See the Reply by https://doi.org/10.1111/jgs.15805.

Background and Purpose Cognitive impairment is one of the main risk factors for falls, and hence it commonly coexists with balance issues. Frailty and sarcopenia are intertwined and prevalent in dementia, and are closely related to falls. We aimed to determine the relationships of the fall risk with balance disturbances, sarcopenia, and frailty in mild-to-moderate Alzheimer’s disease (AD). Methods The study enrolled 56 patients with probable AD. A comprehensive geriatric assessment was performed, and muscle strength and mass, performance status, gait, and balance were evaluated. All parameters were compared between fallers and nonfallers with AD. Results Fallers comprised 53.6% of the study population. The demographic features and AD stages did not differ between fallers and nonfallers. Fallers were more frail than nonfallers ( p <0.05). Frailty was found to be independently associated with fall history (odds ratio=2.15, 95% confidence interval=1.20–3.82, p =0.031). We found that falls were not associated with AD stage, muscle mass and function, balance and geriatric syndromes except urinary incontinence in patients with AD ( p >0.05). Conclusions We found that falls were not influenced by AD stage. Both physical and cumulative frailty were strongly associated with falls in patients with mild-to-moderate AD.

Background: Bleeding is the most frequent complication of kidney biopsy. Although bleeding risk in patients with AA amyloidosis after kidney biopsy has not been studied in a large population, AA amyloidosis has long been perceived as a risk factor for bleeding. The aim of the present study was to evaluate post-biopsy bleeding risk in patients with AA amyloidosis. Methods: We retrospectively analyzed bleeding complications in 88 patients with AA amyloidosis and 202 controls after percutaneous kidney biopsy. All the kidney biopsies were performed under the guidance of real-time ultrasound with the use of an automated core biopsy system after a standard pre-biopsy screening protocol. Bleeding events were classified as major when transfusion of blood products or surgical or radiological intervention was required, or if the bleeding caused hypovolemic shock or death. Bleeding events that did not meet these criteria were accepted as minor. Results: The incidence of post-biopsy bleeding was comparable between AA amyloidosis and control groups (5.7 vs. 5.0%, p = 0.796). Major bleeding events were observed in 3 patients from each group (p = 0.372). Selective renal angiography and embolization were applied to 2 patients from the AA amyloidosis group. One of these patients underwent colectomy and died because of infectious complications. Bleeding events were minor in 2.3% of the patients with AA amyloidosis and 3.5% of the controls (p = 0.728). Conclusions: AA amyloidosis was not associated with increased post-biopsy bleeding risk. Kidney biopsy is safe in AA amyloidosis when standard pre-biopsy screening is applied. Further data are needed to confirm these findings.

Background Insomnia increases the incidence of falls and impairs executive function. Moreover, falls are associated with executive function impairment. The relationship between falls and executive function in patients with insomnia is not clear. The aim of this study was to evaluate relationship between falls and executive function in individuals with insomnia and a control group. Methods This study involved 122 patients (47 insomnia, 75 controls). The Mini‐Mental State Examination, Quick Mild Cognitive Impairment Screen, Trail Making Test A, clock‐drawing test, and digit span test were used to measure executive function. Semantic and working memory dual task was also performed. Fall history was recorded and the Falls Efficacy Scale – International administered. Results The median age of the patients was 71 years (range: 65–89 years), and 60.7% were women. The insomnia group scored lower on the three‐word recall than the control group (P = 0.005), but there was no difference between the groups on cognitive tests. Fall history and fear of falling were more frequent in the insomnia group (P = 0.003, P < 0.001). Semantic and working memory dual tasks were correlated with clock‐drawing test only in the insomnia group (r = −0.316, P = 0.031; r = −0.319, P = 0.029). Depression (odds ratio (OR) = 9.65, P = 0.001) and Trail Making Test A (OR = 1.025, P = 0.07) were independently associated with insomnia. Four‐metre walking speed (OR = 2.342, P = 0.025), insomnia (OR = 3.453; P = 0.028), and the semantic memory dual task (OR = 1.589; P = 0.025) were also independently associated with falls. Conclusion Our study showed that dual tasking and executive function are related to falls in patients with insomnia. Managing insomnia and assessment of executive dysfunction may have beneficial effects on preventing falls.

Objective: The Observation and Interview Based Diurnal Sleepiness Inventory (ODSI) is a valid 3-item tool used for assessment of excessive daytime sleepiness (EDS). The aim of this study was to investigate the reliability and validity of the ODSI in the Turkish language.Methods: Linguistic validation of the ODSI was performed by forward-backward translation. The Turkish version of the ODSI and the Epworth Sleepiness Scale (ESS) were administered in EDS and control groups.Results: The ODSI was tested in 106 older patients. The median age of the patients was 73 (65–89) years and 55.7% were female. The EDS group was older and more dependent on instrumental activities of daily living than the control group. The inter-rater reliability of the ODSI was high (interclass correlation coefficient [ICC]: 0.851, 95% confidence interval [CI]: 0.540–0.958, p<0.001). Test-retest reliability was also high for the total sample (ICC: 0.871, 95% CI: 0.632–0.959, p<0.001). Positive strong correlations were found with the ESS (Speraman’s rho=0.876, 95% bootstrap CI [0.813–0.918], p<0.001). ROC curve analysis showed an area under the curve of 0.968 (95% CI: 0.937–0.998), a cutoff score of ≥6, a sensitivity of 94.1%, a specificity of 87.6%, a positive predictive value of 76.55%, and a negative predictive value of 97.2%.Conclusion: Our data validate the ODSI for application in Turkish-speaking populations. The simplicity, reliability, and the apparent lack of relevant influences of cultural background on performance of the 3-item ODSI make it a valuable tool for clinical management and research.