Geriatric Update Jan 26, 2026

Patients who developed minor acute ischemic stroke (AIS) or high-risk transient ischemic attack (TIA) are at high risk of subsequent stroke. Glucagon-like peptide–1 receptor agonists (GLP-1) can reduce the risk of cardiovascular events in patients with high-risk type 2 diabetes (T2D). In this randomized open-label, blinded end point trial of 636 patients, age, 63.5 years, 25 patients (7.9%) in the GLP-1 liraglutide group and 44 (13.8%) in the control group experienced stroke recurrence (hazard ratio, 0.56; 95% CI, 0.34-0.91). And more patients in the liraglutide group (274 [87.3%]) than in the control group (246 [77.8%]) achieved excellent functional outcomes (odds ratio, 1.95; 95% CI, 1.28-3.00) on the modified Rankin Scale score, ≤1. Symptomatic intracranial hemorrhage and all-cause mortality were low and similar between the groups.

Of 584 patients, age 71, presenting late with ischemic stroke, time from last known well to imaging was 10.5 (6.9-14.0) hours, 232 patients (39.7%) received intravenous thrombolysis (IVT) before transfer to a stroke center, had better 3-month outcomes (Propensity score with overlap weighting (PSOW)–common odds ratio [OR], 1.97; 95% CI, 1.33-2.92) and recanalization during transfer (PSOW-OR, 8.69; 95% CI, 3.16-23.87) than control, without difference in intracerebral hemorrhage.

Patients with stroke, admitted to one of 2423 participating “Get With The Guidelines–Stroke Registry” hospitals were more likely to receive guideline-based care compared with those at nonparticipating hospitals, although clinical outcomes were similar. The half a million patients experienced minor differences in independent ambulation at discharge (OR, 1.02 [95% CI, 1.01-1.04]) and the composite of in-hospital mortality or discharge to hospice (OR, 1.05 [95% CI, 1.02-1.08]). There were no differences in discharge to home or in-hospital mortality.

Patients with osteoporosis or osteopenia, prescribed bisphosphonates are 5% less likely to experience an ischemic stroke than those prescribed calcium or vitamin D. Those prescribed teriparatide are 35% more likely to experience a heart attack, myocardial infarction (MI), and  44% more likely to have atrial fibrillation (AFib). those  prescribed or denosumab were 23% more likely to experience AFib. This was based on an Epic medical records review of 447,208 patients.

The Naox Link device provided viable signal quality for monitoring brain activity for in-ear EEG recordings and was comparable signal quality with conventional EEG in 30 healthy adults during wakefulness and sleep, despite some motion-related artifacts.

In 641 patients, one year after successful catheter ablation for atrial fibrillation, assigned to take rivaroxaban had similar outcomes as the 643 assigned to take aspirin for: stroke, cerebral infarcts, systemic embolism, or new covert embolic stroke at 3 years, as well as no difference in major bleeding, but all events were rare. Commentators stated that it seems that the average CHA2DS2-VASc score of 4 was reverted to a score of 1 in terms of outcomes, and a comparison with placebo would have been interesting, given aspirin’s risk of bleeding.

After recurrent ischemic stroke, switching to antithrombotic therapy, was not associated with improved risk of recurrent stroke of 0.88 (95% CI, 0.76-1.03) compared with continuing aspirin. Antithrombotic meds in the included randomized studies were 2 trials of vitamin K antagonists (n=478), 3 trials of dual antiplatelet therapy (n=2229), 3 trials of direct oral anticoagulant (n=2660) monotherapy, and 1 trial of low-dose direct oral anticoagulant added onto aspirin (n=92). Similarly, secondary outcome was a composite of ischemic stroke, myocardial infarction, and vascular death (or all-cause mortality), was also not statistically significantly different, as was the result of a meta-analysis of pooled data.

Cortical superficial siderosis (cSS) is iron deposit in the superficial brain cortex following bleeding. It leads to higher stroke risk that is mitigated with antiplatelet or anticoagulant treatment. Compared with the non-cSS group, cSS was associated with increased stroke on multivariable analysis {IR 83 vs 42 per 1,000 patient-years, adjusted hazard ratio [HR] for cSS 1.62 (95% CI: 1.14-2.28; p = 0.006)}. This association was not significant in subgroups of patients treated with antiplatelet drugs (n = 6,554) or with anticoagulants (n = 4,044). But patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n = 1,569) had a higher incidence of intracranial hemorrhage (ICrH) (IR 107.5 vs 4.9 per 1,000 patient-years, adjusted HR 13.26; 95% CI: 2.90-60.63; p = 0.001) and of any stroke (IR 198.8 vs 34.7 per 1,000 patient-years, adjusted HR 5.03; 95% CI: 2.03-12.44; p < 0.001) compared with the non-cSS group. 

Long-term air pollution was associated with an increased risk of motor neuron disease (MND); per IQR increase in the 10-year average level, the odds ratio was 1.21 (95% CI, 1.09-1.34) for particulate matters (PM) PM2.5, 1.30 (95% CI, 1.19-1.42) for PM2.5-10, 1.29 (95% CI, 1.18-1.42) for PM10, and 1.20 (95% CI, 1.12-1.29) for NO2. A higher level of PM10 or nitrogen dioxide (NO2) was associated with a higher hazard of mortality, whereas a higher level of all PMs was associated with faster functional decline, particularly motor and respiratory functions, after MND diagnosis.

Obstructive sleep apnea (OSA) is significantly associated with a higher risk of developing incident Parkinson disease (PD) (mild: HR, 3.17; 95% CI, 2.45-4.11; severe: HR, 3.42; 95% CI, 2.87-4.09; P < .001) in 13.7% of 11 million veterans who had OSA, age 60.5 years. Treatment with CPAP early, within 2 years, in the disease course significantly reduced PD by a third (HR, 0.65; 95% CI, 0.49-0.87).

Individuals with higher cardiovascular risk scores demonstrated a significantly increased likelihood of developing vision-threatening conditions: Age-related macular degeneration (AMD) (hazard ratio 6.22), glaucoma (2.33), diabetic retinopathy (5.93), hypertensive retinopathy (4.47), and retinal vein occlusion (3.38). Furthermore, these associations persisted over 5-7 years of follow-up and remained robust after adjustment for race, body mass index, kidney disease, and educational attainment.

Treating isolated diastolic hypertension (IDH), defined as systolic BP <130 mmHg and diastolic BP >80 mmHg, is not less or more effective than in those without IDH. The pooled analysis of 51 randomized controlled trials with 1/3 million participants had 15,845 (4.4%) with IDH. 

White adipose tissue (WAT), particularly in lipid-rich visceral WAT stimulates neutrophils to mount an immune response that prevents fat breakdown and increases inflammation. Neutrophil depletion or blockade of IL-1β production increases fat breakdown, but also could impair the body’s ability to fight infections, cancer, etc.

In 337 diabetes-free individuals, age 41, with obesity and metabolic dysfunction–associated steatotic liver disease (MASLD), a 6-month berberine treatment at a daily dose of 1 g had an excellent safety profile but did not reduce visceral adipose tissue (VAT) area or liver fat content in this randomized trial.

This NYT article is on cognitive shuffling for insomnia that looks good but I haven't tried. I successfully use 5x deep breathing that stimulates the vagus nerve and parasympathetic nervous system, leading to relaxation. I use cognitive distraction to stop the stinking thinking when I perseverate over making a mistake for example.

In rheumatoid arthritis, the association between anticitrullinated protein antibodies (ACPAs) and all-cause mortality seems to be explained by inflammation, with higher C-reactive protein (CRP) levels over time observed in ACPA-seropositive patients contributing to cardiovascular events.

SILINTAN, a supplement promoted and sold for joint pain is recalled by the FDA due to unlisted meloxicam in the product. Meloxicam, an NSAID, is on the Beers list and should not be used by older adults because of vasoconstriction and risk for cardiovascular and renal events.

The 161 veterans, age 62 years, who used the patient-focused self-management intervention (Eliminating Medications Through Patient Ownership of End Results; EMPOWER) were much more likely to completely stop benzodiazepine use (odds ratio [OR], 5.31 [95% CI, 1.12-25.12]), based on Rx refills over 3 months.

Ontario, Canada instituted shingles vaccine for those born between 1946 and 1960. Being born after versus before Jan 1, 1946, decreased the probability of receiving a new dementia diagnosis by an absolute difference of 2% (95% CI 0·4–3·5, p=0·012) over a 5·5-year follow-up. Australia had a similar “experiment” showing 1.8% reduction of dementia.

The CDC reports 413, confirmed measles cases in 14 states in 2026, last week 171 cases in 9 states. For flu activity, the CDC has not updated the website since Dec.

Ohio’s respiratory dashboard showed 802 flu hospitalizations (1383 last week), 629 COVID hospitalizations (771), and 287 RSV (289).

The OMDA call on Thu Jan 29th at 8 am is: by Steven S. Elliott, Chief Magistrate, Summit County Probate Court

“Crying can be the deepest form of prayer. When the heart is full it weeps. This is not always a sign of weakness; it can be a profound expression of our humanity. It can be an invocation, a protest, a longing or a surrender.” Pope Leo XIV

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