Martínez Velilla, Nicolás
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Martínez Velilla
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Nicolás
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Ciencias de la Salud
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Publication Open Access Change in physical activity and systolic blood pressure trajectories throughout mid-life and the development of dementia in older age: the HUNT study(BMC, 2023) Lerfald, Maren; Lydersen, Stian; Zotcheva, Ekaterina; Nilsen, Tom I. L.; Eldholm, Rannveig S.; Martínez Velilla, Nicolás; Selbæk, Geir; Ernstsen, Linda; Ciencias de la Salud; Osasun ZientziakBackground: There is lack of research on combinations of possible modifable risk factors for dementia in a life-time perspective. Dementia has currently no cure, and therefore new knowledge of preventive factors is important. The purpose of this study is to investigate if changes in physical activity (PA) in combinations with systolic blood pressure (SBP) trajectories in mid to late life are related to development of dementia in older age. Methods: This prospective cohort study uses data from four consecutive surveys of the HUNT Study, Norway. Dementia was assessed in the HUNT4 70+sub-study (2017–19). Group-based trajectory modelling identifed three SBP trajectories from HUNT1 (1984–86) to HUNT3 (2006–2008): low, middle, and high. Change in PA was categorized into four groups based on high or low PA level at HUNT1 and HUNT3 and were combined with the SBP trajectories resulting in 12 distinct categories. Logistic regression was used to estimate odds ratios (ORs) of dementia. Results: A total of 8487 participants (55% women, mean age (SD) 44.8 (6.5) years at HUNT1) were included. At HUNT4 70+, 15.2% had dementia. We observed an overall decrease in OR of dementia across the PA/SBP catego ries when ranked from low to high PA (OR, 0.96; 95% CI, 0.93 to 1.00, P=0.04). Within PA groups, a low SBP trajec tory was associated with lower OR for dementia, apart from those with decreasing PA. The strongest association was observed for people with stable high PA and low SBP trajectory (OR, 0.38; 95% confdence interval (CI), 0.13 to 1.10 and adjusted risk diference, -8.34 percentage points; 95% CI, -15.32 to -1.36). Conclusion: Our fndings illustrate the clinical importance of PA and SBP for dementia prevention and that favorable levels of both are associated with reduced occurrence of dementia.Publication Open Access Prevalence of strong anticholinergic use in residents with and without cognitive impairment and frailty: analysis from 106 nursing homes in 12 Asia-Pacific and European countries(Elsevier, 2025-09-11) Cross, Amanda J.; Villani, Emanuele R.; Jadczak, Agathe D.; Pitkälä, Kaisu H.; Hamada, Shota; Zhao, Meng; Gutiérrez-Valencia, M.; Aalto, Ulla; Dowd, Laura A.; Li, Li; Liau, Shin J.; Liperoti, Rosa; Martínez Velilla, Nicolás; Ooi, Choon Ean; Onder, Graziano; Petrie, Kate; Roitto, Hanna M.; Roncal Belzunce, Victoria; Saarela, Riitta; Sakata, Nobuo; Visvanathan, Renuka; Zhang, Tiange G.; Bell, J. Simon; Ciencias de la Salud; Osasun ZientziakPurpose: there is a need to balance the benefits and risks associated with strong anticholinergic medications in older adults, particularly among those with frailty and cognitive impairment. This study explored the international prevalence of strong anticholinergic medication use in residents of nursing homes with and without cognitive impairment and frailty. Methods: secondary, cross-sectional analyses of data from 5,800 residents of 106 nursing homes in Australia, China, Czech Republic, England, Finland, France, Germany, Israel, Italy, Japan, Netherlands, and Spain were conducted. Strong anticholinergic medications were defined as medications with a score of 2 or 3 on the Anticholinergic Cognitive Burden scale. Dementia or cognitive impairment was defined as a documented diagnosis or using a validated scale. Frailty was defined using the FRAIL-NH scale as 0-2 (non-frail), 3-6 (frail) and 7-14 (most-frail). Data were analyzed using descriptive statistics. Results: overall, 17.4 % (n = 1010) residents used >= 1 strong anticholinergic medication, ranging from 1.3 % (n = 2) in China to 27.1 % (n = 147) in Italy. The most prevalent strong anticholinergics were quetiapine (n = 290, 5.0 % of all residents), olanzapine (132, 2.3 %), carbamazepine (102, 1.8 %), paroxetine (88, 1.5 %) and amitriptyline (87, 1.5 %). Prevalence was higher among residents with cognitive impairment (n = 602, 17.9 %) compared to those without (n = 408, 16.8 %), and among residents who were most frail (n = 553, 17.9 %) compared to those who were frail (n = 286, 16.5 %) or non-frail (n = 171, 17.5 %). Conclusions: one in six residents who were most frail and living with cognitive impairment used a strong anticholinergic. However, there was a 20-fold variation in prevalence across the 12 countries. Targeted deprescribing interventions may reduce potentially avoidable medication-harm.