Leptin as a predictor of delirium in geriatric inpatients: An observational study

Background: Delirium is a complex, reversible neuropsychiatric disorder that frequently occurs in the geriatric age group in acute care settings with multifactorial etiology and numerous knowledge gaps in the pathogenesis. Objective: This study aimed to establish an association between leptin levels and delirium in patients aged 60 years and above admitted under the geriatric medicine department of a tertiary care hospital. Materials and Methods: A prospective observational study was conducted in consecutively admitted patients to the geriatric ward. Patients were assessed for delirium within 24 h of admission and daily thereafter until they were discharged from the hospital or died using the Confusion Assessment Method (CAM) or CAM?intensive care unit with subsequent division into delirium and nondelirium groups. Serum leptin levels were measured using enzyme?linked immunosorbent assay. Results: Two hundred patients were recruited in the study. The mean age of participants was found to be 73.1 ± 8.8 years. Prevalence rates of delirium at the time of admission and incidence rates during hospital stay were found to be 20% and 5%, respectively. The occurrence of delirium was also found to be significantly associated with mortality (32.5% vs. 8.7%, P = 0.001). Serum leptin levels were found to be significantly lower in patients with delirium (2.58 ± 1.01 ng/mL vs. 10.72 ± 1.46 ng/mL, P = 0.03). Multivariable regression analysis revealed delirium to significantly correlate positively with age (Odds Ratio [OR]: 1.63 (1.07–2.47), P = 0.021) and negatively with leptin levels (OR: 0.94 (0.90–0.99), P = 0.018). Conclusion: Delirium is a frequently occurring condition in hospitalized older adults with high mortality rates. Leptin might serve as a potential predictor of delirium owing to its probable role in the pathophysiological processes of delirium.

Spectrum of cardiovascular diseases with increasing age and its association with geriatric syndromes

Objective: The burden of cardiovascular diseases (CVDs) is highest among the older adults, who are often carriers of various geriatric syndromes. Studies evaluating CVDs among the old adults in the low? and middle?income countries are limited. This study was conducted to assess the frequency of CVDs and their risk factors among the older population and their association with geriatric syndromes. Subjects and Methods: In this cross?sectional study, 200 health?care seeking adults aged ?75 years were subjected to routine comprehensive geriatric assessment (assessment for functionality, cognition, depression, frailty, and various geriatric syndromes) and a detailed cardiovascular evaluation using electrocardiography, chest X?ray, echocardiogram, HbA1c level, fasting lipid profile, thyroid function test, serum homocysteine level, and serum NT?pro?BNP. Results: The overall frequency of CVDs in this study was 76%. Polypharmacy, multi-morbidity, cognitive impairment, depression, frailty, and impairment of basic and instrumental activities of daily living were present in 50.5%, 91.5%, 6.5%, 10%, 30.5%, 24.5%, and 55% individuals, respectively. CVDs were significantly associated with increased risk of geriatric syndromes (multi?morbidity [odds ratio (OR) 3.61, confidence interval (CI) 1.13 – 11.54, P = 0.030], polypharmacy [OR 5.46, CI 2.23 – 13.34, P = 0.001] and frailty [OR 3.29, CI 1.01 – 10.64, P = 0.047]). Conclusion: The prevalence of CVDs and their risk factors among the older population was high and significantly associated with increased risk of geriatric syndromes. These observations further strengthen the need for routine geriatric assessment and integrated management of geriatric syndromes in older patients with CVDs.

Safety and efficacy of ayush rasayana A and B in improving functionality of the elderly – A single-arm multicenter study

Background: As per Ayurvedic classics, Ras?yana is a term used for unique therapeutic measures intended to improve cognition, memory, physical strength and delay the degenerative processes. Ayush Rasayana A & B are developed from extracts of herbs pertaining rasayana property. Aims & Objectives: To assess the safety and effectiveness of ‘Ayush Rasayana A and B’ in improving physical endurance, quality of life and cognition of elderly. Materials and Methods: This is an open label, single arm, multi-centre study among 256 apparently healthy elderly between 60?75 years. Ayush Rasayan A was given for 6 days and Ayush Rayana B for 180 days. The effect of the trial drug was seen on functional capacity, quality of life and cognitive function and, safety of the intervention was assessed through haematological and biochemical tests, clinical examination and incidence of adverse events. Results: Significant improvement in 6 minute walk test and HMSE score was observed at 187th as compared to baseline (p<0.0001). Quality of life of the participants especially in domains of physical health, social relationship and environment also improved at the end of intervention period (p<0.0001). The haematological and bio-chemical parameters showed no significant changes as compared to baseline and no adverse events were observed during the study. Conclusion: Ayush Rasayana A and Ayush Rasayana B, both were well tolerated by all the participants. This ayurvedic intervention can be safely given to apparently healthy elderly to improve their functionality, quality of life and cognition. However, a randomized controlled trial is warranted to substantiate the efficacy of this drug.

Risk factors for falls in older adults with cognitive impairment

Background: Falls are one of the leading causes of disability among older people. The risk factors of falls widely vary among the older populations, including the different stages of cognitive impairment. We aim to identify the risk factors for falls among cognitively impaired older adults. Materials and Methods: In a cross-sectional study, older adults attending the memory clinic were screened for falls and their risk factors. A total of 112 subjects who satisfied the inclusion criteria and provided informed consent were subjected to a semi?structured interview and comprehensive geriatric assessment. Cognitive impairment was graded by the Clinical Dementia Rating (CDR). Subjects were divided into fallers and nonfallers. A multivariable logistic regression analysis was done to identify the independent risk factors of falls. Results: The prevalence of falls was 39.28% in the study population. Gender (adjusted odds ratio [aOR] [95% confidence interval (CI)]: 2.21 [0.690�117]), body mass index (aOR [95% CI]: 0.89 [0.773�028]), socioeconomic status (middle-class aOR [95% CI]: 0.34 [0.077�526], lower-class aOR [95% CI]: 2.44 [0.349�.160]), multimorbidity (aOR [95% CI]: 19.39 [1.043�0.373]), depression (mild aOR [95% CI]: 2.90 [0.896� 9.429] and moderate aOR [95% CI]: 4.77 [0.967�.597]), and impairment in hobbies and home (aOR [95% CI]: 24.78 [6.251�.294]) part of CDR were the independent predictors of falls. Conclusion: Older adults with cognitive impairment are at high risk of falling with definitive risk factors. Regular screening will help to identify older adults at risk of falls and enable fall prevention to reduce morbidity and dependency.

Comprehensive review of anti-tubercular treatment induced liver injury.

The challenge in the management of tuberculosis is further compounded by the liver injury associated with anti-tubercular treatment (ATT) drugs. The problem of drug-induced liver injury (DILI) associated with ATT drugs is significant in the developing countries because of high disease burden, limited monitoring due to scarce resources and lack of awareness. There is heterogeneity in the pharmacokinetics and pharmacodynamics of the various first line ATT drugs. There are various genetic and environmental factors that affect DILI. Various guidelines have been proposed to treat and monitor DILI. This article reviews the problem, risk factors, mechanism, and management strategies of the DILI associated with ATT.