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Yildiray Topcu,1 Robbert JJ Gobbens,2– 5 Tjeerd van der Ploeg,2 Fatih Tufan6 1Prof. Dr. Cemil Taşcıoğlu Şehir Hastanesi, Istanbul, Turkiye; 2Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands; 3Zonnehuisgroep Amstelland, Amstelveen, the Netherlands; 4Department Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; 5Tranzo, Tilburg University, Tilburg, the Netherlands; 6Istanbul Esenler Avicenna Hospital, Department of Internal Medicine and Geriatrics, Istanbul, TurkiyeCorrespondence: Fatih Tufan, Assoc. Prof. of Geriatrics, Istanbul Esenler Avicenna Hospital, Department of Internal Medicine and Geriatrics, Istanbul, Turkiye, Tel +90 5331683458, Email fatihtufan@gmail.comPurpose: To our knowledge, there have been no comparative studies evaluating the associations of frailty defined using the Tilburg Frailty Indicator (TFI), frailty phenotype by Fried et al, and FRAIL scale with all-cause mortality in Turkiye. In this study, we aimed to evaluate the ability of these instruments in predicting all-cause mortality in outpatients admitted to the outpatient geriatrics clinic of a university hospital.Patients and Methods: This historical prospective study was performed in the geriatrics outpatient clinic of a university hospital in Istanbul, Turkiye. Consecutive older adults (aged ≥ 70 years) who provided written informed consent were enrolled in the study. The survival status of participants was checked electronically using the official death registry system. Univariate analyses and multivariate Cox regression analyses were performed to determine the independent predictors of mortality.Results: A total of 198 participants with a median age of 77 years were enrolled. During the median follow-up period of 2236 days, 54 (27.3%) patients died. In univariate analyses, male sex, history of falls in the previous year, dependency in instrumental activities of daily living, malnutrition, and frailty with respect to the phenotype by Fried et al, FRAIL scale, and TFI were associated with mortality. In multivariate Cox regression analyses, frailty according to each of the three frailty instruments, male sex, older age, history of falls, and malnutrition or malnutrition risk were independently associated with mortality. The Fried scale was the best frailty tool among the three frailty instruments used to predict all-cause mortality.Conclusion: The findings of this study suggest that frailty, determined using each of the three instruments used in the present study, is independently associated with all-cause mortality in patients admitted to the outpatient geriatrics clinic of a university hospital in Turkiye. The Fried scale appears to be the best for predicting all-cause mortality.Keywords: Turkiye, frailty, mortality, malnutrition, falls, dependency

Yildiray Topcu, Fatih Tufan, Cihan Kilic Department of Geriatrics, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey Background: Recently frailty has drawn significant interest as an important predictor of several clinically relevant outcomes. There is no widely accepted instrument for the assessment of frailty and most of the current ones evaluate only physical features. The Tilburg Frailty Indicator (TFI) is a valid and reliable instrument which enables multidimensional assessment of frailty. We aimed to adapt and evaluate the Turkish version of the TFI.Methods: We translated and culturally adapted the English version of the TFI into Turkish using standard guidelines. We enrolled consecutive patients who were 70 years old or older and were admitted to our outpatient geriatrics clinic. We used Cronbach’s alpha values to evaluate the internal consistency and also assessed inter-observer and test–retest variability using intraclass correlation coefficient (ICC).Results: The Cronbach’s alpha reliability coefficients of the instrument ranged from 0.65 to 0.72 and item-total correlation ranged between -0.05 and 0.57. There was a good agreement between two assessments (ICC=0.99) and between two observers (ICC=0.99).Conclusion: We have shown the reliability of the Turkish version of the TFI as a tool to evaluate frailty in a multidimensional manner among the Turkish outpatient population. Keywords: Tilburg Frailty Indicator, Turkish version, internal consistency, validity, older individuals, aging, frailty, multidimensional assessment, psychosocial factors, validation study, cultural adaptation, older adults

Birkan İlhan, Fatih Tufan, Gülistan Bahat, Mehmet Akif Karan Division of Geriatrics, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, TurkeyWe have read the article entitled “Association between frailty and delirium in older adult patients discharged from hospital” by Verloo et al1 with great interest. In their study, the authors observed that frailty is strongly associated with delirium in older patients at hospital discharge. Consequently, they concluded that assessing frailty gives health care professionals the opportunity to improve the effectiveness of primary prevention strategies for delirium, by promptly ascertaining which discharged older adults are at a higher risk of presenting with that syndrome.View original paper by Verloo et al

Yildiray Topcu, Fatih Tufan, Gulistan Bahat, M Akif KaranDepartment of Geriatrics, Istanbul School of Medicine, Istanbul University, Istanbul, TurkeyWe read the recently published and well-designed study of Uchmanowicz et al which suggests that multidimensional assessment of the frailty syndrome (FS) in subjects with heart failure (HF) is very important.1 The authors investigated the association between the dimensions of FS and self-care ability in elderly chronic HF patients. Their findings indicate that only social components of frailty adversely affect the ability to self-care. Their study is especially important regarding two aspects. Firstly, there are limited studies regarding FS in elderly HF patients. Secondly, most commonly used frailty instruments focus on physical components of frailty and overlook psychological and social components. The Tilburg Frailty Indicator (TFI) has the potential to detect psychological and social components of frailty.View original paper by Uchmanowicz and colleagues.

Sevilay Muratli, Fatih Tufan, Gulistan Bahat, Mehmet Akif Karan Department of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, TurkeyWe read the article by Al-Eisa et al1 entitled “Correlation between vitamin D levels and muscle fatigue risk factors based on physical activity in healthy older adults,” regarding an important subject – the association among vitamin D deficiency, physical activity, and muscle fatigue; the findings of this study indicate that increased physical activity is associated with higher vitamin D levels and less fatigue. We would like to comment on this well-designed and performed study. View the original paper by Al-Eisa and colleagues.

Birkan Ilhan, Fatih Tufan, Gulistan Bahat, Mehmet Akif Karan Department of Geriatrics, Istanbul School of Medicine, Istanbul University, Istanbul, TurkeyWe read with interest the article by Kortas et al1 entitled “Effect of Nordic Walking training on iron metabolism in elderly women.” In their study, the authors investigated the effect of Nordic Walking (NW) training on serum ferritin, C-reactive protein (CRP), hepcidin, hemojuvelin, and vitamin D, which have been stated as components of the inflammatory system. In this study, while NW training significantly reduced iron stores and increased hemojuvelin and tended to reduce CRP levels, it did not affect hepcidin levels. The authors also observed a significant weight loss after training. The authors concluded NW training has pro-healthy effects manifested by decreased inflammation and a drop in iron stores.View original paper by Kortas et al.

Sevilay Muratli,1 Fatih Tufan,2 Ozlem Soyluk,2 Gulistan Bahat,1 M Akif Karan11Division of Geriatrics, Department of Internal Medicine, 2Department of Gerontology, Faculty of Medical Sciences, Istanbul University, Istanbul, TurkeyWe read the article on the study of "Link between type 2 diabetes and Alzheimer’s disease: from epidemiology to mechanism and treatment" by Li et al.1 The review is very detailed and rational, considering the link between diabetes and Alzheimer’s disease and giving a new outlook as type 3 diabetes. It provides important information about the effects of the hyperglycemic complications of diabetes and treatment of dementia.View original paper by Li et al

Birkan İlhan, Fatih Tufan, Gülistan Bahat, Mehmet Akif KaranDivision of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Istanbul, TurkeyWe read with great interest the article by Liang et al “Repeated vertebral augmentation for new vertebral compression fractures of postvertebral augmentation patients: a nationwide cohort study”.1 In their study, the authors investigated the factors possibly associated with new vertebral compression fractures in patients who previously had vertebral augmentation procedures. They reported that osteoporosis (OP) was not observed as a risk factor for repeat vertebral augmentation. Among multiple chronic diseases, hypertension (HT) was reported as one factor associated with new vertebral fractures. Among the medications used to treat or prevent OP, they reported calcium/vitamin D, bisphosphonates, and calcitonin were associated with not having repeat vertebral augmentation. However, steroids, paracetamol, and nonsteroidal anti-inflammatory drugs were associated with having repeat vertebral augmentation. We would like to comment on their article.View original paper by Kurimato and colleagues.

Ozlem Yilmaz, Fatih Tufan, Gulistan Bahat, Mehmet Akif Karan Department of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, TurkeyWe read with interest the article by Falsarella et al.1 The authors investigated the relationship between body composition and frailty in community-dwelling elderly individuals aged 65 years or older. The findings of this study have considerable importance in terms of evolving preventive, diagnostic, and treatment measures for frailty in the elderly population. We would like to make a comment on this well-designed study. For calculating body mass index (BMI), using arm span instead of height would be more accurate.2 Conditions such as kyphosis and asymptomatic vertebral fractures are commonly seen in elderly individuals (especially in frail ones), and calculation of BMI using height may result in overestimation of BMI in these circumstances. In this way, subjects with low BMI may be considered to have normal BMI, and this may result in underestimation of malnutrition, which is an important contributor to frailty phenotype.View original paper by Falsarella and colleagues.

Sevilay Muratli,1 Fatih Tufan,1 Ozlem Soyluk,2 Gulistan Bahat,1 Mehmet Akif Karan1 1Department of Geriatrics, 2Department of Endocrinology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, TurkeyWe read the article “Orthostatic blood pressure in people with mild cognitive impairment predicts conversion to dementia” by Hayakawa et al1 with interest. It is well-known that many individuals with mild cognitive impairment (MCI) progress to dementia.2 However, we do not exactly know which risk factors increase this risk and to what extent. Hypertension is a risk factor for Alzheimer’s disease and vascular dementia. However, the findings of this study make us consider hypotension as a new risk factor for dementia. Furthermore, a recently published 6-year prospective general population cohort study suggested that not only orthostatic hypotension (OH), but also symptoms of OH seemed to be risk factors for cognitive decline.3 Notably, in the study by Elmstahl et al3, hypertension and diabetes mellitus (DM) were more common in subjects with dementia. We would like to make some comments on this well-designed study.

Yildiray Topcu,1 Fatih Tufan,2 M Akif Karan1 1Department of Geriatrics, Istanbul Faculty of Medicine, 2Department of Gerontology, Faculty of Medical Sciences, Istanbul University, Istanbul, TurkeyWe read the valuable article of Oliveira et al1 entitled “Resistance training improves isokinetic strength and metabolic syndrome-related phenotypes in postmenopausal women” with interest. In their well-designed prospective study, the authors observed improvement in metabolic syndrome-related phenotypes after 12 weeks of resistance training. We have some comments that could facilitate interpretation of the results of this study.

Abdulmecit Yildiz,1 Fatih Tufan2 1Department of Nephrology, Uludag University School of Medicine, Bursa, 2Department of Geriatrics, Istanbul Faculty of Medicine, Istanbul University, Istanbul, TurkeyWe read the recently published and well-designed study of Lee et al that suggests that bioimpedance analysis (BIA) gives relevant information about hydration status and malnutrition in hemodialysis patients. The authors recommend that utilization of BIA routinely in hemodialysis patients would be rational. We would like to make a few comments about their study.View original paper by Lee et al.

Fatih Tufan Sevket Yilmaz Training and Research Hospital, Geriatrics Unit, Yildirim, Bursa, TurkeyKuptniratsaikul et al report the efficacy of Curcuma domestica extracts in the treatment of knee osteoarthritis.1 One of my concerns about this well designed study is lack of one important adverse event assessment. One of the most important adverse effects of ibuprofen, which is a non-selective non-steroid anti-inflammatory drug, is acute renal failure.2 Although one of the exclusion criteria in this study is renal failure, especially in the elderly population, it is crucial to follow up kidney functions under non-steroid anti-inflammatory treatment.View original paper by Kuptniratsaikul and colleagues.

BACKGROUND/OBJECTIVES: Sarcopenia and sarcopenic obesity (SO) are geriatric syndromes leading to physical disability, poor quality of life and death. The aim of this study was to investigate the prevalence of sarcopenia and SO in nursing homes in Turkey and to define local disparities for diagnosing sarcopenia and SO. SUBJECTS/METHODS: This cross-sectional multicenter study was performed in 711 patients in 14 nursing homes. Comprehensive geriatric assessment tests, handgrip strength and calf circumference (CC) measurements were carried out. Sarcopenia was both defined by handgrip strength and CC criteria. RESULTS: According to handgrip strength measurement, 483 (68%) of patients were sarcopenic (male: 72%, female: 63.8%), 228 were non-sarcopenic. The prevalence of SO was 22% (13.7% in men, 30.2% in women). Patients (82.5%) who were diagnosed as sarcopenic by the handgrip strength test were not sarcopenic according to CC sarcopenia criteria. Therefore, we tried to determine the optimal CC value for diagnosing sarcopenia in our population. CONCLUSIONS: Both sarcopenia and SO were prevalent among Turkish nursing home elderly residents. Most of the patients with sarcopenia were obese or overweight. We showed that diagnosing sarcopenia with CC measurement underestimated the sarcopenia prevalence assessed by handgrip strength. So we concluded that, although different assessment methods are recommended for the diagnosis of sarcopenia local disparities should be considered. European Journal of Clinical Nutrition (2014) 68, 690-694; doi:10.1038/ejcn.2014.15; published online 26 February 2014, INTRODUCTION Sarcopenia is a geriatric syndrome characterized by progressive generalized loss of skeletal muscle mass, strength and function with a risk of adverse outcomes such as physical disability, poor quality [...]

Author(s): Y Topcu [1]; F Tufan [1]; G Bahat [1]; M A Karan [1] To the Editor, We read with interest the findings of the study by Vaughan et al. [...]

Neuroinflammatory responses caused by amyloid β (Aβ) peptide deposits are involved in the pathogenesis of Alzheimer's disease (AD). Thalidomide has a significant anti-inflammatory effect by inhibiting TNF-α, which plays role in Aβ neurotoxicity. We investigated the effect of thalidomide on AD-like cognitive deficits caused by intracerebroventricular injection of streptozotocin (STZ). Intraperitoneal thalidomide was administered 1 h before the first dose of STZ and continued for 21 days. Learning and memory behavior was evaluated on days 17, 18 and 19, and the rats were sacrificed on day 21 to examine histopathological changes. STZ injection caused a significant decrease in the mean escape latency in passive avoidance and decreased improvement of performance in Morris water maze tests. Histopathological changes were examined using hematoxylin-eosin and Bielschowsky staining. Brain sections of STZ treated rats showed increased neurodegeneration and disturbed linear arrangement of cells in the cortical area compared to controls. Thalidomide treatment attenuated significantly STZ induced cognitive impairment and histopathological changes. Thalidomide appears to provide neuroprotection from the memory deficits and neuronal damage induced by STZ. [ABSTRACT FROM AUTHOR]