Prevalence and general characteristics of dementia: a nationwide population-based study of electronic health records in Türkiye.

Background/aim: Türkiye is a country with an increasing life expectancy and an older adult population in parallel with the rest of the world. Several national small-scale studies were performed regarding the prevalence and characteristics of dementia in Türkiye, and the results of these studies differ from each other. We aimed to determine the prevalence of dementia in Türkiye to present the demographic characteristics, the frequency of use of health services, and the management of dementia. Materials and methods: Patients aged 65 years and over with a diagnosis of any type of dementia between January 1, 2019, and December 31, 2020, were retrospectively screened from the electronic health records of the Ministry of Health using ICD-10 codes. Results: In 2019, the total number of dementia cases identified in individuals aged 65 years and older was 247,727, of whom 150,529 (60.8%) were women. In 2020, the total number of dementia cases identified in this age group was 233,949, with 142,878 (61.1%) of these cases being women. The rate of patients admitted to the emergency department was 72.3% and 66.2% of all dementia patients in 2019 and 2020, respectively. In terms of the use of outpatient clinics, most patients with dementia were admitted to neurology (71.0% in 2019 and 62.4% in 2020). The geriatric medicine outpatient clinic was the least used by patients with dementia both in 2019 and 2020. Conclusion: The prevalence of patients living with dementia in Türkiye is lower than the global average. This suggests that most dementia cases are overlooked, highlighting the need to raise dementia awareness both in the community and among primary health care providers who frequently encounter older individuals. The study is significant in that it is the first to show the nationwide frequency of dementia in Türkiye.

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.

Frailty and sarcopenia among Turkish people aged 40 and above living with HIV.

BACKGROUND: People living with HIV face a variety of challenges, including accelerated ageing and geriatric syndromes. In this study, we aimed to examine the prevalence of frailty and sarcopenia among Turkish people living with HIV. METHODS: In total, 100 people living with HIV were recruited in this study. Frailty was determined using Fried's frailty phenotype, and we calculated the Charlson Comorbidity Index, Veterans Aging Cohort Study (VACS) index, fracture risk assessment tool scores, and Mini-Mental State Exam scores. We determined muscle mass using bioelectric impedance analysis, gastrocnemius muscle thickness using ultrasonography, and muscle strength using handgrip strength. RESULTS: The mean ± standard deviation age was 50.0 ± 8.3 years. In total, 11% of the patients were frail. The risk of comorbidity and mortality, VACS index, and 5-year mortality risk was significantly higher in the frail group, as was sarcopenia. Fat-free muscle mass and handgrip strength were correlated with gastrocnemius muscle thickness. Gastrocnemius muscle thickness suggestive of sarcopenia was defined as 13.05 mm. The cognitive impairment rate was 5% and was associated with physical frailty. CONCLUSION: Frailty is common and associated with higher morbidity and mortality rates among Turkish people living with HIV.

Ultrasound Assessment of Sarcopenia in Patients With Sarcoidosis.

OBJECTIVES: Sarcoidosis can cause sarcopenia like other chronic diseases. Ultrasonography is a simple method, which has been used frequently in recent years. We aimed to evaluate the sarcoidosis patients with ultrasonography for sarcopenia and to compare the results of ultrasonography with the accepted standard method, bioelectrical impedance analysis (BIA). METHODS: BIA and handgrip test were applied to all patients diagnosed with sarcoidosis. The patients were classified according to the presence of probable sarcopenia with their handgrip results and the presence of sarcopenia with the appendicular skeletal muscle mass index calculated with using BIA. Ultrasonography was applied to each patient and the thickness of seven different muscle groups of the patients were evaluated. The ability of muscle thickness values measured by ultrasonography to predict sarcopenia was compared with the reference standard test BIA. RESULTS: Forty patients (women/men = 31/9) were included in our study. The mean age was 53.2 ± 12.5 years. A statistically significant positive correlation was observed between handgrip strength and gastrocnemius medialis (GM), rectus femoris (RF) cross-sectional area, rectus abdominis (RA), external oblique (EO), transversus abdominus (TA), and diaphragm thicknesses. Therefore, there was a significant correlation between fat free mass index with RA, EO, and TA muscles. According to the ROC analysis, statistically significant muscle groups predicting sarcopenia were found as GM, RF cross-sectional area, EO, and IO. Again, according to the ROC analysis, it was seen that the thicknesses of GM, RA, EO, IO, and TA muscles corrected for BMI predicted probable sarcopenia with quite high sensitivity and specificity. CONCLUSIONS: Muscle thicknesses measured by ultrasonography are helpful for the diagnosis of sarcopenia that may develop in chronic diseases such as sarcoidosis. Further studies with higher number of patients are needed to validate the results of the present pilot study.

A Quality Improvement Study on Delirium Awareness Day: In Pursuit of Missed Delirium Diagnoses.

The current study aimed to screen for delirium in hospitalized older adults and assess the validity of the Turkish version of the 4A's Test (4AT-TR) as a feasible tool to integrate in routine patient care. The point prevalence of delirium according to clinical evaluation in routine practice was detected among all patients aged ≥60 years in 12 pilot wards. Delirium screening was then conducted by two arms: (a) nurses using the 4AT-TR and (b) geriatricians according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Prevalence of delirium according to clinical impression was 3.3% (n = 4), whereas prevalence was 12.4% (n = 17) according to DSM-5 criteria and 13.8% (n = 17) according to the 4AT-TR. The 4AT-TR performed by nurses had a sensitivity of 66.6% and specificity of 93.5%. Area under the receiver operating characteristic curve for delirium diagnosis was 0.819 (p < 0.001). Most delirium cases remain undetected unless a routine and formal delirium assessment is integrated in hospital care of high-risk patients. The 4AT-TR performed by nurses seems to be a valid tool for determining delirium in hospitalized older adults. [Journal of Gerontological Nursing, 48(8), 43-51.].

Comparative Evaluation of Predictive Ability of Comprehensive Geriatric Assessment Components Including Frailty on Long-Term Mortality.

Background: This study aims to compare the predictive value of all comprehensive geriatric assessment (CGA) parameters with the predictive value of frailty assessment (with Edmonton Frailty Scale (EFS) and Fried Frailty Index (FFI)) for long-term mortality, in older adults.Methods: A total of 967 patients were included, consecutively. At the first admission, age, gender, comorbidities, number of drugs, and laboratory values of the patients were recorded. Each patient underwent CGA which consisted of anthropometric measurements, functional, cognitive, mood, nutritional, gait, fall, sleep duration, and frailty assessment. Fifty-seven months after the first admission, CGA parameters were analyzed to determine their predictive abilities on long-term mortality due to all causes, comparatively.Results: The median age was 73 years (range 65-94 years). The median follow-up time was 39.9 months (range 0.5-57.3 months). Serum albumin level, FFI, EFS, instrumental activity of daily living (IADL) score, and walking time were the best predictors of mortality. There was no significant difference between these parameters in predicting mortality.Conclusion: FFI and EFS have similar predictive value for mortality. In busy clinical practice, a new index based on IADL, walking time, and serum albumin level may be an alternative of frailty assessment for predicting mortality.

Insomnia and falls in older adults: are they linked to executive dysfunction?

BACKGROUND: Insomnia increases the incidence of falls and impairs executive function. Moreover, falls are associated with executive function impairment. The relationship between falls and executive function in patients with insomnia is not clear. The aim of this study was to evaluate relationship between falls and executive function in individuals with insomnia and a control group. METHODS: This study involved 122 patients (47 insomnia, 75 controls). The Mini-Mental State Examination, Quick Mild Cognitive Impairment Screen, Trail Making Test A, clock-drawing test, and digit span test were used to measure executive function. Semantic and working memory dual task was also performed. Fall history was recorded and the Falls Efficacy Scale - International administered. RESULTS: The median age of the patients was 71 years (range: 65-89 years), and 60.7% were women. The insomnia group scored lower on the three-word recall than the control group (P = 0.005), but there was no difference between the groups on cognitive tests. Fall history and fear of falling were more frequent in the insomnia group (P = 0.003, P < 0.001). Semantic and working memory dual tasks were correlated with clock-drawing test only in the insomnia group (r = -0.316, P = 0.031; r = -0.319, P = 0.029). Depression (odds ratio (OR) = 9.65, P = 0.001) and Trail Making Test A (OR = 1.025, P = 0.07) were independently associated with insomnia. Four-metre walking speed (OR = 2.342, P = 0.025), insomnia (OR = 3.453; P = 0.028), and the semantic memory dual task (OR = 1.589; P = 0.025) were also independently associated with falls. CONCLUSION: Our study showed that dual tasking and executive function are related to falls in patients with insomnia. Managing insomnia and assessment of executive dysfunction may have beneficial effects on preventing falls.

Treatment of hypothyroidism improves glomerular filtration rate (GFR) in geriatric patients

Background/aim: Renal function of patients with hypothyroidism increases after reaching euthyroid state. There is no data regarding geriatric age group. The aim of the study was determined to investigate whether renal function of geriatric patients with hypothyroidism increases after they become euthyroid. Materials and methods: Patients who were sixty-five years or older were retrospectively screened in two centers. TSH, T3, T4, creatinine, and eGFR calculated by CKD-EPI formula were recorded under the presence of accompanying hypothyroidism. The same variables were recorded after the patients became euthyroid. Results: 285 patients were included in the study, the median age was 73(65­84), and 234 patients were female. Patients were examined in four groups according to TSH values. There were 160 (56.1%) patients with TSH 5­9.9 uIU/mL, 60(21.1%) patients with TSH between 10­19.9 uIU/mL, 41(14.4 %) patients with TSH between 20­49.9 uIU/mL and 24(8.4%) patients with TSH> 50uIU/mL. There was a significant and negative correlation between the initial TSH values and the first calculated eGFR values (p: 0.001; r: ­0.191). The median eGFR of the patients in hypothyroid cases was 66.59 (14.62­116.07), while the median eGFR value of patients was 69.6 (12.91­109.31) in the euthyroid state. This value obtained after thyroid replacement was significantly improved when compared to the first eGFR (p: 0.001). In logistic regression analysis, pretreatment TSH value was found to independently affect eGFR (p: 0.009; Exb: 1.017). Conclusion: It has been observed that hypothyroidism treatment increases eGFR in geriatric patients. Similar results were obtained after studies with younger patients in the literature. This study is a study in which only geriatric age group patients were examined. It should be kept in mind that hypothyroidism which is not corrected in geriatric patients may also contribute to a decrease in eGFR.

Masked hypertension is associated with end organ damage in geriatric age: Geriatric MASked Hypertension and End organ damage (G-MASH-End organ Study).

Purpose: It is a question whether masked hypertension (MH) leads to end-organ damage in the geriatric age group. The aim of this study is to evaluate the associations between MH and end-organ damage such as left ventricular hypertrophy (LVH) and proteinuria in geriatric population.Materials and methods: One hundred and two patients who were admitted to the outpatient clinic were included in the study. These patients were also included in the GMASH-Cog study in 2016, which examined the relationship between MH and cognitive function. All patients underwent ambulatory blood pressure measurement procedures. Cardiac functions of all patients were determined by echocardiography. Spot urine albumin/creatinine ratio (ACR) was measured in all patients.Results: Forty four of 102 patients (43%) were diagnosed with MH. ACR was 9.61 mg/gr in the MH group and 7.12 mg/gr in the normal group (p = .021). In addition, left ventricular mass index (LVMI) was found to be higher in the MH group than in the normal group. Mean LVMI scores were 107.76 ± 16.37 in patients with MH and 100.39 ± 19.32 in the normotensive group (p = .046).Conclusion: MH is associated with end-organ damage in geriatric patients. Urinary albumin excretion and LVH which are the parameters of end-organ damage were significantly higher in MH patients. MH may cause end-organ damage and should not be overlooked in geriatric patients.

Potentially inappropriate prescribing according to the STOPP/START criteria for older adults.

BACKGROUND: The aim of this study was to demonstrate the prevalence and possible predictors of potentially inappropriate medications (PIMs) and potentially prescription omissions (PPOs) according to the Screening Tool of Older Person's Prescriptions (STOPP) and Screening Tool to Alert doctors to Right Treatment (START) criteria in geriatric patients. METHODS: A total of 374 patients (140 male, 234 female) aged ≥65 years were included. Comprehensive demographic and clinical data including age, gender, current diagnoses/medications, comorbid diseases and medical problems were noted. RESULTS: There were 154 (41.2 %) patients with at least one PIM. Most common PIMs were proton pump inhibitors for peptic ulcer disease (9.6 %), calcium-channel blockers (6.4 %) and anticholinergic/antispasmodic drugs (5.9 %) in chronic constipation. There were 274 (73.3 %) patients with at least one PPO. Most common PPOs were calcium-vitamin D supplement in osteoporosis (OP) (39.6 %), statin (22.5 %) and antiplatelet therapies (16.0 %) in diabetes mellitus (DM) with cardiovascular risk factors. PIM was independently associated with female gender (OR = 2.21, p = 0.003), number of medications (OR = 1.35, p < 0.001), Katz scores of daily life activities (OR = 0.87, p = 0.013) and OP (OR = 0.29, p < 0.001). PPO was independently associated with age (OR = 1.06, p = 0.009), Geriatric Depression Scale score (OR = 1.20, p = 0.007), DM (OR = 6.50, p < 0.001), chronic obstructive pulmonary disease (COPD) (OR = 5.29, p = 0.010), number of medications (OR = 0.88, p = 0.019), and incontinence (OR = 0.39, p = 0.043). CONCLUSION: High prevalence of PIMs and PPOs were found in geriatric patients. Number of medications, female gender, and dependency were associated with PIM. Age, higher scores of Geriatric Depression Scale, DM, and COPD were related with PPOs.

Predictors of 3-month mortality with muscle ultrasound and palliative prognostic tools among patients admitted to palliative care units.

BACKGROUND/AIMS: Prognostic factors are an important issue in progressive and life-limiting diseases. This study evaluate 3-month mortality in patients admitted to the palliative care unit (PCU). METHODS: In this study, the patient's demographics, comorbidities, nutritional status, and laboratory values were recorded. The palliative performance scale (PPS), the palliative prognostic index (PPI), and the palliative prognostic (PaP) score were calculated. The rectus femoris (RF) cross-sectional area (CSA), RF muscle thickness, gastrocnemius (GC) medialis muscle thickness, pennation angle and fascicle length of the GC were measured by ultrasound for survival prediction. RESULTS: A total of 88 patients enrolled during the study period, with a mean age of 73.6 ± 13.3 years and a 3-month mortality rate of 59.1%. The findings of a multivariable Cox proportional hazards regression model based on age, gender, C-reactive protein level and Nutrition Risk Screening 2002 scores as covariates revealed the PPI and the PaP score to be significant predictors of 3-month mortality. In addition, in the unadjusted Cox proportional hazard regression analysis, the CSA of the RF muscle was also found to be a significant predictor of 3-month mortality. CONCLUSION: Findings revealed that the combined use of the CSA of the RF, the PPI, and the PaP score are reliable predictors of mortality in patients admitted to the PCU.

Systematic review and meta-analysis of randomized controlled trials on safety and effectiveness of oral anticoagulants for atrial fibrillation in older people.

A meta-analysis of prospective, randomized controlled trials on novel oral anticoagulants (NOACs) versus warfarin, as most commonly used vitamin K antagonists (VKAs), was done to evaluate their effect on stroke risk and bleeding complications in nonvalvular atrial fibrillation (AF) patients. The study aims to evaluate efficacy and safety of NOACs versus warfarin between patients < 75 years and ≥ 75 years old. Prospective, randomized controlled trials (RCTs) comparing NOACs with warfarin with at least 1-year follow-up in nonvalvular AF patients were included. Search was done at MEDLINE, without time and language restriction. "Cochrane risk of bias 2.0 tool" was used to assess risk of bias. In meta-analysis, random effect model was used. Q statistics was used to assess heterogeneity where it was indicated and I2 was used to assess inconsistency across studies. Five studies as RELY, ARISTOTLE, ENGAGE-AF, ROCKET-AF, and J-ROCKET-AF were included. Overall risk of bias was low for trials. Total patient number in meta-analysis was 73,122. Mean age was between 70 and 73 as a whole. Follow-up period was between 499 days and 2.8 years. Analysis of major stroke and systemic embolism was favoring NOACs than warfarin in older patients group period (RR (95% CI) = 0.57 (0.42, 0.76)). Similar trend was seen in younger patient group without statistical significant (RR (95% CI) = 0.74 (0.43, 1.27)). Analysis of major bleeding showed a general statistically significant trend of occurrence of major bleeding in whole group (RR (95% CI) = 0.70 (0.58, 0.86)) with NOACs. In subgroup analysis, it was consistent for both younger and older patients. Older patients have higher stroke risk that leads to more benefit with anticoagulation than younger patients. NOACs have better efficacy profile than warfarin as they decrease stroke more than warfarin, without increasing bleeding risk. Need for real-world data in old population is necessary.

How we Provide Nutritional Treatment in Hospitalized Patients?

BACKGROUND: In this study, we aimed to evaluate enteral nutrition (EN), parenteral nutrition (PN) and supplemental parenteral nutrition (SPN) in terms of achieving nutritional goals. METHODS: Patients receiving either EN, PN, or SPN treatment followed up by the clinical nutrition team between January and December 2017 at the university research and training hospital were included in the study. Daily nutritional requirements were calculated according to the recommendations. Total energy intake during nutritional treatment (NT) and all metabolic, mechanical, technical complications of NT were recorded. RESULTS: A total of 603 inpatients were included in the study. The nutritional goal was achieved in the majority of the SPN group patients (87.5%) statistically significant relation was found between the achievement of the target (or not) and PN access route (peripheral or central) (P < .001). However, none of the complications found statistically related to achieving the target, including gastrointestinal complications of EN (P = .46), metabolic complications of EN (P = .07), mechanical complications of EN (P = .79), metabolic complications of PN (P = .89), gastrointestinal complications in SPN group (P = .45), and metabolic complications in SPN group (P = .68). CONCLUSION: Nutritional goals could be achieved with SPN without increasing complications in the majority of patients. Commencement of SPN should be considered for positive outcomes in patients who failed to achieve desired nutritional outcomes.

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.

Evaluating skeletal muscle mass with ultrasound in patients with systemic sclerosis.

OBJECTIVES: Patients with systemic sclerosis (SSc) have an increased risk for loss of skeletal muscle mass. Ultrasonography (US) is a safe and promising method to evaluate muscle mass. In this study, we aimed to assess the frequency and clinical associations of low muscle mass status in patients with SSc, investigate the correlations between muscle mass sonographically measured regional muscle thicknesses (MTs), and explore the utility of US in predicting low muscle mass. METHODS: A total of 93 patients with SSc (86 women) were included in the study. Appendicular skeletal muscle mass (ASM) was calculated using a bioelectric impedance analysis and adjusted for height2 (ASM index, ASMI). Low muscle mass was defined as an ASMI of <7.26 kg/m2 for men and <5.50 kg/m2 for women. MT of the gastrocnemius medialis (GM), rectus femoris (RF), rectus abdominis (RA), external oblique (EO), internal oblique (IO), and transverse abdominis (TA) muscles were assessed by US. Correlations between ASMI and individual MTs were evaluated. Receiver operating characteristic analysis was used to determine the optimal cutoff values of MTs in predicting low muscle mass. RESULTS: Low muscle mass was present in 13.9% of patients. Diffuse disease subset (53.8% vs 17.5%), antitopoisomerase-1 antibody positivity (76.9% vs 47.5%), and malnutrition (61.5% vs 8.8%) were more frequent in patients with low muscle mass (P < 0.05 for all). MTs of RA (0.54 vs 0.75 cm), TA (0.30 vs 0.34 cm), and GM (1.23 vs 1.51 cm) muscles were significantly lower in patients with low muscle mass (P < 0.05 for all). RA (r = 0.322; P = 0.002), external oblique (r = 0.310; P = 0.002), TA (r = 0.205; P = 0.049), and GM (r = 0.513; P < 0.001) MTs were positively correlated with ASMI. Selected cutoff values for GM and RA MTs showed the highest sensitivity (92.3% for both) and negative predictive value (97.9% and 97.6%, respectively) in predicting low muscle mass status (area under the curve: 0.846 and 0.760, respectively) in the receiver operating characteristic analysis. CONCLUSIONS: Low muscle mass is prevalent in SSc and patients with diffuse disease are at particular risk for this condition. US measurement of abdominal and calf MTs may be used as a screening method to detect low muscle mass due to its high sensitivity and negative predictive value.

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.