Sirpa Hartikainen

• University of Eastern Finland

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 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....

Background Frailty and protein-energy malnutrition (PEM) are common in older home care clients. In this study, we evaluate the effect of individually tailored dietary counseling on frailty status among home care clients with PEM or its risk aged 75 or older with a follow-up of six months. Methods This intervention study is part of the non-randomiz...

Background Hearing impairment is a known risk factor for Alzheimer’s disease (AD), although less is known about vision impairment or dual sensory impairment (DSI) as risk factors for AD. We studied the association between diagnosed hearing impairment, visual impairment, or DSI, and the risk of AD. Method The Medication use and Alzheimer’s disease...

We studied the incidence and duration of cumulative bisphosphonate use among older Finnish women and men with or without Alzheimer’s disease (AD). The MEDALZ-2005 cohort is a nationwide sample of all persons with clinically diagnosed AD on 31 December 2005 and their age-, gender-, and region of residence-matched control persons without AD. Informat...

The Finnish web-based Meds75+ database supports rational, safe and appropriate prescribing to older adults in primary care. This article describes the content and updating process of Meds75+ and demonstrates its applicability in everyday clinical practice. Meds75+ contains a classification (A–D) and recommendation texts for 450–500 drug substances...

Objectives To produce a consensus list of the top 10 signs and symptoms suggestive of adverse drug events (ADEs) for monitoring in residents of long-term care facilities (LTCFs) who use antipsychotics, benzodiazepines, or antidepressants. Design A 3-round Delphi study. Setting and Participants Geriatricians, psychiatrists, pharmacologists, genera...

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...

Background An increasing number of care‐dependent older people living at home need external support to receive regular dental care. Objectives To investigate the use of oral health care services among old home care clients who participated in an intervention study focusing on oral self‐care and nutrition. Materials and Methods This study employed...

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...

Purpose Because of the common and increasing use of antipsychotics in older adults, we aim to summarize the current knowledge on the causes of antipsychotic-related risk of falls in older adults. We also aim to provide information on the use of antipsychotics in dementia, delirium and insomnia, their adverse effects and an overview of the pharmacok...

Falls prevention and management in older adults is a critical global challenge. One of the key risk factors for falls is the use of certain medications. Therefore, to prevent medication-related falls, the following is recommended in the recent World Guidelines for Falls Prevention and Management: (1) assess for fall history and the risk of falls be...

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...

Objectives: The use of antipsychotics in persons with Parkinson's disease (PD) is common, although their use may aggravate the symptoms of PD. Clozapine and quetiapine are the only antipsychotics recommended in PD treatment guidelines. Information on factors associated with initiation of antipsychotics is needed. We investigated whether recent hos...

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: 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....

Objective: The aim was to study the association between high anticholinergic burden and hyposalivation and xerostomia among older people. Background: Anticholinergic drugs have been shown to cause xerostomia and hyposalivation. Yet there are few studies on the association between anticholinergic burden and hyposalivation and xerostomia in the el...

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’...

Purpose: To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. Methods: An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing appro...

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...

Background our aim was to assess the effectiveness of medication review and deprescribing interventions as a single intervention in falls prevention. Methods Design systematic review and meta-analysis. Data sources Medline, Embase, Cochrane CENTRAL, PsycINFO until 28 March 2022. Eligibility criteria randomised controlled trials of older partici...

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...

Aims: The purpose was to examine the prevalence and determinants of self-reported eating problems in old home care clients, screened separately by a clinical nutritionist and a dental hygienist. Methods and results: The data came from the Nutrition, Oral Health and Medication (NutOrMed) study, the participants of which were ≥75-year-old home car...

Psykoosilääkkeet lievittävät skitsofrenian psykoosioireita ja vähentävät relapsiriskiä. Psykoosilääkityksen pitkäaikaiskäytön hyöty-haittasuhde skitsofrenian hoidossa on osin tuntematon. Etenkin suurten psykoosilääkeannosten pitkäaikaiskäyttö voi altistaa metabolisille, neurologisille, kognitiivisille ja psykologisille haitoille. Psykoosilääkehoido...

Abstract Background With ageing, food intake may decrease and lead to an insufficient nutrient intake causing protein-energy malnutrition (PEM) which is associated with adverse health effects and increased mortality. The aim of this study was to investigate the effects of individually tailored dietary counseling focused on protein intake among home...

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...

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...

Pain treatment is important in older adults but may result in adverse events such as falls. Opioids are effective for nociceptive pain but the evidence for neuropathic pain is weak. Nevertheless, both pain and opioids may increase the risk of falls. This narrative literature review aims to summarize the existing knowledge on the opioid-related fall...

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...

PurposeFall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitato...

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...

Aim The POINT project aims to provide evidence to optimise chronic pain management, prevent adverse consequences of opioids, and improve chronic pain patients’ pain relief, functional capacity, and quality of life. We describe the outline of the project and its work packages. More specifically, we describe a cohort of persons with chronic pain and...

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...

Introduction One of the known risk factors for fall incidents is the use of specific medications, fall-risk-increasing drugs (FRIDs). However, to date, there is uncertainty related to the effectiveness of deprescribing as a single intervention in falls prevention. Thus, a comprehensive update of the literature focusing on all settings in which olde...

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...

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...

Purpose To examine which client characteristics and other factors, including possible adverse effects, identified in the Resident Assessment Instrument—Home Care (RAI-HC) are associated with daily opioid use among aged home care clients. Methods The study sample comprised 2584 home care clients aged ≥ 65 years, of which 282 persons used opioids da...

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...

Background The increasing trend of opioid use for non-malignant pain among older people has raised concerns about whether opioids are used for appropriate indications. On the other hand, pain in patients with dementia may be undertreated.AimsTo examine the prevalence of and indications for daily opioid use among home care clients, and to determine...

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...

Aim: To examine how physical ability and comorbidity associate with oral health. Methods and results: The study population comprised 161 individuals belonging to the Oral Health GeMS study. Outcome variables were the number of teeth with dental caries and deepened periodontal pockets and self-perceived oral health (pain/discomfort in mouth). Physi...

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-...

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...

Frailty is a geriatric condition associated with increased vulnerability to adverse drug events and medication-related harm. Existing clinical practice guidelines rarely provide medication management recommendations specific to frail older people. This report presents international consensus principles, generated by the Optimizing Geriatric Pharmac...

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...

Objective To study the feasibility of evaluating feature importance with Shapley Values and ensemble methods in the context of pharmacoepidemiology and medication safety. Methods We detected medications associated with Alzheimer's disease (AD) by examining the additive feature attribution with combined approach of Gradient Boosting and Shapley Val...

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...

Purpose: To describe oral health and hygiene in old home care clients and investigate how functional ability was associated with them. Materials and methods: This study employed part of the baseline data of a multidisciplinary intervention study of 269 home care clients aged ≥75 years, living in Eastern and Central Finland. Structured interviews...

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/...

Background Reductions in muscle strength and poor balance may lead to mobility limitations in older age. Aims We assessed the effects of long-term once-weekly strength and balance training (SBT) on muscle strength and physical functioning in a community-based sample of older adults. Methods 182 individuals [130 women and 52 men, mean age 80 (SD ±...

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: Increasing numbers of frail elderly people living at home but dependent on supportive care will face complex oral health challenges. Objectives: To investigate the associations of frailty status with oral cleaning habits and oral hygiene taking into account the effects of preventive oral health intervention among home care clients ag...

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 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...

Objectivest: Our aim was to study whether different cardiovascular drugs associate with an inflammatory periodontal condition among community-dwelling older people. Methods: For the current study, we included 158 community-dwelling, dentate, non-smoking older people from the Geriatric Multidisciplinary Strategy-study. The participants underwent a c...

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...

Objective To examine the effectiveness of tailored xerostomia and nutritional 6‐month interventions on xerostomia among home care clients aged 75 years or over who were malnourished or at risk of malnutrition. Background A subjective feeling of dry mouth (xerostomia) is common among older adults and affects their quality of life, nutrition and ora...

Diabetes and cancer are common diseases both with enormous impact on health burden globally. The increased risk of several types of cancer among people with type 2 diabetes mellitus has been indicated repeatedly. This study aimed at exploring and describing the association between type 2 diabetes and cancer incidence. A cohort of 428,326 people wit...

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...