Background and Objectives: Impaired autophagy has been implicated in neurodegeneration, but circulating autophagy-related proteins have shown inconsistent associations with cognitive impairment. We compared serum autophagy-related protein 5 (ATG5) among older adults with normal cognition, mild cognitive impairment (MCI), and clinically diagnosed Alzheimer’s disease (AD), and examined its relationship with global cognitive performance. Materials and Methods: This single-centre cross-sectional study enrolled 164 older adults (55 with normal cognition, 55 with MCI, and 54 with clinically diagnosed AD). Cognitive status was determined through integrated clinical assessment rather than a single test cut-off. An enzyme-linked immunosorbent assay was employed to quantify serum ATG5, yielding quantifiable values for 156 participants, right-censored observations above the highest calibrator for six, and unmeasurable results for two. Since the two 96-well plates, drawn from one ELISA kit lot and processed on the same day, exhibited a substantial discrepancy in measurement scale across runs, they were analysed as distinct strata, with the principal group contrast estimated via a right-censored Tobit regression of log-transformed ATG5 within each plate, controlling for cognitive group, age and sex; a pooled plate-adjusted model also provided support. Supportive analyses used within-plate z-standardised ATG5. Associations with clinical variables were assessed using age- and sex-adjusted partial Spearman correlations with false discovery rate correction. Results: Across both analytical strata (plate 1 omnibus p = 0.293; plate 2 p = 0.264) and within the supportive pooled model (p = 0.143; AD vs. normal geometric mean ratio 0.89, 95% CI 0.73–1.09), serum ATG5 concentrations did not differ significantly between cognitive groups. Concentrations on plate 2 were 47% lower (GMR 0.53, 95% CI 0.45–0.62), a gap exceeding the inter-assay imprecision declared by the manufacturer and unexplained by the calibrator values from plate 2; since relative dispersion matched across both plates (likelihood ratio p = 0.730), the pattern suggests a multiplicative scale shift of unknown origin. Serum ATG5 levels were weakly associated with global cognitive performance assessed via the S-MMSE (partial ρ = 0.283, p < 0.001, FDR p = 0.010), an association that persisted after adjusting for education, albumin and folate and retained a similar magnitude within a linear model (β = 0.044, p = 0.014). Incorporating ATG5 into a model that included age, sex and education failed to enhance discrimination (ΔAUC +0.012 and +0.000). Conclusions: Serum ATG5 did not discriminate normal cognition, MCI, and clinically diagnosed AD. A weak rank-based association with S-MMSE was observed, but the effect was small. These findings do not support serum ATG5 as a diagnostic discriminator for clinically defined cognitive status.

Mannitol, intrakraniyal basıncı azaltmak amacıyla uzun yıllardır kullanılan bir osmotik diüretiktir. Ancak yüksek dozlarda veya uzun süreli kullanımda renal tübüllerde hasara ve elektrolit dengesizliklerine yol açabilmektedir. Bu bölümde, postoperatif dönemde mannitol infüzyonu uygulanmış ve serum kreatinin düzeyleri normal seyretmesine rağmen belirgin hipokalemi ve hipomagnezemi gelişen iki olgu anlatacağız.

Background and Objectives: Sarcopenia is highly prevalent among older adults with chronic kidney disease (CKD) and is associated with adverse clinical outcomes. The finger-ring (Yubi-wakka) test is a simple anthropometric screening tool based on calf circumference; however, its performance in older adults with CKD remains unclear. This study aimed to investigate the association of the finger-ring test with low muscle mass, sarcopenia, and comprehensive geriatric assessment parameters and to evaluate its diagnostic performance for identifying low muscle mass in older adults with CKD. Materials and Methods: This cross-sectional study included 115 patients aged ≥65 years with CKD who were evaluated in geriatric and nephrology inpatient services. After excluding two participants with missing finger-ring measurements, 113 individuals were analyzed. Muscle mass was assessed using bioelectrical impedance analysis and low muscle mass was defined according to EWGSOP2-based Turkish cut-off values. Demographic characteristics, anthropometric measurements, laboratory findings, and comprehensive geriatric assessment parameters were recorded. Correlation analyses, logistic regression models, receiver operating characteristic (ROC) analyses, and likelihood-ratio tests were performed. Results: Among 113 participants, 62 were classified as finger-ring positive (FR = 0) and 51 as finger-ring negative (FR = 1). Low muscle mass was significantly more frequent in the FR = 0 group than in the FR = 1 group (51.6% vs. 24.0%, p = 0.005). Finger-ring test results showed strong correlations with calf circumference (rho = 0.689, p < 0.001) and body mass index (BMI) (rho = 0.631, p < 0.001), whereas the correlation with muscle mass was modest (rho = 0.250, p = 0.008). For detecting low muscle mass, the finger-ring test demonstrated an area under the curve (AUC) of 0.643 (95% CI 0.554–0.732), sensitivity of 72.7%, specificity of 55.9%, positive predictive value of 51.6%, and negative predictive value of 76.0%. In multivariable analyses, BMI remained the strongest independent determinant of finger-ring test results, whereas the association with muscle mass lost statistical significance after BMI adjustment. Adding age and sex significantly improved discrimination, while the contribution of nutritional status was limited. Conclusions: The finger-ring test is associated with low muscle mass in older adults with CKD; however, its diagnostic performance is modest and appears to be substantially influenced by body size and calf circumference. Therefore, the finger-ring test should be considered a simple adjunctive screening tool rather than a stand-alone method for identifying low muscle mass in this population.

Spiritual well-being is a vital component of aging, yet its relationship with standard geriatric markers remains unclear. This study aimed to identify determinants of spiritual well-being among older outpatients by examining its association with Comprehensive Geriatric Assessment (CGA) parameters. In this cross-sectional study, we included 199 patients aged ≥ 65 years admitted to a geriatrics clinic between January 2022 and December 2023. The FACIT-Sp-12 measured spiritual well-being. Comprehensive geriatric assessment parameters included functional status, cognitive function, nutritional status, depressive symptoms, urinary incontinence, falls, polypharmacy and subjective sleep complaints. Religious coping was evaluated using the Religious Coping Scale for Muslims. Data were analyzed using robust multiple linear regression and cross-sectional mediation analysis to identify independent correlates and to assess whether depressive symptoms statistically accounted for part of the urinary incontinence-spiritual well-being association. Participants averaged 76.5 ± 6.6 years; 66.3% were women. Depressive symptom scores correlated most strongly with lower spiritual well-being (rho = -0.40, p < 0.001). Better daily function (Lawton rho = 0.26; Katz rho = 0.23) and greater religious coping (rho = 0.29) accompanied higher scores. When we controlled for confounders, only depressive symptoms (β = -0.38) and religious coping (β = 0.26) remained significant (model R² = 0.36). Physical function did not remain independently associated once depressive symptoms entered the model. In mediation testing, 41% of the association between urinary incontinence and spiritual well-being was statistically accounted for by depressive symptoms. Depressive symptoms appear to be the dominant negative correlate of spiritual well-being in geriatric outpatients, while religious coping shows an independent positive link. The attenuation of functional measures after accounting for depressive symptoms may align with gerotranscendence theory or simply reflect ceiling effects in this functionally well-preserved outpatient sample. Either way, these data underscore the relevance of addressing depressive symptoms and acknowledging religious resources when caring for older adults.

Background and Objectives: This study aimed to translate and culturally adapt the Pictorial Fit–Frail Scale (PFFS) into Turkish and to evaluate its validity and reliability in older adults. Materials and Methods: The study included 156 community-dwelling older adults aged ≥ 65 years. Frailty status was determined using the Clinical Frailty Scale (CFS), and participants with a CFS ≥ 4 were classified as frail. All participants underwent the PFFS, Katz ADL, Lawton–Brody IADL, Short-Form Geriatric Depression Scale (GDS), Mini Nutritional Assessment—Short Form (MNA-SF), Standardized Mini-Mental State Examination (SMMSE), and Charlson Comorbidity Index (CCI). The reliability of the PFFS was assessed using internal consistency (Cronbach α), inter-rater reliability, and test–retest reliability (ICC); its construct validity was assessed using correlation analysis with the CFS. Furthermore, the diagnostic performance of PFFS in identifying frailty was analyzed using the ROC curve. Results: Of the 156 individuals participating in the study, 63.5% were women, and 89 individuals (57.1%) were frail. The Turkish version of PFFS showed high internal consistency (Cronbach α = 0.838). Inter-rater and test–retest reliability were found to be ICC = 0.995 and 0.996, respectively. A strong and positive correlation was found between PFFS and CFS scores (Spearman r = 0.760, p < 0.001). ROC analysis showed that PFFS had good performance in distinguishing frailty (AUC = 0.851, optimal cut-off ≥ 14; sensitivity = 69.7%, specificity = 83.6%). Frail individuals were older, had higher comorbidities, and showed greater dependence in activities of daily living. Conclusions: The Turkish version of the PFFS appears to be a reliable, valid, rapid, and multidimensional tool for assessing frailty in older adults. The PFFS can contribute to the effective assessment of frailty in clinical practice and research.

AMAÇ: Prediyabet (PDM) diyabetin kendisi gibi enflamatuar bir süreçtir. Bu çalışmada PDM hastalarında endojen nonenzimatik antioksidan olan total bilirubin ile kardiak iskemi ve enflamasyon markırı olan iskemi modifiye albümin arasındaki ilişkinin değerlendirilmesi amaçlandı. MATERYAL-METOD: Çalışmaya kronik hastalıkları olmayan sigara ve alkol kullanmayan ve rutin biyokimyasal analizleri için başvuran 100 olgu dahil edildi. 50 olgu yeni tanı PDM, 50 olgu kontrol grubu olarak belirlendi. Olguların açlık kan örnekleri alındı. 4000 RPM de santrifüj edildi ve plazma kısmı -80 ° C’de saklandı. IMA absorbansı ise Bar-Or’un spektrofotometrik metoduyla analiz edildi. Çalışmamızda IMA düzeyleri bireylerin albümin sonuçlarına göre düzeltildi. BULGULAR: İskemi modifiye albümin (IMA) ve albümine göre düzeltilmiş İskemi modifiye albümin (D-IMA) PDM hastalarında kontrol grubuna göre istatiksel anlamlı olarak yüksekti Total bilirubin ve IMA ve D-IMA arasında korelasyon saptanmadı. IMA ve D-IMA albümin dışında diğer metabolik parametreler ile de korelasyon saptanmadı. Albümin ile D-IMA ve IMA arasında negatif korelasyon saptandı. SONUÇ: IMA ve D-IMA düzeylerinin prediyabetik grupta daha yüksek olması prediyabetik hastaların hem aterosklerotik risk faktörleri hem de oksidatif stres açısından kontrol grubuna göre daha fazla risk altında oldugunu düsündürmektedir.