Ingrid Ekström

Olfactory impairment has emerged as a potent marker of future dementia and cognitive impairment. The underlying biological mechanisms for this olfaction-dementia link remain, however, largely unexplored. Recent technological developments have made assessment of biomarkers (e.g. amyloid β, tau) of Alzheimer’s disease (AD) more easily accessible. These new blood-based biomarkers (BBB) can help identify age- and dementia-related changes and understanding the link between cognitive and olfactory decline and future dementia development. This project will investigate the longitudinal trajectories of cognitive and olfactory abilities in relation to aging and dementia and a range of dementia biomarkers. We will target 4 main areas: associations between 1) AD biomarkers and cognitive and olfactory decline in aging and across the preclinical dementia spectrum, 2) AD biomarkers and starting point and rate of cognitive and olfactory decline in relation to a future dementia diagnosis, 3) olfactory impairment and incident dementia across different biomarker profiles, and 4) cross-sectional links between BBB of AD, neuroimaging markers, and specific memory and olfactory abilities in a newly added cohort. We will use data from a Swedish population-based study-SNAC-K, with extensive biomarker assessment at baseline and repeated measures of olfaction, cognition and dementia across &gt

20 years. The project will lead to new and important knowledge regarding the olfaction-dementia association.

Research problem and specific questions: This project aims to contribute key knowledge for optimizing prevention, intervention, and care management of old-age depression by disentangling the complexities of this common and burdensome condition. Compared to earlier in life, old-age depression is characterized by distinct symptom patterns and a more complex clinical course, precipitating intricate care needs and increased healthcare use among older adults. The drivers of these complexities remain poorly understood, and we aim to conduct three interconnected sub-projects scrutinizing them. Specifically, we will: 1) investigate the role of psychosocial, behavioral, and socioeconomic determinants of diverse depressive symptom patterns and transitions between them

2) assess health and survival consequences of different depressive symptom patterns

and 3) evaluate healthcare utilization in people with old-age depression, focusing on complex and avoidable transitions across care settings.Data and method: Longitudinal data on more than 7,000 older adults from four population-based cohorts included in the Swedish National Study on Aging and Care (SNAC) and harmonized via the National E-Infrastructure for Aging Research (NEAR) will be used. We will exploit more than 20 years of already-collected follow-up data, gathered using shared instruments across cohorts. Multi-state transition models will be used to capture diverse shifts across depressive states (no depression, subsyndromal depression, major depression) and care settings (home, formal care, hospital, institution), as well as their associated determinants and consequences.Relevance and utilization: Depression in older adults is a cause of major distress for patients, their families, and the healthcare system. A better understanding of its fluctuating course is required to identify strategies promoting prevention, recovery, and care continuity. Planned in close connection with patient organizations and care provider networks, this project will bring about knowledge sought by multiple stakeholders, ensuring that older adults with depression experience old age with the dignity they deserve.Plan for project realization: The project will be carried out by a multidisciplinary team with expertise in geriatric mental health, epidemiology, and care sciences. Its results will be deployed through the National Association for Social and Mental Health (RSMH). Researcher salaries constitute key budgetary items.

Aging is often accompanied by significant loss in the sense of smell, olfaction. Around 25% of persons aged 60 years and above suffer from olfactory impairment (OI), and prevalence rates increase substantially with age. Still, potentially harmful consequences of smell loss are poorly understood. Although some previous studies have linked OI to depression, low quality of life, poor appetite, and malnutrition, these studies have mainly been based on cross-sectional designs and clinical samples, precluding causal interpretations and generalizations to the population. Smell loss has also been associated with a shorter life span, although without information about cause of death, the underlying mechanisms remain speculative. Based on comprehensive data from two Swedish large-scale population-based longitudinal studies, including standardized measures of olfactory function, we will focus on (1) the longitudinal association between OI and commonly associated conditions such as depression, loneliness, and malnutrition, (2) modifying factors of developing harmful consequences of OI, such as for example demographic and health variables, and (3) why OI would be associated with a shorter lifespan, factoring in cause of death.

Aging is often accompanied by significant loss in the sense of smell, olfaction. Around 25% of persons aged 60 years and above suffer from olfactory impairment (OI), and prevalence rates increase substantially with age. Still, potentially harmful consequences of smell loss are poorly understood. Although some previous studies have linked OI to depression, low quality of life, poor appetite, and malnutrition, these studies have mainly been based on cross-sectional designs and clinical samples, precluding causal interpretations and generalizations to the population. Smell loss has also been associated with a shorter life span, although without information about cause of death, the underlying mechanisms remain speculative. Based on comprehensive data from two Swedish large-scale population-based longitudinal studies, including standardized measures of olfactory function, we will focus on (1) the longitudinal association between OI and commonly associated conditions such as depression, loneliness, and malnutrition, (2) modifying factors of developing harmful consequences of OI, such as for example demographic and health variables, and (3) why OI would be associated with a shorter lifespan, factoring in cause of death.