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Background The prevalence of sarcopenia and its impact in older patients undergoing inpatient cardiac rehabilitation (iCR) after cardiac procedure has been insufficiently studied. The main aim of this study was to evaluate the prevalence of sarcopenia and quantify the functional capacity of older sarcopenic and non-sarcopenic patients participating in iCR. Methods Prospective, observational cohort study within the framework of the ongoing multicenter prehabilitation study “PRECOVERY”. A sample of 122 patients ≥75 years undergoing iCR after cardiac procedure were recruited in four German iCR facilities and followed up 3 months later by telephone. At iCR (baseline), the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F) questionnaire was used to identify sarcopenic patients. In addition, Katz-Index, Clinical Frailty Scale (CFS), handgrip strength (HGS), Short Physical Performance Battery (SPPB) and 6-minute walk distance (6MWD) measured functional capacity and frailty at baseline. Outcomes were prevalence of sarcopenia and the correlation of sarcopenia to functional capacity and frailty at baseline as well as the SARC-F score at follow-up. The Wilcoxon test was applied for pre-post-test analysis. Correlation between sarcopenia and 6MWD, SPPB score and HGS was tested with the eta coefficient with one-way ANOVA. Results Complete assessments were collected from 101 patients (79.9 ± 4.0 years; 63% male). At baseline, the mean SARC-F score was 2.7 ± 2.1; 35% with sarcopenia. Other baseline results were Katz-Index 5.7 ± 0.9, CFS 3.2 ± 1.4, HGS 24.9 ± 9.9 kg, SPPB score 7.5 ± 3.3 and 6MWD 288.8 ± 136.5 m. Compared to baseline, fewer patients were sarcopenic (23% versus 35%) at follow-up. In the subgroup of sarcopenic patients at baseline ( n  = 35), pre-post comparison resulted in a significant SARC-F improvement ( p  = 0.017). There was a significant correlation between sarcopenia measured by SARC-F and poor results in the assessments of functional capacity ( p  < 0.001; r > 0.546). Conclusions The prevalence of sarcopenia in older patients at iCR after cardiac procedure is high (35%) and remains high at follow-up (23%). Sarcopenia screening is important since the diagnosis of sarcopenia in these patients correlates significantly with poor functional capacity. The results indicate that these patients may benefit from prehabilitation aimed at improving perioperative outcomes, increasing functional capacity and mitigating adverse effects. Trial registration German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00032256). Retrospectively registered on 13 July 2023.

Purpose Postoperative delirium (POD) in patients with obstructive sleep apnea (OSA) is associated with increased mortality and healthcare costs. In this study, we investigated the association of OSA risk, serum biomarkers for central nervous ischemia (S100B and NSE), and POD. Methods After research ethics approval, patients completed the STOP BANG assessment before undergoing elective surgery. Blood was drawn for S100B and NSE measurement, and cognitive performance was tested using the Montreal Cognitive Assessment (MoCA) at study admission and postoperatively at discharge. Delirium assessment was performed using the Nursing Delirium Screening Scale (NuDESC) and the Confusion Assessment Method (CAM). Results One hundred twenty-four enrolled patients were separated into three OSA-risk groups based on STOP BANG score testing (low risk, n  = 22; intermediate risk, n  = 67; high risk, n  = 35). Preoperative NSE values increased with OSA risk (NSE in ng/ml; mean [range]; low risk: 15.6 [9.2–44.3]; intermediate risk: 21.8 [7.6–114.1]; high risk: 29.2 [10.1–151]; p  = 0.039). Postoperative MoCA and NuDESC assessments were not different between the OSA-risk groups. We found a decreasing incidence for POD with increasing OSA risk (positive CAM: low risk: 18.1%, intermediate risk: 12.0%; high risk: 11.5%, p  = 0.043). However, this was no longer detectable in a complete case analysis. In patients with POD, postoperative ischemic biomarker values were not different between OSA-risk groups. Conclusion We found a trend of decreasing POD incidence with increasing OSA risk, which was not robust in a complete case analysis. Our results possibly support the phenomenon of hypoxic preconditioning.

Background Postoperative delirium is a common complication of cardiac surgery associated with higher morbidity, longer hospital stay, risk of cognitive decline, dementia, and mortality. Geriatric patients, patients undergoing cardiac surgery, and intensive care patients are at a high risk of developing postoperative delirium. Gold standard assessments or biomarkers to predict risk factors for delirium, cognitive decline, and dementia in patients undergoing cardiac surgery are not yet available. Methods The FINDERI trial (FINd DElirium RIsk factors) is a prospective, single-center, observational study. In total, 500 patients aged ≥ 50 years undergoing cardiac surgery at the Department of Cardiovascular and Thoracic Surgery of the University of Göttingen Medical Center will be recruited. Our primary aim is to validate a delirium risk assessment in context of cardiac surgery. Our secondary aims are to identify specific preoperative and perioperative factors associated with delirium, cognitive decline, and accelerated dementia after cardiac surgery, and to identify blood-based biomarkers that predict the incidence of postoperative delirium, cognitive decline, or dementia in patients undergoing cardiac surgery. Discussion This prospective, observational study might help to identify patients at high risk for delirium prior to cardiac surgery, and to identify important biological mechanisms by which cardiac surgery is associated with delirium. The predictive value of a delirium screening questionnaire in cardiac surgery might be revealed. Finally, the identification of specific blood biomarkers might help to predict delirium, cognitive decline, and dementia in patients undergoing cardiac surgery. Trial registration : Ethics approval for this study was obtained from the IRB of the University of Göttingen Medical Center. The investigators registered this study in the German Clinical Trials Register (DRKS; https://www.drks.de ) (DRKS00025095) on April 19th, 2021.

Background Frailty is an indicator of a decline in quality of life and functional capacity in cardiac rehabilitation (CR) patients. Currently, there is no standardized assessment tool for frailty used in CR. The aim of this study was to determine if the Clinical Frailty Scale (CFS) is feasible for assessing frailty in CR. Methods Prospective, cross-sectional study within the framework of the ongoing multicenter prehabilitation study \"PRECOVERY\". Patients ≥75 years undergoing CR after cardiac procedure (n=122) were recruited in four German inpatient CR facilities. Assessments included: CFS, Katz-Index, hand grip strength (HGS), Short Physical Performance Battery (SPPB) and six-minute-walk test (6MWT). Outcomes were frailty (CFS≥4) and the correlation of frailty with assessments of functional capacity, activities of daily living and clinical parameters. Statistical analysis included descriptive statistics and correlations, using the spearman correlation coefficient and chi-square test to test for significance. Results Data from 101 patients (79.9±4.0 years; 63% male) were analyzed. The mean CFS score was 3.2±1.4; 41.6% were defined as frail (CFS≥4). The mean time required to assess the CFS was 0.20 minutes. The findings show that CFS correlates significantly (p<0.001) with the following factors: Katz-Index, HGS, SPPB-Score and 6MWT (r≤-0.575). In addition, CFS correlated with small to moderate effects with co-morbidities (r=0.250), as-needed medications and need for nursing assistance (r≤0.248). Conclusions The CFS assessment can be performed in under one minute and it correlates significantly with assessments of functional capacity, activities of daily living and clinical parameters in the CR setting. Trial registration German Clinical Trials Register (DRKS; http:// www. drks. de; DRKS00032256). Retrospectively registered on 13 July 2023.

The Otago program (OP) is evidence-based and focuses on fall prevention in older people. The feasibility and usability of a short-term digital program modeled after the principles of the OP in the setting of early geriatric rehabilitation (EGR) are unclear. This study investigated the feasibility and usability of an additional technology-based fall prevention program (FPP) in the setting of EGR. We performed a feasibility study in the setting of EGR. A sample of 30 patients (mobility at least by walker; mini-mental status test score >17) was recruited between March and June 2024 and compared with a retrospective cohort (n=30, former EGR patients). All patients in the intervention group (IG) received a supervised, OP-modified FPP thrice/week for 20 minutes using a technology-based platform called \"Pixformance.\" The device is a digital trainer and enables real-time corrections. The primary end point was the feasibility (given when 80% of the IG participated in 6 trainings within 2 weeks). Secondary outcomes were usability (patients' and facilitators' perspective; ≥75%), risk of falls (Berg Balance Scale), mobility (Timed Up and Go Test), functional independence (Functional Independence Measure), and activities of daily living (Barthel Index). Several further exploratory end points were analyzed including anxiety and depression (Four-Item Patient Health Questionnaire; PH-Q4). Data were accessed at entry to EGR and after 2 weeks prior to discharge. To analyze the pre-posttest results, the dependent Student t test and the Wilcoxon test were applied. A mixed ANOVA with repeated measurements was used for statistical analyses of time-, group-, and interaction-related changes. A cohort of 60 patients (mean 80.2, SD 6.1 y; 58% females, 35/60) was analyzed. The main indication for EGR was stroke (9/60, 15%). Patients were recruited into a prospective IG (n=30) and a retrospective control group (n=30). Of the 30 patients in the prospective IG, 11 patients (37%) completed 6 training sessions within 2 weeks. Reasons why participants did not complete 6 training sessions were diagnostic appointments (33%), pain/discomfort (33%), or fatigue (17%). EGR patients rated FPP usability at 84% and facilitators at 65% out of 100%. Pre-posttest analysis of the standard assessments showed a significant interaction in Berg Balance Scale (<.01). In both groups, a significant improvement over time was found in the Timed Up and Go Test (<.01), Barthel Index (<.01), and Functional Independence Measure (<.01). Likewise, in the IG, the PH-Q4 score (.02) improved. While the technology-based FPP in the EGR setting was generally well-accepted by patients, with high usability ratings, its feasibility was limited. Only 37% of participants completed the required additional training sessions. Further studies should test the technology-based FPP as an integrated part of the EGR complex therapy concept. Our findings suggest potential benefits of incorporating technology-based FPPs in EGR, but further refinement is needed to enhance participation and feasibility.

There are currently 1.8 million people in Germany affected by dementia. Despite advances in research and new treatments, there is no cure for most cases of dementia. The evidence regarding the prevention of cognitive decline in old age is unclear. In addition to the optimized adjustment of drug treatment (e.g., arterial hypertension and diabetes mellitus), preventive measures that can be influenced by individuals themselves play an important role. These include areas such as physical and cognitive activity, remedying hearing loss, sleep, social contacts, abstaining from alcohol as well as tobacco consumption and nutrition. Multimodal concepts and digital approaches appear to be promising and an increase in evidence is expected in the coming years.

Zusammenfassung Derzeit sind 1,8 Millionen Menschen in Deutschland von einer Demenz betroffen. Trotz Forschungsfortschritten und neuen Therapien gibt es für die meisten Demenzerkrankungen keine Heilung. Die Evidenzlage bezüglich der Prävention von kognitivem Abbau im Alter ist nicht eindeutig. Neben einer optimierten Einstellung von medikamentösen Behandlungen (z. B. arterieller Hypertonie und Diabetes mellitus) spielen selbstbeeinflussbare Präventionsmaßnahmen eine wichtige Rolle. Hierzu zählen Bereiche wie körperliche und kognitive Aktivität, Behebung von Schwerhörigkeit, Schlaf, soziale Kontakte, Alkohol- als auch Tabakkonsumverzicht und Ernährung. Multimodale Konzepte und digitale Ansätze erscheinen vielversprechend, und ein Evidenzzuwachs wird in den kommenden Jahren erwartet.

Derzeit sind 1,8 Millionen Menschen in Deutschland von einer Demenz betroffen. Trotz Forschungsfortschritten und neuen Therapien gibt es für die meisten Demenzerkrankungen keine Heilung. Die Evidenzlage bezüglich der Prävention von kognitivem Abbau im Alter ist nicht eindeutig. Neben einer optimierten Einstellung von medikamentösen Behandlungen (z. B. arterieller Hypertonie und Diabetes mellitus) spielen selbstbeeinflussbare Präventionsmaßnahmen eine wichtige Rolle. Hierzu zählen Bereiche wie körperliche und kognitive Aktivität, Behebung von Schwerhörigkeit, Schlaf, soziale Kontakte, Alkohol- als auch Tabakkonsumverzicht und Ernährung. Multimodale Konzepte und digitale Ansätze erscheinen vielversprechend, und ein Evidenzzuwachs wird in den kommenden Jahren erwartet.