Bernhard Iglseder

Background: Serum uric acid has been consistently associated with cardiovascular risk, yet whether this relationship reflects independent vascular pathology or cardiometabolic risk clustering remains unresolved. We examined associations of serum uric acid and hyperuricemia with imaging-defined subclinical coronary and carotid atherosclerosis in a large population-based cohort. Methods: We analyzed data from the Paracelsus 10,000 study, a population-based cohort of adults aged 40–77 years recruited from the Austrian national population registry. Coronary artery calcium (CAC) was assessed by computed tomography in 1561 participants with available cardiac computed tomography and polygenic risk score data; carotid plaque burden was assessed by ultrasonography in 8970 participants. Associations were evaluated using ordinal logistic regression — with CAC categorized by Agatston score (0, 1–99, 100–299, ≥ 300) and carotid plaque burden categorized by total plaque area — with sequential adjustment for cardiovascular risk score (SCORE2), metabolic syndrome, polygenic cardiovascular risk, lipoprotein(a) and systemic inflammation. Results: Higher serum uric acid levels were strongly associated with greater CAC burden in unadjusted analyses (OR 1.60 per 1 mg/dL, 95% CI 1.48–1.74). This association was attenuated but remained significant after adjustment for cardiovascular risk score, metabolic syndrome, polygenic risk, lipoprotein(a), and inflammatory markers (OR 1.26, 95% CI 1.14–1.38). Hyperuricemia was independently associated with higher CAC categories after adjustment (OR 1.67, 95% CI 1.20–2.32). Carotid plaque burden showed a strong unadjusted association with serum uric acid that was substantially attenuated after multivariable adjustment, although a weak association remained statistically significant (OR 1.06, 95% CI 1.01–1.10). Conclusions: Serum uric acid and hyperuricemia are independently associated with subclinical coronary atherosclerosis beyond established cardiovascular risk factors, genetic susceptibility and systemic inflammation. The attenuation of carotid plaque associations after full adjustment suggests that extracoronary plaque burden is largely driven by cardiometabolic risk clustering rather than urate-specific pathways. These findings position uric acid as a clinically accessible marker of subclinical coronary atherosclerosis and raise the question of whether systematic urate assessment should inform cardiovascular risk stratification beyond established risk scores.

Self-rated health (SRH) is a simple but powerful predictor of morbidity and mortality. Its relevance in rheumatoid arthritis (RA) has not been systematically investigated in population-based cohorts. We analyzed 9,399 participants of the Paracelsus 10,000 study, including 293 (3.1%) with physician-diagnosed RA. SRH was assessed with a single-item global question. Associations of RA, sociodemographic, metabolic, and lifestyle factors with poor SRH were examined using multivariable logistic regression. Poor or very poor SRH was reported by 55% of RA participants compared with 31% of non-RA participants (p < 0.001). RA was independently associated with more than twofold higher odds of poor SRH (adjusted OR 2.21 (95% CI 1.61-3.02). Advanced age, metabolic syndrome, and current smoking were linked to worse SRH, whereas male sex, higher education, and higher physical activity were protective. Each one-point increase in Mediterranean diet adherence (PREDIMED score) was associated with a 4% lower odds of poor SRH (OR 0.96, 95% CI 0.94-0.99). No interaction between RA and diet adherence was observed. RA is strongly associated with poor self-rated health in the general population, after adjustment for comorbidities and lifestyle factors. Higher adherence to the Mediterranean diet and greater physical activity were linked to better perceived health, highlighting modifiable targets to improve patient-centered outcomes in RA.

Zusammenfassung: Das zentrale Nervensystem (ZNS) verarbeitet Informationen, koordiniert Bewegungen und ermöglicht Kommunikation – sowohl innerhalb des Körpers als auch mit der Umgebung: Wahrnehmen und Reagieren auf Sinneseindrücke unterliegen der Steuerung des Gehirns, afferente und efferente Bahnen durchlaufen das Rückenmark. Das periphere Nervensystem (PNS) vermittelt zwischen Umgebung und ZNS. Mit zunehmendem Alter verändert sich das PNS, was zu einer Abschwächung von Muskeleigenreflexen und Propriozeption führt. Davon abzugrenzen sind Polyneuropathien (PNP) als Erkrankungen des PNS. Die Ursachen sind vielfältig: Neben isolierten metabolischen, immunmediierten, hereditären, toxischen und infektiösen Ätiologien können PNP auch Ausdruck von Systemerkrankungen sein. Neuropathien in Zusammenhang mit Diabetes, monoklonalen Gammopathien und Malignomen sind im Alter häufiger, auch der Anteil der kryptogenen Neuropathie nimmt im Alter zu. PNP tragen zu einer Beeinträchtigung der Mobilität und erhöhtem Sturzrisiko bei, was die Abklärung funktioneller Fähigkeiten erforderlich macht. Schmerzen und sensorische Störungen wirken sich negativ auf die Aktivitäten des täglichen Lebens aus. Als Folge wird die Kommunikation mit den Lebensumwelten beeinträchtigt. Ein geriatrischer Ansatz ermöglicht neben einer exakten Diagnose auch eine umfassende, auf die individuellen Bedürfnisse zugeschnittene Therapie.

Background/Objectives: Postoperative Delirium (POD) is a frequent complication in older patients undergoing elective surgery. Although multicomponent interventions are effective, deficits in interdisciplinary communication and intersectoral collaboration persist. This study developed and evaluated the “Geriatric Delirium Pass (GeDePa)”, a paper-based tool to systematically document risk factors for POD across care settings. Methods: A multi-method design was applied, comprising (i) a structured literature review, (ii) semi-structured expert interviews, and (iii) a standardized online survey utilizing the RAND/UCLA Appropriateness Method (RAM). A total of 21 healthcare professionals (general practitioners, geriatricians, anaesthetists, surgeons, and nurses) were recruited from Salzburg, Austria, and South Tyrol, Italy (2023–2024). Results: Healthcare professionals confirmed the GeDePa’s practical applicability for early POD risk detection across care settings. The expert rating using the RAM Disagreement Index (DI) method deemed all 45 risk factors as sufficiently relevant and, with the exemption of two risk factors (alcohol use, intraoperative complications), feasible. A detailed analysis provided a more differentiated picture, with full consensus reached for only 18 items. Several factors with uncertain consensus (e.g., cognitive impairment and polypharmacy) were retained based on strong evidence in the literature. Others were excluded despite high ratings if they were considered redundant or impractical (e.g., detailed intraoperative complications). In total, 38 of the 45 risk factors were retained. Conclusions: The GeDePa is a feasible and relevant tool for structured delirium risk assessment and enhancing interdisciplinary communication between primary and hospital care. The finalized German and Italian versions are now available and will undergo further testing and implementation in clinical practice.

Psychosis is a frequent and disabling non-motor complication of Parkinson’s disease (PD). Clozapine and quetiapine are widely used in the treatment of Parkinson’s disease psychosis (PDP). We conducted an exploratory study to compare patient experiences with physician prescribing practices. Patients with PDP hospitalized at a university center completed semi-structured interviews on perceived efficacy, adverse effects, and daily functioning. Neurologists and geriatricians attending training sessions completed a structured questionnaire on prescribing patterns, attitudes toward clozapine, and perceived treatment burden. Data were analyzed thematically and triangulated across cohorts. Eleven patients (mean age 81 years; nine treated with quetiapine, two with clozapine) were included. Most quetiapine-treated patients reported persistent hallucinations, sedation, dizziness, and reduced autonomy. Fourteen physicians completed the survey and most preferred quetiapine, citing monitoring logistics and agranulocytosis risk as barriers to clozapine. Overall, patient priorities centered on symptom control and independence, whereas physician decisions emphasized feasibility and safety. Facilitating clozapine monitoring and incorporating patient-reported outcomes into routine care may improve patient-centered PDP management.

Background: Rheumatoid arthritis (RA) has been linked to an increased risk of chronic kidney disease (CKD), but the predominant renal phenotype and its independence from established risk factors remain unclear. We examined the RA–CKD association in a large, population-based cohort. Methods: RA and CKD were defined using American College of Rheumatology/European Alliance of Associations for Rheumatology and KDIGO criteria. Logistic regression models were employed with stepwise adjustment: first for cardiovascular risk [Systematic COronary Risk Evaluation 2 (SCORE2)], followed by a model including age, sex, metabolic syndrome, smoking status, non-steroidal anti-inflammatory drug (NSAID) use and high-sensitivity C-reactive protein. Interaction terms were tested to evaluate effect modification. Results: Among 9665 participants from the Paracelsus 10,000 cohort, 296 (3.1%) had RA. CKD prevalence was higher in the RA group compared with controls (11.8% vs 6.7%, P < .001). Albuminuria at preserved estimated glomerular filtration rate was the dominant renal manifestation in RA (6.8% vs 4.2%, P = .027). In unadjusted analyses, RA was associated with higher odds of CKD [odds ratio (OR) 1.86, 95% confidence interval (CI) 1.30–2.68], an association that persisted after cardiovascular risk adjustment. However, the association was attenuated and no longer statistically significant in the fully adjusted model (OR 1.43, 95% CI 0.96–2.13). A significant interaction was observed with NSAID use (P = .042), whereby the association was largely confined to RA patients not using NSAIDs. Conclusions: RA is associated with a higher prevalence of CKD, primarily driven by albuminuria at preserved kidney function. This distinct renal phenotype appears largely mediated by metabolic comorbidities rather than inflammation alone. Our findings highlight the need for systematic albuminuria screening in RA patients to enable earlier detection and intervention.