The relationship between skeletal muscle quality and geriatric syndromes remains unclear. We investigated associations between muscle health parameters and geriatric syndromes in older adults. To examine the associations between computed tomography (CT)-derived muscle quality parameters and multiple geriatric syndromes in older adults. Participants were aged ≥ 65 years and had abdominal computed tomography images before and after 1 year of the index date from outpatient and inpatient settings at a medical center between January 2020 and December 2021. We assessed skeletal muscle area (SMA), skeletal muscle radiodensity (SMD), skeletal muscle index (SMI), and normal attenuation muscle area/total abdominal muscle area (NAMA/TAMA) ratio. We used correlation analyses to examine the relationship between muscle health and geriatric syndromes. Among 121 participants, higher SMD was associated with better ADL (r = 0.42, p < 0.001), higher utility (r = 0.36, p < 0.001), less frailty (r = -0.38, p < 0.001), less cognitive impairment (r = -0.3, p < 0.001), and fewer pressure injuries (r = -0.2, p < 0.05). Higher SMI was associated with better ADL (r = 0.24, p < 0.05), higher utility (r = 0.35, p < 0.001), less frailty (r = -0.238, p < 0.05), and reduced depression (r = -0.29, p < 0.05). Higher NAMA/TAMA was associated with better ADL (r = 0.43, p < 0.001), higher utility (r = 0.38, p < 0.001), less frailty (r = -0.4, p < 0.001), less cognitive impairment (r = -0.3, p < 0.05), fewer pressure injuries (r = -0.22, p < 0.05), and lower odds of moderate/severe frailty (OR: 0.58, p < 0.022). Skeletal muscle quality parameters are associated with multiple geriatric syndromes, particularly frailty severity. Further longitudinal studies are needed to establish temporal relationship.
Hip fracture volumes are rising with population aging, and inadequate analgesia following hip fracture surgery has been shown to impede early mobilization and recovery. Liposomal bupivacaine (LB) may extend analgesia, but previous orthopaedic trials have yielded mixed results. We therefore tested whether adding local incisional infiltration of LB to multimodal analgesia confers clinically relevant advantages in geriatric hip fracture surgery. This study was a single-center, prospective, randomized, participant and assessor-blinded, parallel-group exploratory trial in older adults undergoing hemiarthroplasty or total hip arthroplasty for a hip fracture. The intervention was local LB infiltration; the control was no local infiltration. The primary end point was resting pain measured on a visual analog scale (VAS, 0 to 10) at 48 hours postoperatively. Prespecified key secondary end points included early pain with activity, morphine milligram equivalents (MME) of the patient-controlled analgesia (PCA) infusion volume and of the total perioperative oral and intramuscular rescue counts, sleep quality measured on a numerical rating scale (NRS, 0 to 10), total sleep time, and nocturnal awakenings. A total of 76 patients (median age, 77 years; 49 female) were included in the analysis. The primary end point did not differ between the groups (median 0 for both; p = 0.143; point estimate of between-group difference: Cohen d = -0.506, 95% confidence interval: -0.962, -0.048), whereas several secondary outcomes significantly favored LB, including resting pain at 24 hours; activity pain at 8, 24, and 48 hours; and oral rescue administrations (median and interquartile range: 25 [0, 50] versus 50 [25, 100] MME). The LB group had a higher NRS sleep quality score after surgery, with a longer total sleep duration on the operative night, than the control group; the number of awakenings was similar between the groups. Ambulation at 48 and 72 hours and the number of postoperative days to discharge did not differ between the groups. In the context of a standardized multimodal analgesic pathway, local incisional infiltration of LB did not improve the prespecified primary end point of resting pain at 48 hours after geriatric hip fracture surgery. Overall, the current evidence does not support routine clinical use, and further investigation is warranted. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Access to geriatric mental health (GMH) care is limited in rural areas. To meet this need, the Veterans Health Administration provides specialty tele-GMH care for aging rural veterans via regional telehealth hubs. This study aims to create a roadmap describing key phases and determinants underlying the implementation and sustainment of tele-GMH services as part of a qualitative longitudinal evaluation of tele-GMH teams. Semistructured interviews were conducted with clinicians from all 8 tele-GMH teams (n=25) at 3 time points across a 3-year period (October 2021-September 2024). Interview (n=46) data were summarized into key domains using a templated rapid qualitative approach, guided by the Consolidated Framework for Implementation Research (CFIR) 2.0. Further thematic analysis and team discussion elucidated the findings. We identified key activities and determinants of success in three phases: (1) preimplementation (engaging leaders, securing funding/hiring, and defining services); (2) implementation scale-up and expansion (advertising, addressing challenges, seeking feedback, refining, and growth); and (3) sustainment (maintenance). Activities within each phase were cyclical and iterative (ie, nonlinear). Barriers to implementation included unfamiliarity with local aging resources; facilitators included tailoring strategies and engaging referring clinicians. Similar processes emerged across regions in the development and sustainment of tele-GMH services, allowing for the creation of a unified roadmap. Limitations including sampling bias are discussed. Further work could apply and evaluate the utility of the roadmap to guide creation of tele-GMH services in new regions to enhance access to specialty care for aging rural veterans.
In the decade since the American Geriatrics Society (AGS) released a position statement on Care of Lesbian, Gay, Bisexual, and Transgender Older Adults, we have seen significant progress toward achieving equal health and civil rights for lesbian, gay, bisexual, transgender, queer, intersex, and more (LGBTQI+) individuals. Advances have included increased visibility, legalization of same-sex marriage, and legal protections against discrimination. Even so, for LGBTQI+ older adults, substantial gaps, fears of discrimination, and legal uncertainty persist. Older LGBTQI+ adults experience the intersection of ageism with structural discrimination associated with their sexual and gender minority status-homophobia and transphobia. These experiences occur in many sectors of society, including health care, exacerbating disparities, impacting social determinants of health, and leading to accumulated discrimination across time. The potential for setbacks to progress remains as lawsuits are filed and policymakers consider legislation that would roll back rights at the state and federal levels. Recognizing this evolving landscape, AGS established a writing group to update the 2015 position statement with the goals of supporting progress on eliminating discrimination against LGBTQI+ older adults in healthcare and supporting integration of evidence-based approaches to caring for these older adults across care settings. By providing recommendations on inclusive education, policy reform, and focused research, AGS aims to promote the health, independence, quality of life, and dignity of LGBTQI+ older adults. Within education, we recommend standardized training for all healthcare staff, with specialized instruction for clinicians caring for LGBTQI+ older adults. On the policy front, we emphasize maintaining nondiscriminatory measures, supporting chosen families in caregiving, promoting completion of advance directives, and collecting and ensuring privacy of sexual orientation and gender identity (SOGI) information. Research priorities include continuing to advance SOGI data collection, understanding mechanisms driving disparities, developing health promotion interventions, and furthering research into long-term services and supports.
Older adults living with type 2 diabetes represent a particularly vulnerable population. We investigated which continuous glucose monitoring (CGM)-derived targets are associated with all-cause mortality in this population. HYPOAGE is prospective multicenter study including 141 insulin-treated older adults living with type 2 diabetes aged 75 and older, under insulin therapy for at least 6 months. All participants underwent standardized geriatric and diabetic assessments and wore an ambulatory blinded CGM (FreeStyle Libre Pro®) for 28 consecutive days. In this ancillary study, multivariable cox regressions were performed to identify factors associated with mortality after adjustment for age, sex, HbA1c, kidney function, geriatric status, and metformin use. At baseline, participants were 81.5 years old on average. After a median follow-up of 44 months, 58 of 141 patients had died. In adjusted model, higher percentages of level 1 time below range (TBR), level 2 TBR and glycemic variability assessed by the coefficient of variation (CV) were independently associated with an increased mortality risk (hazard ratio [95% CI] 1.51 [1.11; 2.06], 1.25 [1.02; 1.53], and 1.76 [1.21; 2.56] for an interquartile range (IQR)% increase of each parameter, respectively). When recommended CGM targets were considered, only glycemic variability (CV ≤ 36%), remained significantly associated with a lower risk of mortality (hazard ratio 0.57 [0.32; 0.99]), whereas TIR > 50% and TBR ≤ 1% were not. Among insulin-treated older adults living with type 2 diabetes, glycemic variability was independently associated with all-cause mortality, highlighting its potential relevance for clinical management in geriatric diabetes care.
Current evidence regarding the benefits of early outpatient follow-up for older adults after acute myocardial infarction (AMI) is conflicting, and prior studies may have been impacted by confounding by indication by not accounting for geriatric vulnerabilities. We used data from a unique nationwide cohort of older adults hospitalized with AMI, linked to Medicare data, that captured rich data on geriatric vulnerabilities and other potentially influential covariates. We used inverse-probability of treatment-weighted analyses to evaluate associations of early outpatient follow-up with hospital-free survival and physical and health-related quality of life 180 days post-discharge. More than two-fifths of the 1539 participants had a follow-up visit within 7 days, and one quarter had a follow-up visit within 8-14 days. Geriatric vulnerabilities were not more prevalent among participants receiving early outpatient follow-up, and early outpatient follow-up was not associated with differences in hospital-free survival or risk of decline in health-related quality of life.
Lower-limb muscle thickness assessed by point-of-care ultrasound (POCUS) is emerging as a prognostic marker in older adults, but evidence in patients with hip fracture is limited. This study aimed to investigate whether POCUS of the vastus lateralis (VL) muscle could predict one-year all-cause mortality in older adults with hip fracture, and to identify the VL thickness cut-off with the highest prognostic performance. We conducted a prospective observational study involving patients ≥ 65 years hospitalized for proximal hip fracture at Careggi University Hospital, Florence, Italy, between January 2024 and July 2024 Participants underwent comprehensive geriatric assessment and VL POCUS within 24 h of admission. The study outcome was one-year all-cause mortality. Predictive performance of VL thickness was assessed using ROC curve analysis and multivariate logistic regression. Among 154 patients (mean age 86.5 years, 70.1% female), one-year mortality was 42.2%. Mortality was associated with older age, functional and motor impairment, frailty, malnutrition, and higher comorbidity burden. ROC analysis demonstrated good predictive ability of VL thickness (AUC = 0.702), with a cut-off value of < 1.12 cm providing the best discriminative performance (sensitivity 68%, specificity 64%). Patients with reduced VL thickness showed higher mortality (57.9% vs 26.9%, p < 0.001). VL thickness < 1.12 cm independently predicted mortality, after adjusting for age, nutritional status, pre-fracture functional level and comorbidity burden. In older adults hospitalized for hip fracture, VL thickness of < 1.12 cm independently predicted one-year all-cause mortality, suggesting a potential role of muscle POCUS as a prognostic tool in the orthogeriatric setting.
Neurological disorders are increasingly prevalent among older adults in India, often resulting in significant motor and non-motor impairments. There is a rising rates of elder care homes and the aging population, burdens the Parkinson's disease (PD) rising, particularly in countries with low- and middle-income. In response to this burden of neurodegenerative conditions including PD evidence-based, culturally adapted interventions such as yoga promise to offer holistic benefits. A controlled clinical trial will evaluate the efficacy of a customized yoga therapy module for early parkinsonism by targeting motor and non-motor symptoms. We aimed to recruit 130 participants in a 1:1 ratio, of 45-80 years from elder care homes around Mangalore, India, using cluster sampling. Both groups will receive geriatric physiotherapy as standard of care, and the intervention group will receive 1-h yoga sessions, 5 days/week, for 24 weeks. Outcomes of quality of life, cognition, postural stability, gastrointestinal dysfunction symptoms, and sleep will be assessed at baseline, 12 weeks, and 24 weeks and analyzed using SPSS v25. This study was approved by the Institutional Ethics Committee (YEC2 Protocol No.: YEC2/2024/130) and registered in the Clinical Trials Registry of India - CTRI/2025/07/090595. The Department of Geriatric Medicine will initiate PD screening at the designated study sites. A symptom-targeted, participant-specific, customized yoga module was developed, validated, and evaluated by experts.
Postoperative frailty is highly prevalent among older adults undergoing hip surgery and is closely linked to poor clinical outcomes. Despite growing interest in understanding its progression, the temporal patterns of frailty remain underexplored. Moreover, there is a lack of validated models that can predict frailty trajectories and stratify patients by risk in the early postoperative period. This study aimed to identify distinct frailty trajectories within 6 months following hip surgery in older adults and to explore their associated predictors. An interpretable machine-learning model was developed and internally validated for individualized risk prediction and was implemented as a clinically accessible web-based calculator. This prospective longitudinal observational study was conducted among older adults undergoing hip surgery at a tertiary hospital in China. Frailty assessments were performed preoperatively and at 1, 3, and 6 months postoperatively. A total of 209 participants who completed the 6-month follow-up were included in the analysis. Frailty was assessed using the Frailty Index, and group-based trajectory modeling was applied to identify distinct frailty progression patterns. Predictive variables were selected using the least absolute shrinkage and selection operator regression. An interpretable Extreme Gradient Boosting (XGBoost) model was developed using a 60:40 training-test data split. Model performance was evaluated in terms of discrimination, calibration, and clinical utility. Interpretability was assessed using SHAP (Shapley Additive Explanations) at both the global and individual levels. Three distinct frailty trajectories were identified: low-fluctuation frailty (55/209, 26%), high-improvement frailty (81/209, 39%), and high-deterioration frailty (73/209, 35%). Twelve predictors grounded in the Health Ecology Model were selected, spanning individual characteristics, interpersonal networks, and the living environment. The XGBoost model demonstrated excellent discrimination, with a microaverage area under the receiver operating characteristic curve of 0.98 (95% CI 0.96-0.99) in the training set and 0.93 (95% CI 0.90-0.96) in the test set. Calibration was acceptable, with a weighted Brier score of 0.0852. Decision curve analysis showed favorable clinical utility across a range of threshold probabilities. A web-based risk calculator was developed to facilitate personalized frailty trajectory prediction. The XGBoost model demonstrated strong predictive performance and interpretability, enabling the early identification of older patients at risk for adverse frailty trajectories following hip surgery. This tool may support targeted interventions and improve perioperative care in geriatric populations.
An investigation was conducted into the causes of morbidity and mortality in a breeding colony of Daurian pikas (Ochotona dauurica) housed at the Minnesota Zoo. Gross necropsy and histopathology records from all animals that died between 2011 and 2016 were reviewed to identify causes of death and associated comorbidities. Post-mortem tissue mineral panel data were also evaluated. A total of 69 necropsies were performed during the study period, with 30 cases having complete histopathology available for analysis. No animals survived to the geriatric age class. The most common cause of mortality was systemic abscessation (n = 11) secondary to a Gram-negative, non-fermenting, rod-shaped bacterium identified as Castellaniella sp. Other confirmed causes of death included traumatic hemorrhage (n = 4), hepatic necrosis (n = 2), hemorrhagic enteritis (n = 1), and myocardial necrosis (n = 1). Hemothorax occurred in two animals within 24 h of venipuncture. Frequently observed comorbidities included cachexia of undetermined origin (n = 18), cutaneous ascariasis (n = 8), oxyuriasis (n = 8), coccidiosis (n = 5), dental malocclusion (n = 4), hepatic hemosiderosis (n = 3), and small intestinal non-hemolytic Escherichia coli infection (n = 3). Elevated tissue iron concentrations were also detected in several individuals, suggesting potential species sensitivity to iron overload. This review provides important baseline data on morbidity and mortality in managed Daurian pika populations and highlights the need for further research into their husbandry, nutrition, and medical management to improve welfare and survival under human care.
Hospital-associated complications (HACs), including delirium, falls, pressure ulcers, urinary incontinence, and functional decline, frequently co-occur in hospitalized older adults. However, these complications have typically been studied as isolated events. This study aimed to identify latent phenotypes of HACs and examine their associations with admission geriatric characteristics and short-term mortality. In this multicenter observational cohort study, 1599 older adults admitted to acute care hospitals were included. HACs during hospitalization were assessed, and latent class analysis was used to identify phenotypes. Associations with admission-level frailty, functional status, cognitive function, and nutritional status were examined. Discriminative performance was evaluated using receiver operating characteristic analysis, and three-month mortality after discharge was assessed. A three-class latent structure was identified, although separation between the two lower-risk classes was limited. One subgroup, comprising 19% of participants, was characterized by high probabilities of multiple co-occurring complications, particularly functional decline and delirium, and was designated the global HAC phenotype. Admission frailty, functional impairment, and cognitive dysfunction were significantly associated with this phenotype (area under the curve = 0.755). Three-month mortality was significantly higher in the global HAC phenotype compared with other phenotypes (22.2%vs 5.2%), and this association remained significant after multivariable adjustment (adjusted odds ratio 2.24, 95% confidence interval 1.25-4.03). HACs cluster into clinically meaningful phenotypes reflecting multidimensional vulnerability. A global HAC phenotype can be identified from admission assessments and is associated with increased short-term mortality, supporting phenotype-based risk stratification in hospitalized older adults.
Frailty and pre-frailty are highly prevalent conditions among older adults and are associated with increased functional decline, fall risk, hospitalization, and mortality. Multicomponent supervised exercise programs have demonstrated efficacy in improving physical performance and mitigating frailty, particularly when adapted to older adults' functional capacity. However, evidence regarding Vivifrail-based interventions in frail and pre-frail older adults in Brazil remains limited. This study aims to evaluate the effects of a 12-week supervised multicomponent exercise program on functional capacity and fall risk among frail and pre-frail older adults. Additionally, the study intends to characterize participants according to frailty status, clinical-functional vulnerability, cognitive status, depressive symptoms, physical activity level, muscle mass, fear of falling, and sociodemographic and clinical characteristics at baseline. This study protocol describes a prospective, parallel-group, single-blind randomized controlled trial. Older adults aged 60 years and older regularly attending activities at the CONVIVER Community Center in Rio Verde, Goiás, Brazil, will be screened and randomized in a 1:1 ratio into either an intervention group or a control group. The intervention group will participate in a supervised multicomponent exercise program based on the Vivifrail model for 12 weeks, whereas the control group will participate in health education workshops focused on healthy aging. The primary outcomes will be functional capacity, assessed using the 6-Minute Walk Test, and fall risk/mobility performance, assessed using the Timed Up and Go Test. Baseline assessments will additionally include frailty status (Edmonton Frailty Scale), clinical-functional vulnerability (CFVI-20), cognitive status (Mini-Mental State Examination), depressive symptoms (Geriatric Depression Scale-15), physical activity level (International Physical Activity Questionnaire), calf circumference, fear of falling (Falls Efficacy Scale-International), and sociodemographic and clinical characteristics. Recruitment and baseline assessments are planned to occur between July and December 2026 at the CONVIVER Community Center. A total of 70 participants is expected to be enrolled and randomized into the intervention group (n=35) or the control group (n=35). At the time of manuscript submission, participant recruitment had not yet started, and no outcome data had been collected or analyzed. Final results are expected to be published in late 2027. This randomized controlled trial protocol describes a supervised multicomponent exercise intervention tailored to frail and pre-frail older adults in a Brazilian community setting. If effective, the intervention may represent a feasible, low-cost, and scalable strategy to improve functional capacity and reduce fall risk in vulnerable older populations while supporting evidence-based healthy aging initiatives. Brazilian Registry of Clinical Trials RBR-9zvtc5b; https://ensaiosclinicos.gov.br/rg/RBR-9zvtc5b.
Swallowing dysfunction poses significant health risks for older adults. Early detection is crucial to prevent complications such as aspiration pneumonia and sarcopenia. Acoustic analysis of voice, speech, and cough provides a promising, noninvasive method for screening for swallowing dysfunction. Here, we present an Expert Consensus Statement (ECS) on the use of select acoustic metrics for bedside screening of swallowing dysfunction in older adults (>65 years). A multidisciplinary panel of 17 experts, spanning speech-language pathology, otolaryngology, geriatrics, neurology, nursing, emergency medicine, engineering, and computer science, developed this ECS using a modified Delphi method. Consensus discussions were guided by working definitions of swallowing dysfunction, aspiration, frailty, and dementia. After three iterative Delphi survey rounds and four conference calls, nine items reached consensus. These statements emphasized the clinical relevance of "wet voice" as an indicator of airway invasion, the requirement for screening tasks to be feasible for alert older adults, and the necessity of instrumental validation (videofluoroscopic swallowing studies/flexible endoscopic evaluation of swallowing) as a reference standard. Furthermore, the panel reached consensus on artificial intelligence's potential to enhance screening, while stressing the importance of addressing algorithmic bias and ensuring equitable access across diverse populations. The consensus highlights the potential of auditory-perceptual assessment and acoustic metrics to inform screening for swallowing dysfunction in older adults and offers expert insights for clinical investigators who aim to analyze voice, speech, and/or cough sounds as clinically meaningful indicators of laryngeal function to improve early detection and intervention, thereby enhancing patient outcomes.
People living with HIV (PWH) experience accelerated aging and elevated frailty risk, representing the convergence of biological and psychosocial aging processes. We enrolled 665 PWH ages ≥50 years in a multicenter study in China. We examined the intersection of biological factors (e.g., CD4+ T-cell count, comorbidities), psychological factors (i.e., depression, anxiety), and social determinants in frailty development. A Bayesian network model was developed to characterize these complex interactions. Frailty prevalence was 17.1%. The Bayesian network identified depression as a central node connecting immune dysfunction to frailty through a CD4→anxiety→depression pathway. The model achieved robust performance (area under the curve = 0.879). Probability of frailty ranged from 1.4% in individuals aged 50-59 years without risk factors to 74.0% in those ages ≥70 years with depression and multiple comorbidities. This model offers clinicians a practical risk assessment tool for aging PWH and highlights depression as a modifiable target, supporting the integration of mental health screening in HIV geriatric care.
We aimed to provide the first national study of out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical services (EMS) during interfacility transport (IFT). We used a nationwide prehospital patient care report dataset from 2023 to complete a cross-sectional observational study of EMS encounters for IFT during which OHCA occurred. Descriptive statistics were computed, stratified by level of EMS care provided. Multivariable logistic regression analysis was completed to evaluate factors associated with return of spontaneous circulation (ROSC) at the end of the IFT encounter upon transfer of care to the receiving facility. Finally, we completed a similar multivariable logistic regression analysis restricted to the subgroup of patients with an unshockable initial rhythm. A total of 1,466 OHCA incidents occurred during an IFT with EMS: 7.5% with basic life support (BLS), 53.6% with advanced life support (ALS), and 38.9% with critical care transport (CCT). Among these incidents 11.8% were associated with trauma, 9.2% involved cardiopulmonary resuscitation (CPR) prior to EMS unit arrival, 14.7% involved a mechanical device to perform CPR, 22.2% had a shockable initial rhythm, and 58.1% were transported via ground as opposed to air. At the conclusion of the IFT EMS encounter, 50.3% had sustained ROSC. Geriatric age (aOR 0.64, 95%CI 0.44-0.94), BLS care (aOR 0.45, 95%CI 0.22-0.90), and ground transport (aOR 0.58, 95%CI 0.38-0.89) were associated with worse outcomes on adjusted analysis, whereas shockable initial rhythm (aOR 3.86, 95%CI 2.42-6.36) and CCT care (aOR 2.21, 95%CI 1.42-3.48) were associated with better outcomes. The sub-analysis for OHCA during IFT with an unshockable initial rhythm also showed greater odds of ROSC when managed by CCT relative to ALS (aOR 2.65, 95%CI 1.64-4.33) while adjusting for other key factors. Using a large nationwide sample of OHCA incidents that occurred during IFT, we found that higher level of EMS care was associated with superior short-term outcomes while controlling for other key factors. These findings underscore the importance of accurate patient triage at sending facilities and the value of CCT for high-risk patients.
Patients receiving antithrombotic therapy are frequently admitted for in-hospital observation after head trauma despite a normal initial cranial computed tomography (CT) scan. The clinical value of routine observation in asymptomatic patients with minimal head injury remains uncertain. This study evaluated the incidence of delayed intracranial hemorrhage (DIH) and the relevance of routine hospital observation. We conducted a retrospective cohort study of adult patients (≥ 18 years) receiving antithrombotic therapy who presented with minimal head injury, defined as the absence of loss of consciousness, amnesia, disorientation, or neurological symptoms and a Glasgow Coma Scale score of 15. All patients had a normal initial cranial CT. Cases were identified from an institutional trauma database between January 2019 and December 2023. Patients with traumatic brain injury, prior intracranial hemorrhage, or abnormal initial imaging were excluded. According to institutional protocol, patients receiving acetylsalicylic acid monotherapy underwent home observation, whereas other antithrombotic regimens, including anticoagulants and/or antiplatelet agents, required admission. A total of 5800 patients met inclusion criteria (median age 83 years, interquartile range 77-88). Of these, 3697 were admitted and 2103 were managed as outpatients. During follow-up, 179 unique patients (3.1%) developed delayed neurological symptoms and underwent repeat CT imaging. DIH was detected in 9 patients (0.2%). Two cases occurred within 24 h; the remainder were diagnosed between three and nine days after injury. No patient required neurosurgical intervention. DIH after minimal head injury in asymptomatic patients receiving antithrombotic therapy is rare, suggesting limited clinical benefit of routine in-hospital observation after a normal CT scan. Trial registration: 'retrospectively registered' (1057/2023). Level of evidence: III.
BackgroundLanguage and communication disorders in dementia with Lewy bodies (DLB) remain understudied and have rarely been explored from the caregiver's perspective. Comparative studies with Alzheimer's disease (AD) are also limited.ObjectiveTo provide an initial overview of language and communication profiles in DLB, compared to AD and healthy elderly controls (HC); to assess subjective complaints reported by patients, caregivers and healthcare professionals; and to explore their relationships with rapid language screening. A further aim was to aid non-specialist professionals in identifying patients needing speech therapy referral.MethodsSeventeen DLB patients, 15 AD patients, and 11 HC completed the Diagnostic Tool for Language Assessment and the alpha version of the Communication Support Needs Assessment Tool for Dementia (CoSNAT-D), alongside a semi-directed interview (SDI). Proxy-ratings were also collected from caregivers and healthcare professionals (HP) for the CoSNAT-D and SDI.ResultsCompared to HC, DLB patients showed significantly poorer performance in repetition, verbal working memory, sentence comprehension and dictation, and reported more communication difficulties. Compared to AD patients, DLB patients had greater impairments in phonemic fluency, and more frequent reports of discomfort, vocal changes, and difficulties with writing and handwriting execution. Perceptions of communicative difficulties and their functional impact varied across patients, caregivers, and HP.ConclusionsThis study has identified distinct language and communication deficits in DLB versus AD and HC. Discrepancies between patient and caregiver perceptions were frequent in both groups and may contribute to increased caregiver burden. Findings highlight the potential value of rapid screening tools to better support patients and their caregivers.
This study aimed to evaluate the causal effect of C-reactive protein (CRP) on sarcopenia-related traits (grip strength and appendicular lean mass) utilizing a 2-sample Mendelian randomization (MR) approach. Instrumental variables were sourced from publicly accessible genome-wide association study datasets. To verify the heterogeneity and pleiotropy of the identified instrumental variables, the leave-one-out sensitivity analysis, MR pleiotropy residual sum and outlier test, and Cochran Q test were employed, respectively. Subsequently, 4 distinct models including the inverse-variance weighted model, weighted median estimator model, weighted model-based method, and MR-Egger regression (MER) model, were utilized in this MR analysis. After excluding all outliers identified by the MR pleiotropy residual sum and outlier test, no evident directional pleiotropy was found (right-hand grip strength: MER intercept = -0.000367, standard error [SE] = 0.000219, P = .095; left-hand grip strength: MER intercept = -00029, SE = 0.00023, P = .196; appendicular lean mass: MER intercept = -0.000434, SE = 0.00038, P = .255). The inverse-variance weighted analysis suggested a significant causal effect of genetically determined CRP on appendicular lean mass (beta = -0.03613, 95% confidence intervals [CI] [-0.05117--0.02109], P = 2.50 * 10-6) and grip strength (right hand: beta = -0.01507, 95% CI [-0.02379--0.00636], P = 6.99 * 10-4; left hand: beta = -0.01389, 95% CI [-0.02287--0.00491], P = .002), respectively. The results of the MR analysis support that genetically determined CRP may be causally associated with an increased risk of sarcopenia.
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Plasma proteomics and metabolomics snapshots reveal a molecular signature in circulation delineating pathophysiology of major and minor neurocognitive disorder. To identify new cues to disease aetiology and diagnostic approach, we applied plasma proteomics and metabolomics profiling platforms to samples collected in a population-based study of the Singapore Longitudinal Ageing Studies Wave 2 (SLAS-2). In this longitudinal study, blood samples were analysed with standard clinical chemistry, plasma proteomics (Sengenics) and metabolomics (Nightingale) panels. Participants were followed up for the development of mild cognitive impairment (MCI) and dementia for 3-5 years. Of the total 1,892 molecules in all assay types, 463 demonstrated significant associations with baseline prevalent MCI and dementia. We trained an automatic linear modelling of predictors for follow-up new-onset MCI and dementia. The best model consists of 10 variables including ZSCAN18, PRKD3, SPANXN4, DDX43, saturated fatty acids, PPP3CA, NFATC4, IL-8, PAK6, and PDGFB. In terms of molecular function, these molecular markers are involved in immunological dysfunction and inflammatory reaction, protein coding, lipids, DNA-binding transcription factor activity, and nervous system development. In conclusion, our current research has identified an omics signature linked to new-onset mild cognitive disorder and dementia, which we hope can help enhance the accuracy of their diagnosis using circulating blood samples.