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We suggest that water-pipe smoking effects pulmonary epithelial permeability more than passive smoking. Increased central mucociliary clearance in water-pipe smoking may be due to preserved humidity of the airway tracts.

Background: Correct evaluation of orthostatic hypotension (OH) is crucial in geriatric practice, since OH is associated with mortality and morbidity. The study aimed to determine the most appropriate method for measuring blood pressure in transition from supine to upright position in order to diagnose OH in older adults. Methods: Active standing test (AST) and head-up tilt table (HUT) test as well as comprehensive geriatric assessment (CGA), including mini-mental state examination or the cognitive state test, mini-nutritional assessment, basic and instrumental activities of daily living, and Tinetti performance-oriented mobility assessment indexes, were performed in 290 geriatric patients. Results: The prevalence of OH during HUT and AST was 19% and 37%, respectively. In patients with OH during HUT, the frequency of dementia and recurrent falls were higher (P,0.05); on the other hand, the levels of serum vitamin D and albumin and estimated glomerular filtration rate were lower (P,0.05). However, all these parameters for OH during AST were not significant (P.0.05). Comparison of the groups according to CGA measurements revealed significant differences in terms of cognition, nutritional status, activities of daily life, and balance function in patients with OH only during HUT (P,0.05), but not during AST (P.0.05). The sensitivity, specificity, positive predictive value, and negative predictive values of AST were 49.0%, 65.5%, 25.0%, and 84.6% respectively, according to HUT. Conclusion:The results suggest that orthostatic blood pressure changes determined by HUT might be of higher clinical significance than that by AST in older adults. It might be important that the evaluation of OH by HUT should be included in daily geriatric practice.

Orthostatic hypotension (OH) is reported to be more prevalent particularly in patients with Dementia with Lewy bodies (DLB) because of the autonomic dysfunction, but prevalence of OH is not known in patients with Alzheimer Disease (AD). The aim of the present study was to determine whether OH can be used to distinguish DLB from AD. 38 patients with DLB, 88 patients with AD and 521 patients without dementia, underwent Comprehensive Geriatric Assessment. OH were evaluated for the 1 st (OH1) and 3 rd (OH3) minutes, taking the data in supine position as the basis, by Head-Up-Tilt Test. Prevalence of OH1 was 43.2% in AD, 44.7% in DLB and 17.9% in patients without dementia, and OH3 was 44.3% in AD, 47.4% in DLB and 17.9% in non-dementia group. The frequency of OH1 and OH3 was higher in the AD and DLB groups than in the patients without dementia (p<0.001), but there was no significant difference between DLB and AD in terms of OH (p>0.05). The percentage of asymptomatic patients with OH was 87.2% and 89.6% during 1 st and 3 rd minutes, respectively, and this percentage was similar in three groups (p>0.05, for each). There was no significant difference between the two dementia groups in terms of comorbidities, drugs and laboratory values (p>0.05). OH is more prevalent in patients with AD than controls and similar levels are observed in those with DLB. The prevalence of OH equally is greater with DLB or AD disease progression. Clinicians should be aware of OH and its related consequences in the management of the AD in older adults.

AD8 is one of the fast, simple, and sensitive screening methods for detecting both minor and major cognitive impairments. With regard to these features, it can be used in older adults attending the primary care settings with memory complaints.

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Background The aging population and increasing chronic diseases make a tremendous burden on the health care system. The study evaluated the relationship between comorbidity indices and common geriatric syndromes. Methods A total of 366 patients who were hospitalized in a university geriatric inpatient service were included in the study. Sociodemographic characteristics, laboratory findings, and comprehensive geriatric assessment(CGA) parameters were recorded. Malnutrition, urinary incontinence, frailty, polypharmacy, falls, orthostatic hypotension, depression, and cognitive performance were evaluated. Comorbidities were ranked using the Charlson Comorbidity Index(CCI), Elixhauser Comorbidity Index(ECM), Geriatric Index of Comorbidity(GIC), and Medicine Comorbidity Index(MCI). Because, the CCI is a valid and reliable tool used in different clinical settings and diseases, patients with CCI score higher than four was accepted as multimorbid. Additionally, the relationship between geriatric syndromes and comorbidity indices was assessed with regression analysis. Results Patients’ mean age was 76.2 ± 7.25 years(67.8% female). The age and sex of multimorbid patients according to the CCI were not different compared to others. The multimorbid group had a higher rate of dementia and polypharmacy among geriatric syndromes. All four indices were associated with frailty and polypharmacy(p < 0.05). CCI and ECM scores were related to dementia, polypharmacy, and frailty. Moreover, CCI was also associated with separately slow walking speed and low muscle strength. On the other hand, unlike CCI, ECM was associated with malnutrition. Conclusions In the study comparing the four comorbidity indices, it is revealed that none of the indices is sufficient to use alone in geriatric practice. New indices should be developed considering the complexity of the geriatric cases and the limitations of the existing indices.

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