Relation of bone mineral density with fat infiltration of paraspinal muscles: The Goutallier classification.

Objectives: Muscle and bone tissue are interrelated throughout their developmental processes via paracrine and endocrine pathways. Osteosarcopenia has emerged with the growing data proving the high rate of simultaneous occurrence of sarcopenia and osteoporosis. We aimed to evaluate the relationship between osteoporosis, and muscle quality by grading the fatty infiltration in paraspinal muscles according to the Goutallier classification in magnetic resonance imaging (MRI). Methods: Data of postmenopausal patients who underwent MRI for low back pain were analyzed retrospectively. Lumbar spine and femoral neck bone mineral density (BMD) were measured by using dual energy X-ray absorptiometry (DXA). Grade of paraspinal muscle fatty infiltration for each level of lumbar vertebrae including L1-L2, L2-L3, L3-L4, was evaluated separately according to Goutallier classification system. Results: A total of 91 postmenopausal women were included in the study. The mean age of the study population was 60.5 ± 11. Lumbar vertebrae L1-L4 total T-scores and BMD g/cm2 were lower in patients with higher grades of Goutallier classification (P = 0.031 and P = 0.023, respectively). The distribution of the severity of fatty degeneration was significantly higher in the osteoporosis/osteopenia group at all 3 disc levels. No significant correlation was observed between femoral neck BMD and paraspinal muscle fat infiltration. Conclusions: There is a strong relationship between osteoporosis of the lumbar spine and paraspinal muscle quality, which can be considered as a reflection of osteosarcopenia. The Goutailler classification can be an effective and easy method in the evaluation of muscle quality with MRI.

Depression in frail older adults: Associations and gender difference.

Objective: Depression is highly prevalent in frail older adults and both clinical situations share similar clinical and prognostic factors. The aim of this study was to investigate the relationship between frailty and depression by considering each component of frailty, in both genders. Methods: Six hundred and forty-one patients aged 60 years and older, admitted to a Geriatrics outpatient clinic in a tertiary hospital, were included in this cross-sectional study. FRIED criteria were used for defining frailty. Depression was assessed by the Geriatric depression scale (GDS). Evaluations related to disability, nutrition, and cognition were performed by the Katz/Lawton scales, mini nutritional assessment (MNA), and the mini mental state examination (MMSE), respectively. Results: Prevalence of frailty and depression was 48.7% and 36.7%, respectively. Co-occurrence of frailty and depression was observed as 24.0%. Both in men (OR: 3.977, CI: 1.423-11.114, p=0.008) and in women (OR: 2.704, CI: 1.695-4.315, p<0.001), depression was independently associated with frailty, after adjusting with confounders regarding frailty. All FRIED criteria were significantly correlated with the higher GDS scores in women. Two FRIED criteria regarding physical activity and strength measures were not related to depressive symptoms in men. Lawon (p<0.001), MMSE (p=0.004), and MNA scores (p<0.001) were lower in patients with co-occurring frailty and depression, than both as separate conditions. Conclusion: Depression may play a key role in the development of frailty in both genders. Albeit, depressed men seem to be at a higher risk than women for development of frailty are, physical activity and strength measures in the FRIED criteria had a high impact in women for depressive symptoms. Patients with co-occurring frailty and depression are more prone to develop geriatric syndrome related disabilities.

Validation of the five-item version of the Geriatric Depression Scale (GDS-5) in a Turkish elderly population.

BACKGROUND: Late-life depression is a geriatric syndrome which should be taken seriously. Many clinical scales have been developed for the screening of geriatric depression. Most of these have been validated at different times and in diverse populations. A five-question version of the Geriatric Depression Scale (GDS-5) was developed in 1997. This test has been validated and used in different populations. In the present study, we plan to validate the GDS-5 for the Turkish elderly population. METHODS: Patients aged 60 years and older who applied to the Geriatrics Clinic of our hospital between November 2018 and November 2019 were included in the study. We compared the effectiveness of Yesavage Geriatric Depression Scale-30 (YGDS-30) and GDS-5 in screening depression, based on Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) depression criteria. RESULTS: Four hundred participants were included in the study. A significant positive correlation was found between the DSM-5 scale and the GDS-5 scale (rho = 0.726, P <0.001). According to DSM-5, YGDS-30 and GDS-5, 112 participants (28%), 154 patients (%38.5) and 199 patients (%49.8) were diagnosed with depression respectively. When the cut-off value was taken as ≥2, the sensitivity, specificity, positive predictive and negative predictive values for the GDS-5 scale were determined as 96%, 68%, 54%, and 98%, respectively. We obtained these diagnostic measures with 95% confidence intervals. CONCLUSION: This study demonstrated the validity and reliability of the GDS-5 for Turkish elderly populations. This five-question scale will be significant in daily use to screen for depression in elderly individuals with multiple problems.

Frailty in Patients with Parkinson's Disease: Associations with Disability and Timed Up and Go.

INTRODUCTION: Aim of this study was identify the prevalence of frailty in patients with idiopathic Parkinson's disease (PD), to describe the relationship between severity of the disease and frailty, and to evaluate if timed up and go (TUG) is an eligible test for determination of frailty in idiopathic PD patients. METHODS: We conducted a cross-sectional study which included 66 patients, aged 60 and over in a tertiary hospital. Frailty was assessed by the Fried Frailty Index (FFI). Severity of the idiopathic PD was detected by the Hoehn and Yahr (H&Y) scale. Mobility was measured by the TUG test. Demographic characteristics and comprehensive geriatric assessments were evaluated. Descriptive statistics and logistic regression were used in analyses. Receiver operating characteristic (ROC) curves were used to identify the discriminative effect of TUG test on frailty. RESULTS: The numbers of frail, prefrail, and robust subjects were 34 (51.5%), 24 (36.4%), and 8 (12.1%), respectively. Dependency in instrumental activities of daily living (IADL) was significantly associated with frailty (Odds ratio (OR): 36.00, Confidence interval (CI): 8.43-153.80). Multivariate logistic regression analysis results yielded, depression (OR: 10.37, CI: 2.82-38.12) and higher levodopa doses (OR: 6.28, CI: 1.77-22.24) were independently associated with frailty. TUG test performance was strongly associated with frailty with high sensitivity (0.806) and specificity (0.826) (Area under the curve (AUC): 0.831). CONCLUSIONS: Frailty is highly prevalent in idiopathic PD and is strongly associated with disabilities as well as specific risk factors of the disease. The TUG may be a reliable test for prediction of frailty in patients with idiopathic PD.

Risk of sarcopenia in hospitalized patients and related clinical factors: a multicenter study from Turkey.

PURPOSE: To investigate the risk of sarcopenia in hospitalized older patients and to assess the associations between sarcopenia risk and health care outcomes including dependency, malnutrition, and dysphagia. METHODS: This multicenter cross-sectional study was a part of the annual National Prevalence Measurement of Quality of Care (LPZ) in Turkey. Hospitalized patients age 65 and older were included in the study. The SARC-F was used to assess risk of sarcopenia. Dependency was appraised according to the Care Dependency Scale (CDS). Nutritional status was established with respect to the Malnutrition Universal Screening Tool (MUST). Dysphagia was screened by two structured questions. RESULTS: A total of 492 patients were included in the analysis. Two hundred and forty patients (48.8%) were at risk of sarcopenia. Sarcopenia risk was more prevalent among women (p = 0.007) and patients with risk of sarcopenia were older (p < 0.001). Hospital stay was longer and malnutrition and dysphagia were more prevalent in patients with sarcopenia risk than without (all p < 0.001). All nutritional interventions were applied mostly to patients with sarcopenia risk than without. In multivariate analysis, advanced age (OR: 1.068, CI 1.032-1.104, p < 0.001), female gender (OR: 2.414, CI 1.510-3.857, p < 0.001), and dependency (OR: 5.022, CI 2.922-8.632, p < 0.001) were independently associated with sarcopenia risk. CONCLUSIONS: Sarcopenia risk is related with unfavorable outcomes in hospitalized patients. Primarily older female patients are at risk for sarcopenia. It is important to recognize sarcopenia at an early stage and to prevent its progression, before dependency develops. The SARC-F may be a useful tool for screening sarcopenia risk in hospitalized patients.

Influence of Conventional Complete Dentures and Different Attachment Types in Implant-Supported Overdentures on Quality of Life and Nutritional Status in Edentulous Geriatric Patients.

PURPOSE: To determine whether the use of implant-supported overdentures (IODs) with different attachments influences the Mini Nutritional Assessment (MNA) and Geriatric Oral Health Assessment Index (GOHAI) scores in edentulous patients > 65 years of age. MATERIALS AND METHODS: The MNA and GOHAI were administered to 54 edentulous patients > 65 years of age (mean age = 68.35 ± 4.1 years) before treatment (A) and 6 months after treatment (B): 10 with maxillary + mandibular conventional complete dentures (CDs); 10 with a maxillary conventional CD + mandibular magnetic-retained IOD; 12 with a maxillary conventional CD + mandibular ball-retained IOD; 12 with a maxillary conventional CD + mandibular Locator-retained IOD; and 10 with a maxillary conventional CD + mandibular bar-retained IOD. Statistical differences between treatment types were evaluated using one-way analysis of variance and paired-sample t tests. The correlation between MNA and GOHAI scores was determined using Pearson correlation analysis (α = .05). RESULTS: The difference between mean GOHAI-A and GOHAI-B scores was statistically significant for each type of denture (P < .005). The difference between the mean MNA-A and MNA-B scores was statistically significant for all types of denture except for conventional CDs (P < .05). There was a statistically significant positive correlation between MNA and GOHAI scores (P < .01). CONCLUSION: Regardless of the type of denture used, treatment of edentulous geriatric patients is important for improving nutritional status and self-rated oral health.

Effects of Ramadan fasting on lean body mass in the older people.

PURPOSE: In Islam, Ramadan fasting is a unique model that is associated with the restriction of food and fluid intake. We aimed to estimate the physiological effects of Ramadan fasting on muscle function and muscle mass in the older people. METHODS: A random sample was recruited from healthy older Muslims people aged 60 years and older, who expressed an intention to fast for 30 days during the month of Ramadan. Walking speed was expressed in meters per second (m/s). Muscle strength was assessed by hand grip strength (HGS) with a dynamometer. A Bioelectrical impedance analysis (BIA) device (BodystatQuadScan 1500, UK) was used for the evaluation of body composition. Dietary data of the patients during Ramadan were obtained by a 43-item Food Frequency Questionnaire (FFQ). RESULTS: The mean age [Standard Deviation(SD)] of the older people was 66.7(4.7) years of age and 50% were females. There were no significant changes in body weight, muscle function and muscle mass before and after Ramadan fasting in both genders. The mean SMI, mean (SD) kg/m2, values of females and males with adequate milk and yogurt consumption before and after Ramadan fasting were 8.03 (0.75) kg/m2 and 8.43(1.03) kg/m2 for females (p = 0.133) and 10.11(0.79) kg/m2 and 10.35 (0.93) kg/m2 for males (p = 0.59), respectively. CONCLUSIONS: Ramadan fasting supplied no risk for muscle function and muscle mass in the older people. If the older people consume enough milk and yogurt in Ramadan, they may not loss muscle mass.

Sarcopenia, dynapenia, and body composition in Parkinson's disease: are they good predictors of disability?: a case-control study.

BACKGROUND/AIM: To assess sarcopenia and dynapenia and their relationship with disease severity and disabilities in PD and to state body composition in PD. METHODS: We conducted a case-control, cross-sectional study that included 70 patients with idiopathic PD and 85 controls. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. Dynapenia was detected by a handheld dynamometer. Bioimpedance analysis (BIA) was performed, and the SARC-F questionnaire was applied. Disabilities were appointed according to the Katz and Lawton indexes. RESULTS: Sarcopenia and dynapenia were more prevalent in PD than in controls (50 vs 30.6% and 31.4 vs 17.6%, respectively). Dynapenia was significantly associated with the severity of the disease and disabilities (p = 0.047, p = 0.001); however, sarcopenia was not. The skeletal muscle mass index (SMMI), fat mass index (FMI), and fat-free mass index (FFMI) did not differ between the PD and controls. FMI was lower in the advanced stages of the disease. Higher scores in the SARC-F questionnaire were significantly associated with disabilities and the severity of the disease (p < 0.001, p < 0.001). CONCLUSION: Muscle strength was closely associated with the severity of the disease and disabilities in PD, but muscle mass was not. Sarcopenia, defined by the SARC-F questionnaire, was a good predictor of disabilities in PD, while the EWGSOP criteria were not. PD patients have a favorable body composition even in advanced stages of the disease with lower FMI and protected lean mass.

Validity of simplified nutritional appetite questionnaire for Turkish community-dwelling elderly and determining cut-off according to mini nutritional assessment.

BACKGROUND/OBJECTIVES: The aim of this study was to determine a cut-off value for the SNAQ according to both the MNA long and MNA short forms and to assess whether the SNAQ can predict malnutrition or risk of malnutrition in the elderly. SUBJECTS/METHODS: Nutritional status was assessed both by the Mini Nutritional Assessment (MNA) long and short forms. All demographic characteristics, mental status, depressive mood, functional status, and frailty were determined. Receiver operating characteristic (ROC) curves were used to calculate the cut-off of the SNAQ according to both the MNA long and short forms for malnutrition or risk of malnutrition. Reliability and validation of the SNAQ was analysed. RESULTS: We included 905 community-dwelling elderly, but those with middle-stage dementia (MMSE score <18, n = 30) were excluded. The mean age ±â€¯standard deviation (SD) was 71.4 ±â€¯5.5 years (49.3% female and 50.7% male). The prevalence of well-nourished, risk of malnutrition or malnutrition were 55.2%, 44.8%, respectively according to the MNA-long form. The prevalence of elderly at risk of future weight loss (SNAQ score of ≤14) was 31.0% (n = 268; 66.0% female, 34.0% male). The area under the curve (AUC) for SNAQ was 0.725 (95% CI 0.690-0.760). The cut-off value of the SNAQ, according to both the MNA long and short forms, was 14 (sensitivity; 50%, 50% and specificity; 84%, 82%, respectively). The Cronbach's alpha reliability coefficient of SNAQ for internal consistency was 0.639. CONCLUSION: The SNAQ was reliable and valid as an appetite screening tool in community-dwelling Turkish elderly.

Relation of RANKL and OPG Levels with Bone Resorption in Patients with Acromegaly and Prolactinoma.

The objective of this study was to investigate the effect of hyperprolactinemia and high levels of insulin-like growth factor-I (IGF-I) on bone resorption and their relation with receptor activator of nuclear factor-κB ligand (RANKL) and osteoprotegerin (OPG) in patients with prolactinoma and acromegaly. Thirty-one patients with acromegaly, 28 patients with prolactinoma, and 33 healthy individuals were included in the study. Serum concentrations of RANKL, OPG, bone alkaline phosphatase (bone ALP), osteocalcin (OC), C-terminal telopeptide of type 1 collagen (CTX), procollagen type 1 N-terminal propeptide (P1NP) and urine deoxypyridinoline (DPD) levels were detected and bone mineral density (BMD) was measured. Groups were not statistically different from each other with regard to serum levels of RANKL and OPG. The RANKL/OPG ratio was higher in the prolactinoma group than in the control group (p=0.046). A positive correlation between OPG and increasing age was detected in both the prolactinoma and control groups (r=0.524, p=0.004 and r=0.380, p=0.029, respectively). An inverse correlation was observed between IGF-I and OPG after excluding age in the prolactinoma group (r=-0.412, p=0.046). OC and bone ALP were negatively associated with RANKL in the acromegaly group (r=-0.384, p=0.036 and r=-0.528, p=0.003, respectively). There was an inverse correlation between OPG and BMD at the femoral neck in the acromegaly group (r=-0.422, p=0.02). The effect of IGF-I on bone remodeling may be partly mediated by RANKL and OPG. The RANKL/OPG ratio plays an important role in prolactinoma. A positive correlation of OPG with age and an inverse correlation with IGF-I favor the compensatory response of OPG against bone loss in the aging skeleton.