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Aim: To examine cross‐sectional associations between continuous glucose monitoring (CGM)‐derived metrics and cerebral small vessel disease (SVD) in older adults with type 2 diabetes. Materials and Methods: In total, 80 patients with type 2 diabetes aged ≥70 years were analysed. Participants underwent CGM for 14 days. From the CGM data, we derived mean sensor glucose, percentage glucose coefficient of variation, mean amplitude of glucose excursion, time in range (TIR, 70‐180 mg/dl), time above range (TAR) and time below range metrics, glycaemia risk index and high/low blood glucose index. The presence of cerebral SVD, including lacunes, microbleeds, enlarged perivascular spaces and white matter hyperintensities, was assessed, and the total number of these findings comprised the total cerebral SVD score (0‐4). Ordinal logistic regression analyses were performed to examine the association of CGM‐derived metrics with the total SVD score. Results: The median SVD score was 1 (interquartile range 0‐2). Higher hyperglycaemic metrics, including mean sensor glucose, TAR >180 mg/dl, TAR >250 mg/dl, and high blood glucose index and glycaemia risk index, were associated with a higher total SVD score. In contrast, a higher TIR (per 10% increase) was associated with a lower total SVD score (odds ratio 0.73, 95% confidence interval 0.56‐0.95). Glycated haemoglobin, percentage glucose coefficient of variation, mean amplitude of glucose excursions, time below range and low blood glucose index were not associated with total cerebral SVD scores. Conclusions: The hyperglycaemia metrics and TIR, derived from CGM, were associated with cerebral SVD in older adults with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Aims/Introduction: To investigate the changes in the glycated hemoglobin (HbA1c) levels and the relative status of the glycemic control related to the new glycemic targets recommended by the Japan Diabetes Society/Japan Geriatrics Society Joint Committee in 2016 in patients with diabetes mellitus visiting a memory clinic from 2012 to 2020. Materials and Methods: This cross‐sectional study included 1,436 patients aged ≥65 years with diabetes. Patients were categorized into three categories as follows: category I, intact cognitive function and activities of daily living (ADL); category II, mild cognitive deficits or impaired instrumental ADL; and category III, moderate to severe cognitive impairment or impaired basic ADL. Trends in HbA1c levels, glycemic control status (optimally/poorly/excessively controlled) and proportion of individuals receiving drugs potentially associated with severe hypoglycemia among all patients and categories (I, II or III) from 2012 to 2020 were examined using linear, logistic and multinominal logistic regression models adjusted for confounding factors. Results: Between 2012 and 2020, the HbA1c levels, as well as the proportion of patients with poor glycemic control, increased, whereas the proportion of patients with excessive glycemic control and those receiving drugs potentially associated with severe hypoglycemia decreased. Conclusions: Increased levels of HbA1c and decreased proportions of individuals under excessive glycemic control might reflect recent treatment strategies that avoid hypoglycemia in older patients. Given the adverse complications associated with hyperglycemia, more flexible and individualized glycemic targets based on comprehensive assessments, including vascular complications and comorbidities, might be necessary. [ABSTRACT FROM AUTHOR]

Aim: Olfactory impairment is associated with cognitive impairment. However, differences between subjective and objective olfactory impairment measurements in older adults and their relationship with cognitive impairment are unclear. Methods: We assessed the relationship between cognitive and olfactory impairments via a single‐center observational study in 2020. Forty‐seven individuals who visited our memory clinic were enrolled and asked to complete objective and subjective olfactory tests. Participants had dementia, mild cognitive impairment, or normal cognition. We administered the Open Essence (a simple card‐type odor identification test) and self‐administered odor questionnaire to assess objective and subjective olfaction, respectively, and the Mini‐Mental State Examination to assess cognitive function. Results: Older age was related to decreased Open Essence scores (P < 0.001). Compared with the mild cognitive impairment and normal cognition groups, the dementia group had significantly lower Open Essence scores (P < 0.001). Cognitive impairment was also associated with decreased Open Essence scores after adjusting for age, sex, and education (P < 0.001). Participants with dementia did not obtain lower self‐administered odor questionnaire scores than those with normal cognition, and they tended to be unaware of their olfactory impairment. Conclusion: Open Essence scores significantly decreased according to the degree of cognitive impairment. Participants with dementia were unaware of their olfactory impairment, as indicated by odor questionnaire scores. Objective and subjective scores of olfaction differed in participants with dementia. Concomitant assessment of objective and subjective olfaction is useful to screen older adults with both olfactory and cognitive impairments. Geriatr Gerontol Int 2022; 22: 924–929. [ABSTRACT FROM AUTHOR]

White matter hyperintensities ( WMH) are defined as cerebral white matter changes presumed to be of vascular origin, bilateral and mostly symmetrical. They can appear as hyperintense on T2-weighted and fluid-attenuated inversion recovery sequences, and as isointense or hypointense on T1-weighted magnetic resonance imaging of the brain. WMH have been focused on because of their clinical importance as a risk factor for cerebrovascular diseases and cognitive impairment. WMH are associated with geriatric syndrome, which is defined by clinical symptoms characteristic of older adults, including cognitive and functional impairment and falls. Cerebral small vessel diseases, such as WMH, might play an important role as risk factors for cerebrovascular diseases, cognitive impairment and geriatric syndrome through the mechanism of arterial stiffness. However, the vascular, physiological and metabolic roles of arterial stiffness remain unclear. Basically, arterial stiffness indicates microvessel arteriosclerosis presenting with vascular endothelial dysfunction. These changes might arise from hemodynamic stress as a result of a 'tsunami effect' on cerebral parenchyma. In the present article, we review the clinical characteristics of WMH, focusing particularly on two associations: (i) those between cerebral small vessel diseases including WMH and arterial stiffness; and (ii) those between WMH and geriatric syndrome. Geriatr Gerontol Int 2015; 15 (Suppl. 1): 17-25. [ABSTRACT FROM AUTHOR]

The article reports a case study of a 68 year old woman with inferior vena cava (IVC) due to giant liver cyst (GLC) syndrome, which decreased activities of daily life (ADL). Computed tomography (CT) revealed that the cyst compressed the IVC due to dilatation of IVC on the lower level with GLC. The author concluded that her leg was caused with IVC compression due to GLC because of absence of thrombus in the cystic wall and weight loss and treatment of leg edema resulted in no change in IVC.

The article presents a study on the analysis of white matter hyperintensity (WMH), a common finding in the aging brain, which highlights the accuracy of the newly developed modified Rotterdam visual rating scale. The cubed values of the scale are found to have a good correlation with the WMH. WHM is also noted to be involved with the development of various geriatric conditions and it increases with age.

A letter to the editor is presented which discusses the case of a 75-year-old woman with diabetes mellitus (DM), who was diagnosed with sustained hypoglycemia after undergoing diagnostic imaging.

A letter to the editor is presented which highlights a case of a 72-year-old hypertensive man who was diagnosed with Dieulafoy's lesions (DL) in the jejunum.