Yusuf Yesil

Cognitive aspects of frailty: Mechanisms behind the link between frailty and cognitive impairment

Whereas physical impairment is the main hallmark of frailty, evidence suggests that other dimensions, such as psychological, cognitive and social factors also contribute to this multidimensional condition. Cognition is now considered a relevant domain of frailty. Cognitive and physical frailty interact: cognitive problems and dementia are more prevalent in physically frail individuals, and those with cognitive impairment are more prone to become frail. Disentangling the relationship between cognition and frailty may lead to new intervention strategies for the prevention and treatment of both conditions. Both frailty and cognitive decline share common potential mechanisms. This review examines the relationship between frailty and cognitive decline and explores the role of vascular changes, hormones, vitamin D, inflammation, insulin resistance, and nutrition in the development of physical frailty and cognitive problems, as potential underlying mechanisms behind this link. Dual tasking studies may be a useful way to explore and understand the relation between cognitive and physical frailty. Further studies are needed to elucidate this complex relation to improve the outcomes of frailty.

Mean platelet volume as an indicator of disease severity in patients with acute pancreatitis.

AIM Acute pancreatitis (AP) constitutes a systemic inflammatory process which is often accompanied by thrombosis and bleeding disorders. The role of platelets in the pathophysiology of the disease has not been elucidated yet. Mean platelet volume (MPV) is an index of platelet activation and reported to be influenced by inflammation. The objective of the present study is to assess whether platelet volume would be useful in predicting disease severity in AP. Additionally possible relationship of MPV with clinical and radiologic parameters in conjunction with other inflammatory markers during AP was also investigated. PATIENTS AND METHODS A total of 144 AP patients (male/female: 87/57), and 40 healthy subjects (male/female: 23/17) were enrolled in this study. Mean platelet volume and inflammatory parameters were measured for all study participants. Modified Glasgow Prognostic Score (mGPS) and the computerized tomography severity index (CTSI) were used as to predict the disease severity in AP patients. RESULTS A statistically significant decrease in MPV levels was observed in AP patients (8.06 ± 0.71 fL) compared with healthy controls (8.63 ± 0.62 fL) (P<0.001). According to the mGPS, overall accuracy of MPV in determining severe AP was 72.7% with a sensitivity, specificity, NPV and PPV of 70.6%, 73.9%, 81.9%, and 60 respectively (AUC: 0.762). Overall accuracy of MPV in predicting disease severity according to CTSI was not superior compared with other inflammation markers. CONCLUSION The present study demonstrated that MPV is decreased in AP. Assessment of MPV with other inflammatory markers may provide additional information about disease severity in AP.

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.

Thyroid Hormone Levels Predict Mortality in Intensive Care Patients With Cirrhosis

Introduction:Mortality rates of intensive care patients are quite high. The aim of this study was to determine the availability of thyroid function tests and predictive scoring systems on the outcome of cirrhotic patients admitted to the intensive care unit. Methods:A total of 106 patients were included in the final analysis, of which 32 were men (30.2%) and 74 were women (69.8%). Predictors of mortality that were investigated include acute physiology and chronic health evaluation (APACHE II), model for end-stage liver disease (MELD), Child-Turcotte-Pugh (CTP) and sequential organ failure assessment (SOFA) scores and thyroid function tests including free triiodo-L-thryronin (fT3), free tetraiodothyronine/thyroxine (fT4) and thyroid-stimulating hormone/thyrotropin (TSH) levels. Results:High APACHE II, MELD, CTP and SOFA score and suppression of fT3 were all found to be associated with higher mortality in our intensive care patients who have cirrhosis (P < 0.001). Suppression of fT3 was also found to be reciprocally correlated with high APACHE II, MELD, CTP and SOFA scores (P < 0.001). fT4 had also reciprocal correlation with APACHE II, MELD, CTP and mortality. There is no correlation between TSH levels and predictive scores or mortality. Conclusions:Calculation of APACHE II, MELD, CTP and SOFA scores and measurement of fT3 and fT4 levels may all be useful as predictors of mortality in intensive care patients who have cirrhosis.

Is there a link between neutrophil-lymphocyte ratio and microvascular complications in geriatric diabetic patients?

Background: Chronic inflammation plays an important role on development and progression of Type 2 diabetes (T2DM) through immunologic inflammatory mechanisms. Neutrophil to lymphocyte ratio (NLR) is a new, simple and cheap marker of subclinical inflammation. NLR has recently been used as a systemic inflammation marker in chronic diseases as well as a predictor of prognosis in cardiovascular diseases and malignancies. Aim: The objective of the present study was to investigate the relationship between NLR and microvascular complications of diabetes mellitus (DM) in elderly population. Subjects and methods: Two hundred and forty-two patients with DM (145 diabetic patients with complications, 97 diabetic patients without complications) and 218 control subjects were enrolled in this study. NLR and microvascular complications because of DM were evaluated and compared with other inflammatory markers. Results: NLR was higher in the diabetic group (2.21±1.14) than in the controls (2.18±0.76). Furthermore, there was a statistically significant difference between NLR levels in diabetic patients with and without complications (2.46±1.26 vs 2.04±0.51, respectively; p<0.001). The results of the multiple logistic regression analysis depicted that NLR is also an independent predictor for microvascular complications (odds ratio 2.217; 95% confidence interval 1.086–4.526, p=0.029). Receiver operating curve analysis suggested that the optimum NLR cutoff point for microvascular complication was 2.89 with 96.72% specificity, 94.4% positive predictive value. Conclusion: Increased NLR levels may be associated with microvascular complications of DM in the elderly population.