Sarcopenia is associated with mortality in non-critical elderly patients visiting the emergency department.

Introduction: Geriatric syndrome (GS) increases risk of disability and mortality in older adults. Sarcopenia is a predominant illness of GS and accelerate its progression. This study aimed to investigate associations between mortality, emergency department (ED) re-visits and GS-related illnesses among older adults who visited the ED. Method: This retrospective observational study enrolled elderly patients who visited the ED in our hospital between January 2018 and October 2020. Patients were evaluated for potential sarcopenia, which was defined by both low handgrip strength and calf circumference. Follow-up was at least 6 months. Data of age, gender, mortality, ED re-visits, and GS-related illnesses were collected and analyzed for associations. Results: A total of 273 older adults aged 74 years or older were included, of whom 194 were diagnosed with possible sarcopenia. Older adults with possible sarcopenia also had significantly lower body mass index (BMI); a higher proportion needed assistance with daily activities; more had malnutrition, frailty, and history of falls (all p < 0.001) and acute decline in activities of daily living (p = 0.027). Multivariate analysis showed that possible sarcopenia [adjusted hazard ratio, aHR): 9.89, 95% confidence interval (CI): 1.17-83.81, p = 0.036], living in residential institutions (aHR: 2.85, 95% CI: 1.08-7.50, p = 0.034), and frailty (aHR: 7.30, 95% CI: 1.20-44.62, p = 0.031) were associated with mortality. Aged over 85 years (adjusted odds ratio: 2.44, 95% CI: 1.25-4.80, p = 0.02) was associated with ED re-visits. Conclusion: Sarcopenia is associated with mortality among older adults who visit ED. Initial screening for sarcopenia and relevant risk factors among older adults in the ED may help with early intervention for those at high-risk and may improve their prognosis.

Spontaneous spinal epidural hematoma: a case report and review of the literatures.

PURPOSE: To emphasize the importance of early recognition and emergent surgery for spontaneous spinal epidural hematoma (SSEH). CASE REPORT: A 61-year-old female presented with sudden onset of severe neck and back pain after finishing worshiping Buddha followed by quadriparesis, sensory deficits below C4 level and sphincter dysfunction. MR imaging demonstrated acute extensive epidural hematoma of cervico-thoracic spinal segments (C2-T7). Idiopathic SSEH was diagnosed and emergent decompressive laminectomy with hematoma evacuation was performed within 12 hours of symptoms onset. Good functional and neurological outcomes were obtained. CONCLUSION: SSEH is a rare but disabling or even fatal entity. Early diagnosis and prompt surgery improve the neurological and functional outcome but still remain a clinical challenge. Relevant physicians should pay attention to the typical symptoms of the rare entity and SSEH should be one of differential diagnoses.

CDK5 phosphorylates eNOS at Ser-113 and regulates NO production.

Phosphorylation of endothelial nitric oxide synthase (eNOS) is key mechanism in response to various forms of cellular stimulation. Through protein nitration by peroxynitrite, eNOS is believed to be responsible for the major abnormalities in several important neurodegenerative diseases including Alzheimer's (AD) and Parkinson's diseases (PD). Recent studies provide important in vivo evidence that hyperactivation of Cdk5 by p25 plays an essential role in the cell death of neurons in experimental models of AD and PD. This study focuses on the functional regulation of eNOS by Cdk5/p35 complex in a phosphorylation dependent manner. Our results showed that Cdk5 can phosphorylate eNOS both in vitro and in vivo. In vitro kinase assay together with the bioinformatic analysis and site direct mutagenesis revealed that Ser-113 is the major phosphorylation site for Cdk5. Most interestingly, the nitrite production was significantly reduced in eNOS and Cdk5/p35 co-transfected SH-SY5Y cells when compared with co-transfection of Cdk5/p35 and S113A. Together, our data suggest that Cdk5 can phosphorylate eNOS at the Ser-113 site and down-regulate eNOS-derived NO levels.

Increased total TAU but not amyloid-beta(42) in cerebrospinal fluid correlates with short-term memory impairment in Alzheimer's disease.

Given the need for tools for early and accurate diagnosis, prediction of disease progression, and monitoring efficacy of therapeutic agents for AD, the study of cerebrospinal fluid (CSF) biomarkers has become a rapidly growing field of research. Several studies have reported conflicting data regarding the relationships between CSF biomarkers and dementia severity. In this study, we have focused on the identification of CSF biomarkers and their correlations with the impairment of different cognitive domains measured using the Cognitive Abilities Screening Instrument (CASI). Patients with AD (n=28), non-AD dementia (n=16), other neurological disorders (OND, n=14), and healthy controls (HC, n=21) were enrolled. Our results revealed significantly higher CSF total tau (t-tau) and lower amyloid-beta(42) levels in AD patients compared with those in HC and OND groups. Moreover, our data show that CSF t-tau levels, but not Abeta(42) levels, have an inverse correlation with the score of short-term memory in CASI for patients with AD (Spearman: r=-0.444; p=0.018). This data might indicate that the higher CSF t-tau level is associated with more NFT pathology and more severe impairment of short-term memory in AD patients.

The binding and phosphorylation of Thr231 is critical for Tau's hyperphosphorylation and functional regulation by glycogen synthase kinase 3beta.

Neuropathological hallmarks of Alzheimer's disease are extracellular senile plaques and intracellular neurofibrillary lesions. The neurofibrillary lesions mainly consist of the hyperphosphorylated microtubule-associated protein Tau predominantly expressed in the axon of CNS neurons. Hyperphosphorylation of Tau negatively affects its binding to tubulin and decreases the capacity to promote microtubule assembly. Among a number of proline-directed kinases capable of phosphorylating paired helical filament-Tau, glycogen synthase kinase 3beta (GSK3beta) was first identified as a Tau protein kinase I and has been demonstrated to phosphorylate Tau both in vivo and in vitro. However, the phosphorylation mechanism of Tau by GSK3beta remained unclear. In this study, we show that the T231 is the primary phosphorylation site for GSK3beta and the Tau227-237 (AVVRTPPKSPS) derived from Tau containing T231P232 motif is identified as the GSK3beta binding site with high affinity of a Kd value 0.82 +/- 0.16 mumol/L. Our results suggest that direct binding and phosphorylation of T231P232 motif by GSK3beta induces conformational change of Tau and consequentially alters the inhibitory activity of its N-terminus that allows the phosphorylation of C-terminus of Tau by GSK3beta. Furthermore, hyperphosphorylation reduces Tau's ability to promote tubulin assembly and to form bundles in N18 cells. T231A mutant completely abolishes Tau phosphorylation by GSK3beta and retains the ability to promote tubulin polymerization and bundle formation. Taken together, these results suggest that phosphorylation of T231 by GSK3beta may play an important role in Tau's hyperphosphorylation and functional regulation.

Central vasomotor failure in a patient with medulla arteriovenous fistula.

We report on the case of a 60-year-old man who suffered from hiccup, dysphagia and unsteady gait for three months. He was diagnosed with intracranial dural arteriovenous fistula in medulla with retrograde perimedullary vein drainage. He developed quadriplegia, persistent shock status and symptomatic bradycardia immediately after a conventional cerebral angiography study. After excluding cardiogenic, hypovolemic, anaphylactic and septic shock, central vasomotor failure caused by venous thrombosis of the lesion was considered. The patient's central vasomotor failure recovered after continuous dopamine infusion treatment for 42 days. We concluded that venous hypertension with venous thrombosis in rostral ventrolateral medulla (RVLM), a major vasomotor center in the brainstem, was the lesion site. In our case, vasomotor dysfunction caused by an RVLM lesion related to venous thrombosis is considered as causative.

Psychiatric morbidity in dementia patients in a neurology-based memory clinic.

The behavioral and psychological symptoms of dementia (BPSD) often present major problems for patients and their caregivers. In the past, neurologists paid less attention to such symptoms than to the cognitive symptoms of dementia. This prospective study investigated the prevalence of psychiatric morbidity in a neurology-based memory clinic and the stress of caregivers. Our patients with dementia were found to have a high prevalence of BPSD. The most frequent were anxiety, apathy, and delusion; the most distressing to caregivers were agitation, anxiety, delusion, and sleep disturbance. Using Clinical Dementia Rating (CDR), we compared BPSD between patients with mild dementia and those with moderate dementia. Only hallucinations and agitation were different significantly. Moderate dementia patients experienced these symptoms more frequently. The high prevalence of these symptoms might be explained by the fact that the cognitive symptoms were neglected or no enough information were received by many family members of patients with dementia until their own life quality was interfered and then they began to seek medical help. These symptoms and their effect of caregiver distress can be effectively reduced by pharmacologic and nonpharmacoloic managements, caregiver-focused training and education. They can be better approached by assessing neuropsychiatric symptoms regularly, educating the general population better, and treating these patients earlier.

Sensory nerve conduction studies of the superficial peroneal nerve in L5 radiculopathy.

BACKGROUND: Theoretically, sensory nerve action potential (SNAP) of the superficial peroneal nerve (SPN) should be preserved when L5 roots are damaged. Previous study indicated that SNAP of SPN was lost or reduced in amplitude in patiens with L5 radiculopathy. To address this issue, this study compared results of SPN sensory conduction studies between healthy subjects and patients with L5 radiculopathy. METHODS: Ninety-four healthy subjects were enrolled and assigned to two age groups: group I (< or = 60 years, n=61) and group II (> 60 years, n=33). Forty-one patients with unilateral L5 radiculopathy were enrolled by our electrodiagnostic laboratory between July 2000 and July 2003 and assigned to two age groups: 60 years or below (n=19) and above 60 years (n=22). RESULTS: SPN response was found to be abnormal in only 1.6% of group I healthy subjects, but absent or abnormal SPN response was noted in 21.1% of patients with L5 radiculopathy of the same age group (p=0.01). However, a greater proportion of (27.3%) our healthy subjects above 60 years had abnormal SPN responses. This proportion was similar to that of patients with L5 radiculopathy and abnormal SPN response (31.8%) (p=0.72). CONCLUSIONS: SPN sensory responses are reliably obtained in most healthy subjects under 60 years of age. Absence of SNAP or reduced SNAP amplitude of SPN on the side of their lesions did not necessarily exclude the diagnosis of L5 radiculopathy in the patients under 60 years of age.

Lobar cerebral hemorrhage from amyloid angiopathy: clinical, neuroimaging, pathologic and outcome correlations.

Cerebral amyloid angiopathy (CAA) contributes to sporadic lobar intracerebral hemorrhage in older patients, especially those who are more than 70 years old. In clinical practice, a diagnosis of CAA refers to the Boston Criteria, which requires that "definitive" cases be confirmed by pathologic evidence at autopsy. A "Probable" case, means that there is clinical support and that pathologic evidence is available by biopsy from the craniotomy for patients with severe lobar intracerebral hemorrhage. Cerebral amyloid that is deposited in cortical vessels is revealed by apple-green birefringence under polarized light using Congo-red stain. Rebleeding after a first primary intracerebral hemorrhage is common. This paper describes five cases of aged patients with lobar cerebral hemorrhage and craniotomy with hematoma evacuation and biopsy. Pathological results all showed amyloid angiopathy. Various outcomes are discussed, and the literature is reviewed. Findings show that although patients with CAA were at high risk of recurrent hemorrhage after surgery, the mortality rate was relatively low despite the severity of lobar intracerebral hemorrhage.

Stroke registry in Kaohsiung Veterans General Hospital.

BACKGROUND: Stroke ranks as the second major cause of death in Taiwan. For better understanding of stroke characteristics in southern Taiwan and to provide further information to other studies of stroke, we reviewed the clinical data of our in-patients with acute stroke. METHODS: Patients who were admitted to our hospital due to acute stroke between January 1999 and December 1999 were enrolled in our study. We used a stroke registration form to collect clinical data, including laboratory data, stroke subtype, risk factors, neurosonographic result, treatment, related complications, and Rankin Scale. Chi-square test was used to compare clinical parameters among the stroke patients. RESULTS: A total of 578 patients with acute stroke were enrolled in our study. Among 578 patients, 408 (71%) patients were of ischemic stroke and 170 (29%) patients were of hemorrhagic stroke type. In the ischemic stroke group, the prevalence rate of risk factors were hypertension (71%), intracranial arterial stenosis (41%), diabetes mellitus (37%), current smoking (30%), hyperlipidemia (30%), atrial fibrillation (15%) and extracranial carotid stenosis (15%). Hypertension (79%) and diabetes (17%) were also major risk factors in hemorrhagic stroke patients. The in-hospital case-fatality rate for ischemic stroke (8.8%) was less than that for hemorrhagic stroke (20.6%). CONCLUSIONS: The proportion of hemorrhagic stroke in our acute stroke patients was higher in comparison to western countries. Hypertension, diabetes, smoking and hyperlipidemia were major modifiable risk factors in ischemic stroke. Better control of such risk factors is an important issue in either primary or secondary prevention of stroke. In our study, intracranial arterial stenosis (41%) was more common than extracranial carotid stenosis (15%). The result was different from western stroke registration. The cause is worth further study.