Huseyin Doruk

Is there any relation between insulin resistance and cognitive function in the elderly

BACKGROUND Vascular risk factors are blamed as being involved in the pathogenesis of cognitive dysfunction in the elderly. Alzheimers disease or vascular-type dementia could be part of a metabolic syndrome. The aim of this study was to evaluate whether there is any relation between insulin resistance and cognitive status of the elderly regarding normal, mild cognitive impairment (MCI), Alzheimers disease (AD), vascular dementia (VaD) and mixed dementia. METHODS 267 elderly patients admitted to an outpatient geriatrics clinic were evaluated medically and cognitively in this study. The patients were diagnosed using ARDRA and DSM-IV criteria for AD; NINDS-AIREN and DSM-IV criteria for VaD; and Petersen criteria for MCI. Insulin resistance was calculated using both the homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) formulas. RESULTS The mean values of HOMA and QUICKI scores were 2.79 (SD+/-3.56) and 0.346 (SD+/-0.036) for the normal group, 2.81 (SD+/-3.06) and 0.354 (SD+/-0.047) for AD group, 2.20 (SD+/-1.82) and 0.360 (SD+/-0.048) for VaD group, 2.87 (SD+/-1.81) and 0.339 (SD+/-0.038) for mixed dementia group, 2.79 (SD+/-2.81) and 0,349 (SD+/-0.042) for MCI group, respectively. There were no statistically significant differences between HOMA and QUICKI scores of all the groups. CONCLUSION This is the first study of the possible relation between insulin resistance and cognitive function in people categorized according to five forms of cognitive status. Unfortunately the results do not allow generalizations. Further prospective cohort studies that follow a normal cognitive group and MCI patients with and without insulin resistance are necessary.

Effect of vitamin D on insulin sensitivity in elderly patients with impaired fasting glucose

Aim:  Recent data has shown that vitamin D increases insulin sensitivity; however, there is little evidence about the effects of this treatment on elderly people with impaired fasting glucose. The aim of the present study was to investigate the effect of vitamin D treatment on insulin sensitivity and metabolic parameters in elderly people with impaired fasting glucose.

Vitamin B12 and folic acid levels as therapeutic target in preserving bone mineral density (BMD) of older men

The knowledge about vitamin B(12) and folic acid levels in preserving bone mass in older men is limited. In this retrospective study, we aimed to find out whether levels of vitamin B(12) and folic acid are related to BMD in older men. Two hundred and sixty-nine older men were included in the study. Forty-two (15.6%) of them had osteoporotic, 150 (55.8%) had osteopenic, and 77 (28.6%) had normal BMD. Vitamin B(12) and folic acid levels were categorized as indicating normal, borderline, or low vitamin statuses. Femur neck densities showed statistically significant differences in subjects having low, borderline, and normal vitamin B(12), respectively. There were no significant differences between the three tertiles of vitamin B(12) in femur total, trochanteric, and intertrochanteric densities. After adjustment for age, body mass index (BMI), alcohol, smoking, and exercise with analysis of covariance, the difference was still statistically significant between two groups for femur neck density (p=0.011). No significant difference was observed between the groups of folic acid in any femur sites. We found that the normal level of vitamin B(12) in older men may be related to a decrease of femur neck bone loss.

Hyperbaric oxygen-induced changes in bacterial translocation and acinar ultrastructure in rat acute necrotizing pancreatitis

BackgroundWe aimed to investigate the effects of hyperbaric oxygen therapy on bacterial translocation and acinar cell ultrastructure in a rat model of acute necrotizing pancreatitis.MethodsForty-eight male Sprague-Dawley rats were randomly divided into three groups. Acute pancreatitis was induced in groups II and III. Groups I and II did not receive any treatment, and group III was treated with hyperbaric oxygen. All surviving animals were killed 48 h after the induction of pancreatitis. Bacterial translocation and histological and ultrastructural changes were determined.ResultsThe incidence of bacterial translocation in group III was significantly lower in comparison with group II (P < 0.001). Histopathological and ultrastructural injury scores were also significantly lower in group III (P < 0.001 and P < 0.04, respectively).ConclusionsHyperbaric oxygen therapy displayed beneficial effects on pancreatic superinfection and or histopathological and ultrastructural changes in experimental necrotizing pancreatitis.

Metformin Decreases Thyroid Volume and Nodule Size in Subjects with Insulin Resistance: A Preliminary Study.

Objective: The aim of this study was to investigate the effects of metformin on thyroid volume and nodule size. Subjects and Methods: Prospective data were gathered on 100 newly diagnosed subjects with insulin resistance (68 female, 32 male) between August 2008 and May 2010. Each subject followed a standard diet and exercise program, and received 1,700 mg/day of metformin therapy for 6 months. The height, weight, waist circumference (WC) and thyroid hormone levels of each subject were measured. Additionally, the dimensions of the thyroid lobes and maximum diameter of each thyroid nodule were determined by ultrasonography. BMI and thyroid volumes were also calculated. Insulin resistance was estimated by homeostasis model assessment. All these parameters were measured at the beginning and at the end of the treatment period. Results: BMI and WC decreased significantly after metformin therapy (34.5 ± 5.1 vs. 32.7 ± 4.8, p < 0.0001, and 106.3 ± 11.8 vs. 101.8 ± 19.0 cm, p = 0.008, respectively). Insulin resistance also decreased after metformin therapy (4.5 ± 1.9 vs. 2.9 ± 1.7, p < 0.0001). The mean thyroid volume (22.5 ± 11.2 vs. 20.3 ± 10.4 ml, p < 0.0001) and mean thyroid nodule size (12.9 ± 7.6 vs. 11.7 ± 7.2 mm, p < 0.0001) also decreased after treatment. Conclusion: In subjects with insulin resistance, metformin therapy significantly decreased thyroid volume and nodule size.

Accurate diagnosis of sarcopenia in the elderly requires correct measurement of muscle mass.

We readwith interest the article by Gariballa and Alessawho reported that older people with sarcopenia have poor clinical outcome following acute illness compared with those without sarcopenia.1 The results are particularly important as this prospectively designed study addressed the impact of sarcopenia on post-hospitalization recovery among elderly patients. However, some points need to be discussed through evidence based knowledge and the latest guideline recommendations. Clinical definition and diagnostic criteria for age-related sarcopenia developed by The European Working Group on Sarcopenia in Older People (EWGSOP) and published in early 2010 include presence of reduced muscle mass plus reduced muscle strength or decreased physical performance.2 What tests or measures should be used to identify presence of any of these three variables was also defined based on the latest evidence in this recent report. In their study, Gariballa and Alessa used anthropometry (midupper arm circumference and skinfold thickness) to measure muscle mass in their subjects and controls that had a mean age of 79 and 77 years, respectively. In elderly population, age-related changes in skin lipid deposits may change skin elasticity and result in errors,2 whichmay be particularlymore pronounced in advanced ages. Moreover, relatively limited studies exist as to whether anthropometric measures can be used reliably to measure muscle mass among seniors.3 Accordingly, the EWGSOP recommended against the use of anthropometry to identify the presence of muscle mass reduction in the elderly while making a diagnosis of sarcopenia2 In the present study, since Gariballa and Alessa classified their enrollees into two as with and without sarcopenia based on the measurement of muscle mass and function, and that they used anthropometry as the sole criteria to define muscle mass, some of their subjects could have been easily misclassified. In other words, using such a methodology, researchers could categorize individuals with presarcopenia as having sarcopenia or vice versa. Although

Cognitive and functional influences of vildagliptin, a DPP-4 inhibitor, added to ongoing metformin therapy in elderly with type 2 diabetes.

INTRODUCTION Diabetes mellitus has been linked to cognitive decrement faster than usual. Medical management of diabetes can also interfere with the cognitive skills. The purpose of this study was to evaluate the effects of vildagliptin on cognition, as an add-on to metformin therapy in elderly patients with type 2 diabetes mellitus. MATERIALS AND METHODS This was a prospective and observational investigation conducted in 10 elderly type 2 diabetes mellitus patients who were started treatment with vildagliptin 50 mg twice daily to ongoing metformin. All participants underwent detailed clinical cognitive assessment and neuropsychological testing with mini mental state examination (MMSE) and clock drawing test (CDT), along with measurement of functional parameters at entry and study completion. RESULTS Mean follow-up time was 10.9±3.7 months. No subjects reported significant side effects during the study. At follow-up, in accordance with the clinical assessment, neither MMSE nor CDT showed significant changes after addition of vildagliptin to metformin. Basic and instrumental activities of daily living (BADL and IADL), mini nutrition assessment and geriatric depression scale scores also remained unchanged between the two evaluations. DISCUSSION In this pilot study, addition of vildagliptin to ongoing metformin therapy in elderly with diabetes was accompanied by stable cognitive and functional performance after almost one year of follow-up.

Pantoprazole Sodium–Induced Hyponatremia in a Frail Elderly Adult

elderly adult with an itchy, psoriasiform scalp eruption. Individuals at higher risks include those who are bedbound with multiple medical comorbidities and poor mobility. The prognosis in MF is worse in men, older adults, at a higher stage of disease, and with the folliculotropic variant of MF. This woman had at least T3N1M0B0 disease, compatible with Stage IIB, which is advanced. Overall survival at this stage is 37.8% to 63.2% at 5 years after diagnosis and 19.8% to 53.2% at 10 years. Systemic therapy is indicated because of extensive skin and lymph node involvement. Choices include retinoid (bexarotene), interferon, histone deacetylase inhibitors (e.g., romidepsin, vorinostat), chemotherapy (e.g., methotrexate, doxorubicin, gemcitabine, cyclophosphamide, chlorambucil, fludarabine, etoposide), and biologic agents (e.g., bortezomib, alemtuzumab). Because these treatments are expensive and not readily available, this woman was fortunate to receive the biological treatment and chemotherapy free of charge and had a good outcome.

Rivastigmine Associated Hyponatremia in an Older Patient with Alzheimer's Disease

To the Editor: Electrolyte disturbances in subjects receiving rivastigmine are rare. We report a case of hyponatremia caused by rivastigmine in an older adults with Alzheimer’s disease (AD). Ms. Z was an 86-year-old, frail woman treated with daily rivastigmine patch with a dosage titration regimen up to 10 cm/d for AD. Her serum sodium level was 144.8 mEq/L (reference range 135–145 mEq/L). She was taking no medications other than rivastigmine. Two months later, she was hospitalized for confusion and lethargy. Her sodium level was 117 mEq/L. After treatment for hyponatremia, her serum sodium level improved to 135 mEq/L, and her symptoms abated. Urinary tract infection and nausea were assumed as reasons for hyponatremia. Rivastigmine patch 10 cm daily was continued after she was discharged from the hospital. After 4 months, she again presented with complaints of a 5-day history of worsening confusion and lethargy and increasing fatigue and loss of appetite. Her serum sodium level had fallen to 121 mEq/L. Her other laboratory findings were as follows: serum glucose, 80 mg/dL; serum creatinine concentration, 0.88 mg/dL; blood urea nitrogen concentration, 10.5 mg/dL; serum potassium, 3.5 mEq/L; erythrocyte sedimentation rate, 10 mm/h; serum osmolality, 250.8 mOsm/kg; urine osmolality, 405.6 mOsm/kg; and urine sodium 27 mmol/d. Complete blood count, liver enzymes, and thyroid function tests were within reference range. Other laboratory data did not show abnormalities. Her relatives denied she took medications other than the rivastigmine patch. On examination, she was afebrile, with a temperature of 36.61C. Her body mass index was 18.4 kg/ m. Her blood pressure was 110/60 mmHg, and heart rate was 72 beats/min. She was disoriented and not alert. Her physical examination was unremarkable otherwise. A brain computed tomography scan did not show any pathological condition. After this extensive examination, hyponatremia was attributed to the rivastigmine patch, so it was stopped, and hypertonic saline (3%) was administered (1 mL/kg per hour) for 3 hours, followed by fluid restriction. Her sodium level improved to 136 mEq/L by the day of discharge, and her symptoms disappeared. Dementia was managed with donepezil 5 mg/d, later increased to 10 mg/d. One month after rivastigmine patch discontinuation, her serum sodium level was 142 mEq/L. No further episodes of hyponatremia occurred over 6 months of follow-up.

The effects of early vitamin B12 replacement therapy on the cognitive and functional status of elderly subjects

3 OZET: Yafll›larda erken vitamin B12 replasman tedavisi- nin kognitif ve fonksiyonel durumlara etkileri Amac: Bu cal›flman›n amac› dufluk vitamin B12 duzeyli yafl- l›larda erken vitamin B12 replasman›n›n kognitif ve fonksi- yonel durumlara etkilerini noropsikolojik deerlendirme olcekleri ile incelemektir. Yontem: Bu cal›flmada dufluk vitamin B12 duzeylerine (<400 pg/ml) sahip 116 kognitif bozukluu olan hasta ve 211 kognitif bozukluu olmayan toplam 327 yafll› olgu de- ¤erlendirildi. Olgulara ilk bir ay haftada bir, daha sonra befl ay sureyle de ayda bir 1000 mikrogram intramuskuler siya- nokolbalamin verildi. Tum hastalar bafllang›cta ve 6 ay son- ra mini-mental durum deerlendirmesi, saat cizme testi, gunluk yaflam aktiviteleri ve enstrumantal gunluk yaflam aktiviteleri olcekleri ile deerlendirildi. Bulgular: Alt›nc› aydaki deerlendirmede 120 olgu deiflik nedenlerden dolay› vitamin B12 replasman› almam›flt›. Bu olgular›n tam kan parametreleri stabil kal›rken, vitamin B12 duzeyleri, kognitif ve fonksiyonel olcek skorlar› anlaml› ola- rak kotuleflmiflti (p deerleri < 0.05). Bununla birlikte, vita- min B12 replasman› alm›fl 207 olgunun vitamin B12 duzey- lerinde, mini-mental durum deerlendirmesi ve saat cizme olceklerinin skorlar›nda istatistiksel olarak anlaml› artma (p deerleri < 0.05) ve gunluk yaflam aktivitesi ile enstruman- tal gunluk yaflam aktivitesi olceklerinin skorlar›nda korun- ma gosterdi. Sonuc: Sonuc olarak, geriatrik olgularda vitamin B12 du- zeylerinin yak›n takibi, vitamin B12 duzeyleri 400 pg/ml den daha dufluk olan hastalara erken replasman yap›lmas›, kognitif durumun geliflmesi ve fonksiyonelliin korunmas› ac›s›ndan faydal› gibi gorunmektedir. ABSTRACT: The effects of early vitamin B12 replacement therapy on the cognitive and functional status of elderly subjects Objective: The aim of this study was to examine the effects of early vitamin B12 replacement on cognitive and functional status in elderly subjects with low vitamin B12 levels by using neuropsychological assessment scales. Methods: A total of 327 elderly patients with low vitamin B12 levels (<400 pg/ml) were evaluated. While 116 of 327 patients had cognitive impairment, 211 subjects did not. All patients were prescribed 1000 micrograms cyanocobalamin intramuscularly every week for 1 month, then monthly for 5 months. The mini-mental status examination (MMSE), clock drawing test, activities of daily living, and instrumental activities of daily living scales were applied to all patients at baseline and 6 month.