Person: SOYSAL, PINAR
20 results
Search Results
Now showing 1 - 10 of 20
Publication Open Access Orthostatic hypotension and health outcomes: an umbrella review of observational studies(2019-11-07) Veronese, Nicola; Smith, Lee; Torbahn, Gabriel; Jackson, Sarah E.; Yang, Lin; SOYSAL, PINAR; Rivasi, Giulia; Rafanelli, Martina; Petrovic, Mirko; Maggi, Stefania; Isik, Ahmet Turan; Demurtas, Jacopo; SOYSAL, PINARPurpose Orthostatic hypotension (OH) is associated with older age and many negative clinical outcomes in geriatric practice. We aimed to capture the breadth of outcomes that have been associated with the presence of OH and systematically assess the quality, strength and credibility of these associations using an umbrella review with integrated meta-analyses. Methods We systematically searched several major databases from their commencements through to 16th May 2019 for meta-analyses of observational studies of OH and any health-related outcome. We used these metrics to categorize the strength of evidence of significant outcomes (p < 0.05) from class I (convincing) to class IV (weak), according to the pre-established criteria. Results From 975 abstracts, seven meta-analyses of 12 outcomes were included. For each outcome, the median number of studies was four, and the median number of participants was 46,493, with a median of 3630 incident cases. There was suggestive (class III) evidence that OH was associated with significantly higher risk of coronary heart disease (HR = 1.32, 95% CI 1.12-1.56), stroke (HR = 1.22, 95% CI 1.08-1.38), congestive heart failure (HR = 1.30, 95% CI 1.09-1.55), all-cause mortality (RR = 1.50, 95% CI 1.24-1.81), falls (OR = 1.84, 95% CI 1.39-2.44), and dementia (HR = 1.22, 95% CI 1.11-1.35). Conclusion The current evidence base indicates that OH is significantly associated with a range of adverse cardiovascular, cognitive, and mortality outcomes in older people, although the strength of this evidence remains only suggestive. Further research in larger samples and with lower risk of bias is required to build a fuller picture of the impact of OH on health.Publication Metadata only Acetylcholinesterase inhibitors are associated with weight loss in older people with dementia: a systematic review and meta-analysis(2016-12-01T00:00:00Z) Soysal, PINAR; Isik, Ahmet Turan; Stubbs, Brendon; Solmi, Marco; Volpe, Marco; Luchini, Claudio; D'Onofrio, Grazia; Pilotto, Alberto; Manzato, Enzo; Sergi, Giuseppe; Schofield, Patricia; Veronese, Nicola; SOYSAL, PINARWe conducted a systematic review and meta-analysis investigating the influence of acetylcholinesterase inhibitors (AChEIs) therapy on nutritional status and weight across observational and interventional studies. Two authors searched major electronic databases from inception until 10/14/2015 for longitudinal, open-label and randomised double-blind placebo controlled (randomised controlled trials (RCTs)) studies of AChEIs in patients with dementia reporting nutritional status outcome data. Out of 3551 initial hits, 25 studies (12 open-label trials, 9 RCTs and 4 longitudinal studies) including 10 792 patients with dementia were metaanalysed. In longitudinal studies (median follow-up 6 months), a significant cumulative incidence of weight loss between baseline and follow-up evaluation was observed (studies= 2; 5%; 95% CI 1% to 34%, p< 0.0001; I2= 95%). These findings were confirmed in open-label trials (6%; 95% CI 4% to 7%, p< 0.0001; I-2= 78%). In 9 RCTs (median followup 5 months), those taking AChEIs more frequently experienced weight loss than participants taking placebo (OR= 2.18; 95% CI 1.50 to 3.17, p< 0.0001; I-2= 29%). AChEIs therapy contributes to weight loss in patients with dementia, with a 2-fold increased risk observed in the meta-analysis of RCTs. Clinicians should carefully consider the benefit and risk of prescribing AChEIs. Nutritional status should be routinely evaluated in patients with dementia treated with AChEIs.Publication Metadata only When should orthostatic blood pressure changes be evaluated in elderly: 1st, 3rd or 5th minute?(2016-07-01T00:00:00Z) Soysal, PINAR; AYDIN, Ali Ekrem; Okudur, Saadet Koc; Isik, Ahmet Turan; SOYSAL, PINARDetection of orthostatic hypotension (OH) is very important in geriatric practice, since OH is associated with mortality, ischemic stroke, falls, cognitive failure and depression. It was aimed to determine the most appropriate time for measuring blood pressure in transition from supine to upright position in order to diagnose OH in elderly. Comprehensive geriatric assessment (CGA) including Head up Tilt Table (HUT) test was performed in 407 geriatric patients. Orthostatic changes were assessed separately for the 1st, 3rd and 5th minutes (HUT1, HUT3 and HUT5, respectively) taking the data in supine position as the basis. The mean age, recurrent falls, presence of dementia and Parkinson-s disease, number of drugs, alpha-blocker and anti-dementia drug use, and fasting blood glucose levels were significantly higher in the patients with versus without OH; whereas, albumin and 25-hydroxy vitamin D levels were significantly lower (p < 0.05). However, different from HUT3 and HUT5, Charlson Comorbidity Index and the prevalence of diabetes mellitus were higher, the use of antidiabetics, antipsychotics, benzodiazepine, opioid and levodopa were more common (p < 0.05). Statistical significance of the number of drugs and fasting blood glucose level was prominent in HUT1 as compared to HUT3 (p < 0.01, p < 0.05). Comparison of the patients that had OH only in HUT1, HUT(3)or HUT5 revealed no difference in terms of CGA parameters. These results suggests that orthostatic blood pressure changes determined at the 1st minute might be more important for geriatric practice. Moreover, 1st minute measurement might be more convenient in the elderly as it requires shorter time in practice. (C) 2016 Elsevier Ireland Ltd. All rights reserved.Publication Metadata only Neuroleptic Malignant Syndrome in an Elderly Patient With Normal Pressure Hydrocephalus Overlapping Corticobasal Degeneration(2015-06-01T00:00:00Z) Isik, Ahmet Turan; Soysal, PINAR; SOYSAL, PINARIn this case report, neuroleptic malignant syndrome (NMS) in an elderly patient with normal pressure hydrocephalus overlapping corticobasal degeneration was reported. The case highlights the need for clinicians to be cautious when using dopaminergic medication in the elderly patients, since these agents have risks for NMS which is a life-threatening complication. Additionally, co-occurrence of primary and secondary parkinsonian dementia syndromes should be kept in mind to avoid additional complications in the elderly patients.Publication Metadata only Attended with and Head-Turning Sign can be clinical markers of cognitive impairment in older adults(2017-11-01T00:00:00Z) Soysal, PINAR; Usarel, Cansu; Ispirli, Gul; Isik, Ahmet Turan; SOYSAL, PINARPublication Metadata only The Saint Louis University Mental Status Examination Is Better than the Mini-Mental State Examination to Determine the Cognitive Impairment in Turkish Elderly People(2016-04-01T00:00:00Z) Kaya, Derya; Isik, Ahmet Turan; Usarel, Cansu; Soysal, PINAR; Ellidokuz, Hulya; Grossberg, George T.; SOYSAL, PINARIntroduction: Presence of detailed screening instruments to detect cognitive impairment in the older adults- culture and language is very essential. The Saint Louis University Mental Status Examination (SLUMS) is one of cognitive screening scales used. The aim of the study was to establish the validity and reliability of the Turkish version of SLUMS (SLUMS-T).Publication Metadata only Current Concepts in the Diagnosis, Pathophysiology, and Treatment of Delirium: A European Perspective(2015-12-01T00:00:00Z) Soysal, PINAR; Kaya, Derya; Isik, Ahmet Turan; SOYSAL, PINARDelirium is a complex syndrome defined as an acute, fluctuating syndrome of altered attention, awareness, and cognition. Delirium is common in the elderly, but unfortunately underdiagnosed. The consequences could be significant such as an increase in mortality, hospitalization, loss of autonomy, and increased risk to be institutionalized. The predisposing and precipitating factors are well known, but the pathogenesis is not yet identified clearly. However, evidence that delirium is a neurotoxic factor which develops due primarily to neurotransmitter (cholinergic insufficiency) and inflammatory (increase in stress response/neuroinflammation) mechanisms is increasing each passing day. Delirium is associated with serious complications, but can also be treatable if diagnosed early and managed properly. It is important to develop primary and secondary prevention and therefore close contact with the patient, ensuring adequate vision, hearing, nutrition, hydration, and sleep; informing the caregivers about delirium for recognizing early symptoms of delirium, mobilizing the patient as early as possible, and managing the pain are strongly recommended. Besides, clinicians must identify the real underlying medical conditions. If non-pharmacologic interventions are insufficient, pharmacologic therapy should be implemented.Publication Metadata only Intracranial Hypotension-Like Syndrome After a Spinal Tap Test Performed for Idiopathic Normal Pressure Hydrocephalus(2015-09-01T00:00:00Z) Kaya, Derya; Soysal, PINAR; Isik, Ahmet Turan; SOYSAL, PINARIt is somewhat unexpected to have headaches in patients with idiopathic normal pressure hydrocephalus (INPH) for which the treatment is drainage of cerebrospinal fluid (CSF) using shunt. Moreover, intracranial hypotension syndrome (IHS) can be a challenging diagnosis, as CSF leak may be difficult to confirm as imaging findings can be normal. This report describes a woman with INPH who developed symptoms of IHS after a spinal tap test. There might be cases with IHS, like our case, who do not completely fulfill the current diagnostic criteria in terms of not having any objective evidence of intracranial hypotension but who also could not be explained by other conditions and recovered totally after classical IHS treatment. Current diagnostic criteria for IHS might be revised for those having normal neuroimaging and not accepting lumbar puncture. Nevertheless, when the history, signs, and symptoms strongly suggest IHS even with normal imaging, treatment should be started immediately.Publication Metadata only Does vitamin D deficiency increase orthostatic hypotension risk in the elderly patients?(2014-07-01T00:00:00Z) Soysal, PINAR; YAY, Adnan; Isik, Ahmet Turan; SOYSAL, PINAROrthostatic hypotension (OH) is closely associated with falls, cardiovascular events and mortality in the elderly patients. The aim of the study is to evaluate the OH prevalence among patients over the age of 65 years, to find out the impact of this condition on daily living activities, and to determine the possible effects of vitamin D levels on OH in elderly patients. Eight hundred and forty nine geriatric patients who had undergone comprehensive geriatric assessment were retrospectively evaluated and 546 patients were included in the study. The patient-s demographic characteristics, blood pressures, comorbid diseases, polypharmacy status, cognitive and nutritional states, basic and instrumental daily living activity indexes and laboratory values were obtained from hospital files. Serum 25-hydroxyvitamin D [25(OH)D] was measured by radioimmunoassay. The prevalence of OH was found to be 27.5%. Both daily living activity indexes were significantly lower in older patients with OH (p < 0.02), and serum 25(OH)D levels were significantly lower in older patients with OH (p < 0.01). Our findings suggest that vitamin D deficiency may be a factor in OH development. Because this condition is also preventable and correctable, serum vitamin D levels should be checked during the evaluation of OH patients and any detected deficiency should be treated accordingly. (C) 2014 Elsevier Ireland Ltd. All rights reserved.Publication Metadata only Vitamin B12 and folic acid levels are not related to length of stay in elderly inpatients(2013-05-01) SOYSAL, PINAR; Isik, Ahmet Turan; UGUR, Aycan; Kazancioglu, RÜMEYZA; ERGUN, Fatih; SOYSAL, PINAR; KAZANCIOĞLU, RÜMEYZA; BABACAN YILDIZ, GÜLSENObjective: We designed this study, to evaluate the interaction (relation) between vitamin B12 and folic acid levels and length of hospital stay in elderly inpatients.