Serum elevated gamma glutamyltransferase levels may be a marker for oxidative stress in Alzheimer's disease

BACKGROUND: Gamma glutamyltransferase (GGT) plays a role in cellular glutathione uptake, which is an important element of antioxidant mechanisms. An increase in serum GGT is thought to be an early and sensitive marker of oxidative stress. Oxidative stress has a role in the pathogenesis of Alzheimer's disease (AD). The aim of this study was to investigate the GGT levels in AD. METHOD: In this cross-sectional study, 132 patients with AD (mean age: 74.1 +/- 7.4, female 62.9%) and 158 age- and gender-matched normal controls (mean age: 74.5 +/- 6.3, female 67.1%) were evaluated. For cognitive assessment, MMSE and clock drawing tests were performed; DSM-IV and NINCDS-ADRDA criteria were used. Serum GGT, aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase concentrations were determined. RESULTS: Median (min-max) GGT levels were 18 (9-70) in AD group and 17 (5-32) in normal controls. Mann-Whitney U test showed that GGT levels were significantly higher in AD patients (p = 0.012). Linear regression analysis revealed AD was an independent correlate of elevated GGT levels. Hypertension, diabetes mellitus, total cholesterol, and low density lipoprotein cholesterol were not associated with GGT levels. CONCLUSION: GGT levels were increased significantly in AD patients. To evaluate the role of GGT as a marker of oxidative stress in AD, further studies are needed.     

Depression and concomitant diseases in a Turkish geriatric outpatient setting

Depression is an important but inadequately diagnosed mood disorder in elderly. Depressed elderly patients often have chronic concomitant diseases. This paper intended to determine the prevalence of depression and its relation with concomitant disorders and social status among the patients admitted to our geriatric unit. Seven hundred and eighty-nine females and 466 males admitted to our unit were examined for the presence of depression by using the geriatric depression scale (GDS) test. The presence of concomitant diseases was assessed. Depression was diagnosed in 273 patients (21.8%), 193 (70.7%) females and 80 (29.3%) males. Depressed patients suffered from a wide range of other diseases the number and prevalence of which were as follows: Alzheimer's disease (AD) (34; 12.5%), vascular dementia (27; 9.9%), hypertension (HT) (211; 77.3%), diabetes mellitus (DM) (64; 23.4%), osteoporosis (182; 66.7%), atherosclerotic coronary artery disease (CAD) (89; 32.6%), cardiac failure (23; 8.5%), bronchial asthma (8; 2.9%), chronic obstructive pulmonary disease (COPD) (25; 9.2%) and osteoarthritis (133; 48.8%). The correlation between depression and concomitant diseases was statistically significant in hypertensive, demented and osteoporotic patients, as determined in a large elderly population. Previous studies examined the correlation of depression with only one concomitant disease, while we performed the analysis on multiple correlations.     

Blunted baroreflex sensitivity: An underestimated cause of falls in the elderly?

BackgroundAutonomic nervous system disturbance and cardiovascular disorders may be underestimated causes of falls. Heart rate turbulence (HRT), heart rate variability (HRV) and QT dynamicity parameters are noninvasive cardiac autonomic activity markers. The aim of this study was to evaluate autonomic cardiovascular markers in falling older adults.MethodsThis was a case-control study conducted at a geriatric medicine outpatient clinic of a university hospital. Study group consisted of 33 older adults who had falls in the last 12 months and the control group included 31 subjects who had never experienced falls. The patients in the study group were examined with 24-hour Holter electrocardiogram (ECG) and carotid sinus massage was done under monitorization. The 24-hour Holter ECG data were recorded and assessed with the ELATEC software. HRV, QT dynamicity and HRT parameters were analysed.ResultsThirty-three faller and 31 non-faller patients were examined in this study. Age and gender were similar between groups. All patients and control subjects had normal ejection fraction. Carotid sinus massage was done to the patients in the study group and three of 33 were positive (9.09%). There was no significant difference in HRV and QT dynamicity parameters between groups. Both HRT onset (2.51 ± 1.48 vs. 7.29 ± 3.28 P < 0.001) and turbulence slope (0.15 ± 1.10 vs. ?0.73 ± 1.89; P = 0.031) were significantly different between the groups.ConclusionElderly subjects with recent falls have significantly worse HRT parameters than matched non-falling counterparts. Blunted baroreflex sensitivity and impaired cardiac autonomic function can be an important reason for falls in the geriatric age group.     

Brachial Plexus Injuries in Adults with Traumatic Brain Injury : A Retrospective Study

ObjectiveWe aimed to investigate the presence of brachial plexus injury (BPI) in traumatic brain injury (TBI) patients and to draw attention to BPI, which can be overlooked by physicians in TBI patients. MethodsThe study was designed retrospectively by examining the files of 58 patients with moderate to severe TBI to investigate coexistence of TBI and BPI. ResultsBPI was detected in six of 58 TBI patients (10.3%). BPI was detected after an average 116 days from the initial injury. Three patients had lower trunk BPI and three patients had panplexopathy. ConclusionDiagnosis of BPI in patients with TBI is delayed in the acute period of injury. The clinicians should keep in mind that BPIs may occur and remain undiagnosed in patients with TBI.     

Insulin resistance and metabolic syndrome in patients with NAFLD but without diabetes: effect of a 6 month regime intervention

BACKGROUND AND STUDY AIMS: Non-alcoholic fatty liver disease (NAFLD) and the metabolic syndrome are two intertwined diseases sharing the same factor in their pathogenesis; insulin resistance. The aim of the study was to establish a link between glucose tolerance and NAFLD. PATIENTS AND METHODS: Fifty-two non-diabetic NAFLD patients were included in the study. Inclusion criteria were elevated alanine aminotransferase (ALT), hyperechogenic liver detected at ultrasonography, and exclusion of other causes of liver disease. Hepatobiliary ultrasonography and laboratory tests including biochemical and metabolic profiles were performed; HOMA insulin resistance was calculated. RESULTS: The mean age was 43 years, and 61% were male. More than a two fold increase in alanine aminotransferase levels was seen in 37% of the patients. Serum levels of aspartate aminotransferase, gamma-glutamyl transferase, alkaline phosphatase (ALP) were elevated in 36%, 46%, and 30% of patients respectively. Low HDL-C levels were found in 46% and high LDL-C levels in 25%. Other results of note were elevated lipoprotein-a levels in 40%, impaired fasting glucose in 23%, impaired glucose tolerance in 26%, elevated fasting c-peptide levels in 61%, and elevated fasting serum insulin levels in 11% of patients. In 30% of patients, body mass index was over 30 kg/m2 and 78% had a waist-hip ratio more than 0.9. HOMA insulin resistance was significantly related with elevated ALP levels and hepatomegaly. Following a 6 months treatment with a standard diet, liver enzymes and metabolic parameters both improved. Only 7 patients had persistently high liver enzymes. CONCLUSIONS: Basal insulin levels and the oral glucose tolerance test should be an integral part of the evaluation of patients with NAFLD. The association between NAFLD and metabolic syndrome as well as the benefits of dieting on preventing progression of NAFLD should be stressed.     

Hippocampal atrophy correlates with the severity of cognitive decline

BACKGROUND: The aim of this study is to compare the results of magnetic resonance (MR) imaging, particularly the decline in hippocampal volume, of patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI) with healthy age-matched controls, to examine the reliability of hippocampal volumetry in the early diagnosis of AD and the correlation of the severity of hippocampal atrophy with the severity of cognitive decline. METHODS: Twenty-six AD, 22 MCI and 15 normal cognitive status (NCS) patients were scanned with a 3 Tesla MR scanner. Hippocampus volumes were detected manually by Osiris 4.18. RESULTS: Multivariate regression analysis, which was performed to adjust the covariate effects of education, age, gender, hypertension and diabetes mellitus, showed that hippocampal atrophy was correlated with AD and MCI for right hippocampus; AD, MCI and age for left hippocampus independent of other parameters. A second regression analysis revealed that MMSE was correlated with hippocampal volume. CONCLUSIONS: Hippocampal volumetry can be used in early diagnosis of cognitive impairment, as well as grading cognitive decline.     

Psychiatric morbidity and its screening in Turkish women with breast cancer: a comparison between the HADS and SCID tests

Objective: Adjustment disorders (ADs) and major depressive disorder (MDD) are often the most prevalent psychiatric disorders among cancer patients. This study's objective was to determine the overall performance of Hospital Anxiety and Depression Scale (HADS) as a screening instrument in identifying cases of psychiatric morbidity such as ADs and MDD. Methods: Two hundred and four consecutive patients completed a questionnaire including a demographic and clinical data form, HADS, and were examined with the Structured Clinical Interview for DSM‐IV (SCID). The screening performance of HADS was investigated by calculating the area under the receiver operating characteristics curves (AUC), rates of specificity, and sensitivity. Results: For MDD; the AUC was 0.77 on the HADS total, the AUC was 0.79 on the HADS depression subscale, and was 0.72 on the anxiety subscale. For ADs; the results were 0.74, 0.74, and 0.70 respectively. Findings indicated that a HADS total cut‐off score of ?17 to be optimal in identifying cases of MDD. This cut‐off score offered a sensitivity of 0.70 and a specificity of 0.80. Findings suggested that a HADS total cut‐off score of 10 was the optimal combination of sensitivity (0.84) and specificity (0.55) for ADs. When compared with SCID, the percentage of cases identified by HADS was 28% for MDD and 22% for ADs. Conclusions: Compared with SCID, HADS was found to have acceptable levels of sensitivity and specificity in detecting psychiatric morbidity especially for MDD and HADS can be recommended with reservations as a screening tool for breast cancer patients. Copyright © 2007 John Wiley & Sons, Ltd.     

Awareness and Control of Hypertension among the Elderly in a University Hospital

Because medically useful information could also be gathered through hospital-based studies, the aim of this study was to assess the prevalence, awareness, treatment, and control of HT among the elderly at a university hospital in Turkey. A total of 3,038 elderly were enrolled. Overall, 75.1% of the patients had HT. Among the hypertensive elderly, 88.9% were aware that they had HT, and only 20.9% had BPs that were under control. The low prevalence of control, even among individuals aware of their HT, suggests that the education of health care providers at all stages of professional training is especially important.