The doctoral dissertation in the field of Neurology will be examined at the Faculty of Health Sciences at Kuopio Campus. The public examination will be streamed online.
What is the topic of your doctoral research? Why is it important to study the topic?
Alzheimer’s disease (AD) is the most common cause of dementia, and due to population ageing, the number of people with AD is increasing both in Finland and worldwide. Because no curative treatment exists for AD, it is crucial to investigate how the care and well-being of this population could be improved. Previous studies have shown that infections are a common cause of hospitalisation, and both infections and related hospitalisation are associated with long-term cognitive and functional decline, at worst leading to loss of independence. However, studies on infection incidence throughout the AD disease process and infection risk factors are scarce in this population. This doctoral thesis aimed to explore the incidence of hospital-treated infections before and after AD diagnosis, hospitalisation after oral antibiotic initiation, and risk factors of pneumonia by comparing persons with and without AD.
What are the key findings or observations of your doctoral research?
We observed that infection incidence increased more rapidly one to two years before AD diagnosis and from AD diagnosis to five years after infection incidence was twofold in persons with AD compared to persons without AD. Hospital days accumulated in persons with AD due to higher infection incidence, but we did not observe a difference in the median number of hospital days. From AD diagnosis to five years after, a third of infection-related hospitalizations were due to urinary tract infections, and infections typically treated in outpatient care were common causes of hospitalisation in persons with AD. AD was associated with higher odds of hospitalisation within 14 days after oral antibiotic initiation. In persons with AD, one-third of hospitalisations occurred after initiation of an antibiotic for urinary tract infections (pivmecillinam or trimethoprim), compared to one in five persons without AD. AD and most investigated comorbidities, as well as medication use, especially the concomitant use of more than one kind of psychotropic, were associated with a higher risk of hospital-treated pneumonia.
How can the results of your doctoral research be utilised in practice?
Based on the results of this thesis, infection prevention is vital throughout the AD disease process. Infections can be prevented with vaccinations, better oral hygiene, good care of comorbidities, and deprescribing of infection-risk-increasing medications, especially psychotropics. This thesis raised new research topics. It is important to investigate the true causes of hospitalisation in persons who are hospitalised due to typically outpatient-treated infections, for example, cystitis. In addition, more information is needed on the association between asymptomatic bacteriuria and delirium or neuropsychiatric symptoms or AD and whether antibiotic treatment in this situation causes benefit or harm.
What are the key research methods and materials used in your doctoral research?
This thesis is based on the Medication Use and Alzheimer’s Disease (MEDALZ) cohort, combining data from nationwide registers. The cohort included 70,718 community-dwelling persons diagnosed with AD between 2005 and 2011, who were retrieved from the Social Insurance Institution Reimbursement register. Each person with AD was matched with a comparison person without AD according to age, sex and region of residence. Information on comorbidities. was retrieved from the Special Reimbursement Register and Care Register for Health Care. In addition, information on prescription drug purchases was retrieved from the Prescription Register maintained by the Social Insurance Institution. Data on infection-related hospitalisation was retrieved from the Care Register for Healthcare.
The doctoral dissertation of Heli Järvinen, Lic Med, MSc (Pharm), entitled Incidence and risk factors of hospital-treated infections in persons with Alzheimer’s disease will be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Docent Arja Helin-Salmivaara of the University of Helsinki and HUS, and the Custos will be Professor Emerita Sirpa Hartikainen of the University of Eastern Finland. The public examination will be held in Finnish.
