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Ahmet Turan Isik,1 Derya Kaya,1 Esra Ates Bulut,1 Ozge Dokuzlar,1 Pinar Soysal2 1Unit for Aging Brain and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, TurkeyCorrespondence: Ahmet Turan IsikUnit for Brain Aging and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Balcova, Izmir 35340, TurkeyTel +90 232 412 43 41Fax +90 232 412 43 49Email atisik@yahoo.comPurpose: Elderly patients with iNPH (idiopathic normal pressure hydrocephalus) might be potentially high-risk surgical patients. Our purpose was to investigate the outcome of serial removal of cerebrospinal fluid (CSF) in the patients with iNPH who refused to have the ventriculoperitoneal or lumboperitoneal shunt surgery or had contraindications to them.Patients and methods: There were 42 patients, with a median age of 78 years. Recurrent CSF removal was performed when the patients had deteriorated gait which was defined as >10% pre-removal change on the average of two walking trials during timed up and go (TUG). All the patients underwent mini-mental status examination (MMSE), frontal assessment battery (FAB), Stroop test, Tinetti Performance Oriented Mobility Assessment (POMA), TUG and nine-hole peg test (NHPT) with the dominant hand, before and after CSF removal.Results: Thirty-five patients had two CSF removal procedures with a mean interim period of 7.4 months ranging from 1.5 to 35 months. Thirteen patients had three CSF removal procedures. The mean TUG scores were decreased after the first, second and third procedures (p

Neziha Erken,1 Fatma Sena Dost Gunay,1 Pinar Soysal,2 Ahmet Turan Isik1 1Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, TurkeyCorrespondence: Ahmet Turan IsikUnit for Brain Aging and Dementia, Department of Geriatric Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey Tel +90 232 412 43 41Fax +90 232 412 43 49Email atisik@yahoo.comAbstract: Chemobrain is one of the problems that may arise during or after treatment and there is currently no specific treatment for this condition. Our case was a 76-year-old female patient who presented to our clinic with complaints of forgetfulness that did not affect daily living activities for the last year. Breast cancer was diagnosed in 2013 and she has been receiving anastrozole treatment for 6 years after local mass excision surgery and radiotherapy. After a comprehensive geriatric evaluation, cognitive impairment due to systemic cancer therapy was detected and treatment was started with Theracurmin 90 mg twice a day therapy. After 3-months of Theracurmin therapy, she had no cognitive improvement during the follow-up. This case report demonstrated that Theracurmin treatment may be a new option for chemobrain.Keywords: chemobrain, Theracurmin, elderly, cognitive impairment, cancer

Pinar Soysal,1 Nicola Veronese,2,3 Ferhat Arik,4 Ugur Kalan,4 Lee Smith,5 Ahmet Turan Isik6 1Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey; 2National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy; 3Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, E.O. Galliera Hospital, National Relevance and High Specialization Hospital, Genova, Italy; 4Department of Internal Medicine, Geriatric Center, Kayseri Education and Research Hospital, Kayseri, Turkey; 5The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK; 6Unit for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey Aim: Mini Nutritional Assessment-Short Form (MNA-SF) is used to assess nutritional status in older adults, but it is not known whether it can be used to define frailty. This study was aimed to investigate whether or not MNA-SF can identify frailty status as defined by Fried’s criteria. Methods: A total of 1,003 outpatients (aged 65 years or older) were included in the study. All patients underwent comprehensive geriatric assessment. Frailty status was evaluated by Fried’s criteria: unintentional weight loss, exhaustion, low levels of activity, weakness, and slowness. One point is assigned for each criterion, and frailty status is identified based on the number of points scored: 0 points, not frail; 1–2 points, pre-frail; ≥3 points, frail. A total score of MNA-SF 11 indicates malnutrition, risk of malnutrition, and no malnutrition, respectively. Results: Of the 1,003 outpatients (mean age 74.2±8.5 years), 313 participants (31.2%) were considered frail and 382 (38.1%) pre-frail. Among frail and pre-frail patients, 49.2% and 25.1% were at risk of malnutrition and 22.0% and 1.6% were malnourished, respectively. MNA-SF with a cut-off point of 11.0 had a sensitivity of 71.2% and a specificity of 92.8% for the detection of frail participants, and with a cut-off point of 13 had a sensitivity of 45.7% and a specificity of 78.3% for the detection of pre-frailty. The area under the curve for MNA-SF was estimated to be 0.906 and 0.687 for frailty and pre-frailty, respectively. Conclusion: MNA-SF can be useful for frailty screening in older adults. Keywords: malnutrition, frailty, nutritional status, pre-frailty

Esra Ates Bulut,1 Pinar Soysal,2 Ahmet Turan Isik1 1Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey Background: Geriatric syndromes are complex clinical manifestations that are not an isolated disease in older adults and have common risk factors within themselves. The syndromes are significant causes of mortality, morbidity, and increased health care costs. Objective: To determine the frequency of geriatric syndromes such as malnutrition, dementia, depression, falls, polypharmacy, urinary incontinence, pressure ulcer, sarcopenia, and frailty in community-dwelling older adults. Methods: A total of 2,816 patients, who applied to geriatric outpatient clinic and were evaluated by comprehensive geriatric assessment, were included in this cross-sectional retrospective study. Falls in the last year and urinary incontinence were recorded. Polypharmacy was accepted as concurrent use of more than four drugs. Diagnosis of dementia and depression was defined according to Diagnostic and Statistical Manual of Mental Disorders Fifth Edition diagnostic criteria. In addition, frailty and sarcopenia were evaluated according to Fried’s physical frailty scale and European Working Group on Sarcopenia criteria, respectively. Results: The frequency of polypharmacy was 54.5%, urinary incontinence 47.6%, malnutrition 9.6%, depression 35.1%, dementia 21.6%, falls 33.6%, sarcopenia 31.7%, and frailty 28.3%. When all the participants were divided into three groups (60–69, 70–79, ≥80 years), all syndromes were significantly increased with age, except for depression. While 20% of cases in 60–69 years age group did not have any syndromes, 48% of cases in ≥80 years had more than four syndromes simultaneously. Conclusion: The frequency and coincidence of geriatric syndromes, except for depression, increases with age. Therefore, clinicians other than geriatricians taking care of older people should be aware of these syndromes as well as their treatment mechanisms. Keywords: geriatric syndromes, frailty, sarcopenia, dementia, malnutrition

Gulcin Done Unutmaz,1 Pinar Soysal,2 Busra Tuven,1 Ahmet Turan Isik3 1Department of Internal Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Geriatric Center Kayseri Education and Research Hospital, Kayseri, Turkey; 3Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey Background: Polypharmacy and inappropriate drug use cause numerous complications, such as cognitive impairment, frailty, falls, and functional dependence. The present study aimed to determine the effect of the comprehensive geriatric assessment (CGA) on polypharmacy, potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), and to evaluate the economic reflections of medication changes.Methods: One thousand five hundred and seventy-nine older patients, who had undergone CGA, were retrospectively evaluated. The drugs, drug groups, and number of drugs that the patients used were recorded. Appropriate drug therapy was identified by both CGA and STOPP/START criteria. Based on these criteria, PIMs were discontinued and PPOs were started. The monthly cost of these drugs was calculated separately for PIMs and PPOs by using the drugstore records.Results: After CGA, while the prevalence of non-polypharmacy was increased from 43.3% to 65.6%, the prevalence of polypharmacy and hyperpolypharmacy was decreased from 56.7% to 34.4% and 12.0% to 3.6%, respectively. The three most common PIMs discontinued were proton pump inhibitors, anti-dementia drugs, and antipsychotics, respectively. However, the most common PPOs started were vitamin D and B12 supplements, and anti-depressants. After CGA, monthly saved total per capita cost of PIMs was US$12.8 and monthly increased total per capita cost of PPOs was $5.6.Conclusion: It was demonstrated that prevalence of polypharmacy, PIM, and PPO could be decreased by CGA including START/STOPP criteria in older adults. Furthermore, this will have beneficial effects on economical parameters due to decreasing drug-related health care costs. Keywords: cost, comprehensive geriatric assessment, polypharmacy, elderly

Ali Ekrem Aydin,1 Pinar Soysal,2 Ahmet Turan Isik1 1Center for Aging Brain and Dementia, Department of Geriatric Medicine, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey; 2Kayseri Education and Research Hospital, Geriatric Center, Kayseri, Turkey Background: Correct evaluation of orthostatic hypotension (OH) is crucial in geriatric practice, since OH is associated with mortality and morbidity. The study aimed to determine the most appropriate method for measuring blood pressure in transition from supine to upright position in order to diagnose OH in older adults.Methods: Active standing test (AST) and head-up tilt table (HUT) test as well as comprehensive geriatric assessment (CGA), including mini-mental state examination or the cognitive state test, mini-nutritional assessment, basic and instrumental activities of daily living, and Tinetti performance-oriented mobility assessment indexes, were performed in 290 geriatric patients.Results: The prevalence of OH during HUT and AST was 19% and 37%, respectively. In patients with OH during HUT, the frequency of dementia and recurrent falls were higher (P0.05). Comparison of the groups according to CGA measurements revealed significant differences in terms of cognition, nutritional status, activities of daily life, and balance function in patients with OH only during HUT (P0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of AST were 49.0%, 65.5%, 25.0%, and 84.6% respectively, according to HUT.Conclusion: The results suggest that orthostatic blood pressure changes determined by HUT might be of higher clinical significance than that by AST in older adults. It might be important that the evaluation of OH by HUT should be included in daily geriatric practice. Keywords: active standing test, head-up tilt table, orthostatic hypotension, diagnosis