), a m...