Geriatric Update Jun 16, 2025

The CDC reports 1197 confirmed measles cases in 35 states, up from 1168 in 35 states last week. This slowing may be due to less heat and dry air in homes, leading to less airborne transmission, similar to COVID. No new updates on the Ohio Department of Health website.

COVID-19 recovery of mental health and well-being took close to 3 times as long to recover compared with physical health, 9 months vs. 3 months.

Individuals from more recent-born birth cohorts had lower age-specific dementia prevalence rates in the US (21.2%), Europe (38.9%), and England (28.3%). This trend was more pronounced among women than men.

Depression, if present in late-life (HR 1.95, 95% CI: 1.68–2.26; I2 = 77.5%) and midlife (HR 1.56, 95% CI: 1.12–2.18; I2 = 97.5%) significantly increased risk of all-cause dementia.

The association between coffee consumption and dementia was non-linear and J-shaped (Non-linearity = 0.0001), with evidence for higher odds for non-coffee and decaffeinated coffee drinkers and those drinking >6 cups/day, compared to light coffee drinkers. After full covariate adjustment, consumption of >6 cups/day was associated with 53% higher odds of dementia compared to consumption of 1-2 cups/day (fully adjusted OR 1.53, 95% CI 1.28, 1.83). This J-shaped curve was also seen for tea, hypertensive patients who drink 0.5–1 cup of coffee or 4–5 cups of tea per day have the lowest risk of dementia.

Compared with those in the lowest tertile of REM sleep latency (<98.2 min), those in the highest tertile (>192.7 min) had higher amyloid beta (Aβ) burden, phosphorylated tau-181 (p-tau181), and lower brain-derived neurotrophic factor (BDNF) levels. This association does not clarify if dementia leads to REM sleep latency or REM sleep delay contributes to dementia. 

Naps have been implicated with higher risk of dementia and mortality, and this study qualifies it in greater detail. Before you read the detail, I explain my reservation with it: it is an observational study based on UK biobank data that includes 7 day actigraphy, but the hazard ratios were small and should be >2. More concerning is that they didn't control for sleep apnea. Longer nap duration (for 1-SD, HR=1.20, 95%CI: 1.16-1.24, p< 0.0001), greater intra-individual variability (for 1-SD, HR=1.14, 95%CI: 1.10-1.18, p< 0.0001), and higher percentage of naps between 11am-1pm and between 1-3pm were associated with mortality (for 1-SD, 11am-1pm: HR=1.07, 95%CI: 1.03-1.11, p=0.0005; 1-3pm: HR=1.07, 95%CI: 1.03-1.12, p=0.0002).

Medical and work-related costs for adults 50 years and older with dementia, as well as their unpaid caregivers was estimated $344 billion in 2020 and will increase to over $3 trillion in 2060. The unpaid caregiving and forgone wages significantly contribute to the economic burden, especially with Latino and African American caregivers experiencing substantial financial losses of $113 billion in 2020 and will reach $1.7 trillion by 2060, significantly more than for White adults.

The risk Parkinson's disease is fourfold higher in patients with autism, (RR, 4.43 [95% CI, 2.92-6.72]). The hypothesis is that the brain’s dopamine system is affected in both cases, since the neurotransmitter dopamine plays an important part in social behavior and motion control.

Sense of smell declines with increasing age, 21% in those 70-79 years and 59% age >80, and can be a marker of dementia. Olfactory testing could be used in clinical research settings in different languages and among older adults to predict neurodegenerative disease and development of clinical symptoms.

Travel that incorporated cycling at midlife was associated with a lower adjusted risk of all-cause dementia over 13 years than non-active travel like driving or public transportation, based on a prospective cohort study included data collected from the UK Biobank of 479,723 participants, age, 56.5. Adjusted hazard ratio 0.81 (95% CI, 0.73-0.91) for all-cause dementia, 0.78 (95% CI, 0.66-0.92) for Alzheimer’s, 0.60 (95% CI, 0.38-0.95) for young onset dementia, and 0.83 (95% CI, 0.75-0.93) for late onset dementia.

When you pee “just in case,” your bladder starts alerting your brain too early, before having the standard amount of urine, according to this excellent article in the NY Times. This disruption can reduce the volume your bladder can hold over time. “Mind over bladder,” is a way to retrain your bladder to send signals only when more liquid has accumulated. 

Thyroid test intervals were adjusted by age-, sex-, and race-specific factors and reclassified 48.5% of persons with subclinical hypothyroidism as normal, and reclassified 31.2% of persons with subclinical hyperthyroidism as normal to the reference intervals used in two population datasets: the National Health and Nutrition Examination Survey (NHANES; N = 8308; women = 4235), and a Chinese database of routine health checkups from 49 hospitals in 10 provinces for persons aged 18 years or older (N = 314,302), results were similar in both populations.  

Wearing vests weighted with up to a maximum amount of 15% of the participant’s baseline weight, regained only about half the lost weight, while the group not wearing vests reverted to baseline weight at 24 months. Participants age 70.4 years, lost the same amount of weight in both groups at 6 months through calorie restriction to 1100–1300 kcal/day. The authors thought that the mechanism was through higher resting metabolic right, however the difference between groups was not statistically significant.

Close to 50% of dementia is preventable through: controlling cardiovascular risk factors (including blood pressure), obesity, diet, diabetes, smoking, and regular physical activity.  Previous US lifetime risk for dementia had been estimated to be about half this level, about 12% among men and 21% among women, newer data is likely due to better ascertainment of dementia and better participant diversity.

Poor vascular health through age 74 years, hypertension, diabetes, and smoking, contributed to 22%-44% of dementia cases by age 80 years, from a cohort analysis including of 12,274 participants with up to 33 years of follow-up.

Loneliness was associated with the risk for all-cause dementia (hazard ratio (HR) 1.306, 95% confidence interval (CI) 1.197–1.426), Alzheimer’s disease (HR 1.393, 95% CI 1.290–1.504; k = 5), vascular dementia (HR 1.735, 95% CI 1.483–2.029; k = 3) and cognitive impairment (HR 1.150, 95% CI 1.113–1.189). The associations persisted when models controlled for depression, social isolation and/or other modifiable risk factors for dementia in a meta-analysis.

Medication use for agitation in dementia is second line. Relative to haloperidol, midazolam significantly increased the risk for any adverse events (OR 5.25 [95% CI: 2.64–10.45]). Quetiapine was the only drug observed to have a lower frequency of adverse events (OR 0.27 [95% CI: 0.08, 0.97]) than Haldol.

GLP-1 meds are cardioprotective and also were associated with a statistically significant reduction in dementia (OR, 0.55 [95% CI, 0.35-0.86]), but not SGLT2is (OR, 1.20 [95% CI, 0.67-2.17], in 23 different randomized trials including more than 160,191 individuals.

Each of us have different postprandial glycemic responses (PPGRs) to various carbohydrates and can be associated with type 2 diabetes and cardiovascular disease. This study tried to identify trigger foods into types or categories of patients. Overall, rice was the most glucose-elevating carbohydrate meal, but there was considerable interindividual variability. Individuals with the highest PPGR to potatoes (potato-spikers) were more insulin resistant and had lower beta cell function, whereas grape-spikers were more insulin sensitive. Rice-spikers were more likely to be Asian individuals, and bread-spikers had higher blood pressure. Mitigators, such as fiber and protein, were less effective in reducing PPGRs in insulin-resistant as compared to insulin-sensitive participants.

Of 26 patients with irritable bowel syndrome (IBS) 75% randomized to a Mediterranean diet experienced less abdominal pain after a month, compared to 82% assigned the low FODMAP diet – a common and much stricter diet prescribed for IBS.

In December, the FDA released new highly specific guidelines around what food manufacturers can label ‘healthy’ or other terms, like ‘healthful’ or ‘healthiest.’ To make that claim for instance, a 50-gram serving of a dairy product must contain no more than 5% of a person’s daily sugar level and 10% of a person’s daily salt and saturated fat limit.

Dry eyes are a common problem, and running fans during summer can worsen symptoms.  The FDA approved another eye drop, acoltremon (Tryptyr), a selective activator of the TRPM8 calcium channel on the cornea, which is responsible for the sensation of coldness produced by menthol. Earlier drops approved are: loteprednol (Eysuvis) a corticosteroid for short-term treatment <2 weeks,  and lifitegrast (Xiidra) that inhibits T cell mediated inflammatory response by binding to lymphocyte function associated antigen end intracellular adhesion molecule 1. I have had good success with tear duct plugging by ophthalmology and with milking the lower palpebra (eyelid) to help express mucus and oils produced by the Meibomian glands onto the eye surface, which hold the tears on the eye.

Laughter exercise improved dry eyes: vocalize the phrases “Hee hee hee, hah hah hah, cheese cheese cheese, cheek cheek cheek, hah hah hah hah hah hah” 30 times per five minute session.

“Medical education is not completed at the medical school, it is only begun”. Doctor William H Welch

Happy Juneteenth holiday.