A comparison of the 2 thermal ablation procedures for the management of benign thyroid nodules.

INTRODUCTION: In recent years, ultrasound (US)-guided thermal ablation techniques have come to the fore as minimally invasive alternatives to surgery. The purpose of this study was to assess the effectiveness and safety of radiofrequency ablation or microwave ablation procedures in patients with benign thyroid nodules. MATERIAL AND METHODS: This retrospective and single-centre study consisted of 55 patients and 62 benign thyroid nodules that were treated either with radiofrequency ablation (RFA) or microwave ablation (MWA) in our hospital between January 2020 and March 2022. All the patients were at high risk for surgery or with symptomatic TNs and who refused surgery. The TNs diagnosed as benign from the fine-needle aspiration biopsy were evaluated in terms of volume reduction, symptom, and cosmetic scores. In addition, these 2 treatment modalities were compared to each other. RESULTS: Out of 55 patients, 44 (80%) were female and were aged between 24 and 97 years with a median age of 50 years. RFA was applied to 54.5% (n = 30) of the participants, and MWA was applied to 46.5% (n = 25). The volume reduction rate (VRR) after RFA and MWA at the first month was 63.4 ± 14.2 and 65.7 ± 13, respectively. No significant difference was detected between the 2 groups in terms of VRR (p = 0.51). In addition, the mean symptom and cosmetic scores decreased significantly in both procedures, and there was a significant difference due to the symptom score change in the RFA group compared to the MWA group. Of all the patients, one patient experienced haematoma in the RFA, and one patient had transient voice change in the MWA group. No life-threatening complications were noted. CONCLUSION: In the treatment of benign symptomatic thyroid nodules, both RFA and MWA are options worthy of consideration in terms of efficacy and safety.

Balance performance measured by posturography in mild-moderate Alzheimer's Disease: An undervalued assessment.

PURPOSE: The aim of the study was to compare balance performance in mild-moderate stage Alzheimer's disease (AD) patients and healthy peers using clinical balance tests and computerized posturography. METHODS: We recruited 95 patients and divided them into two groups; 51 patients (62 % (n=32) female) in AD group and 44 patients in healthy controls group (50 % (n=22) female). Berg Balance Scale (BBS) and Timed Up & Go (TUG) test were performed. Computerized posturography was performed. RESULTS: The mean age was 77.2±5.5 years in the AD group and 73.8±4.4 years in the control group (p<0.001). Sensory organization test composite equilibrium score (60[30-81], p<0.001), step quick turn-sway velocity (69.2 [38.2-95.8], p<0.001) and step quick turn-time (3.8 [1.6-8.4], p<0.001) were significantly impaired in mild-moderate stage AD patients. Berg Balance Scale (50 [32-56], p<0.001) and TUG test (13.0 [7.0-25.7], p<0.001) results were worse in AD. CONCLUSIONS: Computerized posturography measures were impaired in mild-moderate AD patients. The results highlight importance of early screening for balance and fall risk in AD patients. The study provides multi-dimensional and holistic assessment of balance performance in early-stage AD patients. Alzheimer's disease patients at earlier stages are prone to fall risk and should be evaluated accordingly.

Relationship between chewing ability and malnutrition, sarcopenia, and frailty in older adults.

BACKGROUND: Several studies reported that impaired nutrition is associated with reduced muscle mass, muscle strength, and physical performance. Chewing ability is essential to maintain balanced oral nutrient intake. The study was designed to define the possible relationship between chewing ability and nutrition-related problems (malnutrition, sarcopenia, and frailty) in a holistic perspective. METHODS: This cross-sectional study recruited adults aged ≥65 years. All patients were evaluated with comprehensive geriatric assessment. Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People criterion. Malnutrition was determined according to body mass index, calf circumference, and Mini Nutritional Assessment short form (MNA-SF). Frailty status was diagnosed with the Clinical Frailty Scale. Masseter and gastrocnemius muscle thicknesses (MTs) were measured via ultrasonography imaging. Oral examinations were carried out by a dentist, and chewing performance was examined with a color-changeable chewing gum. RESULTS: Overall, 135 older adults (76 females) were analyzed. Mean ± SD age was 75.7 ± 7.2 years; 37.0% of the patients were frail, 3.7% were malnourished, 12.6% were sarcopenic, and 20.0% had poor chewing function. In the poor chewing function group, age and frailty scores were increased and the MNA-SF scores, handgrip strength, skeletal muscle index, and masseter MT were reduced (all P < 0.05). After adjusting for confounders, regression analysis showed that low grip strength and low gastrocnemius MT were independently associated with poor chewing ability. CONCLUSIONS: Chewing ability was related to sarcopenia. Age and low grip strength in females and low cognitive scores and having low gastrocnemius MT in males were independent variables affecting chewing ability.

Thiol-disulfide homeostasis and ischemia-modified albumin as a marker of oxidative stress in patients with sarcopenia.

AIM: Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength. Chronic inflammatory conditions and increased oxidative stress are in the pathogenesis of sarcopenia. Our aim was to evaluate the relationship between sarcopenia and thiol-disulfide homeostasis and ischemia-modified albumin levels as an oxidative stress marker. METHODS: Patients aged ≥65 years were recruited in this study. Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People criterion. Total thiol, native thiol, disulfide and ischemia-modified albumin levels were measures according to clinical and laboratory features. Patients were divided into two groups according to their sarcopenia presence; thiol-disulfide homeostasis and ischemia-modified albumin levels were evaluated between these groups. RESULTS: Overall, 94 patients were analyzed. The mean age was 75.0 ± 6.71 years. A total of 39% of the patients were diagnosed as probable sarcopenia, 3.2% had sarcopenia, 6.4% had severe sarcopenia and 51.1% were diagnosed as normal. The levels of native thiol, total thiol, disulfide level and disulfide-native thiol, native thiol-total thiol and disulfide-total thiol ratios were similar in patients with sarcopenia when compared with the control group. In addition, there were no differences between albumin and ischemia-modified albumin levels. In univariate regression analysis, handgrip strength was found to be an independent predictor of native thiol and total thiol, and disulfide levels. CONCLUSION: This is the first study in the literature that evaluates the thiol-disulfide homeostasis and ischemia-modified albumin levels in sarcopenic older patients. Long-term studies are warranted to confirm the relationship between oxidative stress markers and sarcopenia. Geriatr Gerontol Int 2021; 21: 584-589.

Long-term effect of masked hypertension management on cognitive functions in geriatric age: geriatric MASked hypertension and cognition follow-up study (G-MASH-cog MONITOR).

OBJECTIVES: Masked hypertension, defined as nonelevated clinic blood pressure with elevated out of clinic blood pressure, has been associated with increased cardiovascular events, mortality and cognitive impairment. No evidence exists regarding the effect of treating masked hypertension. In this study, we followed-up the patients in the G-MASH-cog study for 1 year and aimed to examine the effect of the management of masked hypertension on cognitive functions. METHODS: The G-MASH-cog study participants were followed-up for 1 year. In masked hypertensive individuals, lifestyle modification and antihypertensive treatment (perindopril or amlodipine) were initiated for blood pressure control. Measurements of cognitive tests and ambulatory blood pressure monitoring at baseline and at 1-year follow-up were compared. RESULTS: A total of 61 patients (30 in masked hypertension group; 31 in normotensive group) were included. Mean age was 72.3 ± 5.1 and 59% of the participants were female. Compared with baseline ambulatory blood pressure measurement results, patients with masked hypertension had significantly lower ambulatory blood pressure measurement results after 1-year follow-up. The quick mild cognitive impairment test (Q-MCI-TR) score increased with antihypertensive treatment (Q-MCI score at baseline = 41(19-66.5), at 1 year = 45.5 (22-70), P = 0.005) in masked hypertensive patients. In the final model of the mixed-effects analysis, when adjusted for covariates, interaction effect of the masked hypertension treatment with time was only significant in influencing the changes in Q-MCI scores over time in patients aged between 65 and 74 years (P = 0.002). CONCLUSIONS: Treatment of masked hypertension in older adults was associated with improvement in cognitive functions.

Ultrasonography versus bioelectrical impedance analysis: which predicts muscle strength better?

Background & Aim: Muscle strength seems to be more relevant to the functionality than muscle mass in sarcopenia. Different diagnostic techniques are available for the evaluation of muscle mass. Ultrasonography (USG) seems to have some advantages compared to other techniques especially bioelectrical impedance analysis (BIA) including being not affected of the results by the factors like extreme body mass indexes (BMI) or hypervolemia. The aim of the study is to determine and compare the muscle strength prediction value of muscle mass measured by using USG or BIA and determine the cut-off values for the Turkish population.Methods: One hundred and thirty six patients admitted to geriatrics outpatient clinic for comprehensive geriatric assessment were included in the study. Body composition was determined by BIA and skeletal muscle mass index (SMI) was measured. Thickness of the gastrocnemius muscle was measured via USG. Diagnosis of sarcopenia was made according to the EWSGOP 2 diagnostic criteria.Results: The best cut-off value for gastrocnemius muscle thickness to predict low HGS was ≤13.8 mm (AUC:0.690,p <0.001). SMI was not found to predict low HGS (AUC:0.573,p >0.05). Comparison of AUCs for gastrocnemius muscle thickness and SMI showed that gastrocnemius muscle thickness had higher AUC (p=0.008). For predicting sarcopenia, the best cut-off value of gastrocnemius muscle thickness was found to be ≤12.3 mm in women (AUC: 0.862,p <0.001) and ≤12.3 mm in men (AUC:0.900, p < 0.001).Conclusions: In this study, we found that gastrocnemius thickness measured by USG seems to predict low HGS better than SMI measured by BIA.

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.

Sleep quality and sleep-disturbing factors of geriatric inpatients.

PURPOSE: Insomnia, a common problem in older adults, may be precipitated by multiple factors including medical conditions, social, behavioral, and environmental factors. The aims of our study were to evaluate sleep pattern changes during hospitalization, determine the predictors of sleep quality and sleep disorders in geriatric inpatients. METHODS: In this prospective observational study, all ≥ 65-year-old patients hospitalized in internal medicine wards were assessed at the time of hospitalization and after 1 week. Insomnia Severity Index and Pittsburgh Sleep Quality Index (PSQI) were used to define insomnia and subjective sleep quality. All patients underwent comprehensive geriatric assessment. Data of factors contributing sleep disturbances during hospitalization were recorded. RESULTS: Totally 101 patients were recruited. Mean ± SD age was 73.5 ± 5.2 years and 53.5% were female. Frequency of poor sleepers was 58.4% at baseline and 64.7% after 1 week according to PSQI score (p 0.804). Although the total scores and frequency of insomnia did not change in the first week of hospitalization, sleep duration was significantly shortened (6.4 ± 2.6 h vs. 5.9 ± 2.7 h, respectively; p < 0.001). Age, pain, restless legs syndrome, Katz ADL, and Lawton-Brody IADL scores were independent correlates of insomnia during hospitalization. CONCLUSION: The study showed that insomnia was associated with geriatric syndromes in hospitalized geriatric patients, and hospitalization reduced duration of sleep. Sleep quality and insomnia evaluation should be a fundamental part of assessment in hospitalized older adults. Considering the negative outcomes of insomnia, sleep disrupting factors should be identified and corrected.

A Reliable Tool for Assessing MCI and Dementia: Validation Study of DemTect for Turkish Population.

BACKGROUND AND AIM: Mild cognitive impairment (MCI) and dementia prevalence are expected to increase with aging. The DemTect is a very quick and easy tool to administer and recognize the early stages of dementia and MCI. In this study we aimed to evaluate the reliability and validity of a Turkish version of the DemTect and define cut off values for different age and educational levels. One of our aims is also to compare the sensitivity and specifity of the DemTect to other common screening tools. PATIENTS AND METHODS: Fifty-four patients with MCI, 55 patients with dementia and 91 patients with subjective memory complaints (SMC) were enrolled in the study. The DemTect was translated into Turkish by forward-backward translation and compared with the Mini Mental State Examination (MMSE), the Quick Mild Cognitive Impairment Turkish version (QMCI-TR) and the Montreal Cognitive Assessment (MoCA). In order to test interrater reliability, the DemTect was administered to 11 patients, on the same day, by 2 trained raters. To establish test-retest reliability, the same rater scored the tool a second time on 11 patients within 2 weeks. RESULTS: The median age of the patients was 73 (min-max: 65-90) years, 54.5% were female. We found a strong correlation between DemTect scores and the MMSE, the QMCI, and the MoCA (r = 0.725, r = 0.816, r = 0.821, respectively; p < 0.001). In ROC analysis, the cut-off point of the DemTect to differentiate MCI from SMC was 11.5 with 92.6% sensitivity, 91.2% specificity, AUC 0.973 and the cut-off point of the DemTect to differentiate dementia from SMC was 9.5 with 96.4% sensitivity, 100% specificity, AUC 0.916. Cronbach α was 0.823. Intraclass correlation coefficient was 0.873 (95% CI: 0.598-0.964) for interrater reliability and 0.966 (95% 0.777-0.982) for test-retest reliability (Cronbach α = 0.932, 0.966 respectively). CONCLUSION: The DemTect is a very reliable tool to assess Turkish patients with MCI and dementia.

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..

Does Preoperative Comprehensive Geriatric Assessment and Frailty Predict Postoperative Complications?

BACKGROUND: The influence of preoperative comprehensive geriatric assessment and frailty on postoperative morbidity, mortality, delirium were examined. METHODS: A total of 108 patients were evaluated. The Katz Index of Independence in Activities of Daily Living (ADL), the Lawton Brody Instrumental Activities of Daily Living Scale (IADL), the Mini-Nutrition Assessment test (MNA), the Mini-Mental State Examination (MMSE), Yesavage Geriatric Depression Scale (GDS) were performed. Fried Criteria were used to assess physical frailty. We used the Physiological and Operative Severity Scores for the Enumeration of Mortality and Morbidity score (POSSUM), the American Society of Anesthesiologists Score (ASA), and the Charlson Comorbidity Index (CCI) to determine the risk of postoperative morbidity and mortality. Assessment Test for Delirium (4AT) was applied for detection of delirium. RESULTS: The median age was 71 years (min-max: 65-84). IADL (p = 0.032), MNA (p = 0.01), MMSE scores (p = 0.026) were found to be significantly lower in patients with morbidity. POSSUM physiology score (p = 0.005), operative score (p = 0.015) and CCI (p = 0.029) were significantly higher in the patients with morbidity. Patients developed morbidity were found to be more frail (p < 0.001). The patients with delirium were found to have lower IADL (p = 0.049) and MMSE scores (p = 0.004), higher POSSUM physiology score (p = 0.005) and all of them were frail. It was found that frailty (OR = 23.695 95% CI: 6.912-81.231 p < 0.001), POSSUM operative score (OR:1.118 95% CI: 1.021-1.224 p = 0.016) and preoperative systolic blood pressure (OR:0.937%95 CI: 0.879-0.999 p = 0.048) were independently related factors for postoperative morbidity. CONCLUSION: In our study, CGA and frailty in preoperative period were found to be indicators for postoperative morbidity and delirium.

Frailty and Sarcopenia in Patients With Distal Radius Fracture: A Geriatric Perspective.

INTRODUCTION: Sarcopenia, which is described as loss of muscle mass and function, worsens daily living activities of older people. Sarcopenia is a component of frailty that causes falls and fractures in older people. The aim of this study was to evaluate sarcopenia and frailty status of older people with distal radius fracture (DRF) and compare with age- and sex-matched controls without DRF. MATERIALS AND METHODS: This is an observational cross-sectional study including 27 patients with DRF and 28 controls without fracture who applied to geriatric outpatient clinic. Sarcopenia was diagnosed according to the definition of European Working Group on Sarcopenia in Older People 2. Frailty was assessed by Fried frailty index. Comprehensive geriatric assessment was applied to all participants. RESULTS: Median ages were 70 and 69 years (min: 65, max: 87 in both) in patients with DRF and controls, respectively. The prevalence of sarcopenia was similar between the groups (P = .48). Prefrail-frail (nonrobust) phenotype was higher in patients with DRF (P = .04). Nonrobust phenotype was an independent variable predicting DRF in logistic regression models. DISCUSSION: This study showed that nonrobust phenotype was an independent variable predicting DRF. CONCLUSION: Assessment of frailty and detecting patients with nonrobust phenotype may help clinicians in fracture prevention strategies.

Impact of atrial fibrillation on frailty and functionality in older adults.

BACKGROUND AND AIM: Atrial fibrillation (AF), the most common sustained arrhythmia in older adults, causes significant complications such as stroke, dementia, and decreased quality of life. Frailty is a geriatric syndrome that is associated with increased risk of poor clinical outcomes including falls, disability, and mortality. We aimed to investigate the relationship between AF and frailty and functionality in older adults. METHODS: A total of 123 patients 64 with AF and 59 with normal sinus rhythm were enrolled in the study with cross-sectional design. All patients underwent comprehensive geriatric assessment (CGA). Frailty status was assessed using Fried criteria and FRAIL scale. The brief Older People's Quality of Life questionnaire was applied for quality of life. Results of the laboratory tests were recorded and compared for both groups. RESULTS: Although the frequency of frailty status determined by the Fried criteria and the FRAIL scale was higher in the AF group, this difference was not statistically significant. However, it was found that there was a positive correlation between the European Heart Rhythm Association (EHRA) AF symptom score and frailty according to the FRAIL scale (Goodman and Kruskal gamma coefficient = 0.39, p = 0.020). Comorbidities and polypharmacy were more common in the AF group (p < 0.001, both). CGA revealed lower Lawton-Brody Instrumental Activities of Daily Living scores (p = 0.024), higher fall rates in the previous year (p = 0.016), and slower walking speed (p = 0.020) in the AF group. Total cholesterol, LDL, HDL, total protein, albumin, and prealbumin were lower; brain natriuretic peptide (BNP) and C-reactive protein (CRP) levels were higher in the AF group. CONCLUSIONS: EHRA AF symptom severity score is positively correlated with frailty. AF is associated with worse metabolic profile and clinical features on CGA that AF might be a frailty marker. Frailty should be investigated in AF patients.

An important problem in an aging country: identifying the frailty via 9 Point Clinical Frailty Scale.

OBJECTIVES: Frailty is a geriatric syndrome which develops as a result of cumulative decline in many physiological systems and results in an increased vulnerability and risk of adverse outcomes. The Clinical Frailty Scale (CFS) was validated as a predictor of adverse outcomes in community-dwelling older people and evaluates items such as comorbidity, cognitive impairment and disability. We aimed to study the concurrent and construct validity and reliability of the 9 point CFS in Turkish Population.Methods: This study was designed as a cross-sectional study. Participants, who were admitted to a geriatric medicine outpatient clinic, were included. Validity of 9 point CFS was tested by its correlation with the assessment and opinion of an experienced geriatric medicine specialist and Fried frailty phenotype. Test-retest and inter-rater reliability analyses were also performed.Results: Median age of the 118 patients was 74.5 years (min: 65 max: 88) and 64.4 % were female. The concordance of CFS and experienced geriatric medicine specialist's opinion was excellent (Cohen's K: 0.80, p < 0.001).The concordance of CFS and Fried Frailty phenotype was moderate (Cohen's K: 0.514, p < 0.001).CFS inter-rater reliability and test-retest reliability was very strong (Cohen's K: 0.811, p < 0.001 and Cohen's K: 1.0, p < 0.001, respectively).Conclusions: CFS appears to be a quick, reliable and valid frailty screening tool for community-dwelling older adults in the Turkish population.

The Interaction Between Mild Cognitive Impairment with Vestibulo-ocular Reflex, Dynamic Visual Acuity and Postural Balance in Older Adults.

BACKGROUND: Approximately 30% of the elderly population is falling each year, resulting in a major health problem. Cognitive decline is an independent risk factor for fall. Mild cognitive impairment (MCI) is a cognitive decline that is higher than expected in the subjects' age but does not affect the activities of daily living OBJECTIVE: In the study, vestibulo-ocular reflexes, dynamic visual acuities and postural balances of subjects with mild cognitive impairment were evaluated and compared with the healthy control group. METHODS: For this purpose, 10 subjects with mild cognitive impairment and 10 healthy subjects from the same age group were included in the study. After the hearing test was applied to the subjects, videonistagmography, dynamic visual acuity and computerized dynamic posturography measurements were performed. RESULTS: Computerized Dynamic Posturography VEST parameter, SOT (Sensory Organization Test) 2, SOT 3, SOT 6 and Composite Balance Scores were significantly lower in the MCI group. There was no significant difference between the two groups in terms of videonistagmographic measurements. Dynamic Visual Acuity Perception Time Test scores of the subjects with mild cognitive impairment were significantly longer compared to the control group (p < 0.05). CONCLUSION: As a result of the study, it was concluded that subjects with mild cognitive impairment were more prone to fall compared to control group and that these subjects should be included in fall prevention rehabilitation programs.

Timing of Dysphagia Screening in Alzheimer's Dementia.

BACKGROUND: Dysphagia is an important and frequent symptom in Alzheimer's dementia (AD). We hypothesized that dysphagia could be seen in the early stages of AD and sarcopenia presence rather than the severity of the AD affecting dysphagia. The main aim of this study was to investigate swallowing functions in AD patients according to stages. The second aim was to investigate the correlation between sarcopenia and dysphagia in AD. METHODS: This study involved 76 probable AD patients. For all participants, diagnosis of sarcopenia was based on definitions from the revised version of European Working Group on Sarcopenia in Older People at 2018. Dysphagia symptom severity was evaluated by the Turkish version of the Eating Assessment Tool, a videofluoroscopic swallowing study (VFSS) was performed for instrumental evaluation of swallowing. The patients were divided into 3 groups according to the clinical dementia rating (CDR) scale as CDR 1 (mild dementia), CDR 2 (moderate dementia), and CDR 3 (severe dementia). Swallowing evaluation parameters were analyzed between these groups. RESULTS: Mean age was 78.9 ± 6.4 years, and 56.4% were female. Twenty-six patients had mild dementia, 31 patients had moderate dementia, 19 patients had severe dementia (CDR 3). We found that sarcopenia rates were similar between AD stages according to CDR in our study population and dysphagia could be seen in every stage of AD. In a multivariate analysis, polypharmacy and sarcopenia were found to be independently associated factors for dysphagia, irrespective of stage of AD (OR: 6.1, CI: 1.57-23.9, P = 0.009; OR: 4.9, CI: 1.24-19.6, P = 0.023, respectively). CONCLUSION: Aspirations may be subtle so that AD patients and caregivers may not be aware of swallowing difficulties. Therefore, all AD patients, especially those who have polypharmacy and/or sarcopenia (probable-sarcopenia-severe sarcopenia), should be screened for dysphagia in every stage.

Turkish validation of a new scale from older people's perspectives: Older people's quality of life-brief (OPQOL-brief).

INTRODUCTION: There are various 'quality of life' scales developed for older people. Although quality of life is a subjective concept, most of these scales are based on expert opinions rather than perspectives of older people. The aim of this study is to evaluate validity and reliability of Older People's Quality of Life-brief scale (OPQOL-brief), which is based on perspectives of older people, in Turkish population. METHODS: A cross-sectional study was implemented in a Geriatric medicine outpatient clinic. Total number of 168 older patients who speak in Turkish fluently were recruited. Comprehensive geriatric assessment and OPQOL-brief was applied to all participants together with another quality of life scale validated in Turkish population, CASP-19 (Control, Autonomy, Self-realization, Pleasure). Validity was evaluated with construct validity, convergent validity and discriminant validity. Reliability was assessed with internal consistency and test-retest reliability. RESULTS: Mean age of the study population was 73.3 ± 5.9 years. Female participants were 64.9% (n = 109). Internal consistency was assessed by Cronbach's α coefficient. OPQOL-brief scale demonstrated high internal consistency (Cronbach's α = 0.876). Test-retest reliability was assessed by interclass correlation coefficient (ICC) and showed high reliability (ICC = 0.98, 95%CI = 0.96-0.99, p < 0.001). Strong and significant correlation was detected between OPQOL-brief and CASP-19 scales (r = 0.763, p < 0.001). CONCLUSION: Turkish version of OPQOL-brief has acceptable validity and reliability in Turkish population. The scale can be used to measure quality of life of older people.

Higher Serum Endocan Level Is Associated with Alzheimer Disease.

BACKGROUND: The novel molecule endocan, which is released by endothelium and is regulated by proangiogenic and proinflammatory cytokines, may have a role in the pathophysiology of Alzheimer disease (AD). The aim of this study was to evaluate the relationship between serum endocan levels and AD. METHODS: A total of 134 patients (47 AD, 42 amnestic mild cognitive impairment [aMCI], and 45 control patients) 65 years of age and older were recruited in this study. Cognitive status of the patients was evaluated by performing the Montreal Cognitive Assessment (MOCA) and the Mini-Mental State Examination (MMSE). Serum endocan levels were measured with an enzyme-linked immunosorbent assay kit. RESULTS: Median serum endocan level was significantly higher in AD patients (380.1 ng/mL) than in both aMCI patients (247.7 ng/mL) and controls (277.6 ng/mL; p < 0.01). Serum endocan level had a weak but significant correlation with MMSE and MOCA scores (r = -0.219 and r = -0.232; p = 0.012 and p = 0.01, respectively). Serum endocan level was detected as a factor independently associated with AD. The cutoff serum level of endocan predicting AD was >288.94 ng/mL in receiver operating characteristic curve analysis (area under the curve 0.71, 95% CI 66.7-90.9, sensitivity 80.9%, specificity 59.8%; p < 0.01). CONCLUSION: Higher serum endocan levels may be associated with the pathogenesis of AD.