Brain CT can predict low lean mass in the elderly with cognitive impairment: a community-dwelling study

Background The coexistence of sarcopenia and dementia in aging populations is not uncommon, and they may share common risk factors and pathophysiological pathways. This study aimed to evaluate the relationship between brain atrophy and low lean mass in the elderly with impaired cognitive function. Methods This cross-sectional study included 168 elderly patients who visited the multi-disciplinary dementia outpatient clinic at Kaohsiung Chang Gung Memorial Hospital for memory issues, between 2017 and 2019. The body composition was assessed by dual energy X-ray absorptiometry (DEXA) and CT based skeletal muscle index including L3 skeletal muscle index (L3SMI) and masseter muscle mass index (MSMI). The brain atrophy assessment was measured by CT based visual rating scale. Possible predictors of low lean mass in the elderly with cognitive impairement were identified by binary logistic regression. ROC curves were generated from binary logistic regression. Results Among the 81 participants, 43 (53%) remained at a normal appendicular skeletal muscle index (ASMI), whereas 38 (47%) showed low ASMI. Compared with the normal ASMI group, subjects with low ASMI exhibited significantly lower BMI, L3SMI, and MSMI (all p < 0.05), and showed significant brain atrophy as assessed by visual rating scale (p < 0.001). The accuracy of predictive models for low ASMI in the elderly with cognitive impairment were 0.875, (Area under curve (AUC) = 0.926, 95% confidence interval [CI] 0.844–0.972) in model 1 (combination of BMI, GCA and L3SMI) and 0.885, (Area under curve (AUC) = 0.931, [CI] 0.857–0.979) in model 2 (combination of BMI, GCA and MSMI). Conclusions Global cortical atrophy and body mass index combined with either L3 skeletal muscle index or masseter skeletal muscle index can predict low lean mass in the elderly with cognitive impairment.

The Characteristics of White Matter Hyperintensities in Patients With Migraine

BackgroundThe presence of white matter hyperintensities (WMH) in migraine is well-documented, but the location of brain WMH in patients with migraine are insufficiently researched. Although recent semi-automatic software packages have been developed for calculating WMH, visual inspection remains the gold standard for measuring WMH. The goal of this study was to assess WMH in patients with migraine using a modified version of the Scheltens visual rating scale, a semiquantitative scale for categorizing WMH in the following brain regions: periventricular, lobar (frontal, temporal, parietal, occipital), basal ganglia, and infratentorial regions.Methods263 patients with migraine (31 male/232 female; mean age: 48.0) who were enrolled in the American Registry for Migraine Research from Mayo Clinic with a diagnosis of episodic (n = 46; 17.5%) or chronic migraine (n = 217; 82.5%) and who had brain magnetic resonance imaging were included in this study. Those with imaging evidence for gross anatomical abnormalities other than WMH were excluded. WMH were identified on axial T2 and FLAIR sequences by a board certified neuroradiologist. WMH were characterized via manual inspection and categorized according to the scale’s criteria.Results95 patients (36.1 %: mean age: 41.8) had no WMH on axial T2 and FLAIR imaging and 168 patients (63.9%, mean age: 51.4) had WMH. Of those with WMH, 94.1% (n = 158) had lobar hyperintensities (frontal: 148/158, 93.7%; parietal: 57/158, 36.1%; temporal: 35/158, 22.1%; occipital: 9/158, 5.7%), 13/168, 7.7% had basal ganglia WMH, 49/168, 29.1% had periventricular WMH, and 17/168, 10.1% had infratentorial WMH. 101/168 patients (60.1%) had bilateral WMH and 67/168 (39.9%) had unilateral WMH (34 right hemisphere /33 left hemisphere). 30.0% of patients with WMH did not have WMH reported in their clinical radiology reports.DiscussionNearly 2/3 of patients with migraine had WMH. They were most common in the lobar regions, specifically in the frontal lobe. The categorization of WMH in migraine using the modified Scheltens visual rating scale could help in future studies to clarify the relationship between WMH and headache features and might be a useful method for developing classifiers that differentiate between migraine-specific WMH and other causes of WMH.

Combining Visual Rating Scales for Medial Temporal Lobe Atrophy and Posterior Atrophy to Identify Amnestic Mild Cognitive Impairment from Cognitively Normal Older Adults: Evidence Based on Two Cohorts

Background: Visual rating scales for medial temporal lobe atrophy (MTA) and posterior atrophy (PA) have been reported to be useful for Alzheimer’s disease diagnosis in routine clinical practice. Objective: To investigate the efficacy of combined MTA and PA visual rating scales to discriminate amnestic mild cognitive impairment (aMCI) patients from healthy controls. Methods: This study included T1-weighted MRI images from two different cohorts. In the first cohort, we recruited 73 patients with aMCI and 48 group-matched cognitively normal controls for training and validation. Visual assessments of MTA and PA were carried out for each participant. Global gray matter volume and density were estimated using voxel-based morphometry analysis as the objective reference. We investigated the discriminative power of a single visual rating scale and the combination of the MTA and PA rating scales for identifying aMCI. The second cohort, consisting of 33 aMCI patients and 45 controls, was used to verify the reliability of the visual assessments. Results: Compared with the single visual rating scale, the combination of the MTA and PA exhibited the best discriminative power, with an AUC of 0.818±0.041, which was similar to the diagnostic accuracy of the gray matter volumetric measures. The discriminative power of the combined MTA and PA was verified in the second cohort (AUC 0.824±0.058). Conclusion: The combined MTA and PA rating scales demonstrated practical diagnostic value for distinguishing aMCI patients from controls, suggesting its potential to serve as a convenient and reproducible method to assess the degree of atrophy in clinical settings.

Pengaruh Teknik Relaksasi Genggam Jari Terhadap Tingkat Nyeri Pada Pasien Post Sectio Caesarea Di Ruangan Kebidanan Rumah Sakit Umum Daerah Poso

<p><strong>Latar Belakang :</strong> Nyeri merupakan sesuatu yang tidak menyenangkan yang hanya dapat diungkapkan oleh individu yang mengalaminya. Salah satu terapi nonfarmakologi untuk mengatasi nyeri adalah tekhnik relaksasi genggam jari. Berdasarkan hasil studi awal yang di lakuakan di ruang kebidanan Rumah Sakit Umum Daerah Poso melalui wawancara, perawat atau pun bidan belum pernah melakukan teknik relaksasi gengam jari pada pasien yang telah di lakukan<em> Sectio sesarea</em>. <strong>Tujuan:</strong> Untuk mengetahui pengaruh teknik relaksasi genggam jari terhadap tingkat nyeri pada pasien <em>post sectio caesarea</em> di ruang kebidanan Rumah Sakit Umum Daerah Poso tahun 2017. <strong>Metode Penelitian :</strong> Penelitian ini merupakan jenis penelitian <em>quasy experiment </em>dengan desain pada penelitian ini adalah <em>quasi Experimen</em>t <em>pre post test design</em> <em>with control group</em>. Subyek penelitian adalah pasien post operasi <em>Sectio sesarea</em> yang dirawat di ruang kebidanan. Sampel penelitian diambil dengan teknik <em>Accidental Sampling</em> berjumlah 32 responden. Data diambil dengan menggunakan visual (<em>visual rating scale</em>) dan analisis data dilakukan secara univariat dan bivariat menggunakan uji statistik <em>Wilcoxon</em> dengan nilai signifikansi P-value 95% (<em>p= 0,05</em>). <strong>Hasil : </strong>Ada Pengaruh Teknik Relaksasi Genggam Jari Terhadap Tingkat Nyeri Pada Pasien <em>Post Sectio Caesarea</em><em> </em>yaitu (<em>p=0,000</em>). <strong>Kesimpulan:</strong> Terdapat pengaruh teknik relaksasi genggam jari terhadap tingkat nyeri pada pasien <em>post sectio caesarea</em>.<strong> </strong><strong></strong></p><p> </p><p class="Default"><strong>Kata Kunci : </strong>Nyeri, Pasien <em>Post Sectio Caesarea</em>, Teknik Relaksasi Genggam Jari</p><p class="Default"> </p>