Miia Kivipelto's research while affiliated with Imperial College London and other places

Publications (575)

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Introduction: Frailty, a measure of biological aging, has been linked to worse COVID-19 outcomes. However, as the mortality differs across the COVID-19 waves, it is less clear whether a medical record-based electronic frailty index (eFI) that we have previously developed for older adults could be used for risk stratification in hospitalized COVID-...
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Objectives To evaluate whether SARS-CoV-2 infection in residents of long-term care (LTC) facilities is associated with higher mortality after the acute phase of infection, and to estimate survival in uninfected residents. Design Extended follow-up of a previous, propensity score-matched, retrospective cohort study based on the Swedish Senior Alert...
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This study aimed to quantify the relationships between the American Heart Association (AHA) Cardiovascular Health (CVH) metrics, namely AHA Life’s Simple 7, and cognitive outcomes. We searched PubMed and Embase (January 1, 2010—August 24, 2022) and finally included 14 longitudinal studies (311654 participants with 8006 incident dementia cases). Ran...
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Genome-wide association studies (GWASs) have identified genetic loci associated with the risk of Alzheimer’s disease (AD), but the molecular mechanisms by which they confer risk are largely unknown. We conducted a metabolome-wide association study (MWAS) of AD-associated loci from GWASs using untargeted metabolic profiling (metabolomics) by ultrape...
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Objective This study aims to investigate the relationship between diurnal cortisol patterns, cognition and Alzheimer’s disease (AD) biomarkers in memory clinic patients. Method Memory clinic patients were recruited from Karolinska University Hospital in Sweden (n=155). Diurnal cortisol patterns were assessed using five measures: awakening levels,...
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Background and Objectives ATN (β-Amyloid, Tau, Neurodegeneration) system categorizes individuals based on their core Alzheimer’s disease (AD) biomarkers. An important potential future use for ATN is therapeutic decision-making in clinical practice once disease-modifying treatments, e.g., anti-amyloid, become widely available. In this cross-sectiona...
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Introduction: Identifying strategies to prevent or delay cognitive decline among the rising numbers of elderly is acknowledged as a global public health priority. Research suggests that an active lifestyle in terms of participation in activities has the potential to reduce the risk of later-life cognitive decline. The concept of “active everyday...
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Background and aims Psychosocial factors may affect adherence to lifestyle interventions and lifestyle changes. The role of psychosocial factors in dementia prevention needs more research. We aimed at clarify the issue in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). Methods The population includ...
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Background: The association between health-related quality of life (HRQoL) and care costs in people at risk for cognitive decline is not well understood. Studying this association could reveal the potential benefits of increasing HRQoL and reducing care costs by improving cognition. Objective: In this exploratory data analysis we investigated th...
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Introduction: The aim of this study was to estimate the potential cost-effectiveness of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) program. Methods: A life-time Markov model with societal perspective, simulating a cohort of people at risk of dementia reflecting usual care and the FINGER progr...
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We aimed to evaluate the feasibility of using real-world register data for identifying persons with mild Alzheimer’s disease (AD) and to describe their cognitive performance at the time of diagnosis. Patients diagnosed with AD during 2010–2013 (aged 60–81 years) were identified from the Finnish national health registers and enlarged with a smaller...
Preprint
Alzheimer’s disease is a multifactorial disorder with a heterogeneous patient population. Comorbidities such as hypertension, hypercholesterolemia and diabetes are known contributors to the disease progression. Indeed, therapies targeting these disorders have been shown efficient in dementia prevention. However, their mechanistic contribution to Al...
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Purpose of review: The potential for dementia prevention is deemed substantial if modifiable risk factors were addressed. First large-scale multidomain lifestyle interventions aiming at reducing risk of cognitive decline and dementia have yielded mixed but promising evidence. Recent findings: Despite the impact of the COVID-19 pandemic on trials...
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Mapping the preclinical dementia phase is important for early detection and evaluation of interventions. We assessed the trajectories of cognitive decline in preclinical dementia over 12 years and investigated whether being a fast decliner across 6 years is associated with increased risk of dementia the following 6 years. Rates of cognitive decline...
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Background The COVID-19 pandemic has major influence on lifestyle and mental health, which might affect brain-health and increase the risk of cognitive decline, particularly in older adults. We aimed to describe changes in modifiable risk factors related to brain-health in older adults after one year of COVID-19 restrictions. Methods An online sur...
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Acute and post-acute neurological symptoms, signs and diagnoses have been documented in an increasing number of patients infected by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19). In this review, we aimed to summarize the current literature addressing neurological events following...
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Introduction: Multidomain intervention approaches have emerged as a potential strategy to reduce dementia risk. We sought to describe the baseline assessment approaches, health conditions, and risk profiles for brain aging of participants in the randomized controlled Multimodal INterventions to delay Dementia and disability in rural China (MIND-Ch...
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Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 ris...
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Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 ris...
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Background: This is the study plan of the Karolinska NeuroCOVID study, a study of neurocognitive impairment after severe COVID-19, relating post-intensive care unit (ICU) cognitive and neurological deficits to biofluid markers and MRI. The COVID-19 pandemic has posed enormous health challenges to individuals and healthcare systems worldwide. An em...
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Background Frailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its association with adverse outcom...
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Introduction: We conducted a systematic review and meta-analysis of the cognitive effects of coronavirus disease 2019 (COVID-19) in adults with no prior history of cognitive impairment. Methods: Searches in Medline/Web of Science/Embase from January 1, 2020, to December 13, 2021, were performed following Preferred Reporting Items for Systematic...
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Purpose We compared the prevalence of COVID-19 and related mortality in nursing homes (NHs) in 14 countries until October 2021. We explored the relationship between COVID-19 mortality in NHs with the average size of NHs and with the COVID-19 deaths at a population level. Methods The total number of COVID-19 cases and COVID-19-related deaths in all...
Preprint
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Importance The case fatality rate of SARS-CoV-2 has been high among residents of long-term care (LTC) facilities. It is important to know if the excess mortality persists beyond the acute infection. Objective To evaluate whether SARS-CoV-2 is associated with higher mortality after the first month from documented infection. Design We extended the...
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Liikunnallisesti aktiivinen elämäntapa ylläpitää tehokkaasti ikääntyneiden terveyttä ja toimintakykyä. Liikunnan harrastamiseen vaikuttavat kuitenkin monet yksilölliset tekijät, jotka tulisi huomioida kannustettaessa ikääntyneitä henkilöitä liikkumaan. Tämän tutkimuksen tarkoituksena oli selvittää, minkälaiset liikkumisen kannustimet ovat yhteydess...
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Depression and cognition are associated, but the role of depressive symptoms in lifestyle interventions to prevent dementia needs further study. We investigated the intervention effect on depressive symptoms and their associations with cognition in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER; NCT0...
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Background Thioredoxin-80 (Trx80) is a cleavage product from the redox-active protein Thioredoxin-1 and has been previously described as a pro-inflammatory cytokine secreted by immune cells. Previous studies in our group reported that Trx80 levels are depleted in Alzheimer’s disease (AD) brains. However, no studies so far have investigated peripher...
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Introduction: The educational background and size of the elderly population are undergoing significant changes in Finland during the 2020s. A similar process is likely to occur also in several European countries. For cognitive screening of early Alzheimer's disease (AD), using outdated norms and cutoff scores may negatively affect clinical accurac...
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Introduction: Lifetime exposure to occupational complexity is linked to late-life cognition, and may affect benefits of preventive interventions. Methods: In the 2-year multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we investigated, through post hoc analyses (N = 1026), the association o...
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Introduction: Alzheimer’s disease (AD) is one of the world’s leading public health challenges. One-third of AD cases are attributable to modifiable vascular and lifestyle-related risk factors. The Multimodal Preventive Trial for Alzheimer’s Disease, MIND-ADMINI a 6-month multinational parallel-group randomized controlled trial (RCT), targeted perso...
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Aims: Joint prevention of cardiovascular disease (CVD) and dementia could reduce the burden of both conditions. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) demonstrated a beneficial effect on cognition (primary outcome) and we assessed the effect of this lifestyle intervention on incident CVD (p...
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With population ageing worldwide, dementia poses one of the greatest global challenges for health and social care in the 21st century. In 2019, around 55 million people were affected by dementia, with the majority living in low- and middle-income countries. Dementia leads to increased costs for governments, communities, families and individuals. De...
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There is robust evidence linking vascular health to brain health, cognition, and dementia. In this article, we present evidence from trials of vascular risk factor treatment on cognitive outcomes. We summarize findings from randomized controlled trials of antihypertensives, lipid-lowering medications, diabetes treatments (including antidiabetic dru...
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Alzheimer’s disease (AD) is the most common cause of dementia and there is currently no cure. Novel approaches to treat AD and curb the rapidly increasing worldwide prevalence and costs of dementia are needed. Physical inactivity is a significant modifiable risk factor for AD, estimated to contribute to 12.7% of AD cases worldwide. Exercise interve...
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Dementia prevention is a global health priority. In 2019, the World Health Organisation published its first evidence-based guidelines on dementia risk reduction. We are now at the stage where we need effective tools and resources to assess dementia risk and implement these guidelines into policy and practice. In this paper we review dementia risk s...
Preprint
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Importance: Previous reports have suggested reductions in mortality risk from COVID-19 throughout the first wave of the COVID-19 pandemic. Mortality changes later in the pandemic and pandemic effects on other types of geriatric hospitalizations are less studied. Objectives: To describe the changes in hospitalizations and 30-day mortality in Stockho...
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The COVID-19 pandemic and its related restrictions have affected the everyday life of older people. Advanced age is a significant predisposing factor for a more severe COVID-19 infection, increasing the risk for hospitalization and mortality. Even though restrictions have been, thus, well-grounded, they may also have had detrimental effects on the...
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Risk reduction and prevention of dementia in older adults is a growing research area. In the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER randomized controlled trial) a 2-year multidomain intervention -dietary counseling, exercise, cognitive training, vascular and metabolic risk monitoring- improved co...
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Background The aim of this study is to investigate whether combined cognitive and physical training provides additional benefits to fall prevention when compared with physical training alone in older adults. Methods This is a prespecified secondary analysis of a single-blind, randomized controlled trial involving community-dwelling men and women a...
Preprint
Background: The Clinical Frailty Scale (CFS) is a strong predictor for worse outcomes in geriatric COVID-19 patients, but it is less clear whether an electronic frailty index (eFI) constructed from routinely collected electronic health records (EHRs) provides similar predictive value. This study aimed to investigate the predictive ability of an eFI...
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The ANU‐ADRI is a validated risk index for Alzheimer’s disease comprised of lifestyle, medical and demographic factors, with higher scores indicating more risk. We investigated the association of the ANU‐ADRI score with cognition over the 2‐year FINGER multidomain prevention trial. The ANU‐ADRI score was calculated for the participants in the Finni...
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Background To explore the utility of the International Working Group (IWG)-1 criteria in recruitment for Alzheimer’s disease (AD) clinical trials, we applied the more recently proposed research diagnostic criteria to individuals enrolled in a randomized controlled prevention trial (RCT) and assessed their disease progression. Methods The multinati...
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Engagement with digital health tools ihas not been well‐studied in older populations. We aimed to describe engagement with a preventive eHealth intervention designed to reduce dementia and cardiovascular risk, identify factors associated with engagement, and examine associations between engagement and changes in dementia and cardiovascular risk fac...
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Interventions simultaneously targeting multiple risk factors are most likely to prevent neurocognitive disorders. This was demonstrated in the 2‐year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). However, the feasibility and effects of multimodal interventions in individuals at an early symptomatic di...
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Genetic discoveries of Alzheimer’s disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study res...
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Older adults have higher risk of cognitive impairment and dementia, and they also represent the group most severely affected by the SARS‐CoV‐2 (COVID‐19) pandemic in terms of higher morbidity and mortality. The World‐Wide FINGERS (WW‐FINGERS) global network of multidomain trials for dementia risk reduction and prevention (Kivipelto et al., 2020) pr...
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Higher occupational complexity has been associated with better cognition in late life, but associations with brain changes remain unclear. We assessedwhether occupational complexity was associated with baseline brain structural MRI measures and PIB‐PET amyloid burden in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Di...
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Evidence on the association of the cognitive reserve (CR) with the cognitive trajectories is limited. We examined the influence of lifespan CR indicator on domain‐specific cognitive trajectories taking brain pathologies into account. Within the Rush Memory and Aging Project, 1,697 dementia‐free participants (mean age: 79.6 years) were followed up t...
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U.S. POINTER is testing whether multidomain lifestyle interventions focused on physical exercise, nutrition, cognitive challenge, and risk factor management reduces risk of cognitive decline in a heterogeneous population of at‐risk older adults in America. The study adapts the FINGER (Finnish Intervention Geriatric Study to Prevent Cognitive Impair...
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Findings from observational studies support the benefits of social activities on cognition. The ability to carry out social activities is described by social functioning. However, only little data exists on the associations between social functioning and cognition among the oldest old. The aim of this study is to explore if social functioning is as...
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Most studies have so far investigated the cognitive performances and amyloid status on brain PET scans in cognitively normal, cognitively impaired, or individuals with dementia. In this study associations between brain amyloid status and changes in cognitive performance over time in an at‐risk older general population without dementia or substantia...
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The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized controlled trial that showed significant benefits on cognition for a 2‐year multidomain lifestyle intervention vs regular health advice in 1260 at‐risk older individuals from the general population. The aim of this study was to investiga...
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World‐Wide FINGERS (WW‐FINGERS) is a global network of multidomain lifestyle intervention trials for dementia risk reduction and prevention (Kivipelto et al., 2020). With over 30 countries conducting studies within the network, harmonizing interventions and data collection wherever possible is a priority. However, study‐specific adaptations are ine...
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The coronavirus disease‐19 (COVID‐19) pandemic presents challenges to the conduct of randomized clinical trials of lifestyle interventions. World‐Wide FINGERS is an international network of clinical trials to assess the impact of multidomain lifestyle intervention on cognitive decline in at‐risk adults. Individual trials are tailoring successful ap...
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Alzheimer’s disease (AD) is multifactorial. Interventions simultaneously targeting multiple risk factors are most likely to be effective, as demonstrated in the 2‐year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). While patients with prodromal AD represent a group with high risk of progressing to deme...
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The aim was to investigate 1) the associations of sleep, depressive symptoms, and pain with physical activity and physical functioning in the oldest old age group (85 years and older); 2) the effects of Covid‐19 related restrictions on physical activity in the oldest old. The data is from Cardiovascular Risk Factors, Aging and Dementia (CAIDE 85+)...
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Background: Midlife hypercholesterolemia is an established risk factor for developing Alzheimer's disease (AD), still peripheral cholesterol does not pass the blood-brain-barrier (BBB). A proposed factor linking elevated systemic cholesterol levels and AD is the oxidized cholesterol metabolite 27-hydroxycholesterol (27-OH) that can pass the BBB. A...
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Risk scores for dementia and cardiovascular disease (CVD) predict dementia development, but their link to underlying brain pathology remains unclear. This study explored the cross‐sectional associations between well‐validated CVD and dementia risk scores and dementia‐related cerebrospinal fluid (CSF) and imaging markers in memory clinic patients wi...
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Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) is a randomized trial that showed beneficial effect on cognition with a 2‐year multidomain lifestyle intervention. During the post‐intervention follow‐up, COVID19 pandemic emerged resulting in lockdown and reduced services. Our aim is to investigate how lif...
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Restrictions enforced in many counties during the COVID‐19 pandemic may have both short‐ and long‐term effects on the risk factors relevant for cognitive impairment and dementia. The COVID‐19 pandemic occurred during the post‐intervention follow‐up phase of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FIN...
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Given the complex and multi‐factorial aetiology of dementia, preventive interventions targeting several risk‐factors simultaneously and tailored on specific risk‐profiles are likely to be most beneficial. To date, trials testing lifestyle‐ and vascular‐based multidomain interventions for dementia and cognitive decline prevention have shown inconsis...
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GOIZ ZAINDU (“caring early” in Basque) is a pilot study to adapt FINGER methodology to the Basque Population and evaluate feasibility and adherence to a FINGER‐like multimodal intervention program. Additional exploratory aims included assessment of efficacy on cognition and collection of necessary data to design a large efficacy trial. GOIZ ZAINDU...
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Psychosocial stress has been shown to affect cognitive performance negatively and to increase the risk of developing dementia. Cortisol, a hormone thought to mediate several of the effects of chronic stress, has been shown to be elevated in Alzheimer’s disease (AD) patients. Interestingly, cortisol induces inflammatory responses that are detrimenta...
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Brain‐derived neurotrophic factor (BDNF), including the mature form (mBDNF) and its precursor (proBDNF), has an important role in synaptogenesis, and is possibly also involved in pathophysiological mechanisms related to dementia. In this study we relate, for the first time, serum levels of both mBDNF and proBDNF with cognitive changes in elderly pe...
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Understanding the role of amyloid imaging in the earliest stages of Alzheimer’s Disease (AD) becomes increasingly relevant for secondary prevention. In this context, the AMYPAD Prognostic and Natural History Study (PNHS) is an open‐label, prospective, multi‐centre cohort study (http://amypad.eu/) to determine the value of quantitative amyloid PET i...
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Mandated lockdowns and restricted activity in response to the COVID‐19 pandemic has affected our everyday life1. Seniors, in particular, have been affected due to higher morbidity and mortality2. The World‐Wide‐FINGERS‐SARS‐CoV‐2 survey is part of an international project, consisting of members of the World‐Wide FINGERS (WW‐FINGERS) Network for dem...
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Neurocognitive manifestations of the coronavirus disease 2019 (COVID‐19) have been reported in the acute phase, especially in critically ill patients. The potential mechanisms underlying these symptoms are not fully understood but probably involves the inflammatory, vascular, and neurotropic effect of the coronavirus. While short‐, mid‐and long‐ter...
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Dementia affects more and more people worldwide. Unfortunately, only half of dementia cases are well recognized. This indicates a need for both efficient and tailored tools for diagnosis. To improve the number of correctly diagnosed patients while retaining cost‐effectiveness, we study a stepwise data‐driven approach for the diagnostic workup. By u...
Preprint
Background: Frailty assessment in the Swedish health system relies on the Clinical Frailty Scale (CFS), but it requires training, in-person evaluation, and is often missing in medical records. We aimed to develop an electronic frailty index (eFI) from routinely collected electronic health records (EHRs) and assess its predictive ability for adverse...
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Background: Several studies have assessed the impact of COVID-19-related lockdowns on sleep quality across global populations. However, no study to date has specifically assessed at-risk populations, particularly those at highest risk of complications from coronavirus infection deemed “clinically-extremely-vulnerable-(COVID-19CEV)” (as defined by P...
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Introduction: Lifestyle interventions may prevent cognitive decline, but the sufficient dose of intervention activities and lifestyle changes is unknown. We investigated how intervention adherence affects cognition in the FINGER trial (pre-specified subgroup analyses). Methods: FINGER is a multicenter randomized controlled trial examining the ef...
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Background Executive functions underlie self-regulation and are thus important for physical activity and adaptation to new situations. The aim was to investigate, if yearlong physical and cognitive training (PTCT) had greater effects on physical activity among older adults than physical training (PT) alone, and if executive functions predicted phys...
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Although prevention of dementia and late-life cognitive decline is a major public health priority, there are currently no generally established prevention strategies or operational models for implementing such strategies into practice. This article is a narrative review of available evidence from multidomain dementia prevention trials targeting sev...
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We envisage the development of new Brain Health Services to achieve primary and secondary dementia prevention. These services will complement existing memory clinics by targeting cognitively unimpaired individuals, where the focus is on risk profiling and personalized risk reduction interventions rather than diagnosing and treating late-stage disea...
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Dementia has a devastating impact on the quality of life of patients and families and comes with a huge cost to society. Dementia prevention is considered a public health priority by the World Health Organization. Delaying the onset of dementia by treating associated risk factors will bring huge individual and societal benefit. Empirical evidence s...
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In many countries, the COVID-19 pandemic has led to strong restrictions and changed the everyday lives of older people. In Finland, people aged 70 and over were instructed to stay at home under quarantine-like conditions. Existing studies from other countries have reported increases in negative experiences and symptoms as a result of such restricti...
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Background and Objectives Evidence on the association of the cognitive reserve (CR) with the cognitive trajectories is limited. We aimed to examine the influence of CR indicator on domain-specific cognitive trajectories taking brain pathologies into account. Methods Within the Rush Memory and Aging Project, 1,697 dementia-free participants (mean a...
Article
Full-text available
Background The Finnish Intervention Study to Prevent Cognitive Impairment and Disability is a randomized controlled trial that has tested the efficacy of a multidomain intervention targeting modifiable risk factors to prevent cognitive impairment/dementia. A combination of healthy diet, physical, social and cognitive activity, and management of car...