M. Pau, I. Mulas, V. Putzu, Gesuina Asoni, D. Viale, Irene Mameli, G. Allali
Background. The Motoric Cognitive Risk (MCR) syndrome is defined in non-demented older adults by cognitive complaints and slow gait. Individuals with MCR are at higher risk of dementia and other poor clinical outcomes, such as falls. However, no data are available as regards functional mobility alterations associated with MCR. The main purpose of the present study is to quantitatively investigate such an aspect using the instrumented Timed-Up-and-Go (iTUG) test carried out using a wearable inertial measurement unit (IMU). Methods. Fifty-one women aged over 65 years underwent a geriatric and neuropsychologic assessment (which included the Mini Mental State Examination, MMSE and Addenbrooke’s Cognitive Examination Revised, ACE-R), instrumented gait analysis and iTUG performed using an IMU located on the lower back. Based on subjective cognitive complaints and slow gait, they were assigned either to the MCR (n = 24) or non-MCR (n = 27) group. IMU data allowed calculation of overall and sub-phases iTUG times.Results. Women with MCR were characterized by a significantly higher body mass and body mass index, lower normalized handgrip strength, and similar values of MMSE compared to non-MCRs. A trend was observed in terms of lower overall and sub-domain ACE-R score. They also performed iTUG at a significantly slower speed (22.4 s vs 14.1 of the non-MCR group, p < 0.001) and exhibited increased sub-phase times (29 to 31% higher with respect to non-MCRs).Conclusions. The findings of the present study suggest that the MCR syndrome impairs functional mobility, probably due reduced muscular strength and coordination, fear of falling and increased instability. The instrumental evaluation of functional mobility appears useful in the management of women with MCR, particularly in monitoring the progression of the motor impairments, verifying the effectiveness of interventions targeted in alleviating the impact on daily life of mobility limitations associated with MCR and in defining tailored rehabilitation programs.
背景驾驶认知风险（MCR）综合征是由认知障碍和步态迟缓在非痴呆老年人中定义的。MCR患者患痴呆症和其他不良临床结果（如跌倒）的风险更高。然而，没有与MCR相关的功能移动性改变的可用数据。本研究的主要目的是使用可穿戴惯性测量单元（IMU）进行的仪器化Timed Up and Go（iTUG）测试来定量研究这一方面。方法。51名65岁以上的女性接受了老年和神经心理评估（包括迷你精神状态检查、MMSE和Addenbrooke认知检查修订版（ACE-R））、仪器步态分析和使用位于下背部的IMU进行的iTUG。根据主观认知主诉和步态迟缓，他们被分为MCR（n=24）组或非MCR（n=27）组。IMU数据允许计算整个和子阶段iTUG时间。后果与非MCRs相比，患有MCR的女性的特征是体重和体重指数显著较高，标准化握力较低，MMSE值相似。观察到总体和亚结构域ACE-R评分降低的趋势。他们还以明显较慢的速度进行iTUG（非MCR组为22.4s，非MCR组14.1 s，p＜0.001），并表现出亚相时间增加（非MCR高出29%至31%）。结论。本研究的结果表明，MCR综合征损害了功能活动能力，可能是由于肌肉力量和协调能力下降、害怕跌倒和不稳定性增加。功能性行动能力的工具性评估似乎有助于管理患有MCR的女性，特别是在监测运动障碍的进展、验证旨在缓解与MCR相关的行动能力限制对日常生活的影响的干预措施的有效性以及制定量身定制的康复计划方面。
{"title":"Functional mobility in older women with and without motoric cognitive risk syndrome: a quantitative assessment using wearable inertial sensors","authors":"M. Pau, I. Mulas, V. Putzu, Gesuina Asoni, D. Viale, Irene Mameli, G. Allali","doi":"10.36150/2499-6564-n259","DOIUrl":"https://doi.org/10.36150/2499-6564-n259","url":null,"abstract":"Background. The Motoric Cognitive Risk (MCR) syndrome is defined in non-demented older adults by cognitive complaints and slow gait. Individuals with MCR are at higher risk of dementia and other poor clinical outcomes, such as falls. However, no data are available as regards functional mobility alterations associated with MCR. The main purpose of the present study is to quantitatively investigate such an aspect using the instrumented Timed-Up-and-Go (iTUG) test carried out using a wearable inertial measurement unit (IMU). Methods. Fifty-one women aged over 65 years underwent a geriatric and neuropsychologic assessment (which included the Mini Mental State Examination, MMSE and Addenbrooke’s Cognitive Examination Revised, ACE-R), instrumented gait analysis and iTUG performed using an IMU located on the lower back. Based on subjective cognitive complaints and slow gait, they were assigned either to the MCR (n = 24) or non-MCR (n = 27) group. IMU data allowed calculation of overall and sub-phases iTUG times.Results. Women with MCR were characterized by a significantly higher body mass and body mass index, lower normalized handgrip strength, and similar values of MMSE compared to non-MCRs. A trend was observed in terms of lower overall and sub-domain ACE-R score. They also performed iTUG at a significantly slower speed (22.4 s vs 14.1 of the non-MCR group, p < 0.001) and exhibited increased sub-phase times (29 to 31% higher with respect to non-MCRs).Conclusions. The findings of the present study suggest that the MCR syndrome impairs functional mobility, probably due reduced muscular strength and coordination, fear of falling and increased instability. The instrumental evaluation of functional mobility appears useful in the management of women with MCR, particularly in monitoring the progression of the motor impairments, verifying the effectiveness of interventions targeted in alleviating the impact on daily life of mobility limitations associated with MCR and in defining tailored rehabilitation programs.","PeriodicalId":42690,"journal":{"name":"Journal of Gerontology and Geriatrics","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45154770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Geirsdottir, M. Chang, K. Briem, P. Jónsson, I. Thorsdottir, A. Ramel
{"title":"Determinants of physical function in community dwelling old people","authors":"O. Geirsdottir, M. Chang, K. Briem, P. Jónsson, I. Thorsdottir, A. Ramel","doi":"10.36150/2499-6564-n261","DOIUrl":"https://doi.org/10.36150/2499-6564-n261","url":null,"abstract":"","PeriodicalId":42690,"journal":{"name":"Journal of Gerontology and Geriatrics","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48431756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Aksu, Güzin Zeren Öztürk, Memet Taşkın Eğici, C. Ardic
{"title":"Evaluation of the relationship between lower urinary tract symptoms and fall risks in male patients over 65 years old","authors":"S. Aksu, Güzin Zeren Öztürk, Memet Taşkın Eğici, C. Ardic","doi":"10.36150/2499-6564-n359","DOIUrl":"https://doi.org/10.36150/2499-6564-n359","url":null,"abstract":"","PeriodicalId":42690,"journal":{"name":"Journal of Gerontology and Geriatrics","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49529444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Multiple system atrophy (MSA) is a late-onset, sporadic, progressive, neurodegenerative disorder clinically characterized by autonomic failure and either poorly levodopa-responsive parkinsonism or cerebellar ataxia. There isn’t any effective treatment on disease progression. Current therapeutic strategies are primarily based on dopamine replacement and improvement of autonomic failure. Clonazepam, propranolol, baclofen, amantadine, gabapentin, buspirone have also been used for symptomatic treatment of ataxia in MSA patients, but their efficacy known modest and transient. Herein we describe a MSA-C patient with disabling ataxia and sick sinus syndrome who showed distinct improvement in her symptoms after amantadine treatment and cardiac pacemaker implantation.
{"title":"Management of balance problems in an elderly with multiple system atrophy with predominant cerebellar ataxia (MSA-C) and sick sinus syndrome","authors":"A. Eker, P. Yiğitoğlu, H. Duygu, E. Tan","doi":"10.36150/2499-6564-n262","DOIUrl":"https://doi.org/10.36150/2499-6564-n262","url":null,"abstract":"Multiple system atrophy (MSA) is a late-onset, sporadic, progressive, neurodegenerative disorder clinically characterized by autonomic failure and either poorly levodopa-responsive parkinsonism or cerebellar ataxia. There isn’t any effective treatment on disease progression. Current therapeutic strategies are primarily based on dopamine replacement and improvement of autonomic failure. Clonazepam, propranolol, baclofen, amantadine, gabapentin, buspirone have also been used for symptomatic treatment of ataxia in MSA patients, but their efficacy known modest and transient. Herein we describe a MSA-C patient with disabling ataxia and sick sinus syndrome who showed distinct improvement in her symptoms after amantadine treatment and cardiac pacemaker implantation.","PeriodicalId":42690,"journal":{"name":"Journal of Gerontology and Geriatrics","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43019037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective. Cardiac amyloidosis (CA) among older adults is less infrequent than usually considered, and often underdiagnosed. Geriatricians’ awareness and knowledge of CA is unknown. Objectives of the study are to assess actual CA knowledge among residents/specialists in Geriatrics, and their usual clinical practice in managing suspected CA. Methods. In this Nation-wide survey carried out by the Italian Society of Gerontology and Geriatrics in April-August 2020, we administered to residents/specialists in Geriatrics a questionnaire divided in three sections: socio-demographical, procedural and knowledge. Results were stratified by qualification (resident/specialist) and by performance (best/worst performers). Results. 289 residents and 104 specialists participated. The overall proportion of correct answers was 57.9% (58.4% residents, 56.1% specialists); knowledge about clinical (89% of correct answers, 91% residents and 84% specialists, P = 0.062), ECG (72% of correct answers, no differences between groups), and echocardiographic (86% of correct answers, no differences between groups) signs of CA was good. However, only 8% participants knew how to diagnose ATTRwt CA (no differences between groups), and 19% which diuretic is indicated in CA (22% residents, 13% specialists, P = 0.069). Only 25% of the participants knew the natural history of ATTRwt (19% residents, 41% specialists, P < 0.001), and 37% was aware of the target of the ATTR treatment. Prevalence of CA was underestimated by 57% specialists and 37% residents (P = 0.001). Conclusions. Knowledge of CA among residents/specialists in Geriatrics is uncomplete. Education campaigns on this topic are desirable, to improve physicians’ awareness of CA, thus reducing the number of potential misdiagnosis/delay in correct diagnoses.
{"title":"Cardiac amyloidosis awareness among residents/specialists in Geriatrics: an Italian national survey","authors":"Diana Lelli, C. Pedone, D. Leosco, R. Incalzi","doi":"10.36150/2499-6564-n374","DOIUrl":"https://doi.org/10.36150/2499-6564-n374","url":null,"abstract":"Objective. Cardiac amyloidosis (CA) among older adults is less infrequent than usually considered, and often underdiagnosed. Geriatricians’ awareness and knowledge of CA is unknown. Objectives of the study are to assess actual CA knowledge among residents/specialists in Geriatrics, and their usual clinical practice in managing suspected CA. Methods. In this Nation-wide survey carried out by the Italian Society of Gerontology and Geriatrics in April-August 2020, we administered to residents/specialists in Geriatrics a questionnaire divided in three sections: socio-demographical, procedural and knowledge. Results were stratified by qualification (resident/specialist) and by performance (best/worst performers). Results. 289 residents and 104 specialists participated. The overall proportion of correct answers was 57.9% (58.4% residents, 56.1% specialists); knowledge about clinical (89% of correct answers, 91% residents and 84% specialists, P = 0.062), ECG (72% of correct answers, no differences between groups), and echocardiographic (86% of correct answers, no differences between groups) signs of CA was good. However, only 8% participants knew how to diagnose ATTRwt CA (no differences between groups), and 19% which diuretic is indicated in CA (22% residents, 13% specialists, P = 0.069). Only 25% of the participants knew the natural history of ATTRwt (19% residents, 41% specialists, P < 0.001), and 37% was aware of the target of the ATTR treatment. Prevalence of CA was underestimated by 57% specialists and 37% residents (P = 0.001). Conclusions. Knowledge of CA among residents/specialists in Geriatrics is uncomplete. Education campaigns on this topic are desirable, to improve physicians’ awareness of CA, thus reducing the number of potential misdiagnosis/delay in correct diagnoses.","PeriodicalId":42690,"journal":{"name":"Journal of Gerontology and Geriatrics","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48170964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Calabrese, V. Calsolaro, R. Franchi, S. Rogani, D. Guarino, C. Okoye, F. Monzani
Objective. Dabigatran, a direct inhibitor of thrombin, represents an effective alternative to warfarin. Despite the good tolerance and predictable pharmacokinetic profile, dabigatran may be associated to adverse reactions, including gastrointestinal disorders. Here we report on a case of hepatotoxicity along with an extensive revision of the available literature on dabigatran induced liver injury.Methods & results. An 84 years old man attended the Emergency Department after experiencing fatigue for a few days. He suffered from atrial fibrillation and had been initiated on dabigatran (110 mg bid) in the last four weeks. Clinical examination revealed tachycardia, scleral icterus in the absence of signs of chronic hepatic disease. Blood chemistry showed altered liver function tests: AST 809 IU/L, ALT 1629 IU/L, total bilirubin 2.42 mg/dL, gGT 381 IU/L, ALP 388 IU/L, LDH 552 IU/L. Screening laboratory investigations for infectious, autoimmune or metabolic hepatotoxic pathology were unremarkable. The abdominal ultrasound examination excluded vascular causes, revealing non-homogeneous echo-structure consistent with mild hepatic steatosis. At admission to our Geriatric ward dabigatran was discontinued and fondaparinux was introduced. Resolution of the hepatitis and normalization of blood chemistry was observed within two weeks. Few cases are described regarding hepatotoxicity likely caused by the recent onset of treatment with dabigatran. Conclusions. DOACs associated hepatotoxicity is rare but potentially harmful and should be kept in mind, especially in comorbid patients with unexplained liver injury. The mechanism of liver injury during dabigatran therapy is unknown and, not related to cytochrome P450 enzymes since the drug does not affect CYP450 activity.
目标。达比加群是一种凝血酶的直接抑制剂，是华法林的有效替代品。尽管达比加群具有良好的耐受性和可预测的药代动力学特征，但它可能与不良反应有关，包括胃肠道疾病。在这里，我们报告了一个肝毒性病例，并对达比加群引起的肝损伤的现有文献进行了广泛的修订。方法与结果。一位84岁的老人在感到疲劳几天后到急诊科就诊。他患有心房颤动，并在过去四周开始服用达比加群(110毫克/次)。临床检查显示心动过速，巩膜黄疸，无慢性肝病征象。血液化学显示肝功能改变:AST 809 IU/L, ALT 1629 IU/L，总胆红素2.42 mg/dL, gGT 381 IU/L, ALP 388 IU/L, LDH 552 IU/L。对感染性、自身免疫性或代谢性肝毒性病理的实验室检查无显著差异。腹部超声检查排除血管原因，显示非均匀回声结构，符合轻度肝脂肪变性。在我们的老年病房入院时，停用达比加群，改用氟达哌啶。两周内肝炎消退，血液化学恢复正常。很少有病例描述了可能由最近开始使用达比加群治疗引起的肝毒性。结论。DOACs相关的肝毒性是罕见的，但有潜在的危害，应该记住，特别是在合并不明原因肝损伤的患者中。达比加群治疗期间肝损伤的机制尚不清楚，与细胞色素P450酶无关，因为药物不影响CYP450活性。
{"title":"Dabigatran-induced acute liver injury in older patients: case report and literature review","authors":"A. Calabrese, V. Calsolaro, R. Franchi, S. Rogani, D. Guarino, C. Okoye, F. Monzani","doi":"10.36150/2499-6564-n345","DOIUrl":"https://doi.org/10.36150/2499-6564-n345","url":null,"abstract":"Objective. Dabigatran, a direct inhibitor of thrombin, represents an effective alternative to warfarin. Despite the good tolerance and predictable pharmacokinetic profile, dabigatran may be associated to adverse reactions, including gastrointestinal disorders. Here we report on a case of hepatotoxicity along with an extensive revision of the available literature on dabigatran induced liver injury.Methods & results. An 84 years old man attended the Emergency Department after experiencing fatigue for a few days. He suffered from atrial fibrillation and had been initiated on dabigatran (110 mg bid) in the last four weeks. Clinical examination revealed tachycardia, scleral icterus in the absence of signs of chronic hepatic disease. Blood chemistry showed altered liver function tests: AST 809 IU/L, ALT 1629 IU/L, total bilirubin 2.42 mg/dL, gGT 381 IU/L, ALP 388 IU/L, LDH 552 IU/L. Screening laboratory investigations for infectious, autoimmune or metabolic hepatotoxic pathology were unremarkable. The abdominal ultrasound examination excluded vascular causes, revealing non-homogeneous echo-structure consistent with mild hepatic steatosis. At admission to our Geriatric ward dabigatran was discontinued and fondaparinux was introduced. Resolution of the hepatitis and normalization of blood chemistry was observed within two weeks. Few cases are described regarding hepatotoxicity likely caused by the recent onset of treatment with dabigatran. Conclusions. DOACs associated hepatotoxicity is rare but potentially harmful and should be kept in mind, especially in comorbid patients with unexplained liver injury. The mechanism of liver injury during dabigatran therapy is unknown and, not related to cytochrome P450 enzymes since the drug does not affect CYP450 activity.","PeriodicalId":42690,"journal":{"name":"Journal of Gerontology and Geriatrics","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2021-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48308224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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