A pilot study for a practical screening tool for dementia: validation of 5-minute cognitive test in a geriatric population.

BACKGROUND: The aim of this study is to validate the Turkish version of the 5-minute cognitive test (FCT) in a geriatric population. MATERIALS AND METHOD: In total, 61 participants aged ≥65 years with normal cognitive functions, mild cognitive impairment (MCI), and early stage dementia were included. The FCT was compared to the standardised Mini Mental State Examination (MMSE) and the Qmci-TR (quick mild cognitive impairment) test. RESULTS: Test reliability for the FCT was strong (Cronbach's α = 0.747). We demonstrated a strong correlation of FCT scores with MMSE and Qmci-TR scores (respectively, r = 0.730, P < 0.001, r = 0.723, P < 0.001). The fact that the scores obtained in the dementia group were significantly lower also showed that the test can be used reliably in the differentiation of MCI and early dementia (P < 0.001). CONCLUSIONS: The FCT is a brief, reliable, and valid cognitive screening test for screening dementia at early stages in a Turkish geriatric population.

Relationship Between Appetite-Related Peptides and Frailty in Older Adults.

BACKGROUND: Frailty, is a geriatric syndrome that reduces the resistance to stress situations caused by activities of daily living and increases morbidity and mortality. We hypothesized that a decrease in orexigenic peptides or an increase in anorexigenic peptides might be associated with frailty. We aimed to investigate the relationship between frailty and six appetite-related peptides: ghrelin, neuropeptide Y (NPY), agouti-related peptide (AgRP), cocaine-amphetamine-associated peptide (CART), peptide YY, and alpha MSH (α-MSH). METHODS: This cross-sectional study was conducted on 85 older adults who visited the outpatient clinic. All patients underwent comprehensive geriatric assessment. Frailty status was assessed using the Fried frailty index. Plasma levels of six appetite-related peptides were studied. RESULTS: The mean age was 73.7 ± 5.4 years, 27 (31.8%) of the patients were male, and 32 of the patients (37.6%) were frail. While plasma levels of ghrelin, NPY and AgRP were significantly lower in frail patients, CART and α-MSH levels were higher compared to non-frail patients (p < .05 for all). Peptide YY was found to be higher in the frail group, however, the difference did not reach statistical significance (p = .052). In multivariate logistic regression analysis, the ghrelin, AgRP, CART, and α-MSH levels were independent predictors of frailty. Moreover, a weak correlation was found between all peptides(except NPY) and handgrip strength and Lawton-Brody score. CONCLUSION: Ghrelin, AgRP, CART, and α-MSH levels were found to be independent predictors of frailty. Our results suggest that appetite-related peptides might be playing roles in the pathogenesis of frailty. Further larger prospective studies are needed to test this hypothesis.

The relationship between the severity of insomnia and falls in the elderly.

BACKGROUND: Insomnia is associated with depression, cognitive impairment, hypertension, myocardial infarction, stroke, metabolic syndrome and prostate cancer in the elderly. The aim of this study is to investigate the relationship between severity of insomnia and falls. METHODS: This cross-sectional study was conducted in a single geriatric outpatient clinic at a university teaching hospital. Patients with active infection, who could not complete insomnia severity index (ISI) test because of cognitive impairment and who could not perform handgrip strength and timed up and go (TUG) tests were excluded from the study. RESULTS: A total of 215 patients were included in this study. Logistic regression analysis showed that there is significant relationship between poorer TUG performance, mild insomnia, moderate insomnia, severe insomnia and falls in the elderly (odds ratio (OR) = 1.04, CI: 1.00-1.09, P = 0.041, OR = 2.43, CI: 1.22-4.85, P = 0.011, OR = 3.84, CI:1.35-10.94, P = 0.012, OR = 5.81, CI:1.00-33.72, P = 0.050). CONCLUSIONS: In this study we showed that there is a relationship between the severity of insomnia and falls.

Predictive ability of the G8 screening test to determine probable sarcopenia and abnormal comprehensive geriatric assessment in older patients with solid malignancies.

BACKGROUND: Pre-treatment evaluation for sarcopenia is recommended in cancer patients. New screening tests that are less time-consuming and can identify patients who will potentially benefit from geriatric assessment are being developed; the G8 geriatric screening test is one such example. We aimed to investigate whether the G8 screening test can detect probable sarcopenia and is valid and reliable compared to a comprehensive geriatric assessment (CGA) in Turkish older adults with solid cancers. METHODS: We included solid cancer patients referred to a single center. Probable sarcopenia and abnormal CGA were defined as low handgrip strength. Cut-offs for handgrip strength in the Turkish population have been previously determined to be 32 kg for males and 22 kg for females and impairment in at least one of the CGA tests, respectively. The CGA tests comprised KATZ Basic Activities of Daily Living Scale Lawton-Brody Instrumental Activities of Daily Living Scale, Mini-Mental-State Examination Scale, Geriatric Depression Scale-15, and Mini-Nutritional Assessment Short Form. Receiver operating characteristic curve analyses evaluated the test's predictive ability. Intra-rater and inter-rater reliabilities were assessed. RESULTS: The median age of the 76 patients included was 72 (65-91) years. There was a moderate correlation between handgrip strength and the G8 test total score. The sensitivity and specificity of the G8 test to detect probable sarcopenia alone (cut off score = 12.5) were 50 and 92%, respectively (AUC: 0.747; p < 0.001); to determine abnormal CGA plus probable sarcopenia (cut off score = 13) were 93.33 and 86.89%, respectively (AUC: 0.939; p < 0.001); and to detect abnormal CGA alone (cut off score = 14) were 79.63 and 95.45%, respectively (AUC: 0.893; p < 0.001). The G8 test results agreed with those of CGA (κ = 0.638; p < 0.001). Both inter- and intra-rater assessments of G8 scores revealed a strong agreement (Interclass correlation coefficient = 0.979, p < 0.001 and ρ = 0.994, p < 0.001, respectively). CONCLUSIONS: The Turkish version of the G8 test is a good screening tool to detect probable sarcopenia alone and in conjunction with abnormal CGA in older patients with solid malignancies. The G8 screening tool may thus be useful in detecting probable sarcopenia in Turkish older adults with solid cancers.

Pericardial, pleural and peritoneal involvement in a patient with primary gastric mantle cell lymphoma.

Primary gastric mantle cell lymphoma is a rare form of gastointestinal tumour. Although peritoneal carcinomatosis accompanied by malignant ascites is relatively common, mantle cell lymphoma presenting with ascites is rare. Also, effusions involving pericardial and pleural cavities are uncommon during the course of lymphomas. We report the first case in which pericardial, pleural and peritoneal effusion of a primary gastric mantle cell lymphoma.

The role of thiol-disulfide homeostasis and ischemia-modified albumin in osteosarcopenia.

BACKGROUND: Oxidative stress results from an imbalance between the induction of reactive oxygen species and the ability of cells to metabolize them. Numerous markers can be used to assess the level of oxidative stress. Thiol-disulfide homeostasis (TDH) and ischemia-modified albumin (IMA) are some of them. The aim of this study is to investigate the role of TDH and IMA, which are indicators of oxidative stress, in older patients with osteosarcopenia (OS). METHODS: The study was conducted cross-sectionally in a geriatrics outpatient clinic. Patients who applied to the outpatient clinic for three months were included in the study. Patients with acute infection, delirium, malignancy, severe liver, heart or kidney dysfunction and who did not give their consent for the study were excluded from the study. The study was conducted with 136 patients. Sarcopenia was diagnosed according to muscle ultrasonography (USG) and handgrip strength (HGS) results. Osteopenia/osteoporosis was diagnosed according to bone mineral densitometry (BMD) results. The combination of osteopenia/osteoporosis and sarcopenia was accepted as OS. RESULTS: Native thiol, total thiol value and nativethiol /totalthiol*100 values were significantly lower in the group with OS (respectively; value = 265 ± 53.8 standard deviation (SD) µmol/L, p = ≤ 0.001; value = 295.33 ± 55.77 SD µmol/L, p = 0.001; value = 90.06 (2.8) interquartile ranges (IQR), p = 0.033). Disulfide/native thiol*100 and disulfide/total thiol*100 values were significantly higher in the group with OS (respectively; value = 5.5 (1.7) IQR, p = 0.033; value = 4.97 (1.4) IQR, p = 0.034). CONCLUSION: In our study, the role of oxidative stress in OS was demonstrated by using TDH as an oxidative stress parameter.

Physical frailty is related to oxidative stress through thiol/disulfide homeostasis parameters.

AIM: To evaluate relationship between frailty and oxidative stress through thiol/disulfide homeostasis parameters [Native thiol (NT), total thiol (TT), and disulfide levels (D), disulfide-native thiol (D/NT), disulfide-total thiol (D/TT), native thiol-total thiol (NT/TT) ratios, and ischemia-modified albumin levels (IMA)]. MATERIALS AND METHODS: In total, 139 community-dwelling older adults were included. The frailty status, defined by the FRIED frailty index (FFI) and Clinical Frailty Scale (CFS), and comprehensive geriatric assessment results compared with thiol/disulfide homeostasis parameters and ischemia-modified albumin levels. RESULTS: NT and TT levels were significantly lower in the frail group (respectively; p = 0.014, p = 0.020). The FFI scores were correlated with the levels of NT, TT, D/NT, D/TT, and NT/TT (respectively; r = - 0.25, r = - 0.24, r = 0.17, r = 0.17, r = - 0.17). The significant correlation could not be retained with the CFS scores. In ROC analysis, the AUC for NT was calculated as 0.639 in diagnosing frailty according to the FFI (95% CI 0.542-0.737), AUC was 0.638 for TT (95% CI 0.540-0.735), and AUC was 0.610 for NT/TT (95% CI 0.511-0.780). The AUC was calculated as 0.610 for both D/NT and D/TT in diagnosing physical frailty (95% CI 0.511-0.708). CONCLUSION: Thiol/disulfide homeostasis parameters can be a potential biomarker in diagnosing physical frailty. However, further studies are needed for diagnosing frailty defined with cumulative deficit models.

Elasticity of leg muscles and incidence of falls in older adults: a prospective cohort analysis.

PURPOSE: Aging impacts muscle strength and elasticity, which in turn influence dynamic balance, walking speed, and physical performance. We aimed to evaluate the relationship between the elasticity of leg muscles and incidence of falls in older adults. METHODS: We conducted a prospective cohort analysis with outpatients from a geriatric clinic. Any history of falls in the past year was recorded. Timed up and go test, muscle thickness, and handgrip strength tests were performed. Elasticities of the gastrocnemius medialis (GM) and rectus femoris (RF) muscles were evaluated using shear wave elastography. Patients self-recorded their falls, and additional phone calls were made to them each month for 6 months. RESULTS: The median age of the patients (n = 55) was 72 years (66-86); and 72% were women. The GM showed significantly lower elasticity in patients with history of falls in the past year than in those without it (8.08 kPa [3.90-16.17] vs. 9.70 kPa [4.99-20.95]; p = 0.028). A similar negative correlation between GM and fall incidence was noted among those with additional falls during the follow-up period (6.96 kPa [3.90-12.41] vs. 9.13 kPa [4.99-20.95]; p = 0.019). GM elasticity was significantly correlated with the timed up and go test score (r = - 0.612, p < 0.001), handgrip strength (r = 0.384, p = 0.015), and muscle thickness (r = 0.232, p = 0.049). No such associations were observed for the RF muscles. CONCLUSION: GM muscle elasticity is associated with alterations in muscle structure that may lead to falls in older adults. Therefore, muscle elasticity may be a fall predictor in older adults.

NRS-2002 and mNUTRIC score: Could we predict mortality of hematological malignancy patients in the ICU?

BACKGROUND: Malnutrition is a problem that greatly affects patients with hematological malignancy (HM) throughout the course of illness. Intensity of the malignancy treatment, inadequate energy intake, complex procedures such as hematopoietic stem cell transplantation, and treatment side effects are contributing factors for malnutrition in HM patients. The aim of this study was to compare the accuracy of the modified Nutrition Risk in Critically Ill (mNUTRIC) score and Nutrition Risk Screening 2002 (NRS-2002) in predicting hospital and long-term mortality of HM patients in the intensive care unit (ICU) and to identify effects of malnutrition on ICU mortality. METHODS: This prospective observational cohort study was conducted in a university teaching hospital tertiary ICU service. During the study period, 112 HM patients who were >18 years old were admitted to the ICU. We excluded the patients who were discharged or died within 24 h from the statistical analysis. The patients were followed for 3 years after discharge for long-term mortality. RESULTS: Twenty-nine patients died within 24 h of admission and were excluded from the study; therefore, statistical analysis was done for 81 patients. Logistic regression analysis demonstrated that high malnutrition risk, according to the NRS-2002 score, was associated with greater odds of ICU mortality (P = 0.002, odds ratio = 19.16). CONCLUSION: In this study, we showed that NRS-2002 is superior to mNUTRIC score in predicting ICU mortality in patients with HMs. mNUTRIC score and NRS-2002 were not superior to each other in predicting long-term mortality.

The role of muscle ultrasound to predict sarcopenia.

OBJECTIVES: This study aimed to provide data about the role of muscle ultrasound (US) to predict sarcopenia. METHODS: A total of 313 geriatric outpatients (age ≥65 y) were enrolled in the study. After a comprehensive geriatric assessment, anthropometric measurement and handgrip strength (HGS) data were obtained and a bioelectrical impedance analysis was performed. Sarcopenia was diagnosed using HGS and bioelectrical impedance analysis data. Gastrocnemius medialis (GC), rectus femoris (RF), and rectus abdominis (RA) muscle thickness as well as the RF cross-sectional area (CSA) were measured with US. The role of muscle US to predict sarcopenia was defined with a receiver operating characteristics analysis. RESULTS: The prevalence of probable and confirmed sarcopenia were 43.8% (n = 137) and 13.4% (n = 42), respectively. All muscle US parameters had positive correlations with both HGS and the fat-free mass index. There were inverse correlations between all muscle US parameters and the five-item sarcopenia questionnaire. The RF CSA had stronger correlations with the five-item sarcopenia questionnaire, HGS, and the fat-free mass index than others. The values of GC, RF, and RA muscle thickness and the RF CSA to predict sarcopenia for women/men were 13.9/13.8 mm (area under the curve [AUC]: 0.817/0.707 mm), 13/15.5 mm (AUC: 0.760/0.736 mm), 4.3/5.2 cm2 (AUC: 0.766/0.773 cm2), and 6.6/7.0 mm (AUC: 0.740/0.688 mm), respectively. CONCLUSIONS: GC, RF, and RA muscle thickness and the RF CSA all may predict sarcopenia accurately in geriatric outpatients.

Ultrasonografically assessed osteosarcopenic obesity is associated with frailty in community-dwelling older adults.

OBJECTIVES: Osteosarcopenic obesity (OSO; also known as adiposity) is the combination of three critical conditions. This study aimed to define OSO using muscle ultrasonography (US), and examine the relationship between OSO and frailty compared with its constituent components. METHODS: A total of160 geriatric patients with a body mass index of ≥30 were enrolled in the study. We obtained US measurements of the rectus femoris thickness and cross-sectional area (RFCSA). OSO was defined as the combination of low muscle function (defined by handgrip strength <27 kg in men and <16 kg in women), low muscle mass (RFCSA ≤5.22 cm2), and the clinical diagnosis of osteoporosis. The modified Fried Frailty Index and Clinical Frailty Scale were used to identify frailty. RESULTS: The median age of participants was 72 y, and 83% (n = 137) were female. Patients were divided into four categories: Obese (n = 72; 43.6%), osteoporotic obese (n = 44; 26.7%), sarcopenic obese (n = 19; 11.5%), and osteosarcopenic obese (n = 25; 15.2%). In the subgroup analysis, the prevalence of frailty was significantly higher in the OSO group than in the other groups on both frailty scales (P < 0.05). The regression analysis showed that OSO significantly increased frailty status when adjusted for confounders detailed in Table 1 (Fried Frailty Index: odds ratio: 5.10; 95% confidence interval, 1.669-15.132; P = 0.004; Clinical Frailty Scale: odds ratio: 3.765; 95% confidence interval, 1.236-11.465; P = 0.020). CONCLUSIONS: US-defined OSO is strongly associated with frailty in older adults according to the first study to define OSO using RFCSA measures.

Validity and reliability of the G8 screening test in older non-cancer patients.

PURPOSE: A comprehensive geriatric assessment (CGA) is a time-consuming approach that requires a special team and a screening test, whereas the G8 screening test is a practical and validated test for screening cancer patients. This study aimed to evaluate the validity and reliability of the G8 test in older patients without cancer and to investigate its concordance with CGA in an outpatient clinic. METHODS: Two hundred older patients were included in the study. CGA and G8 tests were performed, and the concordance between them was evaluated for scale validity using Spearman correlation coefficients (r) and kappa analyses. Patients who obtained scores lower than the predefined cutoff values in at least one of the CGA tests were considered to have an abnormal CGA. Inter-rater and intra-rater concordance were assessed for reliability. RESULTS: Of the 200 patients, 57.4% were female, and the median age was 73 (63-93) years. There was a strong concordance between the CGA and G8 screening test (kappa: 0.630; p < 0.001). Inter-rater and intra-rater concordance in the reliability assessments were high (kappa: 0.886; kappa: 875; p < 0.001, respectively), and inter- and intra-clinician assessments of the G8 scores revealed significant correlations (r = 0.962 and r = 0.976, respectively; p < 0.001). CONCLUSION: The G8 screening test is a valid and reliable tool for older adults without malignancy. It is a quick and practical test for physicians who frequently admit older patients.

Relationship between psychological pain and death anxiety with comprehensive geriatric assessment in older adults.

AIM: Psychological pain refers to the torment that results from adverse experiences, such as loneliness, guilt, frustration, hopelessness or loss. Psychological pain may impair physical and psychosocial functioning of older adults. Death anxiety is associated with cognitive function deterioration, change to social environment and increased risk of depression. This study investigated associations among components of comprehensive geriatric assessment (CGA), death anxiety and psychological pain. METHODS: In total, 100 patients aged ≥65 years were included in this study. Demographic characteristics and CGA test scores were examined. The Templer scale was used to evaluate death anxiety; the Psychache scale was used to evaluate psychological pain. Multivariate logistic regression analysis was performed to identify parameters independently associated with poor cognitive performance and death anxiety. RESULTS: The patients' median age was 73 (65-92) years. Death anxiety was detected in 34% of patients. Psychological pain and death anxiety levels were significantly associated with Mini-Mental State Examination, clock drawing test, Geriatric Depression Scale-15 and Instrumental Activities of Daily Living (IADL) scores. Psychological pain levels were independently associated with cognitive performance. Finally, psychological pain and IADL scores were independently associated with death anxiety. CONCLUSIONS: During a CGA, practitioners should note that psychological pain and death anxiety may negatively affect cognitive function and IADL scores. Patients should be re-evaluated, following suitable psychotherapeutic interventions. Geriatr Gerontol Int 2020; 20: 1056-1060..

A Pregnant Woman Who Underwent Laparoscopic Adrenalectomy due to Cushing's Syndrome.

Cushing's syndrome (CS) may lead to severe maternal and fetal morbidities and even mortalities in pregnancy. However, pregnancy complicates the diagnosis and treatment of CS. This study describes a 26-year-old pregnant woman admitted with hypertension-induced headache. Hormonal analyses performed due to her cushingoid phenotype revealed a diagnosis of adrenocorticotropic hormone- (ACTH-) independent CS. MRI showed a 3.5 cm adenoma in her right adrenal gland. After preoperative metyrapone therapy, she underwent a successful unilateral laparoscopic adrenalectomy at 14-week gestation. Although she had a temporary postoperative adrenal insufficiency, hormonal analyses showed that she has been in remission since delivery. Findings in this patient, as well as those in previous patients, indicate that pregnancy is not an absolute contraindication for laparoscopic adrenalectomy. Rather, such surgery should be considered a safe and efficient treatment method for pregnant women with cortisol-secreting adrenal adenomas.