Geriatric Update Nov 24, 2025

The Quick Dementia Rating System (QDRS) was initially developed as an informant rating instrument to detect and stage dementia and was subsequently revised and externally validated as a patient-reported outcome (PRO) tool. This version of the QDRS consists of 10 multiple choice questions that capture cognitive, functional, behavioral, and psychological outcomes reported by the patient in less than 3 minutes with an accuracy of 85% for ADRD diagnosis. The Passive Digital Marker (PDM) uses a machine learning algorithm to extract data from the electronic health record (EHR) for early detection of ADRD with 80% accuracy. The 5325 patients >65, avg age 71, were randomized and over 12 months, the patient reported test QDRS identified more dementia than routine care, but the additional administration of the EHR derived PDM test did not increase dementia detection over QDRS alone.

A Tailored Activity Program (TAP) taught over 8 weeks by occupational therapists who provided activities tailored to people with dementia's interests and abilities and instructed caregivers in their use, improved caregivers’ depression by 2.3 points on the 27 point PHQ‐9 score, while white control subjects’ PHQ scores worsened. No difference was seen in black caregivers.

Compared with the lowest quintile of midlife or late-life physical activity, the top two quintiles were associated with 40% lower all-cause dementia risk over 26 years than the lowest quintile.

Slow turning speed predicted Parkinson's disease approximately 8.8 years before diagnosis. A model, using baseline age, sex, and peak angular velocity, achieved a sensitivity of 60% for identifying those with prediagnostic PD and a specificity of 80.5% for identifying those without prediagnostic PD (area under the curve, 0.805). 

In cognitively intact participants, age, sex, APOE-ε4 status and findings on amyloid PET scans, with amyloid PET results having the largest effect on dementia risk over 10 years of follow-up. Tau PET is better than amyloid PET in predicting dementia, but I would like to see a head to head trial comparing them with blood biomarkers.

In another study of 2916 cognitively intact participants, a stand-alone test, plasma p-tau217 achieved a positive predictive value (PPV) of 79% (95% CI, 74-84) and an overall accuracy of 81% (95% CI, 80-82). In a 2-step workflow, with PET or CSF testing, the PPV and accuracy significantly increased to 91% (95% CI, 86-95), reducing the need for costly PET testing.

An international Delphi consensus panel evaluating 80 repurposing candidates for Alzheimer’s disease has identified 3 high-priority medications: shingles vaccine (Zostavax), sildenafil and riluzole as the most promising based on mechanistic relevance, early efficacy signals, and strong safety profiles in older adults.

Glymphatics, the brain’s cerebrospinal fluid based clean up crew is most active while we sleep. All major CVD risk factors were associated with signs of impaired glymphatic flow as seen across multiple imaging markers on magnetic resonance imaging (MRI), partially mediated by the associations between white-matter hyperintensities and dementia, as well as between diabetes duration and dementia. The Alzheimer’s Association’s US POINTER study demonstrated that a heart-healthy diet and regular exercise can help delay cognitive decline in individuals at increased risk. I would like to see a study looking at obesity and sleep apnea, and if weight loss and CPAP improve glymphatic clearance.

A 12-week multicomponent exercises implemented early after minor injuries are associated with lower proportions of functional decline at 3 months in moderate-risk seniors, avg age 78 years, 12% vs. 25%, RR: 0.48 [0.26, 0.90]. and may help those at high risk recover some physical performance.

Participants (n=1143) mean age, 77 years, with periodontal disease in 1996-1998 had significantly greater white matter hyperintensity (WMH) volume, a marker of cerebral small vessel disease and dementia, than those with good oral health (median WMH%, 2.83 vs 2.52; P = .012) on follow-up in 2011-2013, adjusted odds ratio, 1.56 after multivariable analysis. A database review in the same time frame of 5986 participants (mean age, 63 years) periodontal disease with caries was associated with an increased risk for ischemic stroke (hazard ratio [HR], 1.86) and MACE (HR, 1.36), particularly thrombotic (HR, 2.27) and cardioembolic (HR, 2.58) strokes. A diet high in sugar would increase inflammation, obesity, caries and periodontal disease. The good news, dental care was associated with lower risk for periodontal disease and caries (odds ratios, 0.71 and 0.19, respectively). 

In this population-based cohort study of 10,222 adolescent men enrolled in the Swedish Military Conscription Register followed up for 40 years, higher BP levels in adolescence were associated with greater risk of coronary atherosclerosis in middle age. Elevated risk was observed at BP of 120/80 mm Hg or higher.

This article describes that many younger adults have evidence of atherosclerosis based on young soldier autopsy results, computed tomography angiography and recommends that prevention of cardiovascular disease must move upstream and begin in early life. This may reduce dementia and stroke later in life and ultimately save hospitalizations.

Dr. Eric Topol describes a shift in coronary artery disease approach from obstructive coronary artery disease (blockages) assessed by catheterization, to the focus on non-obstructive arterial disease (atheroma), vulnerable atherosclerotic plaque, and/or inflammation, assessed by non-invasive imaging, with or without AI. I am excited about this because it will allow us to identify vascular disease earlier for prevention of stroke, myocardial infarction, heart failure and dementia.

A health record review of all Danish patients with atrial fibrillation, the almost full implementation of oral anticoagulation from 1999 to 2022 improved the 5-year probability of stroke-free survival by 10.1% in patients aged 65-74, 12.8% in those aged 75-84, and 3.5% in the those >85. The 5-year absolute risk of ICH increased among those >75.

Among older nursing home residents with frailty who were receiving treatment with antihypertensive agents and had a systolic blood pressure (BP) below 130 mm Hg, an antihypertensive treatment step-down strategy did not lead to lower all-cause mortality than usual care. In the >1000 patients >80 years old, BP was 4.1 points lower in the treatment/ deprescribing group than the control group over the 38 months of follow up.

Achievement of blood pressure (BP) control to <140/< 90 mmHg using EHR data extracted over 6 months did not improve with letters that were mailed to patient vs routine care in patients, whose BP was not controlled at the last 2 visits.

In a meta-analysis, outpatient follow-up within 30 days of any hospitalization vs no follow-up was associated with a reduction in risk of 30-day all-cause readmission (RRR, 0.68; 95% CI, 0.60-0.75). Even greater benefit was seen in older adults >65, in heart failure, myocardial infarction and earlier than later follow up.

Quadrivalent modified mRNA influenza vaccine was more efficacious than a standard quadrivalent inactivated flu vaccine, among people ages 18 to 64, the relative efficacy of the modified mRNA vaccine as compared with the control vaccine against influenza-like illness was 34.5%, on the basis of 57 cases in the modRNA group and 87 cases in the control group.

Intranasal, shelf-stable H5N1 bird flu vaccine was well tolerated in phase 1 trial to help protect people from evolving strains of the virus.

The Infectious Diseases Society of America (IDSA) issued a strongly recommends COVID-19 vaccination in immunocompromised individuals immediately. For those undergoing organ transplant or receiving chemotherapy or other immunocompromising treatments, immunization should occur a few weeks before or after administration. IDSA also recommends immunization of close contacts, and co-administration with flu and RSV vaccine is fine. 

Of 233 adults (age, 53.6 years) who had COVID within the past year, a personalized resistance exercise intervention for 3 months, improved walk Test distance compared with baseline was 83 m in the intervention group (n = 94) and 47 m in the control group (n = 98). Also significantly improved were health-related quality of life, Patient Health Questionnaire (depression test), and handgrip strength.  

The pain informed movement program improved post COVID-19 persistent pain and function were with an 8-week, 2 hour per week program. One hour was group-based and focused on pain neuroscience education. The second session was individual and consisted of functional exercises and relaxation techniques. 

In follow up for last week’s thyroid podcast: Guidance from the French Endocrine Society proposes a pragmatic solution to establishing the TSH threshold for adults >60 years, the upper limit of normal is the decade of the patient’s age divided by 10 (eg, TSH 7 IU/L for a 70-year-old patient).

This is an excellent podcast about gratitude and embracing mortality. The website is: https://justsayitnow.org/

The CDC reports 1,730, confirmed measles cases in 43 states, up from 1,700 in 42 states 1 week ago.