Multidimensional Syndrome Research Articles

Medicinal Plants Approach for Diabetes Mellitus-A Computational Model

The multidimensional metabolic syndrome that includes diabetes mellitus poses a serious threat to world health. There is an increasing interest in researching herbal remedies for their possible therapeutic advantages, even as traditional allopathic treatments continue to be widely used. This work throws light on the multiple ways of metabolism and biochemical interactions of medicinal plants in the control of glucose level, highlighting their crucial role in the process. The work clarifies several herbal extracts' efficacy and safety profiles, such as Aloe vera, Garlic, Gurmar, Bitter Melon, Neem, Tulsi, and through a thorough literature review and empirical evidence. These plants, which are abundant in bioactive substances like tannins, flavonoids, and alkaloids, show promise in treating insulin resistance, improving pancreatic function, and controlling blood sugar level. A further assessment of the rising risk associated with diabetes mellitus is discussed, and a differential equation model for diabetes mellitus is developed to minimize the complications. When using medicinal plants to treat diabetes, several factors are considered, including blood sugar level, sugar intake activity, and plasma insulin concentrations. The stability criterion for the mathematical model is examined through the system of differential equations. A representation highlighting the medicinal plants that can aid individuals with diabetes mellitus is provided. The blood sugar level, insulin generalization variable and plasma insulin concentration have all been measured at different points in time. Aloe vera, Gurmar, Garlic, Tulsi, Bitter Melon and Neem are among the medicinal plants selected for their demonstrated anti-hyperglycemic properties due to their easy availability in India. Mathematical solutions were calculated for every plant and proved to be steady.

Shifting trait coordination along a soil‐moisture‐nutrient gradient in tropical forests

Abstract Soil nutrients and water availability are strong drivers of tropical tree species distribution across scales. However, the physiological mechanisms underlying environmental filtering along these gradients remain incompletely understood. Previous studies mostly focused on univariate variation in structural traits, but a more integrative approach combining multiple physiological traits is needed to fully portray species functional strategies. We measured nine leaf functional traits related to trees' resource capture and hydraulic strategies for 552 individuals belonging to 21 tropical tree species across an environmental gradient in Amazonian forests. Our sampling included generalist and specialist species from terra firme (TF) and seasonally flooded (SF) forests. We tested the influence of the topographic wetness index, a proxy for soil moisture and nutrient gradients, on each trait separately and on the trait integration through multivariate indices computed from the eigenvalues of a principal component analysis on the traits of the species. Finally, we evaluated intraspecific trait variability (ITV) for generalists and specialists by calculating the coefficient of variation for each trait. Results showed that (1) the environment had a greater influence on trait syndromes than single trait variation. Moreover, (2) SF specialist species expressed a stronger leaf trait coordination than TF specialist species. Furthermore, (3) the ability of generalist species to occupy a broader range of environments was not reflected by a larger ITV than specialist species but by the capacity to change trait coordination across environments. Our work highlights the need to investigate functional strategies as multidimensional syndromes in physiological trait space to fully understand and predict species distribution along environmental gradients. Read the free Plain Language Summary for this article on the Journal blog.

Transcriptomic and metabolomic changes might predict frailty in SAMP8 mice.

Frailty is a geriatric, multi-dimensional syndrome that reflects multisystem physiological change and is a transversal measure of reduced resilience to negative events. It is characterized by weakness, frequent falls, cognitive decline, increased hospitalization and dead and represents a risk factor for the development of Alzheimer's disease (AD). The fact that frailty is recognized as a reversible condition encourages the identification of earlier biomarkers to timely predict and prevent its occurrence. SAMP8 (Senescence-Accelerated Mouse Prone-8) mice represent the most appropriate preclinical model to this aim and were used in this study to carry transcriptional and metabolic analyses in the brain and plasma, respectively, upon a characterization at cognitive, motor, structural, and neuropathological level at 2.5, 6, and 9 months of age. At 2.5 months, SAMP8 mice started displaying memory deficits, muscle weakness, and motor impairment. Functional alterations were associated with a neurodevelopmental deficiency associated with reduced neuronal density and glial cell loss. Through transcriptomics, we identified specific genetic signatures well distinguishing SAMP8 mice at 6 months, whereas plasma metabolomics allowed to segregate SAMP8 mice from SAMR1 already at 2.5 months of age by detecting constitutively lower levels of acylcarnitines and lipids in SAMP8 at all ages investigated correlating with functional deficits and neuropathological signs. Our findings suggest that specific genetic alterations at central level, as well as metabolomic changes in plasma, might allow to early assess a frail condition leading to dementia development, which paves the foundation for future investigation in a clinical setting.

On the Relationship Between Frailty, Nutritional Status, Depression and Quality of Life Among Older People.

Frailty is a multidimensional geriatric syndrome associated with physical, psychological and social changes. There is a paucity of research on frailty in Sub-Saharan African (SSA) countries, especially Ethiopia. To assess the initial correlations among frailty, nutritional status, depression and QOL (quality of life) in a group of older people in Ethiopia who are later enrolled in a study examining the effects of a nurse-led community intervention on frailty and related health outcomes. Data from 68 community-dwelling individuals 60 years of age, or over, were collected. Frailty was measured using the Amharic version of the Tilburg Frailty Indicator. The statistical analysis included Spearman's rank correlation coefficient for degrees of association, Mann-Whitney U-test for variables with two categories and Kruskal-Wallis for variables with three or more categories. The mean frailty score for participants was 7.3 (±1.9). Participants with higher frailty scores had lower nutritional status (rs = -0.46, p < 0.01). There was a statistically significant relationship (positive) between frailty scores and depression (rs = 0.39, p < 0.01). Depressed (Md = 9, n = 23) and non-depressed frail older people (Md = 7, n = 45) showed a significant difference in their overall frailty score, U = 330.50, z = -2.49, p = 0.01, r = 0.30. There was an inverse significant association between the level of frailty across different domains in the QOL: physical (rs = -0.44, p < 0.01), psychological (rs = -0.45, p < 0.01), social relations (rs = -0.29, p < 0.05) and environmental (rs = -0.47, p < 0.01). The findings from this study were consistent with those from across middle-income and high-income countries. This research indicates that older people living in communities who are identified as frail often suffer from a poor nutritional status, depression and reduced QOL. It suggests that healthcare professionals in Sub-Saharan countries would benefit from recognising the frailty in this population, and developing interventions aimed at enhancing nutrition, mental health and overall well-being.

Frailty after Liver Transplantation: A Complex Unexplored Issue.

Frailty is a multidimensional syndrome predominantly studied in the elderly, characterized by reduced resistance to stressors due to diminished physiological reserve and resilience. Advances in surgical techniques and immunosuppressive drugs have improved long-term survival rates in solid organ transplant recipients, yet the 10-year survival is satisfying. However, liver transplant recipients have a noteworthy risk of developing frailty status. After liver transplant, frailty can be favored by socioeconomic, cultural, and health-related factors, leading to increased risks of hospitalization, morbidity, and mortality. Various tools for frailty assessment exist, but none are universally validated for post-transplant patients. The integration of socioeconomic and psychological factors into frailty evaluation could improve quality of life and long-term outcomes for transplant recipients. Multidisciplinary approaches, including psychosocial support, are essential for managing frailty and enhancing the overall care of transplanted patients. This narrative review aims to comprehensively address the principal frailty risk factors associated with liver transplantation.

Frailty and chronic diseases: A bi-directional relationship.

Frailty is a multidimensional syndrome associated with a decline in reserve capacity across multiple organ systems involving physical, psychological, and social aspects. Weakness is the earliest indicator of the frailty process. Multi-morbidity is the state of presence of two or more chronic diseases. Frailty and chronic diseases are interlinked as frail individuals are more prone to develop chronic diseases and multi-morbid individuals may present with frailty. They share common risk factors, pathogenesis, progression, and outcomes. Significant risk factors include obesity, smoking, aging, sedentary, and stressful lifestyle. Pathophysiological mechanisms involve high levels of circulating inflammatory cytokines as seen in individuals with frailty and chronic diseases such as hypertension, cardiovascular diseases, type 2 diabetes mellitus, chronic kidney disease, and anemia. Hence, frailty and chronic diseases go hand in hand and it is of utmost importance to identify them and intervene during early stages. Screening frailty and treating multi-morbidity incorporate both pharmacological and majorly non- pharmacological measures, such as physical activities, nutrition, pro-active care, minimizing polypharmacy and addressing reversible medical conditions. The purpose of this mini-review is to highlight the interrelation of frailty and chronic diseases through the discussion of their predictors and outcomes and how timely interventions are essential to prevent the progression of one to the other.

The Aftermath of COVID-19: Exploring the Long-Term Effects on Organ Systems.

Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalised. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected by PASC and its complications. The severity and the later development of PASC symptoms are positively associated with the early intensity of the infection. The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. The cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as conditions that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with the respiratory system in long-COVID causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. The renal system also was impacted, which resulted in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite, and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints linked to PASC. Long-COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy, and more study to address its underlying causes and long-term effects is needed.

The impact of frailty and rapid response team activation on patients admitted to the intensive care unit: A case-control matched, observational, single-centre cohort study.

Frailty is a multi-dimensional syndrome associated with mortality and adverse outcomes in patients admitted to the intensive care unit (ICU). Further investigation is warranted to explore the interplay among factors such as frailty, clinical deterioration triggering a medical emergency team (MET) review, and outcomes following admission to the ICU. Single-centre, retrospective observational case-control study of adult patients (>18 years) admitted to a medical-surgical ICU with (cases) or without (controls) a preceding MET review between 4 h and 14 days prior. Matching was performed for age, ICU admission diagnosis, Acute Physiology and Chronic Health Evaluation III (APACHE III) score and the 8-point Clinical Frailty Scale (CFS). Cox proportional hazard regression modelling was performed to determine associations with 30-day mortality after admission to ICU. A total of 2314 matched admissions were analysed. Compared to non-frail patients (CFS 1-4), mortality was higher in all frail patients (CFS 5-8), at 31% vs. 13%, and in frail patients admitted after MET review at 33%. After adjusting for age, APACHE, antecedent MET review and CFS in the Cox regression, mortality hazard ratio increased by 26% per CFS point and by 3% per APACHE III point, while a MET review was not an independent predictor. Limitations of medical treatment occurred in 30% of frail patients, either with or without a MET antecedent, and this was five times higher compared to non-frail patients. Frail patients admitted to ICU have a high short-term mortality. An antecedent MET event was associated with increased mortality but did not independently predict short-term survival when adjusting for confounding factors. The intrinsic significance of frailty should be primarily considered during MET review of frail patients. This study suggests that routine frailty assessment of hospitalised patients would be helpful to set goals of care when admission to ICU could be considered.

Prevalence of burnout and psycho-emotional disorders among non-health workers: a single tertiary care pediatric oncology center experience.

According to scientific literature, burnout can be described as a multidimensional syndrome with three fundamental dimensions: emotional exhaustion, depersonalization and reduced personal accomplishment. Every day, clown-doctors, play therapists, teachers and volunteers, such as ceramic art therapists, work in pediatric cancer wards to improve the quality of life of hospitalized children and activate positive resources during their therapeutic journey. This study investigated burnout levels and the relationship between work-related stress and resilience in a total of 36 operators (clown-doctors, in-hospital teachers, play therapists, and ceramic art therapists), working at the Unit of Pediatric Oncology of IRCCS A. Gemelli University Polyclinic Foundation in Rome, Italy. All participants completed a battery of questionnaires to evaluate burnout (Maslach Burnout Inventory) and resilience (Connor-Davidson Resilience Scale). The results of this study show that these workers are exposed to work-related stress and that the burnout levels are not homogeneous across the various groups considered. The results also show the need to provide non-health hospital workers with a psychological support service or ensure the presence of a mental health professional to help them avoid the risk of burnout. The heavy emotional burden endured by these operators makes them vulnerable and exposes them to burnout.

PREVALENCE OF FRAILTY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. A PILOT STUDY

Abstract Frailty is a multidimensional syndrome that leads to greater vulnerability to stress, increasing the risk of adverse health outcomes. It is a dynamic process, with transitions between being robust, pre-fragile and fragile over time, suggesting that it is modifiable. Inflammatory bowel disease (IBD) results in altered immune function with amplified inflammation. When severe, it manifests with features associated with frailty, such as weight loss, fatigue, and sarcopenia. The first studies on frailty in IBD were carried out in a surgical context. Subsequent studies have associated frailty with increased risk of mortality as an independent factor in IBD patients. Of the available evidence, all are retrospective -except one- and the majority measures frailty with associated ICD-10 diagnoses, which can underestimate its prevalence in younger patients. There is no consensus in the literature on the best tool to measure frailty, however, this pilot study will objectively evaluate, using a risk score, the prevalence of this syndrome, which will allow, in the future, to carry out prospective studies that characterize frailty in IBD, understand the dynamic and longitudinal relationship between frailty and disease activity and, if appropriate, design and test interventions to alleviate this syndrome and its consequences in this population. This was a descriptive study, with the objective to determine the prevalence of frailty in IBD patients in a teaching hospital in Chile. We also compared the characteristics of frail vs non-frail IBD patients. Frailty was measured using SHARE-FI tool, which is a validated score to measure frailty in primary care, even in patients under 65 years of age. 64 patients were recruited, 28 had ulcerative colitis, 33 had Crohn’s disease and 3 had indeterminate colitis. 62.5% were female, with an average age of 42,3 ± 13,65 years. Average years since diagnosis were 11,6 ± 9,89. The prevalence of frailty was 40,62%. No association was observed between the presence of frailty and the type of IBD, IBD activity indices, use of corticosteroids, use of biologic therapy, surgeries associated with IBD, IBD flare-ups with hospitalization within the last year, calprotectin levels, vitamin D levels. The odds of the presence of frailty in women are 4,2 times greater than in men, being women a possible risk factor for frailty. The frailty group had worse quality life measured with the IBD Questionnaire 9 (OR 0,86 [IC95% 0,79-0,94). In conclusion, the prevalence of frailty in IBD was 40,62%. Contrary to what might be assumed, frailty turned out to be a condition independent of the type of IBD, time of evolution, activity and treatment, mostly associated with female sex and a worse quality of life. New studies are required to determine factors predisposing to frailty in IBD patients and prevent its appearance in order to improve their prognosis.

Trait divergence and opposite above- and below-ground strategies facilitate moso bamboo invasion into subtropical evergreen broadleaf forest.

Understanding the invasion of moso bamboo (Phyllostachys edulis) into adjacent evergreen broadleaf forest based on functional traits is crucial due to its significant influence on ecosystem processes. However, existing research has primarily focused on above- or below-ground traits in isolation, lacking a comprehensive integration of both. In this study, we conducted a trait-based analysis including 23 leaf traits and 11 root traits in three forest types - bamboo forest, mixed bamboo and broadleaf forest, and evergreen broadleaf forest - to investigate trait differences, phenotypic integration, and above- and below-ground resource strategies in bamboo and broadleaf species. Our findings demonstrated significant differences in leaf and root key traits between bamboo and broadleaf species, strongly supporting the "phenotypic divergence hypothesis". Bamboo exhibited stronger trait correlations compared to broadleaf species, indicating higher phenotypic integration. Above- and below-ground strategies were characterized by trade-offs rather than coordination, resulting in a multi-dimensional trait syndrome. Specifically, a unidimensional leaf economics spectrum revealed that bamboo with higher leaf N concentrations (LNC), P concentrations (LPC), and specific leaf area (SLA) adopted a "fast acquisitive" above-ground strategy, while broadleaf species with thicker leaves employed a "slow conservative" above-ground strategy. A two-dimensional root trait syndrome indicated a "conservation" gradient with bamboo adopting a "slow conservative" below-ground strategy associated with higher root tissue density (RTD), and broadleaf species exhibiting a "fast acquisitive" below-ground strategy linked to higher root N concentrations (RNC) and P concentrations (RPC), and a "collaboration" gradient probably ranging from broadleaf species with a "do-it-yourself" strategy characterized by high specific root length (SRL), to bamboo adopting an "outsourcing" strategy with thicker roots. In conclusion, key trait divergence from coexisting broadleaf species, higher phenotypic integration, and multi-dimensional opposite above- and below-ground resource strategies confer competitive advantages to moso bamboo, shedding light on the mechanistic understanding of its invasion into subtropical evergreen broadleaf forest and providing theoretical guidance for maintaining the stability of subtropical forest ecosystem.

Identifying Trajectories of Change in Burnout Symptoms of Gaelic Games Athletes Over Two Consecutive Seasons.

Athlete burnout is conceptualized as an enduring multidimensional syndrome, and longitudinal research is essential to understanding its development over time. However, much of the existing work has been limited to a small number of timepoints (≤3) or short intervals between waves (≤3weeks), which fail to account for the chronic and complex nature of the syndrome. This study aimed to address these limitations by tracking burnout in adult athletes at 6 timepoints over a 21-month period for the first time. Data from 207 Gaelic games athletes were included in latent growth analysis to compare burnout trajectories of increasing complexity. A linear model best described all burnout symptoms. On average over the 21-month period, feelings of exhaustion declined, sport devaluation increased, and reduced accomplishment remained stable. Findings provide important insight into potential high-risk periods in the season and can help to inform targeted intervention or prevention efforts.

A Scoping Review of the Effects of Ambient Air Quality on Cognitive Frailty

Environmental and public health research has given considerable attention to the impact of air quality on brain health, with systematic reviews being widespread. No literature review has been conducted for cognitive frailty—a multidimensional syndrome combining physical frailty and cognitive impairment and their apparent co-dependence, linked to increased vulnerability and adverse health outcomes, including dementia. Instead, cognitive decline and frailty are implicitly explored through research on air quality and comorbid cognitive and physical decline in elderly populations. A scoping review was conducted to explore the need for a systematic review. Combining the Arksey and O’Malley, and PRISMA-ScR checklist, a scoping review of SCOPUS using ‘cogniti*’ + ‘resilience’ + ‘air quality’ or ‘cogniti*’ + ‘ageing’ + ‘air quality’ resulted in n = 2503 articles, screened and reduced using inclusion and exclusion criteria, to n = 16 articles. Air quality appears to be a critical risk factor for cognitive decline, even at air quality levels below WHO targets. Moderate long-term ambient air pollution appears linked to increased risk of cognitive frailty, suggesting earlier and more active interventions to protect older people. There are varied effects on cognition across the life course, with both emotional and functional impacts. Effects may be more detrimental to elderly people with existing conditions, including economic and health inequalities. Generalisation of results is limited due to the absence of a dose–response, variations in methods, controlling for comorbid effects, and variance across studies. No literature review has been performed for cognitive frailty, largely due to the fact that it is not presently treated as an explicit outcome. The findings support the need for more research and a more extensive summary of the literature but suggest that there is worsening cognitive function over the life course as a result of increased PM2.5 concentrations. Furthermore, air quality appears to be a critical risk factor even at levels below World Health Organisation targets.

The association of CT-assessed fat-free muscle fraction with frailty and malnutrition and the predictive value of their combination in patients undergoing TAVR

Abstract Background Frailty is a multidimensional syndrome that affects mortality after TAVR. Malnutrition is a related condition and promotes the development of frailty. The current guidelines for the management of valvular heart disease recommend an objective evaluation of frailty for risk stratification in patients with aortic stenosis. However, the proposed frailty scales are time-consuming and provide inconsistent results, due to their semiquantitative nature. Computed tomography (CT) is a part of routine pre-interventional TAVR workup and allows for additional body composition analysis, including the assessment of fat-free muscle fraction (FFMF) as an indicator of muscle quality. Aims The aim of this study was to evaluate the relationship between FFMF and frailty as well as malnutrition, as assessed with various scales and to examine the predictive value of FFMF and frailty in patients with AS undergoing TAVR. Methods Our study cohort consisted of 206 patients undergoing TAVR between 2018 and 2019. Frailty was assessed using the Fried Frailty Phenotype (FFP) and the Katz Index. Malnutrition was measured using the Mini Nutritional Assessment (MNA-LF). Furthermore, the patients were evaluated with CT scans, and skeletal muscle area at the L3/L4 level was determined. The skeletal muscle area was separated in areas of fatty and lean muscle according to densitometric thresholds to calculate the FFMF (Figure 1). Outcome of interest was one-year mortality following TAVR. Results The prevalence of frailty ranged from 46.1% (n=95), as assessed with the FFP score to 7.3% (n=15), as classified using the Katz Index. Nutritional assessment using the MNA-LF scale showed that 107 (51.9%) patients were at normal nutritional status, whereas 85 (41.3%) patients were at risk for malnutrition, and 14 (6.8%) patients were already malnourished. According to the CT evaluation 64 (31.1%) patients had a high FFMF, 73 (35.4%) patients had a medium FFMF, and 69 (33.5%) patients had a low FFMF. A Low FFMF was associated with higher rates of frailty and malnutrition according to all scales tested (Figure 2 A). However, depending on various scales, the prevalence of frailty and malnutrition showed a wide range among patients with a low FFMF, reaching from 10.8% as assessed with the MNA-LF to 66.0% as evaluated by the FFP scale. A low FFMF was associated with increased one-year mortality (20.3%) as compared to a medium (6.8%) or low FFMF (6.3%, p=0.01, Figure 2 B). Moreover, a combination of FFMF with frailty was superior to frailty alone in predicting patient's outcome following TAVR. Conclusion The CT-assessed FFMF is a strong and independent predictor of dismal outcomes in patients undergoing TAVR. A low FFMF is associated with significantly higher rates of frailty and malnutrition. Moreover, a combination of FFMF with frailty scales may better identify vulnerable patients at risk of an unfavorable outcome after TAVR.Figure 1Figure 2 A - B

FRI127 Delay Of A Decade In The Diagnosis Of Primary Aldosteronism In Patients With Onset Of Hypertension ≤ 40 Yo

Abstract Disclosure: S. Parisien-La Salle: None. A. Lacroix: None. I. Bourdeau: None. Introduction: Primary aldosteronism (PA) is a frequent and underdiagnosed cause of secondary hypertension. Mean age at diagnosis is 50-55 years old (yo), however, hypertension often precedes the diagnosis of PA by many years [1,2]. Objective: To evaluate the delay between the diagnosis of hypertension and the diagnosis of PA in patients with onset of hypertension ≤ 40 yo. Methods: We retrospectively collected the clinical information of patients with PA who were diagnosed with hypertension at ≤ 40 yo from our specialized genetics adrenal clinic. Results: We identified 47 patients with PA who presented with hypertension at ≤ 40 yo. Twenty-one patients (44.7%) were female. At diagnosis of PA, 76.6% (36/47) had hypokalemia, 29.8% (14/47) had sleep apnea, 17% (8/47) had type 2 diabetes, 8.5% (4/47) had coronary artery disease and 4.3% (2/47) had atrial fibrillation. More than half of patients (53.2%) were on 3 or more anti-hypertensive drugs. Mean age at diagnosis of hypertension was 30.8 and mean age at diagnosis of PA was 43.5 yo with an average delay of 12.7 years and a median delay of 10 years (IQR: 4,10,19,37).In the group diagnosed with PA within 10 years of the diagnosis of hypertension (n: 24), the average number of anti-hypertensive drugs per patient was 2.3 and 79.2% (19/24) had hypokalemia. In the group diagnosed with PA more than 10 years after the diagnosis of hypertension (n: 23), the average number of anti-hypertensive drugs per patient was higher at 3.4 with a similar prevalence of hypokalemia (73.9% (17/23)).In patients with hypertension diagnosed ≤ 30 yo (n: 23), the mean age at diagnosis of hypertension was 25.3 yo with a median of 28, and the mean age at diagnosis of PA was of 39.2 yo with a median of 34. Thus, the average delay was 13.9 years and the median was 10 years (IQR: 1.5, 10, 26.5, 37). However, in patients with hypertension diagnosed ≤ 20 yo (n: 5), the mean age at diagnosis of hypertension was 16.8 yo with a median of 18, and the mean age at diagnosis of PA was of 25.4 yo with a median of 21 yo. Thus, the average delay was 8.6 years and the median was 3 years (IQR: 2,3,10,28). Conclusion: We demonstrate that in our cohort the median delay is approximately of 10 years between the diagnosis of hypertension and PA for patients diagnosed with hypertension between 30 and 40 yo. Neither the number of antihypertensive drugs, nor the presence of hypokalemia seemed to determine a shorter delay of diagnosis. However, patients diagnosed with hypertension ≤ 20 yo had shorter delays of diagnosis of PA with a median of 3 years. Bibliography: 1. Alam, S.; Kandasamy, D.; et al. High prevalence and a long delay in the diagnosis of primary aldosteronism among patients with young-onset hypertension. Clin Endocrinol (Oxf)2021, 94, 895-903, doi:10.1111/cen.14409.2. Turcu, A.F.; Yang, J.; Vaidya, A. Primary aldosteronism - a multidimensional syndrome. Nat Rev Endocrinol2022, 18, 665-682, doi:10.1038/s41574-022-00730-2. Presentation: Friday, June 16, 2023

Sarcopenia as a Little-Recognized Comorbidity of Type II Diabetes Mellitus: A Review of the Diagnosis and Treatment.

Type II diabetes mellitus (T2DM) is one of the most widespread metabolic diseases worldwide, with a significant impact on morbi-mortality. Sarcopenia has a high risk in this population (two times more risk) and a high impact at the functional level, especially in older adults. In addition, it poses enormous challenges in the diagnosis, prevention, and treatment of this disease concomitantly. The objective is to review the current knowledge on the state of muscle mass and the pathogenesis, diagnosis, and treatment of sarcopenia in people with T2DM. A bibliographic search was conducted in the PubMed-Medline databases for articles from 2015 with previously defined terms. A loss of muscle mass in older diabetic patients who are malnourished or at risk of malnutrition has a proven negative impact on their autonomy and is closely related to the risk of sarcopenia as a high-impact disease, and also with frailty, as an associated multidimensional syndrome. Notably, we found that malnutrition and protein deficiency are often underdiagnosed in obese and overweight T2DM patients. Biochemical markers could help in the future with approaches to managing T2DM and sarcopenia concomitantly. The four essential elements which form the basis of care for patients with diabetes and sarcopenia are pharmacological treatment, nutrition management, regular physical exercise, and correct daily regime. The increasing prevalence of sarcopenia among older patients with T2DM has significant negative impacts on quality of life and is a public health concern. Effective diagnosis and management require a multidisciplinary approach involving pharmacological treatment, nutrition, exercise, and correct daily regime, with future research needed to understand the underlying mechanisms and improve diagnostic and treatment strategies.

Linguistic and non-linguistic markers of disorganization in psychotic illness.

Disorganization, presenting as impairment in thought, language and goal-directed behavior, is a core multidimensional syndrome of psychotic disorders. This study examined whether scalable computational measures of spoken language, and smartphone usage pattern, could serve as digital biomarkers of clinical disorganization symptoms. We examined in a longitudinal cohort of adults with a psychotic disorder, the associations between clinical measures of disorganization and computational measures of 1) spoken language derived from monthly, semi-structured, recorded clinical interviews; and 2) smartphone usage pattern derived via passive sensing technologies over the month prior to the interview. The language features included speech quantity, rate, fluency, and semantic regularity. The smartphone features included data missingness and phone usage during sleep time. The clinical measures consisted of the Positive and Negative Symptom Scale (PANSS) conceptual disorganization, difficulty in abstract thinking, and poor attention, items. Mixed linear regression analyses were used to estimate both fixed and random effects. Greater severity of clinical symptoms of conceptual disorganization was associated with greater verbosity and more disfluent speech. Greater severity of conceptual disorganization was also associated with greater missingness of smartphone data, and greater smartphone usage during sleep time. While the observed associations were significant across the group, there was also significant variation between individuals. The findings suggest that digital measures of speech disfluency may serve as scalable markers of conceptual disorganization. The findings warrant further investigation into the use of recorded interviews and passive sensing technologies to assist in the characterization and tracking of psychotic illness.

An Update on Apathy in Alzheimer's Disease.

Apathy is a complex multi-dimensional syndrome that affects up to 70% of individuals with Alzheimer's disease (AD). Whilst many frameworks to define apathy in AD exist, most include loss of motivation or goal-directed behaviour as the central feature. Apathy is associated with significant impact on persons living with AD and their caregivers and is also associated with accelerated cognitive decline across the AD spectrum. Neuroimaging studies have highlighted a key role of fronto-striatial circuitry including the anterior cingulate cortex (ACC), orbito-frontal cortex (OFC) and associated subcortical structures. Importantly, the presence and severity of apathy strongly correlates with AD stage and neuropathological biomarkers of amyloid and tau pathology. Following from neurochemistry studies demonstrating a central role of biogenic amine neurotransmission in apathy syndrome in AD, recent clinical trial data suggest that apathy symptoms may improve following treatment with agents such as methylphenidate-which may have an important role alongside emerging non-pharmacological treatment strategies. Here, we review the diagnostic criteria, rating scales, prevalence, and risk factors for apathy in AD. The underlying neurobiology, neuropsychology and associated neuroimaging findings are reviewed in detail. Finally, we discuss current treatment approaches and strategies aimed at targeting apathy syndrome in AD, highlighting areas for future research and clinical trials in patient cohorts.

European Respiratory Society statement on frailty in adults with chronic lung disease.

Frailty is a complex, multidimensional syndrome characterised by a loss of physiological reserves that increases a person's susceptibility to adverse health outcomes. Most knowledge regarding frailty originates from geriatric medicine; however, awareness of its importance as a treatable trait for people with chronic respiratory disease (including asthma, COPD and interstitial lung disease) is emerging. A clearer understanding of frailty and its impact in chronic respiratory disease is a prerequisite to optimise clinical management in the future. This unmet need underpins the rationale for undertaking the present work. This European Respiratory Society statement synthesises current evidence and clinical insights from international experts and people affected by chronic respiratory conditions regarding frailty in adults with chronic respiratory disease. The scope includes coverage of frailty within international respiratory guidelines, prevalence and risk factors, review of clinical management options (including comprehensive geriatric care, rehabilitation, nutrition, pharmacological and psychological therapies) and identification of evidence gaps to inform future priority areas of research. Frailty is underrepresented in international respiratory guidelines, despite being common and related to increased hospitalisation and mortality. Validated screening instruments can detect frailty to prompt comprehensive assessment and personalised clinical management. Clinical trials targeting people with chronic respiratory disease and frailty are needed.

The Role of Apathy in Spontaneous Verbal and Nonverbal Behaviors: A Transdiagnostic Pilot Study in Neurodegeneration.

Apathy, characterized by a quantifiable reduction in motivation or goal-directed behavior, is a multidimensional syndrome that has been observed across many neurodegenerative diseases. To develop a novel task measuring spontaneous action initiation (ie, a nonverbal equivalent to spontaneous speech tasks) and to investigate the association between apathy and executive functions such as the voluntary initiation of speech and actions and energization (ie, ability to initiate and sustain a response). We compared the energization and executive functioning performance of 10 individuals with neurodegenerative disease and clinically significant apathy with that of age-matched healthy controls (HC). We also investigated the association between self-reported scores on the Apathy Evaluation Scale (AES) and performance on energization tasks. The individuals with apathy made significantly fewer task-related actions than the HC on the novel spontaneous action task, and their scores on the AES were negatively correlated with spontaneous task-related actions, providing preliminary evidence for the task's construct validity. In addition, the individuals with apathy performed more poorly than the HC on all of the energization tasks, regardless of task type or stimulus modality, suggesting difficulty in sustaining voluntary responding over time. Most of the tasks also correlated negatively with the AES score. However, the individuals with apathy also performed more poorly on some of the executive function tasks, particularly those involving self-monitoring. Our work presents a novel experimental task for measuring spontaneous action initiation-a key symptom of apathy-and suggests a possible contribution of apathy to neuropsychological deficits such as poor energization.