Mehmet Akif Topcuoglu

Rapid aging of global population has led to an attention increasingly focusing on age-related changes in muscle and cognitive functions, specifically the interplay between sarcopenia, frailty and cognitive impairment as the interconnected geriatric syndromes with major health consequences. Despite being the central pathophysiological substrate across these geriatric syndromes, skeletal muscle loss is still insufficiently prioritized as a treatment objective. Incorporating the “malnutrition-sarcopenia-frailty” triad into dementia care is essential for continuity of management, as muscle preservation is fundamental to sustaining cognitive function within an active aging paradigm. This perspective reframes longevity by shifting emphasis from anticipating frailty to living with strength, valuing added years through resilience rather than decline. This narrative review, prepared by experts in neurology and geriatrics, explores the muscle-brain crosstalk and highlights skeletal muscle loss as a modifiable target for nutritional intervention in cognitive impairment and dementia. In conclusion, given the bidirectional links between malnutrition, sarcopenia, frailty, and cognitive decline through shared aging mechanisms, a high protein oral nutritional supplement [enriched with beta-hydroxy-beta-methylbutyrate (HMB)] and vitamin D emerges as a practical, compliant strategy to support muscle health and potentially contribute to preservation of cognitive health in older adults with or at risk of dementia, although direct evidence for cognitive benefit remains limited.

Objectives: This study aimed to assess the mental health status of neurology residents in Türkiye and identify contributing factors, with the goal of enhancing the quality of neurology training. Patients and methods: A web-based, multiple-choice survey was designed by a study-group of the Turkish Society of Neurology. Neurology residents throughout Türkiye were invited to participate via email between October 2023 and May 2024. The questionnaire gathered data on demographics, institutional characteristics, educational activities, and working conditions. Mental health and job satisfaction were evaluated using the Minnesota Job Satisfaction Questionnaire, Maslach Burnout Inventory, Beck Anxiety Inventory, and Beck Depression Inventory. Results: A total of 226 neurology residents (135 females, 91 males; median age: 28 years; range, 25 to 47 years) who completed the online survey were included in the analysis. Participants reported a median of 55 working hours per week, with approximately 10% of this time dedicated to educational activities. Symptoms of depression were present in 64.6% of respondents, while anxiety affected 72.1%. Burnout symptoms were identified in 97.3% of participants, and 46.5% met criteria for burnout. Weekly working hours and time allocated for research and education were positively associated with job satisfaction, yet inversely correlated with burnout, depression, and anxiety. Exploratory factor analysis revealed six principal components influencing burnout and job satisfaction: weekly working hours, time allocated for education, confidence in personal competency, adequacy of clinical equipment, time spent on research, and sociodemographic characteristics (Kaiser-Meyer-Olkin: 0.64; cumulative explained variance: 69.02%). Conclusion: This study demonstrated a high prevalence of burnout, depressive symptoms, and anxiety among neurology residents in Türkiye. Targeted interventions such as the reduction of daily clinical workload and the expansion of protected time for academic activities may be warranted to mitigate these adverse psychological outcomes and promote professional well-being.

Alzheimer's disease (AD) remains the leading cause of dementia, and with current treatments offering limited efficacy, interest in neuronutraceuticals has grown due to their potential to target core mechanisms of AD pathology. This PROSPERO‐registered systematic review, conducted per PRISMA guidelines, screened 4684 manuscripts and included 37 randomised controlled trials (RCTs) evaluating neuronutraceuticals across the AD continuum. Trials ranged from Phase 1 to Phase 3 and investigated compounds acting on amyloid and tau pathology (e.g., DHA and tramiprosate), neuroinflammation (resveratrol, curcumin), hormonal modulation (soy isoflavones), synaptogenesis (bryostatin‐1, magnesium), oxidative stress (Ginkgo biloba, alpha‐lipoic acid), energy metabolism (oxaloacetate, NAD ⁺ , spirulina), synaptic plasticity (Fortasyn Connect, cerebrolysin) and cholinergic transmission (crocin, huperzine‐A). Although three agents showed favourable outcomes in large‐scale RCTs, sodium oligomannate was excluded due to design limitations, and genistein and Ginkgo biloba were dismissed based on neutral findings in other trials. Most studies were underpowered or inconclusive, and Cochrane RoB2 assessment revealed ‘some concerns’ in all but two trials, primarily due to attrition (86.5%) and reporting bias (81%). Overall, current evidence does not support the clinical implementation of neuronutraceuticals in AD, underscoring the need for larger, methodologically rigorous trials to clarify their therapeutic role. Trial Registration: The research protocol was registered with PROSPERO (CRD420251127545)

Objectives: Case reports indicate that caseous mitral annulus calcification (MAC), also termed mitral annulus caseous granuloma, may contribute to stroke and systemic embolism. This retrospective case-control study aimed to assess the prevalence of caseous MAC detected through cardiac computed tomography (CT) in an acute stroke cohort and to identify factors associated with its occurrence. Methods: A total of 149 patients with acute ischemic stroke who underwent emergency cardiac CT, 300 acute ischemic stroke patients who did not undergo cardiac CT, and 268 individuals who underwent cardiac CT but had no history of stroke were included. The first group was consecutively selected (January 2022 to November 2024), while the other 2 groups were identified through propensity matching based on age and sex. Various regression models were applied to determine the degree of association. Results: Caseous MAC was detected in 5.4% of stroke patients who underwent cardiac CT, a prevalence significantly higher than in the control group (1.1%, P =0.02). Regression models demonstrated that caseous MAC significantly ( P =0.011) and independently increased stroke risk by a factor of 7.57 to 10.81 (95% CI: 1.54-36.20). Conclusions: These findings suggest that caseous mitral annulus calcific granuloma may be a potential cause of embolic stroke. Further prospective, multicenter studies are needed to validate these results.

Background/aim: The link between atrial fibrillation (AF) and lean body mass is unclear. This study presents the effects of AF on sarcopenia indices, including ultrasonographic muscle architecture. Materials and methods: In this study conducted in neurology units, 72 subjects with AF (mean age: 71 ± 11years, 49% female) were compared with 538 without AF (mean age:66±12years; 53% female) in terms of sarcopenia indices [anthropometry; Short Physical Performance Battery (SPPB); hand grip strength (HGS); bioimpedance analysis (BIA) indices; skeletal muscle mass index (SMMI) normalized to weight, height and body mass index (BMI); and phase angle (PhA)]; muscle ultrasonography [thickness, cross-section area (CSA), fiber length (fL) and pennation angle (PeA) of rectus femoris (RF), biceps brachii (BB), vastus lateralis (VL), vastus intermedius (VIM) and gastrocnemius medialis (GCM)]; possible causes of sarcopenia such as malnutrition; and consequences of sarcopenia [fall, fatigue, SarQol] along with sarcopenia screening (SARC-F). Possible associations were tested in multiple exploratory linear models, and partial r(pr) and p were reported. Results: Participants with AF exhibited significantly higher SARC-F and SarQol scores. In multivariable models adjusted for age, sex, height, and body weight, AF was independently linked to lower mean and maximum HGS (pr = –0.137, p = 0.014; pr = –0.130, p = 0.02), reduced PhA (pr = –0.193, p < 0.001), decreased RF thickness (pr = –0.120; p = 0.004), and diminished RF+VIM thickness (pr = –0.098; p = 0.019). Additional muscle ultrasound parameters, including BB-CSA, RF-CSA, BB-brachialis thickness, VL fL, and PeA and BIA indices, including SMMI(height), SMMI(weight), and SMMI(BMI), tended to be lower in AF. Conclusion: AF is linked to impaired muscle health and reduced quality of life. Management should include thigh muscle ultrasound and strategies to prevent malnutrition.

Neuronutrient supplements are widely marketed as adjunctive treatments for neurological disorders, but their scientific validity is limited. This review highlights the disconnect between consumer-driven use and the lack of compelling clinical evidence. While a mechanistic possibility exists, the proliferation of these products risks undermining evidence-based neurology without standardized assessment frameworks.