Ilkin Naharci

The Comparative Effects of Valsartan and Amlodipine on vWf Levels and N/L Ratio in Patients with Newly Diagnosed Hypertension

High levels of circulating Von Willebrand factor (vWf) and increased neutrophil to lymphocyte (N/L) ratio may reflect vascular inflammation in hypertensive patients. In present study, we aimed to investigate the effects of valsartan as an angiotensin II receptor antagonist and amlodipine as a calcium channel blocker on the vWf levels and N/L ratio in patients with essential hypertension. Patients were randomized to one of the following intervention protocols: calcium channel blocker (amlodipine, 5–10 mg/day) as group A (n = 20 mean age = 51.85 ± 11.32 y) and angiotensine II receptor blocker (valsartan, 80–320 mg/day) as group B (n = 26 mean age = 49.12 ± 14.12 y). Endothelial dysfunction and vascular inflammation were evaluated with vWf levels and N/L ratio in hypertensive patients before treatment and after treatment in the 12th week. No statistically significant differences were found among the groups in terms of age, sex, and body mass index (BMI). There was a significant decrease in vWf levels (P < .001) and N/L ratio after treatment (P = .04, P < .001, respectively) in both the groups. Von Willebrand factor levels and N/L ratio are very important markers having a role in vascular inflammation and antihypertensive treatment with amlodipine and valsartan may improve cardiovascular outcomes by decreasing these biomarkers.

The effect of fluvastatin on plasma adiponectin levels in dyslipidaemia.

Objective  There is controversy about the effects of statins on insulin resistance and plasma adiponectin. The aim of this study was to investigate the effects of fluvastatin treatment on these parameters in a group of dyslipidaemic patients who had no confounding factors for insulin resistance or alterations in plasma adiponectin.

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.

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.

Quality Indicators of Drug Use and Risk of Pneumonia in Older Adults without Dementia

To the Editor: In a recent issue of the Journal of the American Geriatrics Society, it was a great pleasure to read the study by Jackson and colleagues aimed at developing risk scores to predict future risk of communityacquired pneumonia (CAP) in older adults without dementia. Available data on the risk scores for prediction of developing CAP in older adults are sparse. Therefore, this study will arouse great interest in research on models for predicting pneumonia risk, but a few issues need to be discussed. The authors might not have taken into consideration the quality indicators of drug use that could have affected their results, including polypharmacy and anticholinergic burden. A growing number of older people are at high risk of adverse drug events because of challenges in prescribing. Quality indicators of drug use are widely used to measure quality of prescribing and provide practical insights into how to optimize drug regimens. The most-important indicators of these are polypharmacy anticholinergic burden, which are associated with many adverse events in older adults. Polypharmacy and related complications are commonly observed in elderly adults because they have numerous, frequent doctor visits. Polypharmacy affects older adults in various ways, including adverse drug events, drug–drug interactions, prescribing cascades, and inappropriate drug use. Previous studies have shown that polypharmacy has been a significant predictor of all-cause hospitalization and adverse outcomes, including pneumonia. Because of the association between polypharmacy and pneumonia, clinicians should look for risks early, before development of infection. Recent studies have shown that anticholinergic agents have increased the risk of CAP in older adults. A nested case–control study demonstrated that older adults using a anticholinergic drug had a 65% higher risk of CAP than nonusers. A recent case–control study of 3,061 older adults reported that acute and chronic use of anticholinergic drug increased the risk of CAP. Nonetheless, no study has considered anticholinergic drug use as a risk factor when developing a prediction model for pneumonia. Alternatively, several mechanisms have been suggested as playing a role in the development of anticholinergic-induced pneumonia in older adults. One of them is aspiration due to swallowing dysfunction and dysphagia, low esophageal sphincter pressure, ineffective cough, dryness of mouth, and confusion caused by anticholinergic adverse effects. Other mechanisms are considered to have been a slowing of mucociliary transport and a reduction in salivary secretions, which result in bacterial growth and survival. Some additional data on polypharmacy and anticholinergic burden in the study population may make the prediction model more accurate and useful in clinical practice. Quality indicators of drug use could be included in the research model. Additional findings may be helpful in developing a risk score to identify older adults at high risk for pneumonia.

Mismatch between ADA and AGS recommendations for glycated hemoglobin targets for older adults

In recent years, modified glycemic targets have been defined for older adults with diabetes mellitus. In a sample of elderly patients, we have identified several inconsistencies between the real life applicability of glycated hemoglobin goals recommended by the American Diabetes Association and the American Geriatrics Society.

Zoledronic Acid Use and Risk of Cognitive Decline among Elderly Women and Men with Osteoporosis

OBJECTIVES Bisphosphonates are the first line treatment options in the prevention and treatment of osteoporosis among elderly women or men. Age associated cognitive decline may increase due to adverse effects of medications. The aim of the present study was to observe the course of cognitive skills in elderly subjects treated with a bisphosphonate. MATERIALS AND METHODS This prospective study enrolled 120 community-dwelling, non-demented women and men with osteoporosis aged 65 and older who were treated with first-ever zoledronic acid. Mini mental state examination (MMSE) was measured along with geriatric depression scale (GDS) measurement, clock drawing test (CDT), and other clinical and laboratory evaluations that could affect cognition at baseline and 12 months. The primary outcome was at least one point decrease in the final MMSE score at one year. RESULTS Scores of MMSE (28.29±2.17 and 28.23±2.37, p=0.681), GDS (3.24±2.88 and 2.96±2.88, p=0.062) and CDT (3.69±0.68 and 3.75±0.60, p=0.268) did not change after zoledronic acid infusion at one year. Education in years and presence of newly started medicines with anticholinergic properties was independently associated with at least one point reduction in MMSE score [odds ratio: 3.07 (%95 confidence interval: 1.00-9.44)]. CONCLUSION Among elderly woman and men with osteoporosis, cognitive functions remained stable 12 months after the administration of first-ever zoledronic acid.

Evaluation of prevalence and treatment of neuropsychiatric symptoms in elderly patients with dementia: 9 year-follow-up

Background: This study was designed to evaluate the prevalence and treatment of neuropsychiatric symptoms in elderly patients with dementia. Methods: In this study, stage of dementia, neuropsychiatric symptoms and type, dose and duration of treatment for neuropsychiatric symptoms of 324 consecutive elderly patients with dementia were evaluated retrospectively. Results:At least 1 neuropsychiatric symptom was observed in 238 of 324 patients (73.5%). The mean beginning time of these symptoms was 23 months of diagnosis (from 1 year before the diagnosis till 9 years after the diagnosis). 75% of these symptoms were treated with antipsychotics. These symptoms were treated at the approximately of 3rd weeks of antipsychotic treatment including qutiapine, olanzapine, haloperidol and risperidone. 16% of the symptoms were successfully treated with trazodon 75 mg/day. The results were presented in Table-1 and 2. Conclusions: These results demonstrated that the neuropsychiatric symptoms in elderly patients with dementia should be treated with low dose and short term of antipsychotics and the dose of these drugs should be increased slowly. And also, trazodon therapy should be kept on mind for treatment of these symptoms. P1-396 COGNITIVE AND AFFECTIVE PREDICTORS OF SUBJECTIVE MEMORY COMPLAINTS IN THE AUSTRALIAN IMAGING BIOMARKERS AND LIFESTYLE (AIBL) STUDY OFAGING: A CROSSSECTIONAL ANALYSIS Rachel Buckley, Michael Saling, Kathryn Ellis, Nicola Lautenschlager, Paul Maruff, Ralph Martins, Colin Masters, Christopher Rowe, Greg Savage, Cassandra Szoeke, David Ames AIBL RESEARCH GROUP University of Melbourne, Melbourne, Australia; CogState Ltd, Melbourne, Australia; 3 Edith Cowan University, Joondalup, Australia; 4 Mental Health Research Institute, Melbourne, Australia; 5 Austin Health, Heidelberg, Melbourne, Australia; Macquarie University, Sydney, Australia; CSIRO, Melbourne, Australia; National Ageing Research Institute, Melbourne, Australia.