Geriatric Update Jan 12, 2026
Previously, I mentioned transcranial direct current stimulation improving depression, this study showed that active gamma transcranial alternating current stimulation, improves several cognitive measures, including remembering faces and people’s names. The home-based gamma tACS (5 sessions/wk, 60 minutes each) or sham stimulation was applied to 50 randomized patients, age 67, for 8 weeks, then 8 weeks open label, and 8 weeks of follow up. The mechanism is through increased cholinergic transmission. No added benefit was seen with a second course, suggesting that 8 rather than 16 weeks of treatment is the ideal duration.
Six depressive symptoms emerged as robust midlife indicators of increased dementia risk. This UK study of 6511 patients, age 55, over 25 years, suggests that these symptoms might be early markers of underlying neurodegenerative processes.
Losing confidence in myself (HR 1·51, 95% CI 1·16–1·96)
Not able to face up to problems (1·49, 1·09–2·04)
Not feeling warmth and affection for others (1·44, 1·06–1·95)
Nervous and strung-up all the time (1·34, 1·03–1·72)
Not satisfied with the way tasks are carried out (1·33, 1·05–1·69)
Difficulties concentrating (1·29, 1·01–1·65).
Exercise may be moderately more effective than a control intervention for reducing symptoms of depression, and appears to be no more or less effective than psychological or pharmacological treatments, though this conclusion is based on a few small trials (57 trials with 2189 participants) with rare long‐term follow‐up.
Prolonged benzodiazepine use increases risk of dementia. A mailed educational brochure, physician letter and flyer detailing benzodiazepine risks, led to 26% reduction over 9 months, compared to 17% in control group with provider conversations about benzodiazepine risks or tapering with patients on their own.
Amyloid-β (Aβ) pathology was associated with astrocyte reactivity across cortical brain regions only in the presence of microglial activation. The microglia-dependent effects of Aβ on astrocyte reactivity were further related to cognitive impairment through tau phosphorylation and aggregation. When microglia are not activated, amyloid stops correlating with elevated plasma levels of glial fibrillary acidic protein (GFAP), indicating that the inflammatory process triggers the cascade of Alzheimer’s disease (AD).
A growing number of Americans experienced a sharp increase in serious problems with memory and thinking, from 5.3% in 2013 to 7.4% in 2023. The prevalence of cognitive disability among younger adults aged 18–39 years nearly doubled, from 5.1% to 9.7%, but adults 70 and older declined slightly, from 7.3% to 6.6%.
The subcutaneous lecanemab injection is the first antiamyloid medication available for home use after 18 months initial IV treatment. benefits and safety were comparable with continued IV dosing. systemic symptoms such as headache, fever, and fatigue were much less common with subcutaneous dosing. About 11% of patients experienced mild to moderate local reactions, including redness, swelling, or itching at the injection site, and rates of amyloid-related imaging abnormalities (ARIA) were comparable with IV treatment.
In November I discussed glymphatics in connection with dementia and cardiovascular risk. This podcast by Dr. Eric Topol with Dr. Jonathan Kipnis, discusses glymphatic cleaning of our brains.
The SELECT randomized clinical trial showed that semaglutide reduced the rates of cardiovascular (CV) death, myocardial infarction, and stroke. This SELECT analysis showed lower hospitalizations in the semaglutide group vs placebo for any indication (18.3 vs 20.4 admissions per 100 patient-years; mean ratio [MR], 0.90; 95% CI, 0.85-0.95; P < .001) and for serious adverse events (15.2 vs 17.1 admissions per 100 patient-years; MR, 0.89; 95% CI, 0.84-0.94; P < .001). The number of days hospitalized for any indication per 100 patient-years was lower in the semaglutide group vs placebo (157.2 vs 176.2 days; rate ratio [RR], 0.89; 95% CI, 0.82-0.98; P = .01), as well as hospitalizations for serious adverse events (137.6 vs 153.9 days; RR, 0.89; 95% CI, 0.81-0.98; P = .02).
In older adults on insulin, 3 am hypoglycemia is more common than in younger adults due to decreased hepatic glucose production (gluconeogenesis) and decreased kidney function, leading to less insulin excretion and higher insulin levels. In 5 studies of 482 participants with type 1 diabetes (T1D) mean age 69.2 years, with a mean T1D duration of 36.1 years, higher-level technologies for glucose monitoring and insulin delivery significantly increased time and range (TIR) (MD = +7.90%, 95% CI: 7.09 to 8.72) and reduced time below range (TBR) 3.9 (mean difference [MD] = -0.62%, 95% CI: -1.02 to -0.22) and severe hypoglycemia (SH) risk (OR = 0.16, 95% CI: 0.06 to 0.41; number-needed-to-treat = 20).
Fewer twins who started metformin 68 (5.4%) developed osteoarthritis (OA) over the 11-year follow-up, compared to 79 (6.3%) among the non-treated twins (crude HR, 95% CI = 0.86 0.62-1.19). Treated twins had higher BMI, and after adjusting confounders, HR was 0.60 (95% CI =0.44-0.82), 40% lower risk for being diagnosed with incident osteoarthritis than their untreated co-twins.
Dr. Topol wrote a nice article on aspirin, summarizing the 3 pivotal trials and concluding that bleeding risk far outweighs any benefit, even in high cardiovascular risk patients. This agrees with the USPSTF recommendation against aspirin in primary prevention of CVD in adults >60.
B6 deficiency and excess can cause dementia and neuropathy. The US RDA for vitamin B6 is 1.7 mg for older men and 1.5 mg for older women daily. The German Federal Institute for Risk Assessment (BfR) has recommended that adults and adolescents aged 15 years or older should not consume more than 0.9 mg of vitamin B6 per day from supplements. The European Food Safety Authority (EFSA) in 2023 lowered the tolerable total daily intake for adults from 25 mg/d to 12 mg/d.
Suvorexant significantly reduced overall insomnia severity compared with placebo and improved daytime fatigue and subjective cognition that were captured by the high-frequency smartphone-based ecological momentary assessment (EMA) but not by standard questionnaires in 40 older adults (mean age 68 years) with chronic insomnia, randomized to suvorexant over 16 nights, starting with 2 nights at 10 mg and then 14 nights at 20 mg or placebo. However, suvorexant increased fatigue and sleepiness and reduced alert cognition in the morning but reduced fatigue and sleepiness in the afternoon and evening. Most participants experienced comorbid sleep apnea and insomnia, which is common (69%) among older adults and might have increased fatigue and sleepiness. Participants in the suvorexant group reported numerically worse mood at all 4 times of day. Authors are consultants to the manufacturer who also sponsored the trial.
Nearly 45% of Medicare beneficiaries reported trouble hearing and was associated with higher odds of health care visit dissatisfaction. Compared to no hearing loss, little trouble hearing (OR = 1.168; 95% CI = 1.047–1.302) and a lot of trouble hearing (OR = 1.293; 95% CI = 1.043–1.603), which disappeared when accompanied by someone.
An age-adjusted D-dimer cutoff (age x 10, in µg/L, in patients aged ≥50 years) safely increased the proportion of patients in whom deep vein thrombosis (DVT) can be excluded and saved patient anxiety, discomfort from treatment and healthcare $$$.
A 2000 paper on the herbicide glyphosate has been retracted after it came to light that the stated safety was based on Monsanto data and not independent studies, and subsequent studies have shown that glyphosate is a probable human carcinogen.
Tradipitant, an oral NK-1 receptor antagonist has received FDA approval to prevent motion-induced vomiting. Other NK-1 receptor antagonists have been used in Chemotherapy induced nausea and vomiting:
Aprepitant (generic, $1 a dose), netupitant, and rolapitant. Common side effects include fatigue, hiccups, and indigestion, and they can interact with other drugs metabolized by P450 enzymes.
Influenza vaccinations increased by 5.1% with 1) previsit text message reminders to patients, 2) an automatic pended order, and 3) monthly comparisons of panel vaccination rates to peer clinicians. The intervention in this randomized clinical trial of 80,039 patients, age 65.8 years, across 48 clinics showed vaccine completion of 31.4% compared to 26.4% in the usual care group (97.5% CI, 2.6-7.5%).
COVID-19 vaccinated individuals (22.7 million in France) had a 74% lower risk of death from severe COVID-19 than 5.9 million unvaccinated individuals and no increased risk of all-cause mortality over a median follow-up of 45 months.
Respiratory syncytial virus (RSV) vaccine effectiveness was tested over 2 respiratory illness seasons in more than a quarter million veterans that were vaccinated against RSV and propensity matched to unvaccinated veterans, for a total of 544 364 veterans, 94.5% male, age 76 years. Vaccine effectiveness against documented RSV infection was 82.5% at 1 month and 59.4% at 18 months after vaccination.
The CDC’s new schedule continues to recommend vaccines against some diseases, including measles, polio and whooping cough, for all children. Immunization against six other illnesses — hepatitis A, hepatitis B, meningococcal disease, rotavirus, influenza and respiratory syncytial virus, the leading cause of hospitalization in American infants, as well as COVID (removed in Sept) — will be recommended for only some high-risk groups or after consultation with a health care provider.
The CDC reports 2,119, confirmed measles cases in 44 states by the end of 2025 and started reporting 3 cases in 2 states NC and SC, since start of 2026. For flu activity, the CDC has not updated the website since Dec 30.
Ohio has reported a measles outbreak with 3 unvaccinated children of the same household. Ohio’s respiratory dashboard showed 1938 flu hospitalizations (1611 last week), 845 COVID hospitalizations (666), and 314 RSV (238).
The OMDA call on Thu Jan 15th at 8 am is: Vaccination Update by Robin Jump, MD, PhD
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