Mohamed S. Khater

Evaluation of insulin like growth factor-1 (IGF-1) level and its impact on muscle and bone mineral density in frail elderly male

Decrease in IGF-1 level is a major endocrine dysregulation that has been implicated in frailty, disability, and mortality in older adults. Our aim was to clarify the effect of IGF-1 on muscle and bone mineral density (BMD) in frail males. One hundred elderly males were included and divided into frail group (n=50) and robust group (n=50) based on the study of osteoporotic fractures (SOF) frailty index. Anthropometric measures, femoral BMD, and serum IGF-1 level were measured. Our results showed that the IGF-1 level was significantly lower in the frail males in comparison to the robust with mean value 37.1±24.2 versus 68.5±18.4ng/ml (P<0.05). Receiver operating curve (ROC) analysis of the IGF-1 level revealed that sensitivity was 88.5%, specificity was 100%, cutoff value was 46.5ng/ml and area under the curve (AUC) was 0.897 (P<0.05). Participants with low IGF-1 percentile had significantly higher odds ratio of being frail compared to those with high IGF-1 percentile (odds ratio=12.8, 95% CI: 4.2-38.8, P-value<0.05). Subjects with low IGF-1 percentile had 13.5 times the odds of having an abnormal BMD than those with middle IGF-1 percentile (95% CI: 3.4-53.3, P<0.05). In multivariate analysis BMD, mid arm circumference (MAC), mid calf circumference (MCC), and handgrip strength were significantly affected by IGF-1 percentiles with age and co-morbid diseases adjustment. Male subjects with a low IGF-1 level may be at risk of being frail and having abnormal BMD. 16.8% and 15% of variability in MCC and BMD may be attributed to IGF-1 level respectively.

Normative data for healthy adult performance on the Egyptian-Arabic Addenbrooke's Cognitive Examination III

IntroductionThe Addenbrooke’s Cognitive Examination III (ACE-III) (2012) is a brief cognitive battery that assesses various aspects of cognition. Its five subdomains (attention and orientation, memory, verbal fluency, language and visuospatial abilities) are commonly impaired in Alzheimer’s disease and frontotemporal dementia. ObjectiveThe aim of the study was to provide normative data for healthy adult performance on Egyptian–Arabic ACE-III. Participants and methodsWe adapted the ACE-III (2012) to the Egyptian population. We evaluated this version on 139 cognitively healthy volunteers aged 20 years or older (54.7% male and 45.3% female). We stratified the participants both by age (<60 years and >60 years) and by degree of education (basic, secondary or university education). None of the participants had any complaints of cognitive decline. ResultsWe established normative data for healthy Egyptian adults below 60 years and above 60 years on each of the subdomains of the ACE-III. The data generated from the performance was assigned according to percentiles. We found a significant difference (P<0.001) between the performance of older and younger adults on the category task of the verbal fluency test. ConclusionBy adapting the ACE-III to the Egyptian–Arabic population, we were able to establish normative data for healthy Egyptian adults.

Effects of age, education, and gender on verbal fluency in healthy adult Arabic-speakers in Egypt.

ABSTRACT The objective of this study is to establish the effects of age, gender, and education and to provide preliminary normative data for letter and category fluency tasks in the Egyptian Arabic-speaking population. We evaluated 139 cognitively healthy volunteers aged 20–93 by adapting the letter and category verbal fluency tasks for the Egyptian population. On the letter fluency task, mean number of words generated in one-minute beginning with the Arabic letter “Sheen” (pronounced “sh”) was 8.14 words per minute (SD = 3.25). Letter fluency was significantly influenced by education. On category fluency tasks, mean number of animal names generated in one minute was 14.63 words (SD = 5.28). Category fluency was significantly influenced by age and education. We were able identify that age significantly affects category fluency while education significantly affected both letter and category fluency. We were also able to provide preliminary normative data for both tasks in the Egyptian population.

Prevalence of mild cognitive impairment among older adults living in Mansoura city, Egypt

BackgroundMild cognitive impairment (MCI) represents a high-risk factor for developing dementia. However, the epidemiology of MCI is not well known. AimThis work was performed to determine the prevalence of MCI in nondemented older adults. Participants and methodsA cross-sectional study was carried out on a sample of 100 community-dwelling nondemented older adults aged 60 years or older living in Mansoura city, Egypt. A comprehensive geriatric assessment including medical history and physical examination was carried out for each participant. Cognitive functions were evaluated using the Arabic translation of the Mini-Mental State Examination and the Arabic version of the Montreal Cognitive Assessment test. ResultsThe prevalence of MCI was 32% among the studied population. MCI was associated with advanced age, low education, hypertension, and depression, but sex, smoking, diabetes mellitus, and ischemic heart disease were not associated with MCI. ConclusionMCI is frequent in older people. Our study suggests that approximately 32% of elderly participants free of dementia are affected by MCI, and advanced age, hypertension, and depression are the main factors associated with MCI. Further studies are needed to determine the prevalence of MCI throughout Egypt.

Role of inflammatory markers in Elderly Type 2 Diabetic Patients with Mild Cognitive Impairment

BACKGROUND Type 2 diabetes (T2DM) is a risk factor for Alzheimers disease and mild cognitive impairment. The etiology of cognitive impairment in people with T2DM is uncertain but, chronic hyperglycemia, cerebral micro vascular disease, severe hypoglycemia, and increased prevalence of macro vascular disease are implicated. OBJECTIVES To determine the serum levels of soluble vascular adhesion molecule (sVCAM-1) and highly sensitive C-reactive protein (hs-CRP) in elderly type 2 diabetics with mild cognitive impairment (MCI). METHODS Our study was conducted on 90 elderly subjects (aged 60 years old or more). They were divided into Group І, 30 patients with T2DM and mild cognitive impairment, group ІІ, 30 patients with T2DM without cognitive impairment and group III, 30 healthy subjects as a control group. They were subjected to history taking, full clinical examination, anthropometric measurement, the Addenbrookes Cognitive Examination III (ACE---III 2012), Fasting plasma glucose, 2 hours plasma glucose, HbA1c, lipid profile, protein/creatinine ratio, serum sVCAM-1 and hs-CRP. RESULTS Serum levels of sVCAM-1 in diabetic elderly patients with MCI were significantly higher (946.7 ± 162.01 ng/ml) than diabetic elderly patients without cognitive impairment (479.06 ± 65.27 ng/ml) and control (263.7 ± 72.05 ng/ml) with (P=0.002). Serum levels of Hs-CRP in diabetic elderly patients with MCI were significantly higher than as diabetic elderly patients without cognitive impairment and control with (P=0.005). CONCLUSION Elderly diabetic patients with mild cognitive impairment have higher levels of soluble adhesion molecules and markers of low-grade systemic inflammation than other groups.

The validity and reliability of the Arabic version of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU): A prospective cohort study

BACKGROUND Accurate diagnosis for Arabic speaking critically ill patients suffering from delirium is limited by the need for a valid/reliable translation of a standardized delirium instrument such as the Confusion Assessment Method for the ICU (CAM-ICU). OBJECTIVE To determine the validity and reliability of the Arabic version of the CAM-ICU. DESIGN A prospective cohort study design was used to conduct the current study. SETTINGS Data collection took place in Geriatric, Emergency and Surgical intensive care units. PARTICIPANTS Fifty-eight adult patients met the inclusion criteria and participated in the study. Among the participants 22(38%) patients were on mechanical ventilation. METHODS After translating the CAM-ICU into Arabic language, the Arabic CAM-ICU was administered by two well-trained critical care nurses and compared with reference standard assessments by delirium experts using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM -IV-TR), along with assessment of severity of illness using Sequential Organ Failure Assessment (SOFA). Concurrent validity was assessed by calculating sensitivity, specificity and positive and negative predictive value (PPV and NPV) for the two Arabic CAM-ICU raters, where calculations were based on considering the DSM-IV-TR criterion as the reference standard. The convergent validity of the Arabic CAM-ICU was explored by comparing the Arabic CAM-ICU ratings and the total score of SOFA (severity of illness) and MMSE (cognitive impairment). RESULTS A total of 58 ICU patients were included, of whom 27 (47%) were diagnosed with delirium during their ICU stay via DSM-IV criteria. Interrater reliability for the Arabic CAM-ICU, overall and for mechanically ventilated patients assessed using Cohens kappa (κ) were 0.82 and 1, respectively, p < 0.001. The sensitivities (95% CI) for the two critical care nurses when using the Arabic CAM-ICU compared with the reference standard were 81% (60%-93%) and 85% (65%-95%), respectively, whereas specificity (95% CI) was 81%(62%-92%) for both nurses. High sensitivity and specificity measures were also observed across subgroups; 100% for mechanically ventilated patients, 88% (60%-98%) and 79% (49%-94%) for those aged 65 years or older and 82% (56%-95%) and 75% (43%-93%) for those with SOFA scores at or above the median value. CONCLUSIONS The Arabic CAM-ICU appeared to be valid and reliable tool for diagnosing delirium. Future investigations may lead to a better understanding of the prevalence, predictors, and consequences of delirium among critically ill Arabic speaking patients.

Chronic Diseases and Outcome in Critically Ill Elderly Admitted to ICU

Background: Elderly patients are a significant and increasing proportion of ICU patients. With advancing age, the comorbidities critically ill elderly patients have substantial mortality. The early recognition of patients at high risk of mortality is needed to plan care in advance and to control healthcare costs. Aim: To find out the relation between chronic diseases and outcome in critically ill elderlyadmitted to ICU. Study design: A prospective study. Participants: seventy elderly patients aged 60 years and above. Method: This study was performed in Geriatric ICU in Ain Shams University Hospitals including 70 critically ill elderly patients admitted for 24 hours or more. Each patient was subjected to on admission clinical assessment including detailed history taking, in addition to laboratory investigations. Results: The results of our study showed that ischemic heart disease was the only chronic diseases that had significant statistical effect on mortality in critically ill elderly admitted to ICU with p. value= 0.002. Conclusion: In the current study we found that mortality was associated with history of ischemic heart disease.

Prevalence of Functional Impairment among Frail Elderly

Background Frailty is a state of vulnerability describes a syndrome characterized by progressive multi system decline, loss of physiologic reserve, and increase vulnerability to disease and death. Frailty has emerged as a condition associated with an increased risk of functional decline among the elderly population, which may be differentiated from aging, disability, and comorbidity. Objectives: The aim of this study is to assess the prevalence of functional impairment and cognitive functions among frail elderly. Methods:We examined104 frail elderly. Frailty criteria included unintentional weight loss, exhaustion, weakness, low physical activity, and slow walking speed. physical function was assessed using Activities of daily living (ADL) and Instrumental activities of daily living (IADL). The cognitive function was assessed using the Mini-Mental State Examination (MMSE). Results:The mean age of the studied population was 69 years, 53.85% were males, 46.15% were females, the majority of our participants were illiterates (89.4%), and were living with family (84.62%), only 6.73% were smokers. 36.5% of frail participants were assisted in activity of daily living (ADL) and 7.7% were dependents, while 63.5% were assisted in instrumental activity of daily living (IADL) and 8.7% were dependents; the sample participants in general had borderline scores for MMSE, indicating a cognitive performance in the lower normal range. Conclusions Frail elderly had low normal score on MMSE, and high prevalence of functional impairment.

High‐Sensitivity C‐Reactive Protein Levels Among Healthy Egyptian Elderly

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Relationship between psychiatric disorders, coronary risk factors, and inflammatory mediators among elderly diabetic patients

BackgroundDepression, anxiety, diabetes mellitus (DM), and coronary heart diseases (CHD) all have common immune mechanisms of pathogenesis. ObjectivesThe aim of the current study is to assess the relationship between depression and/or anxiety, coronary risk factors, and inflammatory mediators among elderly patients with DM. MethodsThe present study was conducted on 60 elderly diabetic patients and 30 elderly healthy controls. The patient group was subdivided into two groups: GP1, with 30 elderly diabetic patients with medical complications, and GP2, with 30 elderly diabetic patients without medical complications. The three groups of patients were subjected to clinical examination, were assessed for depression and anxiety, and their lipid profile, C-reactive protein (CRP), and interleukin-1&bgr; (IL-1&bgr;) levels were measured. ResultsInflammatory markers (CRP and IL-1&bgr;) were higher in GP1 and GP2 than in the healthy controls (P=0.000 and 0.021, respectively). Inflammatory markers were higher by a significant level in depressed patients of GP1 and GP2 (P=0.000 for CRP and IL-1&bgr;) and by a nonsignificant level in anxious patients (P=0.461 and 0.07 for CRP and IL-1&bgr;, respectively). Both depressed and anxious patients showed a significant increase in established risk factors for CHD such as a longer duration of DM, a high BMI, higher levels of cholesterol, triglycerides, and low-density lipoproteins, and lower levels of high-density lipoproteins. ConclusionImmune mechanisms play a major role in the increase in the development of CHD associated with depression and DM.