Geriatric Update May 18, 2026
Plasma phosphorylated tau 217 (pTau217) is an excellent biomarker of Alzheimer’s disease (AD) pathology. pTau217 detected amyloid-β prior to Aβ positron emission tomography (PET) positivity. The 317 participants were followed for 8 years and 3 had false negative pTau217, identified with positive PET, with repeat blood tests that were positive. Area under the receiver operating curve was 0.94 (AUC based on sensitivity 0.89 / specificity 0.9).
Neutrophil-to-lymphocyte ratio (NLR), a marker of systemic inflammation, has been associated with increased Alzheimer's disease and related dementias using electronic health records from New York University (n = 284,530) (hazard ratio [HR] = 1.07, 95% confidence interval [CI] 1.02–1.15) and from Veterans Health Administration (VA) Hospitals (n = 85,836) (HR = 1.21, 95% CI 1.10–1.34) from 2011 to 2023. While it is statistically significant, the low ratio is probably not clinically relevant. Moreover, what can we do to reduce inflammation other than lose weight, eat a MIND diet and exercise?
Intrinsic capacity (IC) refers to physical and mental capacities that determine healthy aging. IC is the central element of the World Health Organization care pathway ‘Integrated Care for Older People’ (ICOPE). This cross-sectional study associated IC centiles with comorbidity, frailty and limitations in both activities of daily living and instrumental activities of daily living in France and upper-middle-income (ICOPE Brazil) countries. The 6 domains established in 1918 were confirmed to determine healthspan:
Memory cognition
Mobility
Emotion, Relationship
Vitality (Nutrition, Weight)
Vision
Hearing
Ultraprocessed food (UPF) makes up over half of total dietary energy intake in the US and causes 30 different health problems. Each 10% increase in UPF intake was associated with lower attention scores (−0.05 points) and higher dementia risk (+0.24 points), independent of Mediterranean diet adherence. This was among 2,192 Australian dementia-free adults aged 56.6 (40–70) years.
Intake of legumes and tofu improved chronic lung diseases such as chronic obstructive pulmonary disease (COPD) and the mechanism is thought to be due to flavonoids (glycitein, formononetin, daidzein, and genistein) lowering various disease biomarkers.
Women with Parkinson’s disease (PD) are far less likely than men to undergo deep brain stimulation (DBS), 23% vs 30%, although the prevalence of PD is 40% in women and 60% in men. In interviews with 33 patients – 16 women and 17 men – women were less likely to have reliable support and more likely to “worry about being a burden on their loved ones.”
In cognitively intact older adults with depression, narrative therapy (standardized mean differences [SMDs] = -1.22, 95% confidence interval [CI] = -1.83, -0.60; P-score = .81) and dignity therapy (SMD = -1.28, 95% CI = -2.26, -0.30; P-score = .81) demonstrated the largest reductions in depressive symptoms. For life satisfaction, narrative therapy ranked highest (SMD = 1.13, 95% CI = 0.24, 2.01; P-score = .89), followed by reminiscence therapy and life review. Longer interventions (≥8 weeks) produced greater improvements in life satisfaction (SMD = 1.09, 95% CI = 0.48, 1.70) than shorter ones (SMD = 0.36, 95% CI = 0.16, 0.56) in this meta-analysis of 33 trials with 2,512 older patients (>60 years).
The mean overall suicide rate was 13.7 deaths per 100,000 with 7.9 deaths per 100,000 for firearm-related suicide and 5.8 deaths per 100,000 for other suicide. Firearm suicide rates varied 8-fold across states in 2024 (1.8 deaths per 100,000 in New York vs 15.1 deaths per 100,000 in Wyoming). Handgun permit laws (−6.7%; 95% CI, −9.7% to −3.7%), waiting periods (−12.5%; 95% CI, −22.1% to −1.7%), and requirements for a license for concealed carry (−8.9%; 95% CI, −13.1% to −4.8%) were significantly associated with decreases in firearm suicide rates but not with nonfirearm suicide rates. States with one (−8.1%; 95% CI, −11.4% to −4.7%), two (−12.5%; 95% CI, −16.3% to −8.5%), or all three (−25.3%; 95% CI, −34.2% to −15.2%) of these laws (handgun permit requirements, waiting periods, and concealed carry permits) had progressively lower firearm suicide rates.
A study of 4,955 Medicare patients with an average age of 75.5 found that individuals with dementia are the most likely to be prescribed medications affecting cognition (benzodiazepines, antipsychotics, and anticholinergics). Over 21% of patients with dementia started these drugs in a hospital or post-acute care setting (rehab or skilled nursing facility), followed by 17.2% of patients with cognitive impairment but no dementia (CIND), and 14.2% of cognitively intact patients. About half were still taking them one year later. Efforts are needed to improve prescribing practices and to encourage patients and families to ask whether these new medications are (still) necessary.
A lot of clotting factors are keeping us in balance and low factor XI levels are associated with a reduced risk of ischemic stroke. The experimental drug asundexian inhibits activated factor XI, and 40 mg daily reduced ischemic stroke 6.2% vs. placebo 8.4%, (hazard ratio, 0.74; 95% confidence interval [CI], 0.65 to 0.84). The composite of death from cardiovascular causes, myocardial infarction or stroke was lower in the asundexian group (9.2%) vs 11.1% in the placebo group (hazard ratio, 0.83; 95% CI, 0.74 to 0.92). Death from any cause was 10.5% in the asundexian group vs. 12.3% in placebo (hazard ratio, 0.85; 95% CI, 0.77 to 0.95), while bleeding and side effects were similar.
After cardiac surgery, controlling potassium to above 3.6 mEq/L (relaxed control) or controlling it above 4.5 mEq/L (tight control) had similar outcomes of new-onset atrial fibrillation, flutter, or tachyarrhythmia after cardiac surgery (AFACS), most common within 5 days of surgery, or in clinical outcomes (e.g., stroke, atrial tachyarrhythmias) and mortality at 6 months.
A sample of small changes that New York Times readers have made over the years for better health are: balancing on one leg during the 30 seconds waiting for your microwave to heat something or doing a few push-ups when getting up in the morning.
Muscle power (force times velocity) outperforms strength as a risk indicator and predictor of mortality. 3,889 individuals aged 46 to 75 years were followed over 10.8 years. Hazard ratios (95% CIs) for mortality comparing the lowest vs highest categories of relative muscle power were 5.88 (2.28 to 15.17; P<.001) for men and 6.90 (1.61 to 29.58; P=.009) for women, and for relative strength only, the hazard ratios were 1.62 (0.89 to 2.96; P=.11) and 1.71 (0.61 to 4.80; P=.31), respectively. The combined loss of strength and velocity, much more than each one separately, will impair our autonomy and healthspan.
Also in the NYT was this article on power through explosive strength exercises, called plyometrics, which enable your muscles to produce as much force as possible in a short amount of time. Beginning in your forties, muscle power starts to decline at a faster rate than the loss of muscle strength. That’s significant because power is a predictor of your ability to live safely and independently for longer.
Exercise can restore circadian rhythms in metabolism and hormone secretion. In individuals with type 2 diabetes, afternoon and evening exercise yield greater improvements in inflammation, mitochondrial function, glycemic control and insulin sensitivity when compared with morning exercise, with intensity appearing to influence these effects.
Adding the supplement β-hydroxy β-methylbutyrate (HMB) to strength training is not advantageous concerning fat mass, muscle mass, and muscle strength compared with strength training alone. The meta-analysis of 13 randomized controlled trials included 561 patients age >50.
Nodavirus is a zoonotic disease found in farmed seafood (mostly shrimp) that can cause a new human eye disease called persistent ocular hypertensive viral anterior uveitis, or POH-VAU. Patients develop keratic precipitates, clumps of inflammatory debris on the inner surface of the cornea, along with iris atrophy and dangerously elevated intraocular pressure. The condition recurs, resists standard treatment, and roughly 1/3 of the patients in this study eventually required antiglaucoma surgery.
In two open-label platform trials of vaccinated patients with COVID-19 age >50, nirmatrelvir–ritonavir (Paxlovid) did not reduce hospitalization or death (0.8% in the UK study and 0.6% in the Australian study vs placebo 0.7% and 1.2% respectively). The article didn't describe how many months after the vaccine the infection occurred, or how many days after infection treatment was started, except that it was within 5 days. Viral load was reduced by Paxlovid. I think the low event numbers are a testimony to the efficacy of vaccines.
Cannot, in a moment, get rid of habits of a lifetime. Mahatma Gandhi
