The effect of black mulberry (Morus nigra) consumption on cognition in patients with mild-to-moderate Alzheimer's dementia: A pilot feasibility study.

The purpose of this study was to test the feasibility and the possible effects of black mulberry on cognitive functions in Alzheimer's disease (AD). A total of 39 participants aged 65+ with mild-to-moderate AD were involved and 20 subjects were administered 20g of black mulberry concentrate daily for 12 weeks (intervention group), while 19 received no intervention (control group). Cognitive assessment utilized with Mini-Mental State Examination (MMSE) and AD Assessment Scale-Cognitive Subscale (ADAS-Cog) tests; Geriatric Depression Scale (GDS-15) used for depression screening. At the end of the study, although MMSE scores decreased (p = 0.003) and GDS-15 scores increased (p = 0.034) in control group, there was no change in intervention group. On the contrary, ADAS-Cog scores decreased in intervention group (p = 0.002) while the control group showed no improvement. This study showed that treatment of black mulberry (Morus nigra) for 12 weeks may slightly improve cognitive function in patients with AD.

Prevalence and risk factors of mild cognitive impairment in a tertiary care setting in Turkey.

BACKGROUND: Mild cognitive impairment (MCI) is an intermediate stage between healthy cognition and dementia, particularly Alzheimer's disease. There is limited information on the prevalence of MCI among older Turkish adults. This study aimed to determine the prevalence and risk factors of MCI in Turkey. MATERIAL AND METHODS: A cross-sectional study was conducted with community-dwelling older people who were admitted to a tertiary geriatric outpatient clinic. Information on demographics and clinical variables was obtained. We used a neuropsychological battery to assess the cognitive domains in each subject. Participants who fell below 1.5 standard deviations on 1 or more of the 5 cognitive tests were considered MCI and were classified as either single domain MCI and multiple domain MCI. Risk factors were determined using univariate and multivariate logistic regression analyses. RESULTS: A total of 259 participants were enrolled in this study. The mean age was 74.0 years (SD 7.1 years), 54% were women, and 48.3% had a low level of education (≤ 5 years). The overall prevalence of MCI was 52.1%, with 27.8% for single domain MCI and 24.3% for multiple domain MCI. The prevalence of MCI increased with age: 16.4% aged 65-74 years, 32.0% aged 75-84 years, and 40.9% ≥ 85 years. Advanced age and low educational level were risk factors for both single domain MCI (OR = 1.07; 95% CI: 1.02-1.13; p = 0.003 and OR = 3.18; 95% CI:1.7-6.1; p < 0.001) and multiple domain MCI (OR = 1.1; 95% CI:1.1-1.2; p < 0.001 and adjusted OR = 11.9; 95% CI:5.1-27.8; p < 0.001). CONCLUSION: MCI was common in older Turkish people admitted to a tertiary hospital, especially in those with advanced age and low educational level.

Investigating the association of anticholinergic burden with depression in older adults: a cross-sectional study.

BACKGROUND: Although depression and anticholinergic drug use are common comorbidities that impair health status in later life, there are insufficient data on their relationship. This study aimed to investigate the relationship between depressive symptoms and anticholinergic use in older individuals. METHODS: Community-dwelling older adults (≥65 years) admitted to the tertiary referral geriatric outpatient clinic were included. Participants were evaluated for depressive symptoms using the Geriatric Depression Scale (GDS) with a cut-off score of ≥6 for depression. Exposure to anticholinergic drugs was assessed using the anticholinergic cognitive burden (ACB) scale and three subgroups were created: ACB = 0, ACB = 1, and ACB ≥ 2. The relationship between these two parameters was assessed using multivariate logistic regression analysis considering other potential variables. RESULTS: The study included 1232 participants (mean age 78.4 ± 7.2 years and 65.2% female) and the prevalence of depression was 24%. After adjusting for potential confounders, compared to ACB = 0, having ACB ≥ 2 was related to depression symptoms (odds ratio (OR): 1.56, 95% CI: 1.04-2.35, P = 0.034), whereas having ACB = 1 did not increase the risk (OR: 1.27, 95% CI: 0.88-1.83, P = 0.205). CONCLUSION: Our findings indicate that special attention should be paid to drug therapy in preventing depression in older adults, as exposure to a high anticholinergic load is negatively associated with psychological status.

Predictors of two-year mortality in patients with dementia with Lewy bodies.

BACKGROUND: Data on adverse prognostic factors for mortality in patients with dementia with Lewy bodies (DLB) are limited. The objective of this study was to evaluate two-year mortality predictors in patients with DLB. METHODS: : Individuals aged ≥ 60 years with a diagnosis of DLB, followed by a tertiary-referral geriatric outpatient clinic from 2006 to 2021, were assessed retrospectively using medical or patient records. The mortality status of the patients in the second year after diagnosis was determined. Demographic and clinical characteristics were reviewed to determine their impact on mortality prediction. RESULTS: A total of 108 patients with DLB participated in this study. The mean age was 78.9 ± 6.6 years, and 49.1% were females. At the end of the two-year follow-up, 23 patients (21.3%) died and 85 patients (78.7%) were still alive. Malnutrition, and cognitive and functional impairments were significantly more common in the mortality group. Age, female sex, functional impairment, moderateto-severe clinical dementia rating, and malnutrition were associated with an increased mortality risk. On the multivariable analysis, malnutrition (HR = 5.00; 95% CI: 1.64-15.24; p: 0.005) was the only independent predictor of two-year-mortality. DISCUSSION: Patients with DLB had an unfavorable survival outcomes. Approaches to prevent malnutrition can improve prognosis and reduce early mortality in this vulnerable group. However, further studies are needed to determine mortality risk factors in this population.

Reliability and validity of the Turkish version of the elder abuse suspicion index in community-dwelling older adults.

BACKGROUND: Elder abuse is among the most important ethical issue during the management of older population. The elder abuse suspicion index (EASI) was developed for evaluating abuse in older adults. We aimed to assess the reliability and validity of the Turkish version EASI-Türkiye (TR) among older adults. METHODS: This study included 89 community-dwelling older adults. The EASI-TR and other scales, including HwalekSengstock Elder Abuse Screening Test-Türkiye (HS/EAST-TR), YGDS, Yesavage Geriatric Depression Scale (YGDS), Instrumental Activities of Daily Living (IADL), and Activities of Daily Living (ADL) were administered to all participants. Internal consistency and external validity were assessed. RESULTS: EASI-TR revealed an excellent test-retest reliability and acceptable level of internal consistency (Cronbach's α = 0.711). The item-total correlations ranged between 0.296 and 0.701, except for the second item. This test showed significant correlations with the HS/EAST-TR and IADL (p < 0.05), demonstrating good external validity. DISCUSSION: The EASI-TR appears to have acceptable reliability and validity in screening for abuse in older adults. This tool may recognize cases that require additional evaluation in managing of ethical issues.

Could neutrophil-to-lymphocyte ratio predict mortality in community-dwelling older people with delirium superimposed on dementia?

BACKGROUND: Delirium superimposed on dementia (DSD) is associated with adverse outcomes in older adults. Nonetheless, little is known about the association between inflammatory markers and clinical outcomes of DSD. AIMS: This research investigated the predictive value of the neutrophil-to-lymphocyte ratio (NLR) for short- and long-term mortality among community-dwelling older adults with DSD. METHODS: This retrospective cohort study included 9755 older outpatients who were referred to a tertiary hospital between January 2010 and June 2021. All patients underwent a comprehensive geriatric assessment and routine laboratory tests. Delirium and dementia was diagnosed with the DSM-4 or DSM-5 criteria. We recorded information on mortality during 1 year following the delirium episode. RESULTS: Among 615 patients with dementia, 170 (26.3%) had delirium. Patients with delirium were predominantly older, with higher Deyo-Charlson comorbidity index scores, lower general cognitive performance, lower functional capability, and higher anticholinergic burden compared to those without delirium. At the 1-year follow-up, the mortality rate of DSD was 29.3%. Multivariate analysis showed that NLR at admission was an independent predictor of 1-month mortality (HR = 1.03; 95% CI 1.00-1.05; p = 0.04) and 1-year mortality (HR = 1.02; 95% CI 1.01-1.05; p = 0.01) of DSD patients. DISCUSSION: NLR can predict prognosis in various diseases including cardiovascular disease, malignancies, and cerebrovascular disease, but as yet there is no similar prognostic measure in delirium. Moreover, recent previous studies demonstrated NLR is a potential marker for the prediction of delirium in older adults with different clinical settings. In the current study, we demonstrated that NLR is also a prognostic marker for DSD. CONCLUSIONS: NLR could be useful marker for predicting short- and long-term mortality in patients with DSD. However, further studies are needed to validate these findings.

Psychological Burden among Community-dwelling Older Adults with and without a History of a Recent Covid-19 Infection.

OBJECTIVES: The outbreak of Covid-19's psychological burden to recovered vs. non-infected older individuals has not been compared yet. We aimed to perform a comparative analysis of psychological symptoms in community-dwelling older adults with and without a history of a Covid-19 infection. METHODS: In this study, we utilized a geriatric care unit's outpatient registry to prospectively enroll older adults with and without a history of Covid-19. An interviewer administered generalized anxiety disorder-2 (GAD-2), patient health questionnaire-2 (PHQ-2), six-item cognitive impairment (6-CIT), and post-traumatic stress disorder-5 (PTSD-5) tests over the phone. Correlation and multivariate logistic regression analyses were used to examine associations. RESULTS: The study included 120 older subjects, 46 (38.3%) reported past Covid-19 infection. Anxiety and depression were both significantly more prevalent among subjects without a history of Covid-19. Having no history of Covid-19, female gender, and psychoactive medication use showed independent associations with the risk of depression symptoms among all subjects, and female gender was additionally associated with anxiety symptoms. CONCLUSIONS: This study showed that the risk of depression symptoms was higher in a sample of older adults who were not infected with Covid-19 compared to those recovering from the disease. CLINICAL IMPLICATIONS: The impact of "fear of transmission" on the mental health of the elderly may be a significant issue to deal with. Older women are more prone to mental health risks by Covid-19.

Relationship between blood pressure index and cognition in older adults.

OBJECTIVE: We aimed to examine the contributions of blood pressure index (BPI) and other measurements to cognitive function in older adults. METHOD: Four hundred sixty-six subjects aged over 65 who applied to the outpatient Geriatric Clinics of Gulhane Training and Research Hospital were enrolled in the study. Demographics and clinical conditions were collected from their files. Pulse pressure index (PP) (SBP - DBP), mean arterial pressure index (MAP) [(SBP + DBP x 2)/3] and BPI (SBP/DBP) were recorded. We used the Mini-mental state examination (MMSE) test for evaluating global cognition. We classified participants into two groups based on MMSE score: normal with a score of 27 or more and lower cognitive function with a 26 or lower cognitive function. RESULTS: 31% of subjects (n = 143) had lower and 69% (n = 323) had normal cognitive function. When compared blood pressure measurements between groups, BPI and PP were higher in the subjects with lower cognitive function [BPI: 1.78 ± 0.25 vs. 1.71 ± 0.23, p = .007 and PP: 58.97 ± 17.59 vs. 54.05 ± 15.38, p = .009]. After adjustment for confounders, a 2.545 fold increased risk of cognitive decline was observed among subjects with higher BPI when compared to those with normal (OR: 2.545, 95%CI: 1.024-6.325, p = .044). CONCLUSION: The findings suggest that BPI is an associated with cognition in older adults and may a novel alternative marker for identifying the subjects at the risk of dementia.

Transitional 'hospital to home' care of older patients: healthcare professionals' perspectives.

BACKGROUND: Transitional care is a key area of care provision to older people with chronic and complex health conditions and is associated with the quality of care delivered in the healthcare system. AIMS: This study aimed to explore the perspectives of healthcare providers, including nurses and physicians, regarding transitional care from hospital to home in an urban area of Turkey. METHODS: A qualitative study using a thematic analysis method was carried out. In-depth semi-structured interviews were held with eight clinical nurses and five general physicians involved in the provision of healthcare services to older patients in the transitional care process from hospital to home. FINDINGS: The thematic analysis of in-depth semi-structured interviews with 13 healthcare professionals led to the development of the following themes: 'uninterrupted chain of care transfer', 'commitment to meet patient's needs' and 'support and removing ambiguities'. CONCLUSIONS: Key factors impacting on the quality and safety of transitional care and continuity of healthcare are communication and collaboration between healthcare staff and settings, and older patients' as well as family caregivers' awareness and their feelings of responsibility towards the continuity of care at home.

Functional Status of Older Adults with Dementia at the End of Life: Is there Still Anything to do?

AIMS: There is a lack of data on physical functional status near death of patients with different types of dementia that can contribute to decisions about what kind of care is needed. The aim of this study was to investigate the course of functional status along with the documented reasons for death in participants with dementia who had regularly been followed at a geriatric outpatient unit. SETTING AND DESIGN: A retrospective observational cohort study was done using the database of a geriatric outpatient clinic. SUBJECTS AND METHODS: Sociodemographic and medical records of patients with Alzheimer's disease (AD), vascular dementia, mixed dementia, and dementia with Lewy bodies (DLB)/Parkinson's disease dementia (PDD) who had received routine care in a geriatrics outpatient setting for a minimum of 12 months before death were analyzed. Scores for activities of daily living and documented probable causes of death were recorded. RESULTS: Of the 258 participants, 111 (42 female and 69 male) were included in this study. AD was the leading cause of dementia (51.8%). The median duration of survival with dementia was 4 years. The leading causes of death were cardiovascular disease (CVD) (27.0%) and dementia (27.0%) followed by infections (21.6%) and stroke (10.8%). Disability was the highest in patients with DLB/PDD. CONCLUSIONS: This study found relatively shorter survival after the diagnosis of dementia when compared to other populations. CVD still appeared as a major cause of that in this particular disease. Most debilitating type of dementia was DLB/PDD.

Reliability and validity of the Turkish version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-T)

Background/aim: This study aimed to assess validity and reliability of the Turkish version of Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-T). Materials and methods: The individuals who met inclusion criteria of the study were in patients of a hospital and a long-term care facility. Mini Mental Status Exam (MMSE), Cornell Dementia Depression Scale (CDDS), Global Deterioration Scale (GDS), visual analogue scale (VAS), and PACSLAC-T were administered to all subjects. The scales were repeated with an interval of two weeks for test­retest reliability. Results: A total of 112 patients with dementia were included in the study. The intraclass correlation coefficient ICC for test­retest reliability of the PACSLAC-T was 0.713 with a 95% confidence interval of 0.486­0.843. The Cronbach's α coefficient for total PACSLAC-T was 0.842 for test and 0.888 for retest, which indicated substantial internal consistency. In convergent validity, there were significant correlations between PACSLAC-T total score VAS (r = 0.684, P < 0.001), while no correlation was found between PACSLAC-T total score and CDDS (r = 0.127, P = 0.094), and GDS (r = 0.096, P = 0.167). Also, significant correlations were found between PACSLAC-T total score and MMSE (r = ­0.468, P = 0.016). Conclusion: This study showed that PACSLAC-T could be a promising tool for the management of pain in older adults with limited communication skills.

Long-Term Risk of Reduced Cognitive Performance and Associated Factors in Discharged Older Adults with COVID-19: A Longitudinal Prospective Study.

BACKGROUND: Increasing numbers of reports have suggested a deterioration in cognitive performance after recovery from coronavirus disease 2019 (COVID-19), however insufficient information is available regarding long-term brain health and risk factors related to reduced cognitive performance in advanced age. We investigated the prevalence of reduced cognitive performance and its associated factors among older adults after COVID-19. METHODS: This prospective observational study enrolled older individuals (aged ≥65 years) hospitalized for COVID-19. Discharged patients were contacted after an average of 15 months and a brief battery was administered during telephone interviews to assess their mental status. RESULTS: Among the 174 patients, 77 (44.3%) showed reduced cognitive performance at follow-up. Multivariate analysis revealed that female sex, education level, and increased Deyo/Charlson Comorbidity Index score, which is an objective indicator of chronic disease burden, were independent risk factors for long-term cognitive performance. Depression and anxiety symptoms, assessed using the Patient Health Questionnaire-2 and Generalized Anxiety Disorder 2-item questionnaire at the end of the study, were not associated with reduced cognitive performance. CONCLUSION: Our findings provide key insights into discharged older adults with COVID-19 at risk of long-term cognitive impairment, and help to ascertain the factors associated with this problem.

Incidence of Motoric Cognitive Risk Syndrome and Associated Factors in Older Adults in Türkiye.

Background: Motoric cognitive risk syndrome (MCRS) is characterized by slow gait and subjective cognitive decline. It is a predementia syndrome associated with an increased risk of dementia and mortality. Aims: To investigate the incidence of MCRS and its associated factors in older adults in Türkiye. Study Design: A retrospective study. Methods: This study enrolled community-dwelling older adults admitted to the geriatric outpatient clinic. Participants were assessed for MCRS according to previously described criteria. Logistic regression analysis was conducted to evaluate the association among MCRS and demographic features, clinical status, and geriatric syndromes. Results: Of the 1,352 older adults examined, 577 met the inclusion criteria, and the mean age was 75.2 years. The overall incidence of MCRS was 7.8%. The MCRS group was predominantly older, female, and unmarried, with polypharmacy and higher Deyo-Charlson comorbidity index and Yesavage geriatric depression scale scores than the non-MCRS group. In the multivariate model, significant associations were found between MCRS and age and polypharmacy [odds ratios (OR), 2.22; 95% confidence interval (CI), 1.04-4.71, p = 0.039; OR, 2.02; 95% CI, 1.02-3.99, p = 0.043, respectively]. Conclusion: The overall incidence of MCRS was found in 7.8% of older adults. Advanced age and polypharmacy are risk factors associated with MCRS.

Association of Anticholinergic Drug Burden With Cognitive and Functional Decline Over Time in Dementia With Lewy Bodies: 1-Year Follow-Up Study.

BACKGROUND: The purpose of this study was to investigate the relationship between anticholinergic burden (ACB), and cognitive and functional alterations in patients with dementia of Lewy bodies (DLB) during a 1-year follow-up period. METHODS: This cohort study included patients diagnosed with DLB admitted to a tertiary geriatric outpatient clinic. Cognition, functional performance, and nutritional status were assessed at baseline, 6 months, and 12 months during the follow-up period. The ACB was evaluated, and participants were grouped as ACB ≥1 and ACB=0. RESULTS: A total of 112 patients with DLB (mean age, 79.3 ± 6.8 years; 50.9% female) were included. The mean number of medications was 5.1 ± 4, 56.9% of participants had polypharmacy, and 55.2% had an anticholinergic drug burden. Individuals with ACB ≥1 had lower instrumental activities of daily living (IADL) scores at baseline than those with ACB=0 (P=0.014). The Barthel index and Lawton-Brody IADL scores significantly decreased in the ACB ≥1 group on repetitive measurements over time, whereas only the Lawton-Brody IADL scores worsened in the ACB=0 group (all P<0.001). There were no significant differences in cognitive scores and Mini-Mental State Examination subdomains between the groups. The dependent variable repetitive test revealed a significant deterioration in the orientation subdomain in the ACB ≥1 group over time (P=0.001). Multivariable regression models showed no significant effect of ACB score on cognitive and functional impairment. CONCLUSION: Our study provides evidence that the use of anticholinergic drugs in this vulnerable population may potentially increase the morbidity by adversely affecting functional status and cognitive orientation.