Prevalence of nutrition disorders and nutrition-related conditions in older patients with Alzheimer's disease

BACKGROUNDS

Alzheimer's disease is frequently encountered with nutrition-related conditions such as malnutrition, sarcopenia, frailty, overnutrition, and micronutrient abnormalities in older patients. In this study, we aimed to evaluate the prevalence of nutrition disorders and nutrition-related conditions in the same patient group.

METHODS

A total of 253 older patients with Alzheimer's disease underwent comprehensive geriatric assessment, which included nutrition-related disorders, malnutrition via the Mini Nutritional Assessment-Short Form (MNA-SF), frailty via the Clinical Frailty Scale (CFS), and sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People-2 criteria.

RESULTS

The patients' mean age was 79.8 ± 6.5 years, and 58.1% were women. In our patients, 64.8% had malnutrition or were at risk of malnutrition; 38.3% had sarcopenia; 19.8% were prefrail; and 80.2% were frail. Malnutrition, frailty, and sarcopenia prevalence increased as the Alzheimer's disease stage progressed. Malnutrition was found to be significantly related with frailty scores via CFS (odds ratio [OR], 1.397; P = 0.0049) and muscle mass via fat-free mass index (FFMI) (OR, 0.793; P = 0.001). In logistic regression analysis, age, MNA-SF, and CFS were included in the model to detect the independent correlates of probable and confirmed sarcopenia. CFS was independently associated with probable and confirmed sarcopenia (OR, 1.822; P = 0.013; OR, 2.671; P = 0.001, respectively). Frailty was similarly related with FFMI (OR, 0.836; P = 0.031). Obesity was independently related with FFMI (OR, 0.688; P < 0.001).

CONCLUSION

In conclusion, nutrition disorders and nutrition-related conditions can present concurrently in patients with all stages of Alzheimer's disease; therefore, these frequent problems should be screened and diagnosed accordingly.

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.

Assessment of clinical features and coexisting geriatric syndromes in newly diagnosed dementia with Lewy bodies: a retrospective study in a tertiary geriatrics setting in Turkey

PURPOSE

Identifying the associated clinical conditions in patients with newly diagnosed dementia with Lewy bodies (DLB) may contribute to the disease management. This study aimed to examine the clinical features and coexisting geriatric syndromes of patients with newly diagnosed DLB.

METHOD

This cross-sectional study included newly diagnosed DLB participants who were admitted to a tertiary geriatric outpatient clinic. Of the 857 patients with dementia, 116 DLB diagnoses were eligible for analysis. The core and supportive clinical features of DLB were recorded. Geriatric syndromes including polypharmacy, depression, insomnia, dependency, a history of delirium, falls, malnutrition, urinary incontinence, functional impairment, and living alone, were assessed and recorded at baseline.

RESULTS

The mean age was 79.0 ± 6.9 years, and 50.9% of the participants were female. The majority (63.8%) had mild dementia, 31.9% had moderate, and 4.3% had severe disease. Cognitive fluctuations (78.4%), visual hallucinations (77.6%), and Parkinsonism (73.3%) were the most common clinical features. Functional impairment (59.5%) and urinary incontinence (59.5%) were the leading geriatric syndromes, followed by polypharmacy (56.9%), depressive symptoms (54.7%), falls (52.6%), insomnia (49.1%), malnutrition (24.3%), and delirium (6.0%). Women had more functional impairment and depressive symptoms than men.

CONCLUSION

Although most patients had mild dementia, three-quarters of the DLB cohort had hallucinations, and nearly two-thirds were functionally impaired. The proportion of other serious health conditions also increased, indicating a high comorbidity and geriatric syndrome burden. Comprehensive geriatric assessment is strongly recommended for DLB patients from the time of diagnosis until death to reduce disability and comorbidities.

THE CLINICAL TRIAL REGISTRATION NUMBER

NCT05052450.

Turkish Validity and Reliability of the Self-care of Hypertension Inventory (SC-HI) among Older Adults

PURPOSE

To assess the psychometric properties of the Turkish version of the Self-care of Hypertension Inventory (SC-HI) among older adults with hypertension.

DESIGN

This was a methodological study.

METHODS

The study sample enrolled 176 older adults. The study carried out preliminary psychometric analyses.

FINDINGS

Item-level content validity index ranged between 0.87 to 1.0, and the index of content validity was 0.98. The Cronbach's α for the total scale was 0.84.

CONCLUSION

The cross-cultural adaptation of SC-HI has been realized successfully in Turkish.

CLINICAL EVIDENCE

Health care providers may utilize the scale to evaluate "older individuals" hypertension self-care abilities.

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 ındex (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.

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.

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.

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.