Marcel G M Olde Rikkert

Radboud University | RU · Department of Geriatrics

The mechanism underlying the possible causal association between long-term sleep disruption and Alzheimer’s disease remains unclear Musiek et al. 2015. A hypothesised pathway through increased brain amyloid load was not confirmed in previous work in our cohort of maritime pilots with long-term work-related sleep disruption Thomas et al. Alzheimer’s...

Background Digital mental health interventions could sustainably and scalably prevent and reduce loneliness in older adults. We designed an app containing 29 text-based games and a questionnaire-administering chatbot to stimulate intergenerational contact. Objective This study aims to evaluate the feasibility of a social gaming app in reducing lon...

It is becoming highly accepted that aging, age-related diseases, and geriatric healthcare can move forward if reductionist research is complemented by integrative research uniting knowledge on specific aging mechanisms, multiple biomedical, social, psychological, lifestyle, and environmental factors and their interactions. In this special issue, we...

Introduction Systemic inflammation and endothelial dysfunction are potentially modifiable factors implicated in Alzheimer’s disease (AD), which offer potential therapeutic targets to slow disease progression. Methods We investigated the relationship between baseline circulating levels of inflammatory (TNF-α, IL-1ß) and endothelial cell markers (VC...

Rationale Healthcare systems remain disease oriented despite growing sustainability concerns caused by inadequate management of patients with multimorbidity. Comprehensive care programmes (CCPs) can play an important role in streamlining care delivery, but large differences in setup and results hinder firm conclusions on their effectiveness. Many e...

The geroscience hypothesis – that by intervening on the basic biological mechanisms of aging we could simultaneously reduce the risks of many chronic diseases and dramatically improve healthspan – has garnered substantial traction and enthusiasm in the past decade. And indeed, if successful, there is enormous potential to reduce the burden of disea...

Background Elder abuse is a worldwide problem with serious consequences for individuals and society. To effectively deal with elder abuse, a timely identification of signals as well as a systematic approach towards (suspected) elder abuse is necessary. This study aimed to develop and test the acceptability and appropriateness of ERASE (EldeR AbuSE)...

Policymaking for complex challenges such as pandemics necessitates the consideration of intricate implications across multiple domains and scales. Computational models can support policymaking, but a single model is often insufficient for such multidomain and scale challenges. Multi-models comprising several interacting computational models at diff...

A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the “LIfestyle for BRAin health” (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for...

Background Digital social interventions for older adults have become increasingly important due to their flexibility and potential to reduce loneliness. Digital games provide easy and fun interaction possibilities but need more exploration. Methods Using a mixed-methods design, we piloted a chat-based mobile application (PhotoSnake) designed to el...

BACKGROUND Digital mental health interventions could sustainably and scalably prevent and reduce loneliness in older adults. We designed an app containing 29 text-based games and a questionnaire-administering chatbot to stimulate intergenerational contact. OBJECTIVE This study aims to evaluate the feasibility of a social gaming app in reducing lon...

Numerous clinical trials based on a single-cause paradigm have not resulted in efficacious treatments for Alzheimer's disease (AD). Recently, prevention trials that simultaneously intervened on multiple risk factors have shown mixed results, suggesting that careful design is necessary. Moreover, intensive pilot precision medicine (PM) trial results...

Objectives: The aim of the current study was to investigate the health-related quality of life (HRQol) of the family caregiver in MCI, explore possible determinants and study possible differences with mild dementia. Methods: This secondary data analysis included 145 persons with MCI and 154 persons with dementia and their family caregivers from...

Background: Count scores, disease clustering, and pairwise associations between diseases remain ubiquitous in multimorbidity research despite two major shortcomings: they yield no insight into plausible mechanisms underlying multimorbidity, and they ignore higher-order interactions such as effect modification. Objectives: We argue that two componen...

Introduction: Care integration is a promising strategy to achieve sustainable health-care systems. With DementiaNet, a 2-year program, we facilitated collaboration between primary health-care professionals. We studied changes in primary dementia care integration during and after DementiaNet participation. Methods: A longitudinal follow-up study...

Introduction: In Alzheimer's disease (AD), cognitive decline is driven by various interlinking causal factors. Systems thinking could help elucidate this multicausality and identify opportune intervention targets. Methods: We developed a system dynamics model (SDM) of sporadic AD with 33 factors and 148 causal links calibrated with empirical dat...

Introduction: Care integration in primary elderly care is suboptimal. Validated instruments are needed to enable the implementation of integrated primary care. We aimed to assess construct validity of the Rainbow Model of Integrated Care measurement tool (RMIC-MT) for healthcare professionals working in an integrated primary elderly care setting i...

The concept of resilience, i.e., the capacity of a system to bounce back after a stressor, is gaining interest across many fields of science, policy and practice. To date, resilience research in people with cognitive decline has predominantly addressed the early stages of decline. We propose that: (1) resilience is a relevant concept in all stages...

Objectives: Informal caregiving is becoming increasingly important in dementia care, but causes a considerable burden on caregivers which impacts their wellbeing. We aimed to develop and pilot test a digital monitoring tool (REsilience Monitor for INformal caregivers in Dementia [REMIND]) for wellbeing and resilience of informal caregivers to prov...

Background The aim of this study was to assess the effect of a multimodal prehabilitation program on perioperative outcomes in colorectal cancer patients with a higher postoperative complication risk, using an emulated target trial (ETT) design. Patients and Methods An ETT design including overlap weighting based on propensity score was performed....

Objective To explore how a clinical leadership training programme contributes to successful implementation of integrated dementia care in local primary care networks. Methods and analysis A qualitative design was used in local primary care networks in the Netherlands. Twenty-six primary care professionals, nurses (n=22), general practitioners (n=2...

Purpose Prehabilitation is increasingly offered to patients with colorectal cancer (CRC) undergoing surgery as it could prevent complications and facilitate recovery. However, implementation of such a complex multidisciplinary intervention is challenging. This study aims to explore perspectives of professionals involved in prehabilitation to gain u...

Age-related difficulties and quarantine restrictions impede the possibilities to maintain contact with one's social network. Maintaining these contacts may be supported by digital games. To develop effective and feasible digital tools to foster social interaction, we aimed to explore what older adults find important in social contact and what barri...

The anti-inflammatory agents dexamethasone (corticosteroid), and tocilizumab and sarilumab (IL6-inhibitors) are effective in the treatment of late COVID-19. Other anti-inflammatory agents, like anakinra (IL1-inhibitor), baricitinib and tofacitinib (JAK-inhibitors) and lenzilumab (GM-CSF-inhibitor) have also shown positive results in late COVID-19....

Background: Recent global meta-analyses show that 40% of dementia cases can be attributed to twelve modifiable risk factors. Objective: To investigate how health promotion strategies may differ in specific populations, this study estimated population attributable fractions (PAFs) of these risk factors for dementia in cognitively normal (CN) indi...

Having made substantial progress understanding molecules, cells, genes and pathways, aging biology research is now moving toward integration of these parts, attempting to understand how their joint dynamics may contribute to aging. Such a shift of perspective requires the adoption of a formal complex systems framework, a transition being facilitate...

Sedentary behaviour may increase the risk of dementia. Studying physiological effects of sedentary behaviour on cerebral health may provide new insights into the nature of this association. Accordingly, we reviewed if and how acute and habitual sedentary behaviour relate to brain health factors in middle-aged and older adults (≥45 years). Four data...

Het is een algemeen bekend demografisch gegeven dat in de komende decennia het aantal oudere mensen mondiaal op een indrukwekkende wijze zal groeien. Onderzoek geeft aan dat-hoewel ouder worden geen ziekte is-deze ontwikkeling gepaard zal gaan met een stijgende zorgvraag waarbij de grijze druk (verhouding 65-plussers ten opzichte van de groep 20-65...

Objectives: To explain the heterogeneity in dementia disease trajectory, we studied the influence of changing patient characteristics on disease course by comparing the association of dementia progression with baseline comorbidity and frailty, and with time-varying comorbidity and frailty. Methods: We used individual growth models to study basel...

Clinical reasoning and research in modern geriatrics often prioritises the disease concept. This is understandable as it has brought impressive advances in medicine (e.g. antibiotics, vaccines, successful cancer treatment and many effective surgeries). However, so far the disease framework has not succeeded in getting us to root causes of many age-...

Background: The prevalence of geriatric syndromes, frailty and multimorbidity increases in older age, with a negative impact on health outcomes. Little is known on these problems in older adults with psychiatric disorders. Aim: To evaluate the prevalence of geriatric syndromes and multimorbidity in older adults with psychiatric disorders and the...

On January 1st 2022, the Dutch Journal of Medicine (NTvG) stopped publishing advertisements for drugs, medical devices and continuous medical education sponsored by pharmaceutical industry. In this article we describe how the thinking about pharma-related advertising by the readers, the editorial board and the NTvG-Society, the independent non-comm...

Background Preoperative colorectal cancer care pathways for older patients show considerable practice variation between Dutch hospitals due to differences in interpretation and implementation of guideline-based recommendations. This study aims to report this practice variation in preoperative care between Dutch hospitals in terms of technical effic...

Introduction: The evidence for characteristics of persons with subjective cognitive decline (SCD) associated with amyloid positivity is limited. Methods: In 1640 persons with SCD from 20 Amyloid Biomarker Study cohort, we investigated the associations of SCD-specific characteristics (informant confirmation, domain-specific complaints, concerns,...

Introduction: Currently, care integration for community-dwelling persons with dementia is poor and knowledge on how to effectively facilitate development of integrated dementia care is lacking. The DementiaNet program aims to overcome this with a focus on interprofessional collaboration. The objective of this study is to investigate how care integ...

Background A landmark study by Filippini et al., where authors reported an increased default mode network (DMN) co‐activation during rest in young APOE ε4‐carriers, failed to replicate [1,2]. The rise of genome‐wide association studies (GWAS) in Alzheimer’s disease (AD) has shown there is a significant polygenic contribution of common genetic varia...

Background Emergency physicians (EPs) provide care to older adults with complex health problems. Treating these patients is challenging for many EPs, which might originate from modest geriatric education. Objective Our aim was to assess EPs’ self-perceived needs regarding geriatric emergency medicine (GEM) education, factors determining these need...

The coronacrisis was a serious threat for health care and society. By its complexity and deep uncertainty the pandemic showed that patients, physicians and health care need more resilience and flexibility to manage similar future stressors. Moreover, the pandemic uncovered growing disparities in health among citizens, the close links between health...

The negative OPERAM study results, which are in line with recent trials and reviews, warn against expecting positive patient related outcomes from single standardized medication reviews in all patients with polypharmacy admitted to hospital. The big underlying problem is the enormous heterogeneity of patients with polypharmacy. However, it remains...

Introduction Researchers, policy-makers and healthcare professionals often stress the importance of an early dementia diagnosis. Empirical evidence, however, is scarce leading to a lack of consensus on the necessity of diagnosing dementia early. We emphasise the need for a ‘timely’ diagnosis, that is, one that occurs at the right moment for a perso...

Structural and functional alterations of the brain in persons genetically at-risk for Alzheimer's disease (AD) are crucial in unravelling AD development. Filippini et al. found that the default mode network (DMN) is already affected in young APOE ε4-carriers, with increased co-activation of the DMN during rest and increased hippocampal task activat...

Since coronavirus disease 2019 (COVID‐19) entered the Netherlands, the older adults (aged 70 or above) were recommended to isolate themselves, resulting in less social contact and possibly increased loneliness. The aim of this qualitative study was to explore independently living older adults’ perceptions of social and emotional well‐being during t...

The concept of physical resilience may help geriatric medicine objectively assess patients' ability to ‘bounce back’ from future health challenges. Indicators putatively forecasting resilience have been developed under two paradigms with different perspectives: Critical Slowing Down and Loss of Complexity. This study explored whether these indicato...

The effects of Covid‐19 have been well documented across the world with an appreciation that older people and in particular those with dementia have been disproportionately and negatively affected by the pandemic. This is both in terms of their health outcomes (mortality and morbidity), care decisions made by health systems and the longer‐term effe...

Exercise intervention studies in mild cognitive impairment (MCI), a prodromal stage of Alzheimer's disease (AD), have demonstrated inconsistent yet promising results. Addressing the limitations of previous studies, this trial investigated the effects of a 12-month structured exercise program on the progression of MCI. The NeuroExercise study is a m...

Study objectives While poor sleep quality has been related to increased risk of Alzheimer’s disease, long-time shift workers (maritime pilots) did not manifest evidence of early Alzheimer’s disease in a recent study. We explored two hypotheses of possible compensatory mechanisms for sleep disruption: Increased efficiency in generating deep sleep du...

Background Community nurses and general practitioners evaluate their patient-related communication to be poor. However, their actual communication has hardly been investigated and specific strategies for improvement are unclear. Objectives To explore actual community nurse-general practitioner communication in primary care and gain insights into c...

Background The concept of physical resilience may help geriatric medicine objectively assess patients’ ability to ‘bounce back’ from future health challenges. Indicators hypothesized to forecast resilience after a stressor have been developed under two paradigms with different perspectives: Critical Slowing Down (CSD) and Loss of Complexity (LoC)....

Background Blood pressure (BP) lowering is a promising strategy to prevent dementia, including AD (SPRINT‐MIND). BP lowering should therefore be explored as a secondary prevention strategy in patients with early stages of AD (MCI due to AD and preclinical AD). However, if cerebral autoregulation is impaired in (older) patients with AD, BP lowering...

Background The number of people with dementia living at home is likely to increase, resulting in a growing societal dependency on informal care. Informal caregiving causes a considerable burden on caregivers’ wellbeing, both physical and mental. A decrease in caregivers’ wellbeing is often a direct reason for crisis admission of the person with dem...

Background Filippini et al. reported an increased default mode network (DMN) co‐activation during rest in young APOE ε4‐carriers [1]. This work has been of substantial importance, often used to illustrate the trajectory of DMN alterations in APOE ε4‐carriers from young adults and normal aging to mild cognitive impairment and AD. However, this study...

Background: Recent evidence indicates that disrupted sleep could contribute to the development of Alzheimer's disease by influencing the production and/or clearance of the amyloid-β protein. We set up a case-control study to investigate the association between long-term work-induced sleep disruption, cognitive function, and brain amyloid-β burden....

Alzheimer’s disease (AD) is a complex, multicausal disorder involving several spatiotemporal scales and scientific domains. While many studies focus on specific parts of this system, the complexity of AD is rarely studied as a whole. In this work, we apply systems thinking to map out known causal mechanisms and risk factors ranging from intracellul...

Complexity science methods offer new opportunities for prognosis and treatment in healthcare and clinical psychology because of the increasing need for integration of the detailed knowledge of physiological and psychological subsystems and the increasing prevalence of multiple disease conditions in our aging societies. This chapter explains how the...

Background: Sedentary behaviour might be a potential risk factor for cognitive decline. However, the short-term effects of sedentary behaviour on (cerebro) vascular and cognitive performance in older people are unknown. Methods: We used a cross-over design with 22 older adults (78 years, 9 females) to assess the short-term hemodynamic and cognit...

Anatomical magnetic resonance imaging (MRI), diffusion MRI and resting state functional MRI (rs-fMRI) have been used for Alzheimer’s disease (AD) classification. These scans are typically used to build models for discriminating AD patients from control subjects, but it is not clear if these models can also discriminate AD in diverse clinical popula...

Background Implementation of integrated primary care is considered an important strategy to overcome fragmentation and improve quality of dementia care. However, current quality indicator (QI) sets, to assess and improve quality of care, do not address the interprofessional context. The aim of this research was to construct a feasible and content-w...

Background Impaired recovery of blood pressure (BP) after standing has been shown to be related to cognitive function and mortality in people without dementia, but its role in people with Alzheimer’s disease (AD) is unknown. The aim of this study was to investigate the association of the orthostatic BP response with cognitive decline and mortality...

Background: Recent evidence indicates that disrupted sleep could contribute to the development of Alzheimer’s disease by influencing the production and/or clearance of the amyloid-β protein. We set up a case-control study to investigated the association between long-term work-induced sleep disruption, cognitive function, and brain amyloid-β accumul...

Background: Recent evidence indicates that disrupted sleep could contribute to the development of Alzheimer’s disease by influencing the production and/or clearance of the amyloid-β protein. We set up a case-control study to investigate the association between long-term work-induced sleep disruption, cognitive function, and brain amyloid-β burden....

The aim of this study was to investigate whether the effect of physical activity on cognitive function in persons with dementia is moderated by patient characteristics as Apolipoprotein E and dementia type. We included 101 individuals with dementia and calculated the reliable change index to determine the change in global cognition, executive funct...

Background Besides physical activity as a target for dementia prevention, sedentary behaviour is hypothesized to be a potential target in its own right. The rising number of persons with dementia and lack of any effective treatment highlight the urgency to better understand these modifiable risk factors. Therefore, we aimed to investigate whether h...

Objectives: Older adults with psychiatric disorders have a substantially lower life expectancy than age matched controls. Knowledge of risk factors may lead to targeting treatment and interventions to reduce this gap in life expectancy. In this study we investigated whether frailty independently predicts mortality in older patients following an ac...

BACKGROUND Physical activity is linked to many positive health outcomes, stimulating the development of exercise programs. However, many falls occur whilst walking and so promoting activity might paradoxically increase fall rates, causing injuries and worse quality of life. The relationship between activity exposure and fall rates remains unclear....

Objective: To develop survival prediction tables to inform physicians and patients about survival probabilities after the diagnosis of dementia and to determine whether survival after dementia diagnosis can be predicted with good accuracy. Methods: We conducted a nationwide registry-linkage study including 829 health centers, i.e., all memory clin...

Objectives: Acute illnesses and subsequent hospital admissions present large health stressors to older adults, after which their recovery is variable. The concept of physical resilience offers opportunities to develop dynamical tools to predict an individual's recovery potential. This study aimed to investigate if dynamical resilience indicators b...

Objective To identify determinants within 3 different domains (ie, somatic comorbidities, cognitive functioning, and neuropsychiatric symptoms [NPS]) of health-related quality of life (HRQoL) over time in memory clinic patients without dementia. Methods This longitudinal multicenter cohort study with a 3-year observation period recruited 315 indiv...

The current meta-analysis first aimed to quantify the overall effect of physical exercise training on the quality of life (QoL) in healthy older adults. Second, the effects on the social, physical, and psychological QoL were assessed. In total, 16 randomized controlled trials were included. The primary analysis showed a medium effect of physical ex...

Societal dependency on informal care for people with dementia will grow. Informal caregiving causes a considerable burden on caregivers, often a direct reason for crisis admission of the person with dementia. Close monitoring the wellbeing of caregivers and early intervening may prevent crisis admissions. Therefore, our aim is to develop a user-fri...

Objective: The aim of the present study was to characterize the clinical pathways that people with dementia (PwD) in different countries follow to reach specialized dementia care. Methods: We recruited 548 consecutive clinical attendees with a standardized diagnosis of dementia, in 19 specialized public centers for dementia care in 15 countries....