Background: Cholinesterase inhibitors (ChEIs) are currently considered to be the first line treatment for Alzheimer’s disease (AD). Although the target organ for cholinesterase inhibitors is the brain, they may adversely affect cardiacfunction,andtheircholinergicsideeffectsonthecardiovascularsys-tem are still unclear. In this study, it was aimed to examine the side effects caused by donepezil, rivastigmine and galantamine on cardiac rhythm pulse pressure changes in in elderly patients with AD. Methods: 190 consecutive elderly patients with AD were enrolled the study. Elderly patients with AD divided into three groups according to ChEIs including donepezil, rivastig- mine and galantamine. The ECG parameters and pulse pressure were re-corded at the baseline and 1 month after dose of 10 mg/d of donepezil, 10 cm2/dofrivastigmineand24mg/dofgalantamine. Results: 154of190con-secutive elderly patients completed the study. There were no significant changes relative to the baseline in any of the ECG parameters or pulse blood pressurewith any of the administered ChEIs(p > 0.005 foreach comparison) (Figure 1 and 2). Conclusions: It was demonstrated that none of the three ChEIs were associated with increased negative chronotropic, arrhythmo-genic and none of them have changed pulse pressure in the elderly patients with AD. However, when physicians prescribe these drugs, they should be aware of the comorbidities, especially cardiac conduction disease and med- ications of the elderly patients. Background: Nowadays, current therapy methods for Alzheimer’s disease (AD)canonlyreducethesymptomsofthedisease.Therefore,itisimportant to development of new therapeutic agents. Glucagon-like Peptid-1 (GLP-1) has effect on neuronal plasticity, cell survival, neurite outgrowth and protec-tionagainstexcitotoxiccelldeathandoxidativeinjuryduetothecAMPcou- pled receptors with in the brain of rodents and humans. In this retrospective preliminary study we evaluated whether sitagliptin, a GLP-1 inhibitor can improve the cognitive function in elderly diabetic patients with AD. Methods: Eleven diabetic and 13 nondiabetic elderly patients with AD were evaluated retrospectively in our geriatric clinics. Baseline and 6 months after records of MMSE, ADL, IADL and blood sugar under the si- tagliptine therapy were reviewed. Results: Baseline values of the patients were presented as a table. Mean changes of MMSE, ADL and IADL scores from baseline were higher in the sitagliptin treated patients during the 6 months ( P < 0.005, for each comparison). Mean changes of the scores from the baseline were presented in figure. Conclusions: This is the preliminary study, and it is too early to recommend, but we have considered that the sitagliptin can improve the cognitive functions in the patints with AD. Randomized, controlled prospective studies should be done. Therefore we have started a new prospective study related to the cognitive effects of the sitagliptin. Background: Continuous positive airway pressure (CPAP) for sleep apnea syndrome (SAS) may improve cognitive functioning and mood, and reduce daytime sleepiness in patients with Alzheimer’s disease (AD).The purpose of the study was to determine if CPAP slows the rate of cognitive decline in mild to moderate AD’s patients. Methods: This is an exploratory study in- cluding all the patients followed at the Lille memory clinic between 2003 and 2010 for a mild to moderate AD (AD was diagnosed according the NIA criteria (2011); initial Mini Mental State Examination (MMSE) was (cid:1) 15 points), and with a severe SAS defined on a polysomnography exam- inationwithanapnea-hypopneaindex (cid:1) 30.Accordingtothecomplianceof the CPAP treatment, two groups of AD patients were constituted (patients with CPAP vs without CPAP). Mean annual MMSE rates were compared between these two groups. Results: Among the 29 patients included in the study, 20 (69%) accepted with a good compliance the CPAP treatment. The two groups of patients did not differ on epidemiological data. SAS was more severe in the patient group treated with CPAP (IAH: 57.1 6 18.6 vs

We aimed to investigate the effects of treatment with amlodipine and valsartan, on markers of bone remodeling in newly diagnosed hypertensive adults. Forty-three subjects with newly diagnosed were included in the study. Patients were also randomly divided into two groups, and each group received monotherapy with amlodipine or valsartan. Blood levels of bone turnover markers and osteoprotegerin (OPG) / receptor activator of nuclear factor-κB ligand (RANKL) / RANK system were measured. Amlodipine reduced sRANKL levels and sRANKL/OPG ratio more than valsartan, and this decrease was statistically signifi cant (p<0.001, p=0.002, respectively). Although blood OPG concentration did not change after treatment in both groups, sRANKL/OPG ratio decreased signifi cantly (p<0.001). Amlodipine also caused some reduction in CTx blood levels compared to valsartan. So we can suggest that amlodipine may be a better option than valsartan in patients with osteoporosis or terms of prevention of bone loss in hypertensive adults.

Objectives Discontinuation of bisphosphonate treatment remains high even with the long acting parenteral options. Whether there are some unidentified causes of noncompliance more specific to aged individuals is unknown. The aim of this study was to investigate baseline predictors of adherence to Zoledronic acid (ZOL) infusions among non-demented older adults with osteoporosis.Methods Patients aged65years who received a first ever ZOL infusion for osteoporosis were prospectively enrolled. Risk factors for osteoporosis and fractures, comorbidities, geriatric assessment measures, including depression, and anticholinergic burden were determined at baseline. Adherence was defined as taking the next ZOL infusion at 12months.Results A total of 187 participants were included (mean age: 75.76.3years, female: 77.5%). Adherence to the next ZOL infusion was 66.8% (n=125). Non-adherent participants (n=62, 33.2%) had significantly higher frequency of historical height decrease and depression at baseline. Poor adherence was associated with height decrease, presence of depression, and higher anticholinergic burden in univariate analysis. After adjustment for relevant confounders, fragility fracture history (OR: 0.38, 95%CI: 0.17-0.86, p=0.020), depression (OR: 0.32, 95%CI: 0.12-0.82, p=0.018), and higher anticholinergic burden (OR: 0.67, 95%CI: 0.49-0.93, p=0.017) were the predictors of lower adherence to ZOL infusion.Conclusions The rate of adherence to the next ZOL infusion was still suboptimal among older women and men in this study. Past osteoporotic fractures, depression, and higher anticholinergic drug burden predicted poor ZOL adherence. It was a novel finding that drug-related anticholinergic side effects adversely influenced adherence to another medication without anticholinergic properties.

Background: Peripheral arterial disease (PAD) was reported to increase the risk of dementia(s) even more than stroke. We assessed the prevalence of PAD in a group with definite diagnosis of dementia. Methods: Patients aged 65 years or older with Alzheimer's disease (AD), vascular dementia (VaD), or AD-VaD were enrolled (n = 162, mean age: 78.87 [6.05] years). An age- and gender-matched control group was also included (n = 190). Peripheral arterial disease was diagnosed by the ankle-brachial index. Results: Frequency of PAD among patients with and without dementia was 35.2% and 16.3%, respectively (P < .001), being similar among different types of dementia. After adjustment for covariates, dementia (odds ratio: 2.41, 95% confidence interval: 1.34-4.32; P = .003) was among the predictors of PAD diagnosis along with older age, female gender, and diabetes. Conclusions: The prevalence of PAD was more than double in patients with dementia, with no difference among AD, VaD, and AD-VaD types.

Frailty has emerged as an important risk factor for disability. Age-related declines in physical and physiological function lead to increased risk of loss of independence and poor quality of life. Recent evidence has shown the effectiveness of physical exercise programmes in preventing or reversing frailty. The aim of this study was to evaluate changes in the functioning of frail elderly individuals after undergoing resistance training for 3 days a week for 8 weeks. The effectiveness of exercise training was investigated in 48 frail elderly individuals who were randomly assigned to the following intervention groups: high-intensity (HI; n=16; age: 69–96 years) or low-intensity (LI; n=16; age: 77–93 years) strength training groups or a control group (n=16; age: 76–93 years) with no specific exercise programme. Participants were assessed for muscle strength, physical function, activities of daily living, depression and quality of life. The HI group had significantly better results (P<0.05) on the Short Physical Performance Test than the LI group; however, the LI group did show a significant improvement in those scores, whereas the scores of the control group worsened. Results for the other evaluations were similarly favourable in both exercise groups (P>0.05). The study showed that LI exercise was as effective as HI exercise for most parameters tested. Exercise training is useful for the prevention or treatment of frailty, as it improves functioning by contributing positively to muscle strength, gait, balance and quality of life.

Introduction: The decreasing level of physical activity in frail elderly effects negatively both physically and spiritually. The aim of the study to investigate the effect of exercise training on activities of daily living, quality of life, fatigue and depression in frail elderly. Methods: Forty-eight frail elderly were included. Subjects were divided into three groups as control group (free exercise training), low intensity (40% of 1RM) and high intensity (70% of 1RM). Exercise training program included strengthening, balance and flexibility was applied 40–50 minutes a day, three times a week for 8 weeks with a physiotherapist. Activities of daily living, quality of life, fatigue, and depression assessment were recorded in the baseline and eighth week of the study. Results: Mean ages of the control group, low and high intensity exercise groups were 85.4 ± 4.7, 84.5 ± 4.8, and 84.2 ± 6.9 years, respectively. After the exercise training program, it was shown that high intensity group had better results (p<0.05) in quality of life and had similar increasing (p<0.05) of activities of daily living, fatigue and depression. Conclusion: In our study, it was recorded that the fatigue and depressive symptoms, which were often seen in frail elderly decreased and also the level of independence in activities of daily living and quality of life increased as a result of exercise training. Although this general evaluation, especially high-intensity exercise training was been found more effective. The high-intensity exercise training should be considered for prevention and treatment of frailty in elderly subjects.

Urgency urinary incontinence (UUI) is involuntary leakage of urine associated with urgency. Medications with anticholinergic cognitive burden (ACB) are considered as a risk factor for cognitive limitations and decreased physical functionality. Our aim was to investigate whether high ACB will be an independent risk factor for UUI in elderly or not. The analysis was carried out on 1050 subjects aged ≥ 65 years. Out of those, 189 were eligible to meet the study criteria. They were divided into two groups: The study group included subjects with UUI (n:82) and the control group included those without UUI (n:107). ACB was calculated for each subject by adding the score of each drug and classified as having absent (ACB=0), low(ACB=1 or 2), and high (ACB≥3) anticholinergic properties based on ACB scale. Age, gender and cognitive status did not differ between groups. There was more subjects with definite and possible ACB in the study group compared to the control group (17.3% and 29.6% vs. 1.9% and 25%; p<0.001. In multivariate regression analysis high ACB was found to be a risk factor for UUI (OR: 11.2; CI: 2.333–53.776; p=0.003) while low ACB not (OR:1.652; CI: 0.809–3.376; p=0.168). We found that high ACB is an independent risk factor for UUI. Central effects of medications with ACB and their functionality-limiting effects are possible causes of UUI in this population. Further randomized and controlled studies are needed to enlighten the causal relationship between ACB and UUI.

Data on the effect of anticholinergic burden (ACB) on cognitive status in older adults with subjective cognitive decline (SCD) are limited. Our aim was to study whether ACB increases the future risk of dementia in older adults with SCD. The analysis was carried out on 1496 older adults. Out of those, 109 older patients had been diagnosed with SCD at baseline and followed up over 36 months were studied. They were divided into two groups according to cognitive status at last visit: group I included the subjects with SCD who did not progress to dementia and group II included those who progressed to dementia. ACB was calculated for each subject by adding the score of each drug and classified as no or low ACB (ACB ≤ 2) and high ACB (ACB ≥ 3). Sixteen (13.8%) of 109 participants with baseline SCD developed dementia. High ACB was present in 17 subjects (18.1%) in group I and 8 subjects (53.3%) in group II (p=0.003). The 75–84 and 85+ age groups (HR=3.595; CI:1.117–11.574; p=0.032 and HR=12.203; CI:2.889–51.537; p=0.001, respectively), hypertension (HR=7.835; CI:1.020–60.189; p=0.048), and high ACB (HR=4.312; CI: 1.563–11.899; p=0.005) were found to be possible risk factors for dementia among subjects with SCD in the univariate model. In the final multivariate cox regression model, subjects with high ACB had a 3.3-fold the risk of the development of dementia. High ACB is associated with an increased risk of dementia in older adults with SCD.

Geriatrics & Gerontology InternationalVolume 17, Issue 2 p. 347-348 CASE REPORT Remission in visual hallucinatory experiences after citalopram treatment in a patient with dementia Ahmet Ozturk, Ahmet Ozturk Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this authorHalit Yasar, Halit Yasar Ankara Military Hospital, Neurology Medicine Ankara, Ankara, TurkeySearch for more papers by this authorMurat Gulsun, Murat Gulsun Gulhane Military Medical Academy, Psychiatry Medicine, Ankara, TurkeySearch for more papers by this authorAdem Balıkcı, Adem Balıkcı Gulhane Military Medical Academy, Psychiatry Medicine, Ankara, TurkeySearch for more papers by this authorErgun Bozoglu, Ergun Bozoglu Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this authorMehmet Ilkin Naharcı, Mehmet Ilkin Naharcı Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this authorOzgur Boyraz, Ozgur Boyraz Gulhane Military Medical Academy, Neurology Medicine Ankara, Ankara, TurkeySearch for more papers by this authorHasan Oztın, Hasan Oztın Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this authorHuseyin Doruk, Huseyin Doruk Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this author Ahmet Ozturk, Ahmet Ozturk Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this authorHalit Yasar, Halit Yasar Ankara Military Hospital, Neurology Medicine Ankara, Ankara, TurkeySearch for more papers by this authorMurat Gulsun, Murat Gulsun Gulhane Military Medical Academy, Psychiatry Medicine, Ankara, TurkeySearch for more papers by this authorAdem Balıkcı, Adem Balıkcı Gulhane Military Medical Academy, Psychiatry Medicine, Ankara, TurkeySearch for more papers by this authorErgun Bozoglu, Ergun Bozoglu Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this authorMehmet Ilkin Naharcı, Mehmet Ilkin Naharcı Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this authorOzgur Boyraz, Ozgur Boyraz Gulhane Military Medical Academy, Neurology Medicine Ankara, Ankara, TurkeySearch for more papers by this authorHasan Oztın, Hasan Oztın Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this authorHuseyin Doruk, Huseyin Doruk Gulhane Military Medical Academy, Geriatric Medicine, Ankara, TurkeySearch for more papers by this author First published: 27 February 2017 https://doi.org/10.1111/ggi.12858Citations: 1Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume17, Issue2February 2017Pages 347-348 RelatedInformation

OBJECTIVE: Data on the effect of anticholinergic cognitive burden (ACB) in older adults with subjective cognitive decline (SCD) are limited. We aimed to study whether ACB increases the future risk of dementia in older adults with SCD. METHODS: The retrospective cohort analysis was carried out on 1496 older adults. Out of those, 109 older patients with SCD followed up over 36 months were studied. They were divided into two groups according to cognitive status at last visit: group I included the subjects with SCD who did not progress to dementia and group II included those who progressed to dementia. The drugs with anticholinergic effects that were received by subjects three months or more were identified from records. The drugs were categorized as having absent (ACB = 0), possible (ACB = 1), and definite (ACB = 2) anticholinergic properties based on an ACB scale. ACB was calculated for each subject by adding the score of each drug and classified as no or low ACB (ACB ≤ 2) and high ACB (ACB ≥ 3). RESULTS: The mean age of all subjects was 72.5 ± 6.3 years and 66.1% of the sample was female. The median follow-up time for all subjects was 75 months (range, 36–185). Fifteen (13.8%) of 109 participants with baseline SCD developed dementia. High ACB was present in 12 subjects (12.8%) in group I and 7 subjects (46.7%) in group II (p = .001). The 75–84 and 85+ age groups (hazard ratio (HR) = 3.595; CI: 1.117–11.574; p = .032 and HR = 12.203; CI: 2.889–51.537; p = .001, respectively), hypertension (HR = 7.835; CI: 1.020–60.189; p = .048), and high ACB (HR = 4.312; CI: 1.563–11.899; p = .005) were found to be possible risk factors for dementia among subjects with SCD in the univariate model. In the final multivariate Cox regression model, subjects with high ACB had a 4.2-fold the risk of the development of dementia. Metoprolol (28.6%), trazodone (21.4%), and trospium (12.9%) were leading used drugs with anticholinergic properties. Among subjects with a total ACB score ≥ 3, the majority were on trospium (29.0%), followed by metoprolol (16.2%), paroxetine (16.2%), and trazodone (16.2%). CONCLUSION: We found that high ACB increases 4.2-fold the risk of the development of dementia in older adults with SCD in long-term follow up. The results of our study are promising, however, the effect of ACB on cognitive status among subjects with SCD is still lacking. To clarify the association between ACB and the risk of dementia, large and longer prospective studies are needed in this population.

OBJECTIVESBisphosphonates are the first line treatment options in the prevention and treatment of osteoporosis among elderly women or men. Age associated cognitive decline may increase due to adverse effects of medications. The aim of the present study was to observe the course of cognitive skills in elderly subjects treated with a bisphosphonate.MATERIALS AND METHODSThis prospective study enrolled 120 community-dwelling, non-demented women and men with osteoporosis aged 65 and older who were treated with first-ever zoledronic acid. Mini mental state examination (MMSE) was measured along with geriatric depression scale (GDS) measurement, clock drawing test (CDT), and other clinical and laboratory evaluations that could affect cognition at baseline and 12 months. The primary outcome was at least one point decrease in the final MMSE score at one year.RESULTSScores of MMSE (28.29±2.17 and 28.23±2.37, p=0.681), GDS (3.24±2.88 and 2.96±2.88, p=0.062) and CDT (3.69±0.68 and 3.75±0.60, p=0.268) did not change after zoledronic acid infusion at one year. Education in years and presence of newly started medicines with anticholinergic properties was independently associated with at least one point reduction in MMSE score [odds ratio: 3.07 (%95 confidence interval: 1.00-9.44)].CONCLUSIONAmong elderly woman and men with osteoporosis, cognitive functions remained stable 12 months after the administration of first-ever zoledronic acid.

Hastaliklarin onlenmesi ve sagligin gelistirilmesi, genc eriskinlerde oldugu gibi yaslilik doneminde de onemli bir saglik hizmetidir. Bilindigi gibi, yas arttikca kronik hastalik orani artmaktadir. Yaslilarin %80’ninde en az 1 ek hastalik, %50’sinde ise en az 2 ek hastalik vardir. Yaslilarda, kronik saglik sorunlarinin yuksek prevalansi goz onune alinmalidir. Ayrica kanita dayali mudahaleler ile problemler olusmadan, yasam kalitesini maksimum artirmaya calismak onemlidir. Unutulmamalidir ki, fonksiyonelligin kaybi ve bagimlilik yaslanmanin kacinilmaz bir sonucu degildir. Yaslilarin tumu icin sagligin gelistirilmesinden bahsetmek mumkundur.