Geriatric Update Apr 27, 2026
In a prospective cohort of 884 patients with stage 1A non-small cell lung cancer (NSCLC), the 12% octogenarians had higher postoperative complication rates (40% vs 22%) but achieved similar 5-year overall survival and lung cancer-specific survival to younger patients, with comparable recovery in quality of life by 12 months.
A magnetic resonance imaging (MRI) before treatment in men undergoing radical prostatectomy can provide independent prognostic value for prostate cancer outcomes. In a systematic review of 40 studies, MRI-detected extra-prostatic extension was independently associated with biochemical recurrence (pooled HR 2.16, 95% CI 1.84-2.54), metastatic failure (HR 3.18, 95% CI 2.04-4.97), and prostate cancer-specific mortality (HR 10.93, 95% CI 5.05-23.65). MRI-detected seminal vesicle invasion was especially associated with biochemical recurrence (HR 2.74, 95% CI 2.06-3.65) and metastatic failure (HR 5.58, 95% CI 1.15-27.13).
Incorporating structured, home-based exercise programs such as walking and resistance band exercises into routine chemotherapy care significantly reduced treatment-related cognitive impairment (chemo-brain) with better thinking and less mental fatigue.
When asked to prioritize living longer or maintaining quality of life, patients about to start a new systemic cancer treatment chose quality of life by an 8-to-1 margin. But, this meta-analysis of 791 randomized controlled trials (RCT) with 555,580 patients showed that rates of upfront treatment modifications and downstream clinical outcomes – such as survival, incidence of serious adverse events or hospitalization rates – did not vary based on preference. We clinicians have to do better at including quality of life information when discussing treatment options.
Each 1% reduction in body mass index (BMI) was associated with 1% lower risk for obesity-related cancers at 3 years, equating to a 4.9% risk reduction with 5% weight loss – with 5 years equating to a 5.4% risk reduction and 5% weight loss. Additionally, for any malignancy, each 5% weight loss correlated with cancer risk reductions of 3.9% at 3 years, 3% at 5 years and 4.4% at 10 years. This was a retrospective observational study of 143,630 propensity matched adults (BMI ≥ 30) from an integrated US health system's electronic health record.
In 11 European countries, mortality from cardiovascular disease (CVD) has declined while mortality from dementia has increased among individuals with diabetes over 20 years. This makes sense, as with better prevention and treatment of CVD we live longer and are more likely to develop dementia, while rising obesity rates also contribute to increase in dementia. Clinicians may have additionally become more aware of the dementia diagnosis and then coded it more over time.
Hospitalization for drug poisoning rose during the first 4 weeks of gabapentinoid treatment (gabapentin or pregabalin) and was almost double with an adjusted incidence rate ratio (aIRR) of 1.81 (95% CI 1.66-1.99, P<0.001). Gabapentinoids and benzodiazepines were four times more likely (aIRR 3.95, 95% CI 3.07-5.07, P<0.001) to cause drug poisoning compared with people taking neither drug, and combination with opioids doubled the poisoning risk (aIRR 2.14, 95% CI 1.77-2.58, P<0.001). This was based on 16,827 individuals in the UK database review, age 47.
The number of US patients prescribed long-term opioid therapy declined from 2015 to 2023 by 24.3%, but co-prescribing of opioids with gabapentinoids increased from 47% in 2015 to 58.7% in 2023. This combination is on the Beers list because it is particularly dangerous in older adults, causing delirium, confusion, dizziness, falls, etc.
The FDA is moving to allow compounding pharmacies to produce more than a dozen injectable peptides that were banned because of potentially significant safety risks. Several are pushed by social media influencers as “anti-aging” products. I strongly recommend against all of them.
The combination of two blood tests improved Alzheimer’s disease screening and reduced overdiagnosis in people with asymptomatic Alzheimer’s pathology. The ratio of phosphorylated tau 217 to non-phosphorylated tau (%p-tau217), with the other measuring microtubule-binding region-tau243 (eMTBR-tau243), had an accuracy of 81%, a positive predictive value of 84%, a negative predictive value of 77%, and a sensitivity of 82%.
Although anemia was associated cross-sectionally with higher levels of AD blood biomarkers and longitudinally with increased dementia risk (hazard ratio [HR], 1.66; 95% CI, 1.21-2.28), the observational study did not fully adjust for inflammation. It controlled for IL-6 but not other inflammation markers. In 3,363 Swedish adults, age 72, adjusted Hazard ratio (aHR) for dementia was 1.09 (95% CI, 0.43-2.75) among those with anemia only, which is not significant. In contrast, the highest risk for dementia was found in men with anemia and elevated glial fibrillary acidic protein (GFAP), aHR 7.16 (3.44-14. 88).
Delirium triples the risk of dementia, hazard ratio (aHR) 3.38 (95% CI 2.46–4.63) and is associated with higher early mortality (≤90 days: aHR 4.23 [95% CI 3.27–5.49]) and late mortality (>90 days: 1.64 [1.33–2.03]).
In this Cochrane review of 16 randomized controlled trials (2,115 participants, >60 years old) of postoperative delirium (POD), 12 melatonin-only trials showed lower incidence with 163/729 (22.4%) versus 230/732 (31.4%) in controls (RR 0.67; 95% CI 0.52-0.88; p = 0.004). Four ramelteon trials, however, showed no significant effect (25/166 [15.1%] vs 24/161 [14.9%]; RR 0.98; 95% CI 0.47-2.01; p = 0.948). Trials using melatonin doses >5 mg demonstrated a greater reduction in POD, with delirium occurring in 57/314 patients (18.2%) in the melatonin group compared with 113/308 patients (36.7%) in control groups (RR 0.52; 95% CI 0.40-0.68; p < 0.001).
10 Small Things Neurologists Wish You’d Do for Your Brain:
Wear a helmet
Wear ear plugs when around noise (concerts, mowing the lawn, etc.)
Get your eyes checked
Wear a mask on smoggy or smoky days
Take a walk and swap your chair for a stool
Floss your teeth every day
Join a book club
Sleep well
Watch your neck (bad massages or chiropractic care)
Manage your cholesterol
And I want to add: Manage your blood pressure to <120/80.
Human pegivirus (HPgV) was found in brain tissue and cerebrospinal fluid from half the samples, 5 of the 10 people with Parkinson’s Disease (PD), but in none of those without the condition.
A case series of 14 PD patients with intractable seizures found an association of vitamin B-6 deficiency with levodopa doses exceeding 1,000 mg daily, with higher doses (>1,500 mg levodopa) associated with shorter duration from treatment initiation to identification of vitamin B-6 deficiency, leading the FDA to issue a warning. We must be careful with B-6 replacement because high as well as low levels can lead to nerve damage and dementia. In January I wrote that adults should not consume more than 0.9 mg of vitamin B6 per day from supplements and the European Food Safety Authority (EFSA) in 2023 lowered the tolerable total daily intake of vitamin B6 for adults from 25 mg/d to 12 mg/d because of the risk of neurotoxicity and dementia. I recommend a multivitamin for seniors to prevent deficiency of a number of vitamins that are absorbed less efficiently in older adults, but in select PD patients on carbidopa/levodopa, checking a level may be indicated.
Prodromal symptoms of constipation, hyposmia, and REM sleep disorders increased the risk of developing PD in the next 3 years by a factor of 23, based on 6,000 men in the health professional study without PD, followed for 3.5 years, in which 103 participants developed PD.
One potentially new therapeutic approach for PD disease is with the implantation of dopaminergic progenitor cells or blood-derived potent stem cells in the striatum in Parkinson's disease bilaterally. One study in the United States with 12 patients, who also received immunosuppression, showed no serious adverse events and in particular no tumors, and an increase in 18Fluoro-DOPA uptake in the putamen within the high-dose group on PET. A second study in Japan with seven patients over 24 months showed no safety signals with clinical improvement in six patients and with 18F-DOPA uptake increasing by approximately 45% on PET.
In 15 participants with Parkinson's disease and 15 healthy controls, music was associated with faster walking speed, longer steps, and better arm movement without worsening step timing when compared with a metronome or controls.
Dysfunction of the somato-cognitive action network (SCAN) (newly identified in 2023)—which is thought to control action execution by integrating goals, physiology, body movement and whole-body motor plans (foot, hand and mouth) with behavioral motivation—is a potential contributor to the diverse clinical manifestations of PD and could lead to new treatment approaches.
An influenza screening risk score with 6 items (subjective fever, interference with usual activity, headache, wheeze, phlegm, and recent flu vaccine) had a range from -5 to +6 points. The AUC was 0.75. The prevalence of influenza was 15%.
In 5 academic medical centers, AI scribe adoption was associated with 13.4 minutes decrease in total EHR time, 16.0 minutes less documentation time, and an increase of 0.49 visits per week. Changes associated with AI scribe adoption were greatest for primary care specialists, advanced practice clinicians, female clinicians, and clinicians who used AI scribes in 50% or more of visits.
Because of Medicaid cuts, 446 hospitals – 267 in urban areas and 176 in rural areas – are at risk of paring down services or shutting completely. They served around 6.6 million patients in 2024 and employ 275,000 direct patient workers.
The EPA said that it would try to curb levels of microplastics and pharmaceuticals in the drinking water of hundreds of millions of Americans. It was not yet clear how they would implement this.
The CDC head Dr. Jay Bhattacharya blocked the publication of a study that was accepted and showed COVID-19 vaccines roughly halved the chances that a U.S. adult would need to visit the emergency room or be hospitalized with their infections last fall and winter, according to two sources familiar with the findings of this new study. This network has published in New England Journal of Medicine and The Lancet and all of these other very high-profile journals in the past. This seems like pretty aggressive interference by a political appointee into CDC scientific processes.
The CDC reports 1,782 confirmed measles cases in 37 states vs 1,738 cases in 33 states last week.
The OMDA call on Thu April 30 is on: Medical School Admissions, by Doug Moses, MD, FAAP
Be so completely yourself that everyone else feels safe to be themselves, too. (Justin Preston)
