Geriatric Update Dec 15, 2025
Invasive management for acute coronary syndrome (ACS) showed worse outcomes than medical mgmt. and should not be considered routine in frail older adults. This was the conclusion after additional studies with more rigorous frailty assessments came out after a meta-analysis was published that showed invasive treatment reduced cardiac events in ACS but increased bleeding risk thus negated the benefit. Sometimes science changes very rapidly.
Among patients who underwent coronary-artery bypass grafting (CABG) for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, or repeat coronary revascularization than aspirin alone at 1 year.
Among 1445 patients with myocardial infarction (MI) and multivessel disease, age 80, at 3 years, revascularization of all vessels that showed ischemia, was better than only the culprit vessel: death, MI, stroke, or ischemia-driven revascularization occurred in 165 patients (22.9%) in the physiology-guided complete revascularization group and 216 patients (29.8%) in the culprit-only group (hazard ratio [HR], 0.72). Secondary outcome of cardiovascular death or MI also occurred in a significantly lower number of patients in the physiology-guided complete revascularization group (92 patients [12.8%]) compared with the culprit-only group (132 patients [18.2%]; HR, 0.66). Hospitalizations for heart failure were less frequent in the physiology-guided complete group compared with the culprit-only group (103 [14.3%] vs 143 [19.7%]; HR, 0.7).
In a nonrandomized clinical trial including 171,727 intensive care unit patients, magnesium supplementation was not associated with a statistically significant reduction in tachyarrhythmias.
Central retinal artery occlusion (CRAO) is a subtype of ischemic stroke that results in vision loss of the affected eye, 66% of alteplase 0·9 mg/kg vs 48% of participants getting 300 mg oral aspirin and intravenous saline placebo within 4·5 h of symptom onset had some vision improvement. The difference was not statistically significant, likely due to the small power of 70 patients, age 70, but warrants further study.
Even low-risk alcohol drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors, based on a UK biobank study of 135,103 participants, age 64. Wine preference (>80% of alcohol from wine) and drinking with meals showed small attenuation of mortality, especially from cancer, but did not eliminate the excess mortality associated with high-, moderate- and even low-risk drinking. Previous protective findings are being questioned due to selection biases, reverse causation, and residual confounding.
All types of alcohol use and amount increased dementia risk. While correlational observational data suggested a protective effect of light drinking, this could be in part attributable to reduced drinking seen in early dementia and reverse causation; genetic analyses did not support any protective effect, suggesting that any level of alcohol consumption may contribute to dementia risk.
Participants with cognitive impairment, n=99,age 72, before PET scan, stated they would make lifestyle changes to improve brain health, but after amyloid findings on PET scan, no change in self-reported physical activity, diet, social activity, stress reduction activity, or sleep quality was observed. Significantly less cognitive activity was reported at follow-up.
While amyloid antibodies showed small improvements over placebo in 19 publications with 23,202 total participants, none of the changes, including those for lecanemab, aducanumab, and donanemab, exceeded the minimal clinically important difference. Harms included significantly increased risks of amyloid-related imaging abnormalities (ARIA)-edema (relative risk [RR] = 10.29; number needed to harm [NNH] = 9), ARIA-hemorrhage (RR = 1.74; NNH = 13), and symptomatic ARIA-edema (RR = 24.3; NNH = 86). Only 2 of the 19 studies had a low risk of bias. The supplement shows the results in Forest and Funnel plots nicely for visual learners.
Four distinct turning points or phases in an average brain have been identified: at ages 9, 32, 66 and 83. The phase from ages 9 to 32 is the only time in life when our neural networks are becoming increasingly efficient, during the adulthood phase, from 32 to 66, the average person’s brain architecture essentially stabilizes without major changes, at a time when researchers think people are generally plateauing in intelligence and personality. After the last turning point >83 the brain becomes increasingly reliant on individual regions as connections between them begin to wither away.
This 3 min video summarizes the benefits of exercise for dementia in the recent study that showed a 40% reduction of dementia with exercise.
Dr. Sanjay Gupta talks with neurologist Dr. Michael Okun about Parkinson’s disease and makes 5 recommendations how to prevent it:
Breathe clean air
Drink clean water
Eat clean food
Keep your body moving
Get enough sleep
Melatonin increased total sleep time by 12 minutes and cognitive outcomes on Mini-Mental State Examination scores by MD +1.8 points in older adults with cognitive impairment in a meta-analysis of 10 randomized controlled trials, n=516, but effects on sleep efficiency, circadian markers, depression and activities of daily living were small and nonsignificant.
A slow music-listening intervention (60-80 beats/min), did not improve delirium, pain, or anxiety among 158 mechanically ventilated older adults.
Using blood samples from umbilical cords and data from the Norwegian Dementia Disease Initiation cohort, this study found that healthy newborns had serum concentrations of p-tau217, a dementia biomarker, around 10 pg/mL, nearly 3 times higher than those measured in patients with Alzheimer’s disease. In newborns p-tau217 supports neuroplasticity, and I look forward to learning more about it.
The percentage of low-value surgery by salaried providers in direct care was 20%, compared with 35% in the private-sector (χ22,304 908 = 90007.01; P < .001). After adjusting for case mix, the private sector demonstrated significantly greater odds of low-value surgery (odds ratio [OR], 1.41; 95% CI, 1.38-1.45). Over 4 years low-value surgery decreased by 22% in direct care and 7% in private sector care.
Gabapentin and pregabalin are gabepentinoids can lead to edema, dizziness, ataxia, falls, confusion, etc. and are on the Beers list. In 120 veterans >65 years, who potentially experienced the gabapentinoid-loop diuretic (for the swelling) prescribing cascade, clinicians almost never documented consideration of gabapentinoid adverse drug effects in their management of edema. Potential downstream harms, including worsening kidney function, electrolyte abnormalities, and falls (some precipitating emergency department visits and/or hospitalizations) were common among patients initiating both a gabapentinoid and a loop diuretic.
In this survey study of 6260 US adults, overall trust in scientists was high (86.0%), but significantly lower among individuals with more conservative political views, 70.5% vs 93.7%. among liberal respondents.
12 former FDA commissioners, who served under both Republican and Democratic presidents, including Scott Gottlieb and Brett Giroir, who served as commissioners during President Donald Trump's first term wrote in a piece published in the New England Journal of Medicine: “A Threat to Evidence-Based Vaccine Policy and Public Health Security at the FDA.”
The FDA approved zoliflodacin (Nuzolvence) and gepotidacin (Blujepa), oral treatments for urogenital gonorrhea that expand options as drug resistance rises for current meds, but the costs are >$1,000 to several thousand $$$.
Listeriosis has increased to the highest level of 3041 cases in 2024 in Europe. Of these, 72% were hospitalized and 8% died. Case numbers have risen significantly since 2020 due to the aging population 81% of cases, and greater immune suppression through medications. The remaining cases are newborns and pregnant patients. In July the US CDC stopped tracking this serious illness along with 7 of 9 other pathogens affecting public health.
The CDC reports 1,888, confirmed measles cases in 43 states, up from 1,804 in 43 states 1 week ago.
The OMDA call on Thu Dec 18th at 8 am is: Hidden Neurological Events in Dementia: Clinical Recognition, Differential Diagnosis, and Underlying Risk Factors, by Russ Barker, MHA, DHSc(c), Seagull Health.
Happy Hannukkah!
