Eva Skovlund

Background: Idiopathic normal pressure hydrocephalus (iNPH) and Alzheimer's disease (AD) are neurodegenerative disorders with partly overlapping clinical features. Since the treatment is different, we need better knowledge about how the cognitive profile differs between these conditions. Objective: We aimed to compare the cognitive profile of iNPH patients with that of a large cohort of confirmed AD patients. Methods: Patients diagnosed with iNPH and accepted for shunt surgery were compared with patients with biomarker verified Alzheimer's disease in The Norwegian Register of Persons Assessed for Cognitive symptoms (NorCog). All patients underwent a standardized cognitive assessment with age and education adjusted z-scores. We used the Clinical Dementia Rating Scale (CDR) to adjust for disease severity. Since the cognitive score distributions were highly skewed, we used nonparametric analyses stratified by CDR stage combined with multinomial logistic regression. Results: In total, 276 iNPH patients were compared to 1113 AD patients. iNPH patients performed significantly poorer on phonemic fluency [median z-score difference (AD—iNPH) 0.30, 95% confidence interval (CI) 0.20 to 0.50], but significantly better on other cognitive tests, in particular immediate (median difference −0.35, 95% CI −0.49 to −0.20) and delayed recall (median difference −0.46, 95% CI −0.59 to −0.34). The differences persisted after adjustment for CDR and were most pronounced in early stages of the disease. Conclusions: iNPH seems to affect phonemic fluency more and memory less than AD. As the disease progresses, the cognitive profiles become more similar, and the conditions cannot be distinguished by cognitive tests.

Dry mouth is a common and burdensome condition in older adults and its severity may increase with use of anticholinergic medications. The aims were to describe anticholinergic medication use among acutely ill older adults, examine the association between anticholinergic burden and dry mouth severity using the composite Dry Mouth Severity Points (DMSP) measure and investigate whether the association differs by sex. Patients ≥70 years admitted to Oslo municipal inpatient acute care unit were eligible. Anticholinergic burden (ACB) was assessed using the ACB calculator and classified as 0, lower (ACB = 1-2) or high (ACB = ≥ 3). Dry mouth severity was quantified with DMSP, range 0-4, assigning one point for each indicator above cut-off: General Xerostomia Question ≥ 3, Summated Xerostomia Inventory ≥ 11, Clinical Oral Dryness Score ≥ 6 and unstimulated whole saliva secretion rate ≤ 0.1 mL/min. Associations were examined with ordinal logistic regression. Of 382 examined patients, 256 (mean age 84 ± 7 years, 70% women) had complete data. Mean [standard deviation (SD)] ACB score was 2.0 (1.7); 18% had ACB = 0, 50% had ACB = 1-2 and 32% had ACB = ≥ 3. DMSP scores of 0, 1, 2 and ≥ 3 were present in 29%, 36%, 23% and 12%, respectively. Compared with patients with ACB = 0, those with ACB = 1-2 [odds ratio (OR) = 2.06, 95% confidence interval (CI) 1.07-3.97) and ACB = ≥ 3 (OR = 2.25, 95% CI 1.09-4.63) had higher odds of more severe dry mouth. Women had significantly higher ACB and DMSP scores than men. Even lower anticholinergic burden was associated with greater dry mouth severity, highlighting the need for early recognition and proactive management in acutely ill older adults.

Background: Polypharmacy in older adults is associated with inappropriate prescribing and adverse drug events. In a previous trial, we demonstrated improved Health-Related Quality of Life (HRQoL) following medication reviews by geriatricians and general practitioners in home-dwelling older adults. Whether similar benefits can be achieved during acute admissions in primary care remains unclear. Objective: To assess the effect of collaborative medication reviews during acute admissions to a Municipal Inpatient Acute Care (MIPAC) unit. Methods: In this single-blind, parallel-group, randomised controlled trial, patients ≥70 years using ≥6 regular medications admitted to a MIPAC unit in Oslo, Norway, were randomised 1:1 to receive either a structured medication review or usual care. The intervention involved assessment by MIPAC physicians specialised in general practice, geriatric supervision and discussion with the patient’s general practitioner. The primary outcome was HRQoL measured with the 15D instrument at 16 weeks. Secondary outcomes included physical and cognitive function, oral health, healthcare utilisation and mortality. Results: We included 137 participants (mean age 85 years, 69% women; 67 intervention, 70 control). At 16 weeks, there was no significant difference in 15D scores between groups (mean difference 0.009; 95% CI, −0.063 to 0.079; P = .8). The intervention group had more medication changes during admission, but differences diminished post-discharge. No differences were observed in secondary outcomes. Conclusion: Collaborative medication reviews during acute primary care admissions did not improve HRQoL. The findings underscore the need for longitudinal, patient-centred strategies initiated in clinically stable phases.

Background: Vaginal discharge (VD) is a common health concern among women of reproductive age worldwide. In low- and lower-middle-income countries (LLMICs), one in four women experiences distressing VD which may indicate underlying infections. About one-third of these cases are caused by one of three curable sexually transmitted infections (STIs) —Chlamydia trachomatis [Ct] , Neisseria gonorrhea [Ng], Trichomonas vaginalis [Tv] —or by bacterial vaginosis (BV). Syndromic management, the standard approach to care in LLMICs, relies on empirical antibiotic treatment, often resulting in overtreatment and contributing to antimicrobial resistance. To reduce unnecessary use of antibiotics, affordable, accurate, and rapid diagnostic tests such as point-of-care tests (POCTs) are needed—particularly in settings where over-the-counter antibiotic use is common and psychosocial problems may be somatized. Additionally, education on VD and appropriate antibiotic use, along with recognition of mental health or domestic violence issues, may be important for facilitating acceptance of POCTs. Methods: This study is a randomized controlled double-blind, superiority trial with follow-up assessments at 4 weeks and 4 months conducted in a Nepalese teaching hospital and its outreach centers. Participants are randomly assigned to one of three study arms: Arm 1 receives treatment, based on syndromic management; Arm 2 receives POCT-guided treatment using the Cepheid GeneXpert® (for Ct and Ng ), pH and whiff tests (for BV and Tv ), and the OSOM® test (for Tv ); Arm 3 receives the same POCT-guided treatment as Arm 2, plus an educational intervention, and referral for psychosocial concerns. The primary outcome is the proportion of participants overtreated with antibiotics at the primary consultation, comparing Arm 1 versus Arms 2 and 3. Secondary outcomes include over-the-counter antibiotic acquisition, subsequent health-seeking behavior, and changes in VD symptom development over time. Discussion: The trial assesses the effectiveness and impact of integrating POCTs into VD management in a resource-limited setting. Results of comparing syndromic-based management with POCT-guided diagnostic testing and treatment, both alone and combined with psychosocial and education-based interventions, inform strategies to reduce antibiotic overuse and improve broader reproductive health concerns. Trial registration: ClinicalTrials.gov NCT05977491. Registered on 8 April 2023. https://clinicaltrials.gov/study/NCT05977491?cond=vaginal%20discharge&rank=6 Protocol version: Version 6, October 30, 2025.

Background and purpose: Chemoradiotherapy (CRT) for squamous cell carcinoma of the anus (SCCA) results in favorable survival. However, treatment intensity must be balanced against late side effects. The aim of this current study was to prospectively investigate patient-reported outcomes (PROs) before CRT and up to 5 years after completed CRT for SCCA. Patient/material and methods: This prospective study included 120 patients with SCCA receiving CRT to total doses of 54–58 Gy with concomitant mitomycin and 5-fluorouracil. Patients completed PRO questionnaires before CRT, and at 3 months, 1-, 3-, and 5 years after completed CRT. The questionnaires were the EORTC QLQ-C30 and QLQ-CR29, St. Marks incontinence score, Fatigue Questionnaire, the Hospital Anxiety and Depression Scale, and a scoring for neuroticism. Results: Patients reported a high burden of symptoms and impaired functional outcomes prior to treatment. Tumor-related symptoms, such as buttock pain, improved (difference 11.1, p = 0.002) at a clinically relevant level 3 months after CRT, consistent with tumor response. Other functional outcomes and symptoms, such as body image (difference 11.5, p < 0.001), worsened. While some outcomes, such as anxiety (difference 10.4, p = 0.001), improved over time, several were persistently impaired, in particular anorectal and sexual function, where symptom burden remained high 5 years after CRT. Chronic fatigue (CF) was reported by 28% of patients at 5-year follow-up. Interpretation: Five years after CRT for SCCA, patients report a persistently high symptom burden regarding anorectal and sexual function, and one-third report CF, demonstrating the long-term impact of treatment.

Aims: Stroke risk in atrial fibrillation (AF) patients increases over time, but the optimal reassessment interval remains unclear. This study evaluated changes in the CHA2DS2-VA score in AF patients with low (score 0) or intermediate (score 1) stroke risk and explored appropriate reassessment intervals. Methods and results: Using Norwegian national registries (2011–18), 40 782 individuals with incident AF aged ≥18 years and a low or intermediate CHA2DS2-VA score were identified. Patients were followed from first AF diagnosis until an increase in the CHA2DS2-VA score, and the proportion with increased score was assessed across age groups. The number needed to reassess to detect one new CHA2DS2-VA risk factor was calculated at different time intervals after AF diagnosis. The CHA2DS2-VA score increased in 50% of patients after a median follow-up of 1.7 years. The proportion of patients with an increased CHA2DS2-VA score was 19% at 6 months, 25% at 1 year, and 40% at 3 years after AF diagnosis. At 1 year, the proportion of patients with a new risk factor was lower in those aged 18–44 years (8%) and 45–54 years (14%) compared to those aged >55 years (30%), with the number needed to reassess at 1 year being 12, 7, and 3 patients, respectively. Conclusion: New risk factors emerged in half of AF patients within 1.7 years. Age-specific differences underscore the need for tailored reassessment, suggesting a shorter interval of 6 months for patients ≥55 years and 1 year for those <55 years and routinely at age 65 and 75 years.

Introduction: Radiotherapy (RT) is a frequently offered treatment option for brain metastases (BMs) in patients with non-small-cell lung cancer (NSCLC). This study presents patient-reported outcomes (PROs) in a cohort of NSCLC with BMs treated with RT. This study researched how PRO scores at the start of RT may be useful in survival estimates and how PROs change over time after RT. Methods: NSCLC patients with first-time BMs treated with RT were identified in a prospective observational study. PROs were collected at the start of RT and monthly for up to 1 year. Differences in PRO mean scores at the start of RT (M0) and at month 2 (M2) after treatment are reported. Prognostic values of PROs were analyzed in a stepwise adjusted Cox model. Results: Of 294 patients identified, 239 (81%) responded at M0; 105/239 (44%) responded at both M0 and M2. High scores for weakness of legs at M0 were associated with short survival when adjusting for performance status and status of extracranial metastases. Those responding at M0 only had worse mean scores for overall QoL and PF but similar scores for fatigue and dyspnea compared to patients responding over time. At M2, patients with <6 months survival after RT reported worse scores for overall QoL, PF, fatigue, and dyspnea; long-term survivors reported stable scores. Conclusions: NSCLC patients diagnosed with BMs and expected survival < 6 months should be offered optimal palliative care rather than RT.

Up to 40% of non-smallcell lung cancer (NSCLC) patients develop brain metastases (BMs). The potential benefits of radiotherapy (RT) in patients with poor performance status (PS) are questionable, with considerable risk for futile treatment. We analyzed overall survival after initial radiotherapy in NSCLC patients with BMs, focusing on the relationship between PS and survival after RT. This study reports a prospective observational study including consecutive 294 NSCLC patients with first-time BMs. Overall survival (OS) was calculated from the start of RT to death or last follow-up (1 June 2023). Overall, in the 294 included patients (median age 69 years), the median OS was 4.6 months; 2.5 months after WBRT (n = 141), and 7.5 months after SRT (n = 153). After WBRT, mOS was equally poor for patients with ECOG 2 (1.9 months) and ECOG 3–4 (1.2 months). After SRT, mOS for patients with ECOG 2 was 4.1 months; for ECOG 3 patients, mOS was 4 1.6 months. For NSCLC patients with ECOG 2 diagnosed with BMs who are not candidates for surgery or SRT, WBRT should be questioned due to short survival.

Introduction: Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management. Methods: We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale − 8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals. Results: We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives. Discussion: Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.

Background Although several lifestyle intervention studies have been conducted in low/middle-income countries, there were no such studies in Nepal. Therefore, a group-based culturally tailored Diabetes Prevention Education Program (DiPEP) was conducted recently. The study aimed to evaluate the effect of DiPEP in glycated haemoglobin (HbA1c), weight, waist circumference, physical activity and diet among population with pre-diabetes. Method A two-arm cluster randomised controlled trial was conducted in 12 clusters of two urban areas in Nepal. The DiPEP was a 6 month intervention (four 1-hour weekly educational sessions and 5 months of follow-up by community health workers/volunteers (CHW/Vs)). A postintervention assessment was done after 6 months. Linear mixed model was used to estimate the mean difference in primary outcome (HbA1c) and secondary outcomes (weight, waist circumference, physical activity and diet) between intervention and control arms, adjusted for baseline measure. Results In intention-to-treat analysis with a total of 291 participants, the estimated mean difference in HbA1c was found to be 0.015 percentage point (95% CI −0.074 to 0.104) between the intervention arm and the control arm, while it was −0.077 (95% CI −0.152 to −0.002) among those who attended at least 3 out of 4 educational sessions. The estimated mean difference in weight (in participants who attended ≥1 educational session) was −1.6 kg (95% CI −3.1 to −0.1). A significantly lower grain consumption was found in intervention arm (−39 g/day, 95% CI −65 to −14) compared with the control arm at postintervention assessment. Conclusion Although compliance was affected by COVID-19, individuals who participated in ≥3 educational sessions had significant reduction in HbA1c and those who attended ≥1 educational session had significant weight reduction. Grain intake was significantly reduced among the intervention arm than the control arm. Hence, group-based lifestyle intervention programmes involving CHW/vs is recommended for diabetes prevention. Trial registration number NCT04074148.