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Nordström, Peter
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Publications (10 of 102) Show all publications
Bergman, J., Nordström, A. & Nordström, P. (2018). Alendronate use and the risk of nonvertebral fracture during glucocorticoid therapy: a retrospective cohort study. Journal of Clinical Endocrinology and Metabolism, 103(1), 306-313
Open this publication in new window or tab >>Alendronate use and the risk of nonvertebral fracture during glucocorticoid therapy: a retrospective cohort study
2018 (English)In: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 103, no 1, p. 306-313Article in journal (Refereed) Published
Abstract [en]

Context: Glucocorticoids increase the risk of nonvertebral fracture, but no clinical trial has shown that nonvertebral fractures can be prevented by co-administration of an anti-osteoporotic drug.

Objective: To estimate the effect of alendronate on the risk of nonvertebral fracture in older adults taking oral glucocorticoids.

Design: Retrospective cohort study using national Swedish registers.

Setting: Hospitalized care and ambulatory specialist care.

Patients: Among adults aged 50 years or older (N=3,347,959), we identified those who initiated oral glucocorticoid therapy from 2006 through 2011 (≥2.5 mg/day of prednisone or equivalent for ≥91 days). The final analysis included 16,890 alendronate users and 16,890 nonusers, who were matched using time-dependent propensity scores.

Main Outcome Measure: Nonvertebral fracture. This was not pre-specified.

Results: Over a median follow-up of 14.5 months, the incidence rate of nonvertebral fracture was 2.0 cases per 100 person-years in alendronate users and 2.4 cases in nonusers. This difference corresponded to a 16% lower rate in users (hazard ratio 0.84, 95% confidence interval 0.75 to 0.94). For hip fractures specifically, the rate was 34% lower in alendronate users relative to nonusers (hazard ratio 0.66, 95% confidence interval 0.55 to 0.78). The association of alendronate use with a lower risk of nonvertebral fracture was strongest in patients who received high doses of glucocorticoid.

Conclusion: Alendronate use was associated with a lower risk of nonvertebral fracture, including hip fracture. Similar, but not statistically significant, associations have been reported in meta-analyses of clinical trials.

Place, publisher, year, edition, pages
Cary: Oxford University Press, 2018
Keywords
bone-mineral density, induced osteoporosis, postmenopausal women, vertebral fracture, double-blind, metaanalysis, prevention, prevalence, trial, efficacy
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-141851 (URN)10.1210/jc.2017-01912 (DOI)000424934300036 ()29126139 (PubMedID)
Available from: 2017-11-14 Created: 2017-11-14 Last updated: 2018-06-09Bibliographically approved
Bergman, J., Nordström, A. & Nordström, P. (2018). Bisphosphonate use after clinical fracture and risk of new fracture. Osteoporosis International, 29(4), 937-945
Open this publication in new window or tab >>Bisphosphonate use after clinical fracture and risk of new fracture
2018 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, no 4, p. 937-945Article in journal (Refereed) Published
Abstract [en]

Summary: Among older adults with a previous fracture, treatment for osteoporosis was initially associated with a higher risk of new fracture. However, the relative risk of new fracture decreased over time, a trend that is consistent with a beneficial effect, as treatment for osteoporosis is prescribed to reduce high fracture risks.

Introduction: The purpose of this study was to examine whether bisphosphonate use is associated with a lower risk of new fracture after a clinical fracture in older adults.

Methods: Data were available for 3,329,400 adults in Sweden who were aged ae<yen> 50 years between 2006 and 2011. During this period, 260,353 sustained a clinical fracture and were naïve to bisphosphonates at the time. Those who subsequently received a bisphosphonate were matched to up to three others on sex, year of birth, and type and year of initial fracture. The final cohort comprised 83,104 adults (26.3% bisphosphonate users).

Results: During the period from initial fracture to initiation of bisphosphonate treatment, the incidence rate of any new clinical fracture was higher in those who later became bisphosphonate users than in those who remained nonusers (175.1 vs. 75.9 per 1000 person-years; hazard ratio 2.30, 95% confidence interval 2.19 to 2.41). Similarly, during the first 6 months of treatment, the incidence rate was higher in bisphosphonate users than in nonusers (128.8 vs. 90.2 per 1000 person-years; hazard ratio 1.41, 95% confidence interval 1.32 to 1.51). However, this difference decreased over time: by months 12 to 18, the incidence rate was similar in users and nonusers (59.3 vs. 55.3 per 1000 person-years; hazard ratio 1.03, 95% confidence interval 0.91 to 1.16).

Conclusions: There was a decrease in the relative risk of new fracture during bisphosphonate treatment, a trend that is consistent with a beneficial treatment effect, as bisphosphonates are prescribed to reduce high fracture risks.

Place, publisher, year, edition, pages
Springer London, 2018
Keywords
Elderly, Men, Nonvertebral, Older, Osteoporosis, Refracture
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-146426 (URN)10.1007/s00198-017-4367-7 (DOI)000427631200016 ()29397408 (PubMedID)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2018-06-09Bibliographically approved
Bergman, J., Nordström, A. & Nordström, P. (2018). Bisphosphonate use after clinical fracture and risk of new fracture: response to comments by Wu et al. [Letter to the editor]. Osteoporosis International, 29(9), 2159-2160
Open this publication in new window or tab >>Bisphosphonate use after clinical fracture and risk of new fracture: response to comments by Wu et al.
2018 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 29, no 9, p. 2159-2160Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Springer London, 2018
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-150244 (URN)10.1007/s00198-018-4615-5 (DOI)000442202800025 ()30014156 (PubMedID)
Funder
Swedish Research Council, 2016-02584
Available from: 2018-07-24 Created: 2018-07-24 Last updated: 2018-09-11Bibliographically approved
Hallkvist, O. M., Johansson, J., Nordström, A., Nordström, P. & Hult, A. (2018). Dairy product intake and bone properties in 70-year-old men and women. Archives of Osteoporosis, 13(1), Article ID 9.
Open this publication in new window or tab >>Dairy product intake and bone properties in 70-year-old men and women
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2018 (English)In: Archives of Osteoporosis, ISSN 1862-3514, Vol. 13, no 1, article id 9Article in journal (Refereed) Published
Abstract [en]

SUMMARY: In the present population-based study including 70-year-old men and women, total dairy product intake was associated with a weak positive association with tibia trabecular and cortical cross-sectional areas.

PURPOSE: Milk consumption has recently been suggested to increase fracture risk. Therefore, we aimed to investigate associations between dairy product consumption and peripheral bone properties. Furthermore, we explored whether consumption of milk and fermented dairy products affected bone properties differently.

METHODS: The Healthy Aging Initiative is a population-based, cross-sectional study investigating the health of 70-year-old men and women. Out of the 2904 individuals who met the inclusion criteria, data on self-reported daily dairy product consumption (dl/day), peripheral quantitative computed tomography (pQCT) examinations at the 4 and 66% scan sites of the tibia and radius, and dual-energy X-ray absorptiometry (DXA) scans were collected from 2040 participants. Associations between dairy product consumption and bone properties were examined using multiple linear regression models adjusted for sex, muscle area, meal size, dietary protein proportion, current smoking status, and objectively measured physical activity.

RESULTS: Total dairy product intake was associated with larger trabecular (2.296 (95% CI, 0.552-4.039) mm2, per dl/day increase, p = 0.01) and cortical cross-sectional areas (CSAs) in the tibia (1.757 (95% CI, 0.683-2.830 mm2, p = 0.001) as measured by pQCT and higher areal bone mineral density (aBMD) of the radius (3.231 (95% CI, 0.764-5.698) mg/cm2, p = 0.01) as measured by DXA. No other measurement in the tibia, radius, femoral neck, or lower spine was associated significantly with dairy product intake. Bone properties did not differ according to the type of dairy product consumed.

CONCLUSION: No evidence of a negative association between dairy product consumption and bone health was found. Furthermore, total dairy product consumption was associated with increased CSAs in the tibia, regardless of dairy product type. Collectively, our findings indicate the existence of a weak but significant positive association between dairy product consumption bone properties in older adults.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Bone mineral density, Dairy product, Older adults, Peripheral quantitative computed tomography
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-144507 (URN)10.1007/s11657-018-0420-1 (DOI)000423631300001 ()29380156 (PubMedID)
Available from: 2018-02-05 Created: 2018-02-05 Last updated: 2018-06-09Bibliographically approved
Berginström, N., Nordström, P., Ekman, U., Eriksson, J., Nyberg, L. & Nordström, A. (2018). Pharmaco-fMRI in Patients With Traumatic Brain Injury: A Randomized Controlled Trial With the Monoaminergic Stabilizer (-)-OSU6162.. The journal of head trauma rehabilitation
Open this publication in new window or tab >>Pharmaco-fMRI in Patients With Traumatic Brain Injury: A Randomized Controlled Trial With the Monoaminergic Stabilizer (-)-OSU6162.
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2018 (English)In: The journal of head trauma rehabilitation, ISSN 0885-9701, E-ISSN 1550-509XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: To examine the effects of monoaminergic stabilizer (-)-OSU6162 on brain activity, as measured by blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI), in patients in the chronic phase of traumatic brain injury suffering from fatigue.

SETTING: Neurorehabilitation clinic.

PARTICIPANTS: Patients with traumatic brain injury received either placebo (n = 24) or active treatment (n = 28). Healthy controls (n = 27) went through fMRI examination at one point and were used in sensitivity analysis on normalization of BOLD response.

DESIGN: Randomized, double-blinded, placebo-controlled design.

MAIN MEASURES: Effects on BOLD signal changes from before to after treatment during performance of a fatiguing attention task.

RESULTS: The fMRI results revealed treatment effects within the right occipitotemporal cortex and the right orbitofrontal cortex. In these regions, the BOLD response was normalized relative to healthy controls at the postintervention fMRI session. No effects were seen in regions in which we previously observed activity differences between patients and healthy controls while performing this fMRI task, such as the striatum.

CONCLUSION: (-)-OSU6162 treatment had influences on functional brain activity, although the normalized regional BOLD response was observed in regions that were not a priori hypothesized to be sensitive to this particular treatment, and was not accompanied by any effects on in-scanner test performance or on fatigue.

Identifiers
urn:nbn:se:umu:diva-152090 (URN)10.1097/HTR.0000000000000440 (DOI)30234850 (PubMedID)
Available from: 2018-09-26 Created: 2018-09-26 Last updated: 2018-09-26
Johansson, J., Hult, A., Morseth, B., Nordström, A. & Nordström, P. (2018). Self-reported protein intake and properties of bone in community-dwelling older individuals. Archives of Osteoporosis, 13(1), Article ID 10.
Open this publication in new window or tab >>Self-reported protein intake and properties of bone in community-dwelling older individuals
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2018 (English)In: Archives of Osteoporosis, ISSN 1862-3514, Vol. 13, no 1, article id 10Article in journal (Refereed) Published
Abstract [en]

SUMMARY:This study revealed that a quick and simple estimation of protein intake was related to measures of bone density and area in 70-year-old individuals. Furthermore, these associations were mediated by muscle mass when investigating peripheral measurement sites such as arms and legs.

PURPOSE: Recent evidence suggests that dietary protein is beneficial for bone health in older individuals, but less is known about the influence of muscle mass on this relationship. This cross-sectional study aimed to investigate associations among protein intake, bone health, and muscle mass in 2332 men and women aged 70 years.

METHODS: Volumetric bone mineral density of the radius and tibia was measured using peripheral quantitative computed tomography. Using dual-energy X-ray absorptiometry, we measured areal bone mineral density (aBMD) at the L1-L4 vertebrae, radius, and femoral neck, together with appendicular lean mass. Participants reported their average meal size and proportion of meat/fish intake. Associations were investigated using multiple linear regression models, adjusted for multiple covariates.

RESULTS: Self-reported protein intake was associated with aBMD of the femoral neck (β = 0.082) and L1-L4 vertebrae (β = 0.063) in men (both p < 0.05) after adjusting for multiple covariates, including appendicular muscle mass. No significant association was detected among women. In addition, protein intake was associated with tibial cortical area (β = 0.08), periosteal circumference (β = 0.072), radial aBMD (β = 0.064), and trabecular area (β = 0.078) in men (all p < 0.05), although these associations were attenuated after adjustment for appendicular muscle mass (all p > 0.05).

CONCLUSION: Self-reported protein intake was associated with bone properties in 70-year-old men. The strength of these associations in peripheral bone sites may be partially mediated by muscle mass from protein intake.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Appendicular muscle mass, Bone mineral density, Community dwelling, Peripheral quantitative computed tomography, Protein intake
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-144514 (URN)10.1007/s11657-018-0421-0 (DOI)000423810200001 ()29388047 (PubMedID)
Available from: 2018-02-05 Created: 2018-02-05 Last updated: 2018-06-09Bibliographically approved
Nordström, A. & Nordström, P. (2018). Traumatic brain injury and the risk of dementia diagnosis: A nationwide cohort study. PLoS Medicine, 15(1), Article ID e1002496.
Open this publication in new window or tab >>Traumatic brain injury and the risk of dementia diagnosis: A nationwide cohort study
2018 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 15, no 1, article id e1002496Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Traumatic brain injury (TBI) has been associated with dementia. The questions of whether the risk of dementia decreases over time after TBI, whether it is similar for different TBI types, and whether it is influenced by familial aggregation are not well studied.

METHODS AND FINDINGS: The cohort considered for inclusion comprised all individuals in Sweden aged ≥50 years on December 31, 2005 (n = 3,329,360). Diagnoses of dementia and TBI were tracked through nationwide databases from 1964 until December 31, 2012. In a first cohort, individuals diagnosed with TBI (n = 164,334) were matched with up to two controls. A second cohort consisted of subjects diagnosed with dementia during follow-up (n = 136,233) matched with up to two controls. A third cohort consisted of 46,970 full sibling pairs with discordant TBI status. During a mean follow-up period of 15.3 (range, 0-49) years, 21,963 individuals in the first cohort (6.3% with TBI, 3.6% without TBI) were diagnosed with dementia (adjusted odds ratio [OR], 1.81; 95% confidence interval [CI], 1.75-1.86). The association was strongest in the first year after TBI (OR, 3.52; 95% CI, 3.23-3.84), but the risk remained significant >30 years (OR, 1.25; 95% CI, 1.11-1.41). Single mild TBI showed a weaker association with dementia (OR, 1.63; 95% CI, 1.57-1.70) than did more severe TBI (OR, 2.06; 95% CI, 1.95-2.19) and multiple TBIs (OR, 2.81; 95% CI, 2.51-3.15). These results were in general confirmed in the nested case-control cohort. TBI was also associated with an increased risk of dementia diagnosis in sibling pairs with discordant TBI status (OR, 1.89; 95% CI, 1.62-2.21). A main limitation of the present study is the observational design. Thus, no causal inferences can be made based on the associations found.

CONCLUSIONS: The risk of dementia diagnosis decreased over time after TBI, but it was still evident >30 years after the trauma. The association was stronger for more severe TBI and multiple TBIs, and it persisted after adjustment for familial factors.

Place, publisher, year, edition, pages
Public Library of Science, 2018
National Category
Geriatrics
Identifiers
urn:nbn:se:umu:diva-144509 (URN)10.1371/journal.pmed.1002496 (DOI)000423818400017 ()29381704 (PubMedID)
Available from: 2018-02-05 Created: 2018-02-05 Last updated: 2018-06-09Bibliographically approved
Berginström, N., Nordström, P., Ekman, U., Eriksson, J., Andersson, M., Nyberg, L. & Nordström, A. (2018). Using Functional Magnetic Resonance Imaging to Detect Chronic Fatigue in Patients With Previous Traumatic Brain Injury: changes linked to altered Striato-Thalamic-Cortical Functioning. The journal of head trauma rehabilitation, 33(4), 266-274
Open this publication in new window or tab >>Using Functional Magnetic Resonance Imaging to Detect Chronic Fatigue in Patients With Previous Traumatic Brain Injury: changes linked to altered Striato-Thalamic-Cortical Functioning
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2018 (English)In: The journal of head trauma rehabilitation, ISSN 0885-9701, E-ISSN 1550-509X, Vol. 33, no 4, p. 266-274Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate whether functional magnetic resonance imaging (fMRI) can be used to detect fatigue after traumatic brain injury (TBI).

Setting: Neurorehabilitation clinic.

Participants: Patients with TBI (n = 57) and self-experienced fatigue more than 1 year postinjury, and age- and gender-matched healthy controls (n = 27).

Main Measures: Self-assessment scales of fatigue, a neuropsychological test battery, and fMRI scanning during performance of a fatiguing 27-minute attention task.

Results: During testing within the fMRI scanner, patients showed a higher increase in self-reported fatigue than controls from before to after completing the task (P < .001).The patients also showed lower activity in several regions, including bilateral caudate, thalamus, and anterior insula (all P < .05). Furthermore, the patients failed to display decreased activation over time in regions of interest: the bilateral caudate and anterior thalamus (all P < .01). Left caudate activity correctly identified 91% of patients and 81% of controls, resulting in a positive predictive value of 91%.

Conclusion: The results suggest that chronic fatigue after TBI is associated with altered striato-thalamic-cortical functioning. It would be of interest to study whether fMRI can be used to support the diagnosis of chronic fatigue in future studies.

Place, publisher, year, edition, pages
Wolters Kluwer, 2018
Keywords
fatigue, functional magnetic resonance imaging, neuropsychology, traumatic brain injury
National Category
Neurology
Research subject
Rehabilitation Medicine
Identifiers
urn:nbn:se:umu:diva-140021 (URN)10.1097/HTR.0000000000000340 (DOI)000442745900013 ()
Funder
Västerbotten County CouncilTorsten Söderbergs stiftelse
Available from: 2017-09-29 Created: 2017-09-29 Last updated: 2018-09-11Bibliographically approved
Nordström, P., Toots, A., Gustafson, Y., Thorngren, K.-G., Hommel, A. & Nordström, A. (2017). Bisphosphonate Use After Hip Fracture in Older Adults: A Nationwide Retrospective Cohort Study. Journal of the American Medical Directors Association, 18(6), 515-521
Open this publication in new window or tab >>Bisphosphonate Use After Hip Fracture in Older Adults: A Nationwide Retrospective Cohort Study
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2017 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 18, no 6, p. 515-521Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aim of this study was to investigate the association between bisphosphonate use and the risk of new fracture in a nationwide cohort of individuals with previous hip fractures, with emphasis on individuals above 80 years of age.

DESIGN, SETTING, AND PARTICIPANTS: From a nationwide cohort with hip fracture (2006-2012) (n = 93, 601), each individual prescribed bisphosphonates after hip fracture (n = 5845) was matched with up to three individuals not prescribed bisphosphonates, resulting in a cohort of 21,363 individuals.

MAIN OUTCOME MEASURE: A new hip fracture.

RESULTS: During a mean follow-up period of 2.98 (range, 0.02-8) years, 4581 fractures occurred in the cohort. Before the initiation of bisphosphonate therapy, individuals later prescribed bisphosphonates had an increased risk of hip fracture (multivariable adjusted odds ratio [OR], 2.63; 95% confidence interval [CI], 2.23-3.24) compared with controls. In the period after bisphosphonate therapy initiation, individuals prescribed bisphosphonates had a lower risk of hip fracture (multivariable adjusted hazard ratio [HR], 0.76; 95% CI, 0.65-0.90) compared with controls. Similar effects were seen after the initiation of bisphosphonates in individuals aged more than 80 years (HR, 0.79; 95% CI, 0.62-0.99). In contrast, the initiation of bisphosphonate therapy did not influence the risk of injurious falls not resulting in fracture (HR, 0.95; 95% CI, 0.86-1.05).

CONCLUSION: Bisphosphonate use was associated with a decreased risk of hip fracture in this nationwide cohort of older men and women, with similar risk reductions in individuals older than 80 years.

Keywords
Hip fractures, bisphosphonates, cohort study, older individuals
National Category
Orthopaedics
Identifiers
urn:nbn:se:umu:diva-134010 (URN)10.1016/j.jamda.2016.12.083 (DOI)000402431200009 ()28238673 (PubMedID)
Available from: 2017-04-25 Created: 2017-04-25 Last updated: 2018-06-09Bibliographically approved
Toots, A., Littbrand, H., Boström, G., Hörnsten, C., Holmberg, H., Lundin-Olsson, L., . . . Rosendahl, E. (2017). Effects of exercise on cognitive function in older people with dementia: a randomized controlled trial. Journal of alzheimers disease, 60(1), 323-332
Open this publication in new window or tab >>Effects of exercise on cognitive function in older people with dementia: a randomized controlled trial
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2017 (English)In: Journal of alzheimers disease, ISSN 1387-2877, Vol. 60, no 1, p. 323-332Article in journal (Refereed) Published
Abstract [en]

Background: Although physical exercise has been suggested to influence cognitive function, previous exercise studies show inconsistent results in people with dementia. Objectives: To investigate effects of exercise on cognitive function in people with dementia. Method: The Umea a Dementia and Exercise (UMDEX) study, a cluster-randomized controlled trial, was set in 16 nursing homes in Umea, Sweden. One hundred-and-forty-one women and 45 men with dementia; mean age of 85 y and mean MiniMental State Examination (MMSE) score of 15, were randomized to a High-Intensity Functional Exercise program or a seated attention control activity. Blinded assessors measured global cognitive function using the MMSE and the Alzheimer's disease Assessment Scale -Cognitive subscale (ADAS-Cog), and executive function using Verbal fluency (VF) at baseline and 4 months (directly after intervention completion), and MMSE and VF at 7 months. Results: Linear mixed models showed no between-group effects in mean difference from baseline (95% confidence intervals, CI) at 4 months in MMSE (-0.27; 95% CI -1.4 to 0.87, p = 0.644), ADAS-Cog (-1.04, 95% CI -4 to 1.92, p = 0.491), or VF (-0.53, 95% CI -1.42 to 0.35, p = 0.241) or at 7 months in MMSE (-1.15, 95% CI -2.32 to 0.03, p = 0.056) or VF (-0.18, 95% CI -1.09 to 0.74, p = 0.707). Conclusion: A 4-month, high-intensity functional exercise program had no superior effects on global cognition or executive function in people with dementia living in nursing homes when compared with an attention control activity.

Place, publisher, year, edition, pages
IOS Press, 2017
Keywords
Cognition, dementia, exercise, residential facilities
National Category
Physiotherapy Geriatrics
Identifiers
urn:nbn:se:umu:diva-128727 (URN)10.3233/JAD-170014 (DOI)000408582800026 ()28800328 (PubMedID)
Note

Originally published in manuscript form with title [Effects of exercise on cognitive function in older people with dementia: a randomized controlled study]

Available from: 2016-12-13 Created: 2016-12-13 Last updated: 2018-06-09Bibliographically approved
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