An Atherosclerosis Indicator Hyaluronic Acid: Can Plasma Hyaluronic Acid Be Useful in Diagnosing Alzheimer's Disease?

BACKGROUND: The aim is to compare the plasma levels of hyaluronic acid (HA) which is closely related to inflam-mation and vascular changes and arterial stiffness (AS) related values in patients with Alzheimer's disease (AD), amnestic type mild cognitive impairment (aMCI), and normal cognitive functions (NCF). METHODS: Ninety participants were categorized into three groups, patients with AD, MCI, and NCF. Arterial stiffness measurement in the nephrology outpatient clinic, and storage and analysis of plasma samples in the biochemistry laboratory. RESULTS: Of the 90 patients, 32 had NCF, 32 had aMCI, and 26 had AD. Between groups, there was no difference in HA, pulse wave velocity, and augmentation index. The HA level had no statistically significant correlation with any of the other variables. CONCLUSIONS: Plasma HA levels will not be useful in the diagnosis of AD. More comprehensive studies with larger number of patients are needed.

Decreased abdominal wall muscle mass defined by muscle ultrasound is associated with malnutrition according to Global Leadership Initiative on Malnutrition criteria in renal transplant recipients: A cross-sectional study.

BACKGROUND: Changed body composition with increased fat content and decreased muscle mass is seen in renal transplantation recipients (RTRs). Increased fat mass might mask underlying muscle mass loss; measuring low body mass index and weight reduction alone may not be sensitive enough to diagnose malnutrition in RTRs. We aimed to determine the prevalence of malnutrition in stable RTRs using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to assess the use of muscle ultrasonography (US) to compare the performance of various muscle US measurements in the diagnosis of reduced muscle mass. METHODS: Ninety-one patients who had renal transplantation >6 months ago were enrolled in the study. GLIM criteria were performed for all patients, but not those at risk of malnutrition. Bioelectrical impedance analysis and muscle US were performed to identify reduced muscle mass. RESULTS: The prevalence of malnutrition according to GLIM criteria was 25.3% (n = 23). All muscle US measurements were lower in the malnourished group than the well-nourished group; however, the malnourished group had substantially lower muscle thicknesses in abdominal muscles, specifically the external oblique (EO) and internal oblique (IO) muscles, than the well-nourished group (P = 0.001 and P = 0.007, respectively). There was a significant association between malnutrition and EO (odds ratio [OR] = 0.338, 95% CI = 0.163-0.699; P = 0.003) and IO (OR = 0.620, 95% CI = 0.427-0.900; P = 0.012) regardless of age and sex. CONCLUSION: One in four RTRs experience malnutrition. Muscle US could be used effectively for the diagnosis of reduced muscle mass and malnutrition in RTRs according to GLIM criteria.

Calf circumference predicts sarcopenia in maintenance hemodialysis.

BACKGROUND: Early recognition of sarcopenia in hemodialysis (HD) patients will be of great importance in preventing adverse outcomes and improving the quality of life in these patients. The main goal of this study was to evaluate the diagnostic accuracy of calf circumference (CC) measurement in detecting sarcopenia among CKD patients undergoing maintenance HD. METHODS: This cross-sectional study included 52 patients (53 ± 17 years) who were currently in a maintenance HD. Muscle strength was evaluated using handgrip strength, and smooth muscle mass index (SMI) was assessed through bioelectrical impedance analysis, and CC was measured at the widest part of the calf with the foot pressed against a hard surface. RESULTS: Out of the total patient population, sarcopenia was identified in 32.7% (n = 17). The two groups were comparable in terms of age, weight, and height, but the median body mass index of sarcopenic group was statistically lower than nonsarcopenic group (21.6 kg/m2 [18.9-24.6] vs 24.7 kg/m2 [21.4-27.3]. The sarcopenic group had a substantially smaller CC than the nonsarcopenic group (30.0 cm [26.5-32.0] vs 31.5 cm [30.3-34.8], P = 0.013; respectively). In the regression analysis, CC was found to be independently associated with post-HD SMI (P < 0.001; odds ratio, 1.938; and 95% CI, 1.020-2.856). CC was positively but weakly correlated with handgrip strength, however strong and significant correlation was found between CC and SMI (r = 0.277, P = 0.047 and r = 0.733, P < 0.001; respectively). A CC of 31 cm or less predicted confirmed sarcopenia in HD patients (area under the curve = 0.709, P = 0.006, specificity = 0.556, sensitivity = 0.765). CONCLUSIONS: Low muscle mass and potentially low muscle strength in HD patients can be accurately identified through the use of CC measurements. Specifically, a CC measurement below 31 cm has found to be a useful indicator to identify individuals on maintenance HD.

The Role of Muscle Ultrasonography to Diagnose Malnutrition and Sarcopenia in Maintenance Hemodialysis.

BACKGROUND: Sarcopenia and malnutrition are commonly seen and fundamental indicators of prognosis and are directly associated with increased mortality in maintenance hemodialysis (MHD) patients. We aimed to reveal the frequency of malnutrition and sarcopenia in patients undergoing MHD and investigate the role of muscle ultrasound (US) parameters to predict sarcopenia and malnutrition. METHODS: A total of 45 patients who have undertaken MHD for more than 6 months three times a week were evaluated for the present study. The US measurement was performed on gastrocnemius medialis, rectus femoris (RF), and abdominal muscles, including rectus abdominis, external oblique abdominalis, internal oblique abdominalis, and transversus abdominis. Nutritional status of the participants was assessed by mini-nutritional assessment short-form (MNA-SF). RESULTS: The prevalence of probable and confirmed sarcopenia was 51.1% (n = 23) and 35.6% (n = 16), respectively. The malnutrition and risk of malnutrition were observed in 31.1% of the whole study population (n = 14). All muscle US measurements were lower in the sarcopenic group; however, the difference is meaningful only for RF cross-sectional area (CSA) (P = .046). The malnourished group had substantially lower muscle thickness and CSA, except for the gastrocnemius muscle thickness. The value of RFCSA to predict sarcopenia and malnutrition was observed as 4.61 cm2, respectively (P < .05). RFCSA was independently associated with sarcopenia (odds ratio: 0.37; 95% confidence interval: 0.17-0.79; P = .011) and malnutrition (odds ratio: 0.45; 95% confidence interval: 0.23-0.87; P = .017). CONCLUSION: RFCSA may be a useful and simple predictor for predicting patients undergoing hemodialysis who are at risk of sarcopenia and malnutrition.

Lower gastrocnemius muscle stiffness, derived from elastography, is an independent factor for falls in older adults.

BACKGROUND AND AIMS: It is well known that components of sarcopenia (i.e., decreased muscle strength and mass) are related to falls in older adults. However, the possible effects of changes in muscle quality on falls have not been identified. This study aimed to evaluate the changes in muscle quality reflected by muscle stiffness derived from shear-wave elastography (SWE) and its association with falls in older adults. METHODS: A total of 101 geriatric outpatients were included in the study. Assessments of physical performance, muscle strength (handgrip strength), muscle mass (muscle ultrasonography and bioelectrical impedance analysis), and muscle stiffness of the medial head of gastrocnemius (GCM) in relaxation and passive stretching were performed. The history of falls in the previous year was questioned and recorded. RESULTS: The median (25-75 percentiles) age of participants was 73 (69-77) years, and 66.3% (n = 67) were female. According to fall history, participants were divided into non-fallers and fallers groups, and 72 (71.3%) and 29 (28.7%) participants were in each group, respectively. The median muscle stiffness of (Emean) the GCM in passive stretching was significantly lower in the fallers group (p < 0.001), and it was significantly correlated with the number of falls in the previous year (r: - 0.274, p: 0.010). In regression analyses, the Emean value of GCM in passive stretching was significantly associated with falls independent of confounders (OR: 0.944, 95% CI 0.90-0.98, p = 0.010). DISCUSSION AND CONCLUSION: This is the first study to reveal the relationship between falls and SWE-defined lower GCM stiffness independently of muscle mass and strength.

Turkish translation, cross-cultural adaptation and reliability of the Groningen Frailty Indicator.

BACKGROUND: Frailty is an important geriatric syndrome that can be seen as a way of recognizing and distinguishing the complex health conditions of older people. Due to the time limitation, short and simple instruments are most feasible in clinical practice, and several quick screening tools have been developed and validated, Groningen frailty indicator (GFI) is one of these scales. We aimed to validate and evaluate the reliability of the GFI in outpatient older adults in the Turkish population. METHODS: A total of 101 older patients were enrolled to the study. GFI was scored by a geriatrician for every patient at first admission to the geriatric outpatient clinic. Fried Physical Frailty Phenotype (FPFP) was performed as a reference test. RESULTS: The median age (IQR) was 72.0 (10.0) and 62.4% of the study population (n = 63) was female. Based on the GFI, 34 patients (33.7%) were defined as robust, and 67 patients (66.3%) were defined as living with frailty. There was a statistically significant concordance between GFI and FPFP (Cohen's kappa: 0.415 p < 0.001). GFI had excellent consistency in inter-rater reliability (Cronbach's alpha: 0.99, 95% CI 0.97-1.00) and in intra-rater reliability (Cronbach's alpha: 0.99, 95% CI 0.96-1.0). CONCLUSION: Our study showed that GFI is a valid and reliable scale in the Turkish older population.

An 8-year observational study of the death places of patients with COPD in Turkey.

AIM: The place of death is one of the indicators of the quality of end-of-life care, which has become an essential public health issue with the aging of the population and the increase in life expectancy. There is a lack of data regarding the location of deaths caused by chronic obstructive pulmonary disease (COPD), the third-leading cause of mortality worldwide. This retrospective, cross-sectional study aimed to investigate the places of death of patients with COPD in Turkey and their trends over the years. METHODS: The study included patients who had a COPD International Classification of Diseases code in the hospital information system and were provided a medication report for this disease in a university hospital's chest diseases outpatient clinic between January 1, 2014, and December 31, 2021. The place and date of death were obtained from the death notification system and recorded as an in-hospital or out-of-hospital death. RESULTS: A total of 1402 (77.3%) patients died in the hospital and 412 (22.7%) died outside the hospital, and when comparing the pandemic period and before, no significant difference was observed between the places of death. Sixty-three (49.6%) of 127 patients over the age of 90 years died outside the hospital, and a significant relationship was observed between advanced age and out-of-hospital mortality (P < 0.005). CONCLUSION: According to our findings, a substantial number of patients with COPD in Turkey die in hospitals. The insufficiency of nursing homes and lack of hospice care cause more hospital deaths. Our data are expected to guide the development of end-of-life care policies for patients with COPD in our country. Geriatr Gerontol Int 2023; 23: 938-944.

The relationship between urinary incontinence and abdominal muscle thickness in community-dwelling older women undergoing comprehensive geriatric assessment.

PURPOSE: Urinary incontinence (UI) is one of the most common geriatric syndromes in older adults, especially in women. The aim of this study is to show the relationship between urinary incontinence and abdominal muscle thickness measured by muscle ultrasonography (US) in community-dwelling older women adults. METHODS: Eighty-seven community-dwelling older women participated in our study. The presence and the type of UI were recorded. Clinical and demographic characteristics were collected, and a comprehensive geriatric assessment was performed on all participants. Abdominal muscle layer thicknesses were evaluated with muscle US. RESULTS: The prevalence of UI was 55.2% (n = 48) of the study population. The median [IQR] age of the patients in the UI group was 73.0 [69.0-77.5] years and it was 69.0 [67.0-73.0] years in patients without UI (p = 0.007). Abdominal muscle thicknesses were measured smaller in patients with UI than those without UI except for internal oblique muscle thickness. The median [IQR] rectus abdominis muscle thickness was lower in patients with UI than in patients without UI, and the difference was statistically significant (p < 0.003). RA muscle was associated with UI regardless of age, polypharmacy, malnutrition, and frailty (OR: 0.58; 95% CI 0.38-0.89; p = 0.01). CONCLUSIONS: We have shown that UI was independently related to the rectus abdominis muscle thickness, which may reflect the function and mass of the pelvic floor muscles.

How does hospitalization affect the frailty status of geriatric patients? Prospective study from internal medicine wards of a university hospital.

OBJECTIVES: Frailty is a dynamic process. Frailty in the baseline, discharge, and post-discharge are important in the management of patients. We aimed to see how hospitalization affects frailty and to evaluate its effects on health outcomes. METHODS: It was conducted with patients aged 65 and over who were hospitalized in the internal medicine wards of a university hospital. Frailty was evaluated by Clinical Frailty Scale within the first 24 h of hospitalization, within 24 h before discharge, and at third months after discharge. RESULTS: Ninety-six (57.8%) of patients at baseline, 79 (50.6%) at discharge, and 68 (47.9%) at 3 months were frail. According to baseline, 12 (7.7%) patients changed from frail to non-frail at discharge, while 4 (2.6%) patients became frail (p = 0.08). According to the baseline, 18 (12.5%) patients went from frail to non-frail at 3 months, while 7 (4.9%) patients turned frail (p = 0.04). In regression analysis, living with frailty at discharge and low education level increased re-hospitalization. Five or more are considered living with frailty. DISCUSSION: Hospitalization may have positive effects on frailty in older adult patients hospitalized in internal medicine wards, the main effect is seen to be more significant in the post-discharge follow-up.

Phase angle is associated with frailty in community-dwelling older adults.

OBJECTIVES: Frailty is a geriatric syndrome associated with adverse outcomes. Malnutrition and sarcopenia are conditions intertwined with frailty. Phase angle (PhA), used to evaluate nutritional status and sarcopenia, shows the cell membrane integrity and is closely related to clinical outcomes and mortality in many chronic conditions. The aim of this study was to evaluate the relationship between PhA and frailty in community-dwelling older adults. METHODS: The study included 299 older adults admitted to a geriatric outpatient clinic. A comprehensive geriatric assessment was performed on all participants. Frailty was evaluated via the Clinical Frailty Scale, ≥4 levels were accepted as living with frailty. All participants underwent bioelectrical impedance analysis, and PhA was recorded for each participant. RESULTS: The prevalence of frailty among the participants was 53%. The median PhA was lower in patients living with frailty than in those who were robust (5.10 [4.55-7.80] and 5.90 [3.90-6.90] degrees, respectively, and P = 0.014). Multivariable regression analysis showed that PhA was also associated with frailty in both sexes (odds ratio [OR], 0.920; P = 0.034 for men; OR, 0.81; P = 0.005 for women, respectively) independent of age, handgrip strength, nutritional status, body mass index, living alone, and burden of morbidities. CONCLUSION: PhA calculated with bioelectrical impedance analysis was significantly associated with frailty. Further research with large samples is needed to determine whether PhA demonstrates potential utility as a biomarker for frailty.

The role of ultrasonographically measured rectus femoris muscle on falls in community-dwelling older adults: a single-center study.

BACKGROUND: There are many risk factors for falls and sarcopenia has emerged as an important risk factor. Measuring muscle mass is a useful method to determine sarcopenia. Our aim was to determine the difference in muscle mass between older adults with (fallers) and without history of falls (non-fallers) using ultrasonography (US). METHODS: Two hundred ten geriatric patients were enrolled. Fall was defined as an event declared by the person who fell. Sarcopenia was defined by EWGSOP2 criteria. Muscle mass was assessed by muscle ultrasonography of five different muscles. RESULTS: The mean age of the whole study group was 74.1 ± 6.3 years and 58.1% (n = 122) of the total study population was female. Among the participants, 69 patients (31.3%) had a fall history. The sarcopenia ratio was 23.2% in the fallers, and it was 13.7% in the non-fallers, the difference was statistically insignificant (p > 0.05), the measurement of rectus femoris muscle (RF) thickness and cross-sectional area (RFCSA) were significantly smaller among the fallers than non-fallers (p < 0.05). The ROC analysis revealed that RF and RFCSA could determine the history of falls [for RF area under curve (AUC): 0.606, 95% confidence interval (CI) 0.526-0.686, p = 0.010 and for RFCSA AUC: 0.621, 95% CI 0.538-0.704, p = 0.004]. RFCSA was statistically relevant with a history of falls, regardless of age, sex, multimorbidity, incontinence, nutritional status, and frailty status. CONCLUSION: Decreased RF and RFCSA determined by muscle US is a potentially modifiable risk factor for falls in older adults. Muscle US may be used for determining the risk of falls in older adults.

Pan-immune inflammation value; a novel biomarker reflecting inflammation associated with frailty.

BACKGROUND: Frailty is suggested to be associated with age-related changes in the immune system, namely immunosenescence. Few studies have investigated the association of frailty with circulating immune biomarkers reflecting immunosenescence. Pan-immune inflammation value (PIV) is a new composite circulating immune biomarker to predict inflammation status. AIM: This study aimed to assess the relationship between PIV and frailty. METHODS: A total of 405 geriatric patients were enrolled in the study. All participants underwent a comprehensive geriatric assessment. The comorbidity burden was evaluated with Charlson Comorbidity Index. Frailty status was evaluated via the Clinical Frailty Scale (CFS), and patients with CFS scores ≥ 5 were defined as living with frailty. PIV was calculated using the formula: (Neutrophil × monocyte × platelet)/lymphocyte. Patients were defined as PIV-low (≤ 372) and PIV-high (> 372). RESULTS: The median age of participants was 72 (IQR = 67-78) years and; 63.0% (n = 225) were female. Patients were divided into two categories (i.e., robust and living with frailty groups), and 320 (79.0%) and 85 (21.0%) patients were in each group, respectively. Median PIV was higher in the living with frailty group (p = 0.008). In the linear and logistic regression analyses, both PIV and PIV-high (> 372) were significantly associated with frailty independently of confounders. DISCUSSION AND CONCLUSION: This is the first study revealing the relationship between PIV and frailty. PIV may be seen as a novel biomarker reflecting inflammation associated with frailty.

Dysphagia is closely related to frailty in mild-to-moderate Alzheimer's disease.

INTRODUCTION: Physical phenotype and the cumulative deficit model are two well-known concepts of frailty. One of the main components of frailty is loss of muscle mass and function, which may also include swallowing muscles, therefore is a risk factor for dysphagia. Since dysphagia is seen starting from the early stages of Alzheimer's Disease (AD), in this study we aimed to reveal the relationship between frailty and dysphagia and dysphagia-related quality of life through Swallow Quality of Life (SwalQoL) tool in patients with AD and compare them with cognitively intact older adults. METHODS: Comprehensive geriatric assessment, dysphagia evaluation by Eating-Assessment Tool (EAT-10) and SwalQoL questionnaire, and frailty assessment via FRAIL and Clinical Frailty Scale (CFS) were performed on all 101 participants of the study. Thirty-five patients were cognitively intact, 36 patients were diagnosed with mild AD, and 30 patients were diagnosed with moderate AD. RESULTS: Sex distribution was similar between the groups, however, there was a statistically significant age difference. The prevalence of frailty increased according to both frailty indexes as the cognitive status deteriorated. All parameters of SwalQoL except fear and sleep parameters deteriorated as cognitive status impaired. In quantile regression of the total score of the SwalQoL questionnaire and multivariable logistic regression of EAT-10, frailty, as defined by CFS and FRAIL, was associated with dysphagia and poor quality of life regardless of age, presence of dementia, as well as nutritional status. CONCLUSION: Swallowing difficulties in AD negatively affects the quality of life, and it is closely related to frailty in mild-to-moderate AD.

Closure of pressure injury and mortality in internal medicine wards.

PURPOSE: The prevalence of pressure injury (PI) in hospitalized patients ranges from 5 to 15%, and is significantly greater in critical care and palliative care units. Prevalence of PI is considered an indicator of health care quality and is associated with increased morbidity and mortality. The study aims to determine the features of PI and its association with mortality among hospitalized patients in the inpatient service of a university hospital. METHODS: The present study comprised 89 patients hospitalized on the internal medicine inpatient service who had PI at the time of hospitalization and or who developed PI during hospitalization. Patients were categorized based on the state of PI closure (complete/incomplete). Mortality rates for 1 month, 3 months, 6 months, and 1 year were computed. RESULTS: The median age was 74. (IQR: 62-82). Forty-eight patients were female, and 15.7% of hospitalized patients had PI. A third of patients died during their index hospitalization. Patients with completely closed PI had decreased one-month, three-month, six-month, and one-year mortality rates. Complete closure of PI influenced all four mortality rates independently of other parameters, as determined by Cox regression analysis of the factors impacting mortality. CONCLUSION: As life expectancy rises, the frequency of PI increases, resulting in a rise in health care expenses. To reduce these expenses, prevention, early identification, and treatment of PI are essential. The primary finding of the study is that complete closure of PI in hospitalized patients reduces the risk of death.

Relationships of Fall Risk With Frailty, Sarcopenia, and Balance Disturbances in Mild-to-Moderate Alzheimer's Disease.

BACKGROUND AND PURPOSE: Cognitive impairment is one of the main risk factors for falls, and hence it commonly coexists with balance issues. Frailty and sarcopenia are intertwined and prevalent in dementia, and are closely related to falls. We aimed to determine the relationships of the fall risk with balance disturbances, sarcopenia, and frailty in mild-to-moderate Alzheimer's disease (AD). METHODS: The study enrolled 56 patients with probable AD. A comprehensive geriatric assessment was performed, and muscle strength and mass, performance status, gait, and balance were evaluated. All parameters were compared between fallers and nonfallers with AD. RESULTS: Fallers comprised 53.6% of the study population. The demographic features and AD stages did not differ between fallers and nonfallers. Fallers were more frail than nonfallers (p<0.05). Frailty was found to be independently associated with fall history (odds ratio=2.15, 95% confidence interval=1.20-3.82, p=0.031). We found that falls were not associated with AD stage, muscle mass and function, balance and geriatric syndromes except urinary incontinence in patients with AD (p>0.05). CONCLUSIONS: We found that falls were not influenced by AD stage. Both physical and cumulative frailty were strongly associated with falls in patients with mild-to-moderate AD.

Changes in Place of Death of Older Adults during the COVID-19 Pandemic: A Retrospective Study from an Aging Country.

In the COVID-19 pandemic, due to the difficulties in patients' applications to health centres, changes have occurred in the places of death of older adults. It is aimed to investigate the change in the places of death of older adults in Turkey, which is one of the countries most affected by the pandemic. Patients admitted to the geriatric outpatient clinic of a university hospital from 01.01.2013 to 29.02.2020 were included. Place and date of death were recorded as hospital or out-of-hospital death. According to results, while the median age of those who died during the pandemic was higher than before (p < 0.001) and during the pandemic, the hospital mortality ratio was higher than before. During the pandemic period, the hospital mortality ratio of older adults has increased in Turkey. This situation, which has occurred despite the increasing healthcare burden, can show the importance of the measures taken and robust health infrastructure.

Changes in muscle quality identified by shear-wave elastography and association with sarcopenia.

BACKGROUND AND AIMS: This study aimed to investigate the potential role of shear-wave elastography (SWE) in evaluating muscle quality and assess its association with muscle strength and mass. METHODS: A total of 129 patients aged 18-87 years were included. Patients aged >65 years underwent comprehensive geriatric assessment. Anthropometric measurements, assessment of physical performance, muscle strength (handgrip strength [HGS]), muscle mass (B-mode muscle ultrasonography), and muscle quality (identified via SWE) were performed for all patients. RESULTS: The median (interquartile range) age of participants was 69 (59-76) years and 62% (n = 80) were female. According to HGS, patients were divided into normal and low HGS groups, and there were 85 (65.9%) and 44 (34.1%) patients in each group, respectively. The median average value of SWE measurement (Vmean ) of the rectus femoris (RF) in passive stretching was significantly lower in the low HGS group. In regression analyses, Vmean was significantly associated with HGS independently of age, sex, and body mass index. Optimal cutoff values of the Vmean value (m/s) of RF in passive stretching for predicting low HGS were ≤2.62 for male (area under the curve [AUC], 0.882; 95% CI, 0.705-0.938; P = <0.0001), and ≤2.52 for female (AUC, 0.719; 95% CI, 0.605-0.833; P = 0.002). CONCLUSION: To the best of our knowledge, this is the first study revealing SWE is a good predictor of muscle strength, and it could be a useful tool for evaluating muscle quality in clinical practice. Further randomized controlled studies are needed to confirm the presented cutoff values.

Cognitive assessment in the time of pandemics: mandatory surgical face mask usage affects cognitive test performance of older adults.

BACKGROUND: The most important disadvantage of surgical mask usage is that it can aversely affect communication. This study aimed to evaluate the possible effects of face masks on the cognitive test performance of older adults. METHODS: A total of 198 geriatric patients were enrolled after applying the exclusion criteria. Within the comprehensive geriatric assessment (CGA), cognitive status assessment was performed with the Mini-Mental State Examination test (MMSE) and Quick Mild Cognitive Impairment Screening test (Q-MCI) tests. RESULTS: The median age was 70 (66-77) years, and there were 119 female (60.7%) patients. Patients were divided into normal cognitive status (NC), mild cognitive impairment (MCI), and probable Alzheimer's disease (AD) groups. There were 129 (65.2%), 30 (15.2%), and 37 (18.7%) patients in each group, respectively. For differentiating MCI from NC, calculated optimal cut-offs for the Q-MCI and MMSE total scores were ≤50 (sensitivity 83.3%, specificity 90.7%) and ≤26 (sensitivity 63.3%, specificity 87.5%), respectively. For differentiating AD from MCI, calculated optimal cut-offs for the Q-MCI and MMSE total scores were ≤28 (sensitivity 76.8%, specificity 86.7%), and ≤24 (sensitivity 94.4%, specificity 64.5%), respectively. CONCLUSION: Our results revealed that screening tests are still sensitive in discriminating cognitive disorders although cut-offs are lower with mask usage than for previously validated cut-offs. This is the first study revealing the impact of surgical mask usage on cognitive test performance, indicating that cut-offs validated before the pandemic may cause overdiagnosing of cognitive disorders since the previous cut-offs are not validated for mask usage. Large sample studies are needed to determine new cut-offs validated with mask usage.