I am a medical doctor from Italy, specialized in both neurology and epidemiology. I moved to Sweden with my family 1996.
I am currently employed as a professor at Karolinska Institutet. Since 2007, I have been the director of the Aging Research Center (ARC). In 2010, I was granted the Distinguished Professor Award by Karolinska Institutet. I have scientific, clinical, and pedagogical commitments.
- My scientific production has led to 285 articles in peer-reviewed journals, 23 book chapters, and 12 reports. By October 2014 I had 18,093 citations and an h-index of 70.
- Under my supervision, 15 PhD students and nine postdocs have completed their studies since 1996. I am currently the main supervisor of 2 PhD students and co-supervisor of 5 students.
- Since 1996, as principal investigator, I have regularly received grants from the major research councils in Sweden and from international agencies. Together with a multidisciplinary team of senior researchers, I was awarded a 10-year grant to build ARC by The Swedish Council for Working Life and Social Research (Forte; 11 million Swedish krona per year).
- I have received several prizes, including the Lifetime Achievement Award from the American Alzheimer’s Association, Sohlberg’s Nordic Prize in Gerontology, and the Karolinska Institutet Folksams prize in epidemiologic research.
Relevant issues for the board of research
1. To be able to implement KI’s “Strategy 2018” concerning research quality, research infrastructure, and support for younger researchers
2. To strengthen clinical research
3. To facilitate the integration of basic research within clinical and epidemiological research
4. To reinforce the dialogue and the interaction between research and education
I am the principal investigator of the SNAC-Kungsholmen population study, the scientific coordinator for the Kungsholmen Project on Aging and Dementia, and co-investigator in several Swedish (Swedish Brian Power) and European consortia (NEW-AGE, HATICE, ESCAPE; MPI-age). My research group consists of 18 people, including two lecturers, two assistant professors, six post-docs, seven PhD students, one research assistant, and one research coordinator. We have four major lines of research: 1) Postponing dementia onset: Risk and protective factors for Alzheimer’s disease and other dementias, 2) Understanding the natural history of the dementias, 3) The body-mind connection, and 4) Health status and health trends in older people.
Postponing dementia onset: Risk and protective factors for Alzheimer’s disease and other dementias. In the last two decades, significant progress has been made regarding the identification of risk and protective factors in dementia. Our group has contributed to the accumulating evidence that lifestyle and cardiovascular risk factors play important roles in the pathogenesis and development of dementia. In addition, we have proposed a life-course model for the development of dementia that is now commonly accepted. This model asserts that a) life-long cumulating lesions (of different kinds) lead to dementia when they no longer can be counteracted by compensatory mechanisms; b) most cases of dementia will occur in late life and most will be of the mixed type (i.e., neurodegenerative and vascular); c) there are specific time windows when some determinants may be active, although not during the whole life period; d) risk and protective factors may interact in both increasing and attenuating their effects on dementia development; e) not all old persons develop dementia, even at advanced ages, and learning from those who “escape” can shed new light on the pathogenesis of dementia; and f) delay of dementia onset seems to be the only realistic endpoint in prevention. Following this model, we are now examining old (vascular and psychosocial factors) and new hypotheses (psychological stress, nutrition, and pollution) with three major goals: a) to identify possible pathways through which protective factors may compensate for previous risk exposures, b) to detect underlying mechanisms, and c) to verify the extent to which established risk and protective factors may anticipate or delay dementia onset.
Understanding the natural history of the dementias from mild cognitive impairment, early detection and progression to disability, institutionalization and death. ~~Cognitive deficits can be observed up to ten years before a dementia diagnosis is made; a sharp decline is more evident in the final three years. My colleagues and I have validated the use of such early cognitive deficits as a predictive tool for incipient dementia in the general population, but to date none of the proposed definitions has shown itself to be a sufficiently good predictor at the community level. This is mainly because cognitive impairment is common in the elderly population and has multiple causes. In our ongoing work on this topic, we are examining various individual-difference variables that might modulate both the onset of dementia and the decline once dementia has started. Of special interest here is whether certain favorable conditions (e.g., high educational level, an active lifestyle, advantageous genetic variants) would lead to a later change point and more rapid decline during the final years preceding dementia diagnosis, reflecting greater cognitive reserve. We are also integrating cognitive data with MRI findings to increase the ability to predict dementia onset, whereas social factors are taken into account when studying disability, institutionalization, and death in people affected by dementia.
The body-mind connection. ~~Ongoing demographic changes are expected to lead not only to an increased number of people with chronic diseases, but also to the development of different patterns of diseases, such as multiple health and functional problems, referred to here as chronic multimorbidity (15). Multimorbidity is a very common syndrome in elderly people. It occurs in more than half of the 75+ old population, and the prevalence is higher in very old persons, women, and people from disadvantaged social classes. Almost nothing is known about risk factors for multimorbidity, but the consequences are well established: functional impairment, poor quality of life, and high health-care utilization and costs. We have recently started a new project to study the effect of multimorbidity on cognitive functions. Preliminary data show that multimorbidity affects both the progression from MCI to dementia and the progression of dementia toward functional dependence. Furthermore, specific chronic disorders such as heart failure, atrial fibrillation, and anemia are associated with an increased risk of dementia, which suggests that dementia may also develop in the absence of neurodegeneration. Finally, we have documented a deleterious effect of polypharmacy and of specific chronic disorders (depression, stroke, diabetes) in the development of cognitive impairment. On the basis of these findings, we hypothesize that chronic multimorbidity is a frail state that may anticipate onset of dementia by several years.
Health status and health trends in old ages. Human health is a dynamic and multidimensional status, and this is especially evident in aging, when health changes occur more frequently and at an increased rate. Using data already collected in our cohort studies of middle-aged and elderly people, we are now addressing two research questions: 1) How can we measure the health status of older adults in a more comprehensive way? 2) What are the chains of events that culminate in the development of poor health in elderly people? Specifically, we aim to: 1) integrate multiple health dimensions in a score to better describe health and health trajectories among older adults and to relate health to work capability and societal engagement; 2) quantify the effect of the major social, environmental, psychological, and biological determinants and their life-long interactions on health and survival in older adults; 3) assess geographical variation in mental and physical health and their known determinants in Sweden; and 4) explore time trends in mortality and morbidity among the older population. This research line represents a timely initiative after two decades during which researchers in the aging field (including several from our group) have identified numerous factors that contribute to heath in aging. The challenge is now to understand the interplay among these many factors in a life course perspective, taking into account different components and their impact at the societal level.
In 2008 in collaboration with other centers at KI and the universities of Lund and Umeå, I started a National Graduate School for Aging Research, which supports an educational program with a biological, psychological, and socio-demographic profile. Preparations for a larger-scale multidisciplinary interaction at the national level are ongoing.
Academic honours, awards and prizes
- 2013 Lifetime Achievement Award from the American Alzheimer’s Association
- 2011 Wajlit och Eric Forsgrens prize for AD researcher - Umeå University
- 2010 The Sohlberg's Nordic Prize in Gerontology
- 2010 Sofiahemmet-Research and Education prize in dementia research
- 2009 Karolinska Institutet Folksams prize in epidemiologic research
- 2008 The Swedish Society of Medicine – “Inga Sandeborg’s prize”
- 2001 Italian Society of Neurology - Award “In memory of Prof L Amaducci”
AWARDS & HONORS
- 2011 Forte- mid-term evaluation of ARC: ‘We recommend support at a higher level’
- 2011 KI - ERA evaluation (international independent panel): grading ‘Oustanding’
- 2010-2015 The Karolinska Institutet - Distinguished Professor Award
- 1996-1999 Medical Research Council, Sweden – 4-year position as a Research Scientist
- 1990-1993 Medical Research Council, Sweden – 4-year position as a PhD student