Iulia Maria Chiriac

Depressive symptoms in older people with metabolic syndrome: is there a relationship with inflammation?

To investigate if there is a higher prevalence of depressive symptoms in older people with metabolic syndrome (MetS) compared with those without and whether dedpressive symptoms are independently associated to MetS and its single components and to the inflammatory markers.

Dementia correlates with anticoagulation underuse in older patients with atrial fibrillation

OBJECTIVES Stroke prevention in older atrial fibrillation (AF) patients remains a challenge. This study aimed to investigate whether a dementia diagnosis is an independent correlate of lower prescription rate of oral anticoagulant treatment (OAT) in a sample of older AF patients. METHODS Cross-sectional retrospective study. Consecutive older community-dwelling AF patients referred for a comprehensive geriatric assessment, were considered. Evaluation of physical, social and mental health, and administration of the Cumulative Illness Rating Scale (CIRS) and Barthel Index were performed. Dementia cases were ascertained by consensus of 2 experienced geriatricians. Dementia severity was assessed using the Clinical Dementia Rating scale (CDR). RESULTS 316 AF patients (ages 74.7±7.0years, 55.7% women) with high stroke risk (77.5% had a CHA2DS2VASC score ≥3), low bleeding and falling risk, and no neuropsychiatric/behavioral symptoms, were included. 60.1% were prescribed with OAT. Among patients with dementia (n=86, 27.2%), 22.0% received inadequate antithrombotic prophylaxis (i.e. antiplatelet) and 38.5% no treatment. Proportion of those receiving inadequate or no prophylaxis increased at increasing CDR score. By multiple regression models, either dementia (yes vs no), OR=1.33, 95%CI=1.11-1.46, p<0.001, and dementia severity (CDR>1), OR=2.38, 95%CI=2.19-2.60, p<0.001, were associated with lack of OAT prescription independently of age, paroxysmal AF, and comorbidity burden. CONCLUSIONS Dementia might be associated with underuse of OAT in older AF patients even in the absence of established contraindications. Future studies are needed to assess the real dimension of the problem and clinicians barriers to prescribing OAT in demented patients.

Executive dysfunction assessed by Clock-Drawing Test in older non-demented subjects with metabolic syndrome is not mediated by white matter lesions

Metabolic syndrome (MetS) has been associated with greater occurrence of white matter hyperintensities (WMH). It remains uncertain whether MetS as a construct is associated with poorer cognitive performances. This study explores whether MetS is associated with poorer performances in global and domain‐specific cognitive tests in older non‐demented subjects independently of its individual components, WMH severity and other variables.

The Metabolic Syndrome Predicts Longitudinal Changes in Clock Drawing Test Performance in Older Nondemented Hypertensive Individuals.

OBJECTIVES The present study evaluated the metabolic syndrome (MetS) as independent predictor of 1-year longitudinal changes in cognitive function. METHODS 104 stroke- and dementia-free older hypertensive subjects were studied. MetS was defined by NCEP ATP-III criteria. Cognitive function was assessed by the Clock Drawing Test (CDT); 1-year changes in cognitive function were expressed as annual changes in CDT performance. Brain magnetic resonance imaging studies (1.5T) were performed. RESULTS Participants with MetS exhibited greater cognitive decline than those without (-1.78 ± 1.47 versus -0.74 ± 1.44 CDT points, t = 3.348, df = 102, p < 0.001). MetS predicted cognitive decline (β = -0.327, t = -3.059, df = 96, p = 0.003) independently of its components, age, baseline cognition, neuroimaging findings, blood pressure levels, and duration of hypertension. With the exception of systolic blood pressure, none of the individual components of MetS explained 1-year changes in CDT performance. CONCLUSIONS MetS as an entity predicted accelerated 1-year decline in cognitive function, assessed by CDT, in a sample of older hypertensive subjects.

Handgrip strength predicts longitudinal changes in clock drawing test performance. An observational study in a sample of older non-demented adults

ObjectiveImpairment of physical performance might identify older people at higher risk of dementia over time. The present study evaluated handgrip strength as independent predictor of cognitive decline.DesignObservational, prospective. Follow-up duration: 11.2 ± 0.8 months.Setting and participantsGeriatric outpatients center. 104 consecutive stroke- and dementia-free older adults (44% men, ages 80.2±5.4 years).MethodsThe Clinical Dementia Rating scale and the Clock Drawing Test (CDT) were administered. Handgrip strength was assessed using a Jamar hand dynamometer. Brain magnetic resonance imaging studies at 1.5 T were performed. White matter damage was expressed as severity of white matter hyperintensities (WMHs). Longitudinal changes in cognitive function were expressed as 1-year decline in CDT performance.ResultsA robust association was observed between baseline handgrip strength and 1-year cognitive decline after multiple adjustment. Of note, the strength of such association was only minimally attenuated after adjusting for deep WMHs extent (β coefficient for handgrip strength = 0.183, SE= 0.038, p= 0.007, R2= 0.58).ConclusionsHandgrip strength predicted accelerated 1-year decline in cognitive function, assessed by CDT, in a sample of older adults. Future studies are needed to elucidate the causal mechanisms linking limitations in physical function with dementia risk.

The Metabolic Syndrome and the Phenotype of Frailty: A Causal Link?

MMSE, Mini-Mental State Examination; OR, odds ratio; B, regression coefficient; CI, confidence interval. All models were controlled for sex (male, yes/no), body mass index (continuous, kg/m), diabetes mellitus (yes/no), statins and antihypertensive therapy (yes/no), and baseline number of frailty traits (continuous, 0e5). Model predicting gait speed change was also controlled for baseline gait speed (continuous, sec) and baseline interaction term (MetS)*(gait speed). Model predicting handgrip strength change was also controlled for baseline handgrip strength (continuous, kPa) and baseline interaction term (MetS)*(handgrip strength). *Subjects presenting with all 5 frailty traits at baseline were not included (n1⁄4 4). yP < .01. zP < .001. To the Editor: Frailty is a common geriatric syndrome that confers increased risk of adverse health outcomes.1,2 Because of its close association with functional disability, frailty has a devastating impact on individuals, families, and society as a whole. Thus, searching for modifiable risk factors for such conditions is a major challenge. We have previously described cross-sectional associations between the metabolic syndrome (MetS), a clustering of major cardiovascular risk factors,3 and frailty, defined according to the Fried phenotype.2 We found that MetS was associated with frailty and with specific indicators of frailty status, that is, slow gait, reduced handgrip strength, and fatigability in performing usual activities,2 in a sample of 118 older noninstitutionalized adults. Importantly, such associations were not driven neither by individual altered components of MetS nor by MetS severity, that is, the sum of its altered components. A total of 96 such individuals were reassessed about 8 months (8.1 1.3) later. Here we sought to evaluate MetS as a predictor of longitudinal unfavorable changes in frailty status. Methods used for sample recruitment and variable assessment have been previously described.2 Herewe also considered activities of daily living (ADL) disability (dependency in 1 or more of the following: dressing and undressing, using the toilet, taking a bath). SPSS 17.0 (SPSS Inc, Chicago, IL) was used for analyses. Eight-month changes in body weight, gait speed, and handgrip strength were expressed as continuous variables. Unfavorable change in frailty status was defined as acquiring 1 of any of the 5 frailty traits1 during the observational period. Multiple regression models were constructed to identify predictors of unfavorable changes in frailty status. P values at .05 were considered statistically significant. Overall, 96 individuals (baseline age 78.1 4.7 years, 51 women, 29.2% frail) completed the longitudinal assessment. During the observational period, 16 subjects (10 withMetS, P1⁄4 .03) acquired at least 1 more trait of frailty from baseline. Changes in body weight, physical activity habits, and exhaustion in performing usual activities were not significant from baseline. Baseline MetS was associated with more rapid decline in gait speed and handgrip strength. Gait speed changes (seconds) were 1.19 1.1 in subjects with MetS versus 0.13 0.7 in those without (P < .001). Handgrip strength changes (kPa) were 0.41 0.4 in women with MetS and 0.07 0.5 in those without (P1⁄4 .01), 0.60 0.6 in menwith MetS, and 0.23 0.5 in those without (P 1⁄4 .03). After multiple adjustment, MetS predicted adverse longitudinal changes in frailty status, handgrip strength, and gait speed (Table 1). Our results suggest that MetS might represent a biological correlate of late-life frailty. Although the design of the present

Vascular depression in the elderly. Does inflammation play a role

Vascular depression in the elderly. Does inflammation play a role?Depression is the most common comorbidity in the elderly, and it is a major determinant of disability. The late-onset depression in highly associated to cardiovascular disease. Depressive symptoms may follow vascular brain damage, especially when mood regulating areas are affected. However depression is strongly associated to vascular disease even when there is no manifest brain damage. Recently great attention has been given to chronic inflammation, both related to depression and vascular disease. Both experimental and clinical evidence shows that a rise in the concentrations of proinflammatory cytokines and glucocorticoids in depressed patients is associated with defect in serotonergic function. Chronic inflammation may underlie many forms of depression associated with vascular disease and metabolic syndrome. The importance of the inflammation hypothesis of depression lies is that psychotropic drugs may have central anti-inflammatory action, and that new generation of central anti-inflammatory drugs may be useful in depression treatment.

Markers of Visceral Adiposity for Dementia Risk Assessment. The Epicardial Adipose Tissue (EAT) Thickness

months after surgery, but 5% to 10% may remain clinically silent for up to 5 years. These hernias are more common with vertical than transverse incisions, but they can also develop through small laparoscopic puncture sites. Risk factors for incisional hernias include obesity, postoperative wound infection, older age, chronic pulmonary disease, ascites, malignant tumor, and malnutrition. Gas in the bowel wall or free gas in the abdomen or the hernial sac seen on CT is a sign of a complicated hernia, which was the case with this woman. Computed tomography is an accurate method of identifying the various types of abdominal wall hernias, especially if they are clinically occult, and of distinguishing them from other conditions such as hematomas, abscesses, and neoplasia. Diagnosis is frequently unclear, and delays in initiating treatment often result in loss of tissue and life. Successful management is possible with greater awareness of the subtleties of presentation of these disorders and an aggressive diagnostic response to initial complaints. Abdominal wall hernias in elderly adults usually present no diagnostic dilemma, although individuals and physicians frequently neglect these hernias. Sonography and CT can confirm the diagnosis preoperatively, to reduce unnecessary morbidity and mortality, especially in older adults.

Depressive symptom clusters and optimistic traits are associated with left ventricular mass increase in older subjects independently of blood pressure levels and hypertension

1 Toba K, Nakai R, Akishita M et al. Vitality index as a useful tool to assess elderly with dementia. Geriatr Gerontol Int 2002; 2: 23–29. 2 Kobayashi K, Hashimoto K, Kato R et al. The aging males’ symptoms scale for Japanese men: reliability and applicability of the Japanese version. Int J Impot Res 2008; 20: 544–548. 3 Corona G, Rastrelli G, Vignozzi L, Mannucci E, Maggi M. How to recognize late-onset hypogonadism in men with sexual dysfunction. Asian J Androl 2012; 14: 251–259. 4 Wang C, Nieschlag E, Swerdloff R et al. Investigation, treatment and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA and ASA recommendations. Eur J Endocrinol 2008; 159: 507–514. 5 Buvat J, Maggi M, Guay A, Torres LO. Testosterone deficiency in men: systematic review and standard operating procedures for diagnosis and treatment. J Sex Med 2013; 10: 245–284. 6 Wu FC, Tajar A, Beynon JM et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med 2010; 363: 123–135. 7 Matsumoto AM. Andropause. Clinical implications of the decline in serum testosterone level with aging in men. J Gerontol A Biol Sci Med Sci 2002; 57: M76–M99.