Geriatric Update Feb 9, 2026

In older adults with mild cognitive impairment or dementia, combining aerobic exercise with resistance training is most effective for boosting cognitive function, even at modest activity levels. A meta-analysis of 68 studies and 6544 participants showed that a minimum threshold of 336 Metabolic Equivalent of Task minutes (MET) per week was required to yield cognitive benefits, while 934 Metabolic Equivalent of Task minutes per week was the minimum dose for clinically meaningful improvements. Walking is 2-3 METs, depending on speed, thus patients would need to walk just over an hour a day at slow pace, or an hour 5 times a week at a fast pace to get 934 minutes for clinically relevant cognitive benefit. The US recommended 150 min a week is minimum, and at 6 METS would be sufficient, which is equals 11 mph bicycling intensity.

SuperAgers are individuals whose brain power at 80 or older compares to that of people 20 to 30 years younger. This study showed that SuperAgers had significantly lower frequency of APOE-ε4 alleles and higher frequency of APOE-ε2 alleles compared to Alzheimer’s dementia cases and controls. Table 3 and 4 shows the odds ratios. The prevalence of APOE-ε3 and 4 is much higher in the population, so that the percentage of APOE-ε4 in SuperAgers was similar, about 20% as APOE-ε2, see figure 2.

Conversely, half of dementias and >90%  of Alzheimer’s disease was contributed by APOE-ε3 or APOE-ε4 in 4 large databases: UK Biobank, Alzheimer’s Disease Genetics Consortium, Anti-Amyloid Treatment in Asymptomatic Alzheimer’s (A4) and FinnGen.

Women have about twice the risk of developing Alzheimer’s disease (AD) than men. This large-scale X chromosome-wide association study (XWAS) of AD identified the novel SLC9A7 locus, which regulates pH homeostasis in Golgi secretory compartments and is anticipated to have downstream effects on amyloid β accumulation.

Always listening to music, compared with never/rarely/sometimes, was associated with a 39% decreased risk of dementia (95% CI = 0.45,0.82, p = 0.001), and a 17% decreased risk of Cognitive impairment no dementia (CIND) (95% CI = 0.74, 0.92, p = 0.001). Playing an instrument (often/always) was associated with a 35% decreased dementia risk only (95% CI = 0.42,0.99, p = 0.047). Participants who both listened to and played music had a 33% decreased dementia risk (95% CI = 0.51,0.89, p = 0.006) and a 22% decreased CIND risk (95% CI = 0.65,0.92, p = 0.004).

Of 54 blood biomarkers reflecting inflammatory, vascular, metabolic and neurodegenerative processes, 5 were consistently and positively associated with all multimorbidity measures: Growth differentiation factor 15, hemoglobin A1c, cystatin C, leptin and insulin. faster disease accumulation was directly associated with gamma-glutamyl transferase and inversely with albumin. in 2,247 individuals age >60 from the Swedish National Study on Aging and Care over 15 years.

Of 469 metabolites examined, 235 were associated with new onset type 2 diabetes (T2D) during 26 years of follow-up. Of those, a 44-metabolite signature improved T2D risk prediction beyond conventional factors.

Even low-risk alcohol drinking was associated with higher mortality among 135,103 older adults with health-related or socioeconomic risk factors. Wine preference and drinking only with meals were associated with attenuating the excess mortality associated with alcohol consumption. Moderate-risk drinking was associated with higher all-cause (HR, 1.10; 95% CI, 1.03-1.18) and cancer (HR, 1.15; 95% CI, 1.05-1.27) mortality, and low-risk drinking was associated with higher cancer mortality (HR, 1.11; 95% CI, 1.01-1.22).

Abdominal adipose tissue is associated with chronic musculoskeletal pain: women (visceral adipose tissue: OR 2.04 per SD (95% CI 1.85 to 2.26); subcutaneous adipose tissue: OR 1.60 (95% CI 1.50 to 1.70); and their ratio: OR 1.60 (95% CI 1.37 to 1.87)) and men (visceral adipose tissue: OR 1.34 (95% CI 1.26 to 1.42); subcutaneous adipose tissue: OR 1.39 (95% CI 1.29 to 1.49); and their ratio: OR 1.13 (95% CI 1.07 to 1.20)). Higher levels of adipose tissue were also associated with greater odds of reporting chronic pain, suggesting that excessive and ectopic fat depositions may be involved in the pathogenesis of multisite and widespread chronic musculoskeletal pain.

The GLP-1 semaglutide for 3 months before total knee replacement surgery in patients with diabetes, led to lower odds of severe adverse events (odds ratio 0.25, CI 0.12-0.47), <2 months did not, and as little as 1 month of semaglutide led to lower minor adverse events (MAE)  (odds ratio 0.16, CI 0.07 to 0.31), with consistent reduction in MAE across all increased exposure durations.

Treatment with once-weekly semaglutide was associated with significant reductions in hospital admissions and overall time spent in hospital, extending its benefits beyond CV risk reduction and holding up in subgroup analyses.

GLP-1s were associated with cardiovascular, renal, and metabolic benefits in type 2 diabetes without increasing cancer risk, though gastrointestinal adverse events were common:

• Heart failure (eOR, 0.71 [95% CI, 0.64-0.79])

• Peripheral artery disease (0.75 [0.67-0.84])

• Kidney-specific composite outcomes (0.76 [95% CI, 0.66-0.87]) 

• Major cardiovascular events, myocardial infarction and stroke: liraglutide (0.86 [95% CI, 0.80-0.91]), albiglutide (0.65 [0.47-0.89]), and dulaglutide (0.78 [0.68-0.90])

Patients with acute kidney injury (AKI) exhibited a significantly increased risk of developing dementia, 1.88-fold increased risk (95% confidence interval, 1.76-2.01) over 12 years, in 207788 patients hospitalized for AKI.. Most AKI is due to dehydration, assuring adequate hydration is key as we get older, and is often complicated by lack of thirst or avoiding intake to prevent frequent urination.

Regular aspirin use was defined as 2 or more standard tablets (325 mg) per week. The 10-year adjusted risk ratio (ARR) for lifestyle scores 0 to 1 (unhealthiest: body mass index, alcohol intake, physical activity, diet, and smoking) was 1.28%. In contrast, the 10-year ARR for lifestyle scores 4 to 5 (healthiest) was 0.11%. The 10-year number needed to treat with aspirin was 78 for participants with lifestyle scores 0 to 1, 164 for score 2, 154 for score 3, and 909 for scores 4 to 5.

Aspirin prevents metastasis by limiting platelet TXA2 suppression of T cell immunity and has shown in mice to decrease cancer mortality.

But in people, low dose aspirin (LDA) was not associated with overall cancer incidence over the long term (hazard ratio [HR] = 0.98; 95% CI, 0.92-1.05), by stage at diagnosis or cancer type, including colorectal cancer (HR = 1.01; 95% CI, 0.84-1.21), and LDA was associated with increased cancer-related mortality (HR = 1.15; 95% CI, 1.03-1.29) in 19,114 community-dwelling older adults (mean [SD] age 75 over 8.6 years of the ASPREE trials that went away after the trial was over, but showed no improved outcome.

Metastatic prostate cancer in older adults is treated with different meds, however, these differences may not result in differences of overall life expectancy. As providers, we are responsible for counseling our patients about treatment side effects that may severely impair quality of life with little or no survival benefit.

Colchicine favorably affected coronary plaque stabilization on optical coherence tomography in 128 randomized patients, age 58, with acute coronary syndrome. The mechanism is by increasing fibrous cap, decreasing C-reactive protein, interleukin-6 and myeloperoxidase levels.

Among 109,504 patients, age 63, with gout who were newly prescribed urate-lowering treatment (ULT), achieving serum urate levels lower than 6 mg/dL within 12 months was associated with a lower 5-year risk of major adverse cardiovascular events, weighted HR, 0.91; 95% CI, 0.89-0.92). Patients, whose urate was <5 mg/dL had a larger risk reduction (weighted survival difference, 2.6%; 95% CI, 0.9%-3.6%; weighted HR, 0.77; 95% CI, 0.72-0.81).

IsCHEMiA, derived from the first letters of each variable — includes six factors that predicted poststroke epilepsy: infarct size ≥ 5 cm, cortical involvement, any hemorrhagic transformation, early symptomatic seizure within 7 days of stroke, middle cerebral artery involvement, and age younger than 65 years; discrimination was consistent across all cohorts, with c-statistics of 0.870 (perfect is 1.0).

Death rates from accidental falls tripled from 2000 to 2023 due to longer life, greater risk of falls with higher age, and less reserve as we age. Accidental fall death rates are >100 times higher for people 85+ than people 45–54 years old. Heart disease, as the most common cause of death, dropped 19.5%, and cancer, the second most common cause by 6.8%, therefore we live longer. Another reason is greater awareness and reporting on death certificates, but icy weather contributes to Northern states making up the top 10 and Southern states the bottom of the list. Other contributors are obesity, binge drinking and antidepressant meds that increased in recent years.

Laughter exercise practiced 4 times a day was noninferior to 0.1% sodium hyaluronic acid in alleviating the symptoms of dry eye disease and improved tear film stability and the function of the meibomian gland in 299 participants, avg age 29.

This Cochrane review found no clear evidence that any cannabis-based medicine provided substantial pain relief or meaningful global improvement compared with placebo. THC-dominant products may increase nervous system adverse events, while THC/CBD-balanced and CBD-dominant formulations showed inconsistent effects on patient-reported improvement and adverse events, with none demonstrating clinically relevant benefits.

Mirtazapine at doses 15 to 45 mg daily over 56 days does not improve severe breathlessness among patients with COPD or interstitial lung disease, age 74 years. Although the study was underpowered with 113 in the mirtazapine and 112 in the placebo gorup, the primary endpoint effect did not reach the pre-specified treatment effect of 0.55 for worst breathlessness score reduction that the study was powered to detect for the primary analysis. There were 215 adverse reactions in 64% of the mirtazapine group and 116 in 40% in the placebo group.

A systematic review of 63 studies found the risk of brain cancer did not increase, even with prolonged cellphone use (defined as 10 years or more), among those who spent a lot of time on their cellphones, or for people who made a lot of calls, including no increased risks of leukemia or brain cancer in children exposed to radio or TV transmitters or cellphone towers.

The administration launched TrumpRx.gov to help American patients use their own money to buy prescription drugs. The website will not sell drugs, instead, it is an entry point where consumers can search for their medicines and then navigate to websites offered by major manufacturers to buy medication directly with a prescription. I have found CostPlus Drugs by Mark Cuban to be the cheapest way to buy meds, even cheaper than co-pays. 

The CDC reports 585, confirmed measles cases in 17 states vs 413, cases in 14 states last week. For flu activity, the CDC has not updated the website since Dec 30.

This study reviewed the CDC website and found 44 databases (54%) were current, and 38 (46%) were paused without explanation. Thirty-four of the 38 databases (89%) had no data entries dated within 6 months of the date of analysis, others were paused more recently, including 4 that addressed respiratory diseases, including disease burden and nonvaccine prevention measures, and 1 addressed public health (drug overdose deaths).

Ohio’s respiratory dashboard showed 652 flu hospitalizations (1938 last week), 473 COVID hospitalizations (845), and 327 RSV (314).

The OMDA call on Thu February 12 is by Liz Wheeler, BSN, RN, CHPN, IPCO, QCP, CDP, Proactive LTC Consulting. Topic to be determined.

Our new website: www.PG-65.com is up again (please note the dash between PG and 65), which stands for Practical Geriatrician.  (or Parental Guidance-65...)  

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