Background The high illiteracy rates in the North African and Middle Eastern region make direct cognitive testing challenging. Validated instruments for dementia in Arabic language are lacking specially those targeting low-educated subjects. Objectives The aim of this study was to develop a cognitive evaluation battery suitable for both educated and illiterate Egyptian elderly people. Design A cross-sectional study was conducted. Setting: Ain-Shams University geriatric and ophthalmology wards, geriatrics outpatient clinic, and geriatric clubs. Participants: 159 male and female participants aged ≥ 60 years were recruited. Measurements Cut-off points were determined according to DSM-IV criteria for dementia and MMSE scores which divided the participants into 3 quadrants as normal, having mild cognitive impairment and having dementia then application of the new battery test was done. Results Test re-test reliability ranged from adequate to high in most of its tests with r ≥ 0.7. There was a statistical significance between all battery tests when divided into normal and dementia according to DSM IV criteria except in digit span forward length, digit span backward length, stimulus cue of confrontation naming and judgment. Means and standard deviations were calculated for each battery subset, for the whole sample, for low-educated group and group with > 9 years education according to three quadrants of MMSE. Conclusion A new valid and reliable neurocognitive evaluation battery that can differentiate between normal, mild cognitive impairment, and dementia in both educated and illiterate subjects under the name of Ain Shams Cognitive Assessment (ASCA) scale is now available.

There was a low prevalence of vitamin D insufficiency in an elderly rural population and a higher prevalence of vitamin D insufficiency among males than females.

Background With aging of the population dementia became a public health problem increasing health care costs. It affects about 5-10% of elderly population above the age of 65 with doubling prevalence each 5 years till reaching about 50% at the age of 85 1, 2. The Mini-Mental State Examination (MMSE) was published in 1975 as a practical method to assess cognitive functions. Although it has some advantages as it is affected by age and education and does not measure executive function, indeed it is the most commonly used screening method in the assessment of the severity of dementia in clinical and research fields and for longitudinal follow up of patients. Researchers stated that most of the healthcare professionals use the MMSE and its variants during their medical practice 3, 4. MMSE has several strengths including that it can be quickly administered in clinical interview and research settings. It has demonstrated utility in its widespread and long-standing use in cognitive screening. The test largely meets its goals as a screening tool of cognitive function and serial measurement of cognitive changes 5. The maximum score for MMSE is 30, with lower scores indicating more severe cognitive problems. The cut point established for the MMSE defines 'normal' cognitive function and is usually set at 24 6. However, these scores need to be adjusted according to age,

Background: Anemia is a common problem with serious consequences in older person but is often overlooked despite considerable evidence that low hemoglobin levels indicate physiologic decline in these patients. Multiple studies demonstrate that anemia is an independent risk factor for increased morbidity and mortality, and decreased quality of life in community-dwelling older persons. Increasing functional deterioration is associated with decreasing hemoglobin concentration in an inverse and linear manner. Aim: to assess the prevalence of anemia in free-living elderly subjects living in an urban community of Meet Abbad-Nabaroh, Dakahlia. Egypt and its impact on their functional level. Methodology: A cross-sectional study was done including 93 elderly ≥ 60 ys old, both males and females recruited from Meet Abbad-Nabaroh, Dakahlia, Egypt. All subjects underwent a complete medical history taking, clinical evaluation then blood hemoglobin level was measured, and anemia was defined according to the World Health Organization definition of anemia (hemoglobin level less than 13 g per dL [130 g per L] in men and less than 12 g per dL [120 g per L] in women). Results: The study revealed that the prevalence of anemia is 15.05% among the studied participants (14.5% among the male group and 16.1% among females), 14% had mild anemia and 1% had moderate anemia, with significant increase with age as there was significant difference (p = 0.042) between the different age groups of the studied participants, also history of blood loss and anemia showed positive significant correlation (p-value = 0.001), and highly significant correlations between intake of non steroidal anti inflammatory drugs (NSAID) and anemia (p-value = 0.000). The impact of anemia on functional status and risk of fall respectively showed significant difference between anemic and non anemic as regards instrumental activity of daily living (IADL) (p = 0.007), and timed up and go test (p-value = 0.01), also there is significant corre-* Corresponding author. M. A. Kamel et al. 169 lation between anemia and mini mental state examination (MMSE) (p-value 0.046) with worse performance among the anemic ones. Conclusion & Recommendation: anemia represents a health problem of significance among the community dwelling elderly with bad drawback on their functional level; their need for health & community services has a financial impact so this problem needs more assessment for better prevention and treatment.

judgmental approach to such patients to be more readily achieved. From the theoretical point of view, much of the nosological debate incorporating inferred degrees of suicidal intent is rendered unnecessary, as the differences are more apparent than real, with the primary activity being that of conservation withdrawal in order to escape an intolerable situation.

Background Hospitalization of the elderly patients carry greatest risk for complications and unfavorable outcomes, so better outcome requires a comprehensive geriatric assessment by multidisciplinary teams to detect the patients at higher risk for functional decline and institutionalization, such care and assessment have shown to reduce the hospital stay and functional decline, also increases the chances of living at home, one of this multi-dimentional management is the use of prognostic indices which predict the outcome of the admitted elderly patients, of which is MPI. The MPI showed good accuracy in estimating both short-and long-term mortality in hospitalized older patients with the most common conditions leading to death (Pilotto et al., 2012).

Background: The term "frailty" has been used clinically as a global concept to describe a condition, common in the old, of impaired strength, endurance, and balance, vulnerability to trauma and other stressors, and high risk for morbidity, disability, and mortality. A variety of factors may contribute to frailty or to one or more of its specific features. These include inflammatory, musculoskeletal, cardio respiratory, metabolic, hematologic, neurologic, immunologic and endocrine factors. Hormones important to the development of frailty that has been proposed include testosterone, luteinizing hormone (LH) and dehydroepiandrosterone (DHEA). Objective: to study the association between LH level and frailty among the elderly Method: A case control study was carried out. The case group included 80 Frail elderly subjects selected according to the American Geriatric Society Criteria; whereas 80 non-Frail elderly subjects were selected as the control group. Each participant was subjected to Comprehensive Geriatric Assessment and laboratory assessment of luteinizing hormone. Results: LH level was lower in frail subjects compared to non frail. Lower levels were significantly correlated with increased degree of dependency in both frail males and females. Conclusion: Luteinizing hormone level was lower among frail elderly. Further studies are needed to confirm such an association and to plan clinical practice accordingly.

Background: Post hepatitis C virus chronic liver disease (CLD) is prevalent among the Egyptian population with a bad impact upon their quality of life (QOL). Hepatocellular carcinoma (HCC) is one of the long term and fatal complications of CLD and it also has its negative impact on patient's quality of life. Aim: To assess impact of CLD and HCC on the quality of life of group of hospitalized elderly patients. Methodology: Ninety elderly patients were divided into three groups: 30 elderly with post hepatitis C virus CLD, 30 elderly with HCC and 30 others free of liver disease as control group (Cn), all were recruited from the in-patient ward and the outpatient clinic of the Geriatric Department, Ain-Shams University Hospital. After giving consent, comprehensive geriatric assessment was done with assessment of their quality of life by using the Short Form-36 health survey (SF-36). Investigations including liver enzymes, serum albumin, serum bilirubin and abdominal ultrasound were done. Results: All QOL domains were the highest among control group, followed by HCC group and the least among CLD group. The differences were statistically significant in most subscales and total score [Mean of Cn = 81.9 ± 12.4, Mean of CLD = 47.5 ± 21.9, Mean of HCC = 62.3 ± 16.1; P Cn/CLD ≤ 0.001, P Cn/HCC ≤ 0.001, P CLD/HCC = 0.004]. Albumin was the only biochemical marker correlated positively with total SF score and two subscales (PF and EF) [r = 0.408; P = 0.025]. Conclusion & Recommendation: Our study showed a decrease in the QOL of Egyptian post hepatitis C virus CLD and HCC patients compared with Egyptian population norms. The results showed that CLD were more affected than HCC patients. This had a particularly serious negative impact on their life. The findings indicate a need for updated counseling and educational materials designed to provide adequate information and consistent healthcare service to this patient setting.