GERİATRİ PRATİĞİNDE HANGİSİ DAHA YIKICIDIR: FİZİKSEL KIRILGANLIK MI? KOGNİTİF KIRILGANLIK MI?

Giriş: Fiziksel kırılganlıkla birlikte bilişsel fonksiyonlarda etkilenme olarak tanımlanan kognitif kırılganlık, mobilizasyon kısıtlılığı, depresyon, demans, morbidite ve mortalite riskinde artış ile ilişkilidir. Bu çalışmanın amacıyeni bir tanım olan kognitif kırılganlığın fiziksel performansla ilişkisini araştırmaktır. Yöntem: Geriatri polikliniğine ayaktan başvuran ayrıntılı geriatrik değerlendirme yapılan 600 hasta çalışmaya alındı. Demans tanılı hastalar kognitif kırılganlık tanımına uygun olarak dışlandı. Tüm hastaların iskelet kas kütlesi, yürüme hızı, kas gücü ölçümleri sırasıyla biyoimpedans, 4 metre yürüme testi analizi, el dinamometresi ile kaydedildi. Sarkopeni tanısı, Avrupa Yaşlılarda Sarkopeni Çalışma Grubu (EWGSOP) kriterlerine göre konuldu. Kırılganlık için Fried Fiziksel Kırılganlık Ölçeği kullanıldı. Hastaların global kognisyonu Mini Mental Durum Muayenesi (MMSE) veya Montreal Kognitif Değerlendirme Ölçeği (MOCA) ile değerlendirildi. Bulgular: Hastaların %70’inin kadın cinsiyette olduğu ve yaş ortalamasının 73,39±7,06 yıl olduğu görüldü. Kırılgan olmayan grubun daha genç olduğu, daha az ilaç kullandığı ve kronik hastalık yükünün daha az olduğu bulundu. Yaş, cinsiyet, hastalık yükü, ilaç sayısı düzeltilip regresyon analizi yapıldığında; kırılgan olmayan ve fiziksel kırılganlığı olan hastalara göre, kognitif kırılgan hastalarda günlük yaşam aktiviteleri, yürüme hızı ve el kavrama gücünün en çok etkilendiği belirlendi. Sonuç: Yaşlı hastalardaki eş zamanlı kognitif - fiziksel fonksiyonların bozulması hastalarda daha kötü fonksiyonellikle ilişkili olduğu saptandı. Bu yüzden kırılganlık açısından tarama yaparak erken dönemde hastalara müdahalede bulunulması yıkıcı etkilerin azalmasına neden olabilir.

WHICH IS MORE DEVASTATING IN GERIATRICS PRACTICE: PHYSICAL FRAILTY? COGNITIVE FRAILTY?

Introduction: Cognitive-frailty, defined as the presence of both physical frailty and cognitive impairment, is associated with mobility restriction, depression, dementia, and increased risk of morbidity and mortality. The aim of the study was to investigate the relationship between a new concept defined as cognitive frailty and physical performance. Materials and Methods: A total of 600 patients who admitted to geriatric outpatient clinic, were included to the study. Patients diagnosed with dementia were excluded in accordance with the definition of cognitive frailty. Skeletal muscle mass, walking speed, muscle strength measurements of all patients were recorded using with bioimpedance, 4 meter walking test analysis and hand dynamometer, respectively. Diagnosis of sarcopenia was determined according to European Working Group on Sarcopenia in Older Adults (EWGSOP) criteria. Fried Physical Frailty Scale was used to diagnose frailty. Global cognition of the patients were assessed by Mini Mental State Examination (MMSE) and Montreal Cognitive Asssessment (MOCA). Results: 70% of patients were women and mean age of patients was 73.39±7.06. It was observed that the non-frail group was younger, used fewer drugs, and had a lower burden of chronic disease. Activities of daily living, walking speed and hand grip strength were the most affected in cognitive frail patients compared to non-frail and physical frail patients when the regression analysis performed adjusted to age, gender, burden of systemic diseases, number of drugs. Conclusion: Simultaneous cognitive - physical functional impairment in older patients was found to be associated with poorer physical performance and functionality. Therefore, screening patients for frailty and intervening early may cause decrease of the destructive effects.

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