No abstract

Aims: Although evidence has accumulated that white matter hyperintensity (WMH) is associated with the deterioration of cognitive function and impairment of activities of daily living (ADL), the clinical relevance of WMH in elderly patients with diabetes mellitus (DM) is not still clear. The aim of this study was to examine whether WMH volume is associated with ADL and cognitive function and whether glucose control and glucose variability can affect WMH volume in these patients.Methods: This cross-sectional study investigated the associations of WMH with cognitive function and instrumental ADL (IADL), as well as metabolic and vascular risk factors in a total of 178 elderly patients with diabetes. The study assessed WMH volumes and the functional status of cognition and IADL. WMH volumes were evaluated by obtaining axial T2-weighted and fluid-attenuated inversion recovery sequence images on brain magnetic resonance imaging and assessing the images using Software for Neuro-Image Processing in Experimental Research.Results: We found a significant association between WMH volumes and Mini-Mental State Examination (MMSE) scores (p = 0.039) and between WMH and IADL status (p = 0.006). Furthermore, we found significant relations of large WMH volumes with a high glycoalbumin/glycohemoglobin ratio (GA/HbA1c) (p < 0.001). Large WMH volumes were also found to be associated with a low body mass index (p = 0.014) and a low diastolic blood pressure (p = 0.024), but not with HbA1c. Multiple regression analysis showed that high GA/HbA1c, which reflects high glucose variability, was a significant determining factor for large WMH volumes. We also found that GA/HbA1c was negatively associated with both MMSE (p = 0.036) and IADL (p < 0.001).Conclusion: GA/HbA1c, which is a marker of glucose variability, was independently associated with WMH volumes, which could lead to the decline of cognition and IADL in elderly patients with DM.

Aims: Sarcopenia is a serious problem because of its poor prognosis. Growth differentiation factor 15 (GDF15) is associated with mitochondrial dysfunction, inflammation, insulin resistance and oxidative stress, which may play crucial roles for the development of sarcopenia. We aimed to examine whether serum GDF15 level is associated with muscle mass, strength and lower extremity function in older patients with cardiometabolic disease. Methods: Serum GDF15 levels were measured in 257 patients with cardiometabolic diseases (including 133 patients with diabetes) who had visited the frailty clinic, using a latex turbidimetric immunoassay. Appendicular skeletal muscle index, handgrip strength, timed-upand-go test and gait speed were evaluated. Power, speed, balance and total scores based on the sit-to-stand test were calculated to assess lower extremity function. Results: The highest tertile of serum GDF15 was independently associated with low handgrip strength, low gait speed, long timed-up-and-go time and scores of lower extremity function but not an appendicular skeletal muscle index in multiple logistic regression analyses after adjustment for covariates. Patients in the highest tertile of GDF15 were at the risk of having three to nine times lower grip strength, three times lower gait speed, five to six times lower mobility and five to 11 times reduction in lower extremity function as compared with those in the lowest GDF15 tertile dependent on the models. Conclusions: Elevated serum GDF15 level was independently associated with low muscle strength and lower extremity function in older patients with cardiometabolic disease. Serum GDF15 could be one of the biomarkers for muscle weakness and low physical performance.

Aims/Introduction: Older adults with diabetes mellitus are susceptible to sarcopenia. Diffusion tensor imaging studies have also shown that patients with diabetes have altered white matter integrity. However, the relationship between these structural changes in white matter and sarcopenia remains poorly understood. Materials and Methods: The study included 284 older patients (aged ≥65 years) who visited the Tokyo Metropolitan Geriatric Hospital Frailty Clinic. We used diffusion tensor imaging to measure fractional anisotropy (FA) and mean diffusivity (MD) to evaluate changes in white matter integrity. We investigated the associations between sarcopenia, or its diagnostic components, and FA or MD in seven white matter tracts considered to be associated with sarcopenia according to the patients' diabetes status. Results: We found significantly low FA or high MD values in the bilateral anterior thalamic radiations (ATR) and right inferior fronto-occipital fasciculus (IFOF) of patients with Asian Working Group for Sarcopenia 2019-defined sarcopenia, in all patients and those with diabetes. Using binominal regression analyses, we associated low FA values in the left ATR and right IFOF with sarcopenia in all patients and those with diabetes, after adjusting for age, gender, HbA1c, blood pressure, cognitive function, physical activity, depression, nutritional status, and inflammation. Conclusions: White matter alterations in left ATR and right IFOF are associated with the prevalence of sarcopenia in patients with diabetes. Specific changes to the left ATR and right IFOF tracts could play critical roles in the occurrence of sarcopenia in patients with diabetes.

Aim We examined whether the Dementia Assessment Sheet for Community‐based Integrated Care System 8‐items (DASC‐8) is useful for screening frailty and as a comprehensive geriatric assessment (CGA). Methods Outpatients (N = 431; 269 women; Mage = 78.9 ± 6.8 years) with cardiometabolic disease from a frailty clinic participated. Frailty status was assessed using modified Cardiovascular Health Study criteria, the Clinical Frailty Scale and the Kihon Checklist. Cognition, higher‐level activities of daily living, sarcopenia, physical activities, depression, nutrition, medication adherence, social network and quality of life were assessed as CGA components. We examined the association of DASC‐8 category with frailty or CGA components using multiple logistic regression analyses, adjusted for age and sex. Results Most participants (n = 310, 71.9%) were in Category I, 90 (20.9%) were in Category II and 31 (7.1%) were in Category III. There were no significant differences in sex, body mass index, or past medical history, except regarding age or cerebral infarction. Logistic regression analyses showed that, for all definitions of frailty, the odds ratios of frailty significantly increased as category progressed. Cognitive function, higher‐level activities of daily living, handgrip strength, gait speed, physical activities, medication adherence, social network and quality of life decreased as the category increased. Although depressive tendency increased in Category II, there was no significant difference in muscle mass or prevalence of sarcopenia among the categories. Malnutrition was observed in Category III. Conclusions DASC‐8 category was associated with frailty and several CGA components in older patients with cardiometabolic disease. Geriatr Gerontol Int 2020; 20: 1157–1163.