Mehmet Emin Kuyumcu

The Evaluation of Neutrophil-Lymphocyte Ratio in Alzheimer’s Disease

Background/Aim: There is growing consensus in the literature that inflammation plays a significant role in the pathophysiology of Alzheimer’s disease (AD). The blood neutrophil-lymphocyte ratio (NLR) is a new, inexpensive and easily applicable marker of inflammation. The aim of this study was to investigate the association between NLR, as an inflammatory biomarker, and AD. Methods: 241 AD patients and 175 patients with normal cognitive function were evaluated in this study. Results: The mean ± SD NLR of AD patients was significantly higher than that of patients with normal cognitive function (3.21 ± 1.35 vs. 2.07 ± 0.74, p < 0.001, respectively). Receiver operating characteristic curve analysis suggested that the optimum NLR cutoff point for AD was 2.48 with 69.29% sensitivity, 79.43% specificity, 82.30% positive predictive values and 65.30% negative predictive values. Logistic regression analysis showed that elevated NLR (OR: 4.774, 95% CI: 2.821–8.076, p < 0.001) was an independent variable for predicting AD. Conclusion: Elderly people with AD have higher NLR than healthy controls. Elevated NLR levels are usually considered as an inflammatory marker. The results of this study suggested that inflammation plays a role in the pathogenesis of AD.

The association between homocysteine (hcy) and serum natural antioxidants in elderly bone mineral densitometry (BMD).

Previous studies showed oxidative stress had an important impact on osteoclastic and osteoblastic functions. Oxidative stress or low levels of antioxidants are supposed to reduce BMD and cause osteoporosis. hcy, gamma glutamyltransferase (GGT), uric acid, albumin and total bilirubin are simple laboratory parameters that are related with oxidative stress. In this study we compare the serum hcy and antioxidant levels in patients with osteoporosis, osteopenia and control subjects. A total of 2190 elderly persons (1348 patients with osteoporosis, 643 patients with osteopenia and 199 control subjects) who were referred to the outpatient clinic of the Department of Internal Medicine, Division of Geriatric Medicine at Hacettepe University Hospital for comprehensive geriatric assessment were included in this cross-sectional study. Mean age of subjects were 72.30 ± 6.34 in osteoporosis group, 71.92 ± 6.90 in osteopenia and 71.86 ± 5.88 in control group (p: 0.260). Multivariate regression analysis revealed that hypertension (HT) (OR: 0.675, 95% CI: 0.534-0.854, p: 0.001), diabetes mellitus (DM) (OR: 1.669, 95% CI: 1.301-2.142, p: <0.001), age (OR: 1.025, 95% CI: 1.006-1.044, p: 0.009), male gender (OR: 0.451, 95% CI: 0.358-0.569, p<0.001), uric acid (OR: 0.893, 95% CI: 0.837-0.952, p: 0.001), hcy (OR: 1.042, 95% CI: 1.023-1.061, p<0.001), albumin (OR: 0.521, 95% CI: 0.376-0.724, p<0.001), GGT (OR: 1.010, 95% CI: 1.003-1.017, p: 0.003), creatinine (OR: 0.630, 95% CI: 0.459-0.864, p: 0.004) were independent variables predicting the occurrence of osteoporosis. This study shows there is an imbalance between natural antioxidative and oxidative markers in patients with osteoporosis. Higher serum uric acid and albumin levels are associated with a lower prevalence of osteoporosis whereas higher hcy and GGT levels are associated lower BMD and higher osteoporosis prevalence.

Altered Levels of Homocysteine and Serum Natural Antioxidants Links Oxidative Damage to Alzheimer's Disease

Increasing evidence supports the theory that oxidative stress plays an important role in the pathogenesis of Alzheimers disease (AD). Homocysteine (Hcy), uric acid (UA), bilirubin, and albumin are simple laboratory parameters that are related to oxidative stress. In this study we compared serum Hcy and antioxidant levels in patients with AD and normal cognitive function. In this cross-sectional study, 143 AD patients and 1,553 patients with normal cognitive function aged 65 years and over were enrolled. Mean values of UA and albumin levels of AD patients were significantly lower than normal cognitive function subjects (p: 0.003 versus p < 0.001, respectively). Mean value of Hcy levels of AD patients was significantly higher than normal cognitive function subjects (p = 0.031). Multivariate regression analysis revealed that Mini-nutritional assessment short form (OR: 0.905, 95% CI: 0.850-0.965, p = 0.002), hypertension (OR: 1.573, 95% CI: 1.148-2.155, p = 0.005), UA (OR: 0.879, 95% CI: 0.788-0.981, p = 0.021), Hcy (OR: 1.040, 95% CI: 1.022-1.059, p < 0.001), and albumin (OR: 0.505, 95% CI: 0.339-0.753, p < 0.001) were independent variables predicting the occurrence of AD. Our study supports the hypothesis that a decrease in antioxidants and an increase in oxidative damage are linked to AD.

Is increased red cell distribution width (RDW) indicating the inflammation in Alzheimer's disease (AD)?

Increasing evidence indicates that inflammation has a substantial role in the pathogenesis and progression of AD. RDW, a measure of heterogeneity in the size of circulating erythrocytes, is associated with inflammatory markers in many numerous diseases. Present study was undertaken to assess the interrelationships between RDW and AD. A total of 197 patients with AD (male/female: 96/101, mean age 76.2 ± 6.9) and 133 patients as controls with normal cognitive function (male/female: 72/61, mean age 71.68 ± 5.3) were enrolled in this cross-sectional study. RDW values of all participants were measured. Mini-Mental State Examination (MMSE) and clock drawing tests were performed for cognitive assessment. DSM-IV and NINCDS-ADRDA criteria were used for diagnosis of AD. The mean RDW values were significantly higher in AD group (13.93 ± 1.1 vs. 13.24 ± 1.2; p<0.001) and also a negative moderate correlation between RDW and MMSE was identified (r: -0.453; p<0.001). After adjusting for confounders, RDW has the strongest association with AD (odd ratio (OR) 1.51, CI=1.10-2.07). In present study RDW levels were significantly increased in patients with AD. Whereas elevated RDW value is usually considered as a novel biomarker of inflammation, the results of our study may support the role of inflammation in pathophysiology of AD. Furthermore the correlation of RDW with poorer cognition status suggests that it may be used as a marker of AD severity.

Increased mean platelet volume (MPV) indicating the vascular risk in Alzheimer's disease (AD)

Vascular risk factors play a significant role in the pathogenesis and progression of AD. MPV is an index of platelet activation and may be a potential marker of inflammation to demonstrate the vascular damage in AD. The aim of the present study is to assess whether platelet volume would be useful in predicting vascular damage in AD. A total of 126 patients with AD (male/female: 44/82, mean age 76.2 ± 6.8 years) and 286 patients as controls with normal cognitive function (male/female: 123/163, mean age 75.2 ± 6.3 years) were enrolled in this cross-sectional study. MPV values were determined for all study participants. Mini-Mental State Examination (MMSE) and clock drawing tests (CDT) were performed for cognitive assessment, DSM-IV and NINCDS-ADRDA criteria were used for diagnosis of AD. The mean MPV values were significantly higher in AD group (8.46 ± 1.15 vs. 8.17 ± 0.90; p=0.011). In this study, significantly higher MPV values in patients with AD have been detected. Since increased MPV levels are usually considered as a vascular risk factor, the results of this study suggested the role of platelet activation in the vascular pathogenetic basis of AD.

Malnutrition in Turkish nursing homes: A correlate of short term mortality

ObjectiveElderly nursing home residents are under high risk of malnutrition. Early interventions to prevent malnutrition may play a critical role in malnutrition-mortality correlation. This study aimed to obtain insight into the prevalence of malnutrition in nursing homes in the capital city of Turkey and the role of malnutrition in predicting the risk for short-term mortality.DesignThis study was conducted in seven different residential care facilities in Ankara.MeasurementsNutritional status was evaluated by Mini Nutritional Assessment-Short Form.ResultsThe mean age of the 534 participants was 79.46±7.22 years. Nutritional assessment revealed that 15.9% of all older adults suffered from malnutrition and another 53.6% were at risk of malnutrition. The mortality rate for all subjects was 118 (22.1%) over 18 months, which was significantly higher in participants with malnutrition.ConclusionsWe noted a high prevalence of malnutrition and a strong correlation of increased mortality with malnutrition in nursing home residents. Given the negative impact of malnutrition on mortality and morbidity, an emphasis should be placed on an effective nutritional policy in nursing homes.

Digit (2D:4D) ratio is associated with muscle mass (MM) and strength (MS) in older adults: Possible effect of in utero androgen exposure

Decline in MM and MS with aging, defined as sarcopenia, is related with physical disability, poor quality of life and death. Its mechanisms are not fully understood. Testosterone increases muscle protein synthesis. However, the effects of in utero androgen exposure to MM and MS in older adults have not been studied. In utero androgen exposure is inversely related with 2D:4D ratio. The aim of this study was to investigate the relationship between 2D:4D ratio as an indicator of in utero androgen exposure and MM and MS in elderly patients. A total of 151 older adults were included. Calf-circumference (CC) and skeletal muscle mass index (SMI) were used for the assessment of MM and hand grip strength for the assessment of MS. Mean age ± SD of the patients was 73.72 ± 6.23. Fifty-two (34.4%) of patients were male, 99 (65.6%) were female. Right and left 2D:4D were significantly and negatively correlated with hand grip strength (r=-0.365, p=0.018 and r=-0.434, p=0.005, respectively), CC (r=-0.422, p=0.002 and r=-0.459, p=0.001, respectively) and SMI (r=-0.354, p=0.018 and r=-0.348, p=0.022, respectively) in men. In women, right and left 2D:4D were significantly and negatively correlated with hand grip strength (r=-0.252, p=0.022 and r=-0.234, p=0.033, respectively), CC (r=-0.229, p=0.024 and r=-0.302, p=0.003, respectively) and SMI (r=-0.382, p<0.001 and r=-0.431, p<0.001, respectively). In this study, we found that 2D:4D ratio was significantly and negatively correlated with parameters depicting MM and MS which may suggest the possible role of in utero androgen exposure in the development of MM and MS loss in the elderly.

Coexistence of osteoporosis (OP) and coronary artery disease (CAD) in the elderly: It is not just a by chance event

Cardiovascular disease (CVD) and OP are common age-related conditions. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CVD. But available data in geriatric population is limited. In this study we aimed to seek the possible relationship between CAD and low bone mineral density (BMD) in a large number of geriatric patients. A total of 2235 patients aged 65 years or more were included in this cross-sectional study. All patients underwent a complete geriatric assessment and evaluated for CAD and cardiovascular risk factors. BMD was measured by dual-energy X-ray absorptiometry at the lumbar spine (L1-L4) and femoral neck. BMD results were classified into three groups; normal (T-score: ≥-1.0×S.D.), osteopenia (T-score between -1.0 and -2.5×S.D.), and OP (T-score: ≤-2.5×S.D.). CAD was present in 397 (29.7%) of 1335 patients with OP, in 199 (27.4%) of 726 patients with osteopenia and in 34 (19.5%) of 174 patients with normal BMD. Multivariate regression analysis revealed that presence of OP or osteopenia increased the prevalence of CAD as an independent correlate (OR=1.643; 95% CI=1.068-2.528, p=0.030). This study highlights the need for careful evaluation of elderly patients with low BMD for possible CAD.

Validation of Katz index of independence in activities of daily living in Turkish older adults

OBJECTIVE Katz Index of Independence in Activities of Daily Living Scale (Katz ADL) is a widely used tool to assess the level of independency in older adults. The objective of this study was to assess the validity and reliability of the Turkish version of the six item Katz ADL in geriatric patients aged 65 years and older. METHODS The participants were recruited in a geriatric medicine outpatient clinic (n=211). The Katz ADL was translated to Turkish and it was administered with the Barthel index (BI) and SF-36 physical functioning subscale (SF-36 PF) which are already validated in Turkish. Reliability was assessed by internal consistency, interrater and test-retest analysis. Construct validity was assessed by Spearman correlations between the Katz ADL and other functional status indices. RESULTS The internal consistency was high (Cronbachs α=0.838). The test-retest reliability and inter-rater reliability were excellent (ICC 0.999 [0.999-1.000 95% CI]). Regarding the convergent validity strong associations between Katz ADL, BI and SF-36 PF were demonstrated (rs=0.988, p<0.001 and rs=0.674, p<0.001). CONCLUSION Validating an instrument, which has originally been developed in a different culture, is a complex but neccessary task. It provides an opportunity for comparison of information across different cultures. To our knowledge, this is the only study to demonstrate reliability and validity of the Katz ADL-six item version in the geriatric population living in Turkey. Turkish version of the Katz ADL is a valid and reliable scale to detect the disability status in the basic activities of daily living in older adults.

Inverse relationship between neutrophil lymphocyte ratio (NLR) and bone mineral density (BMD) in elderly people.

Osteoporosis is, an age related disorder, influencing elderly people worldwide. The latest data suggests that inflammation plays a critical role in bone remodeling and in pathogenesis of osteoporosis. NLR is a simple, non-invasive and cost-effective marker of inflammation in various malignancies and inflammatory diseases. The objective of the present study was to compare NLR levels in osteopenic, osteoporotic and control subjects and to assess the correlation between NLR levels and BMD. A total of 1635 patients aged 65 years or more were included in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine and femur. Complete blood count (CBC), biomarkers of inflammation (C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)), glucose/lipid metabolism and established risk factors were determined. In osteoporosis group, NLR levels were found to be elevated as compared to osteopenic and control group (2.54±1.45, 2.37±1.00 and 2.18±0.85, respectively). At multivariate analysis NLR emerged as independent predictor of osteoporosis (OR=1.122; 95%=1.020-1.235, p=0.018) and there was a significant negative correlation between lumbar spine (L2-L4), femoral neck scores and NLR (r=0.348, p<0.001; r=0.264, p=0.004, respectively). Elderly people with osteoporosis have elevated NLR levels, suggesting that inflammation may play an important role in bone remodeling.