Geriatric Update Apr 14
The CDC reports 712 confirmed measles cases, up from 609 last week. In Ohio, the Dept of Health reports 20 cases
SGLT-2 inhibitors have been shown to cause genitourinary infections. This study compared them with GLP-1 agonists and showed risks of UTI within the first year were nearly identical: 10.0% in SGLT-2 and 10.2% in GLP-1, risk ratio of 0.98 (95% CI 0.94, 1.03). For genital tract infection (GTI), the 1-year risks were elevated under SGLT-2 therapy at 2.0% vs. 0.7% (risk ratio 2.95 [95% CI 2.52, 3.44]). During the 5-year follow-up, the relative UTI risk remained almost constant (0.96 [95% CI 0.94, 0.99]) whereas the GTI risk ratio with SGLT-2 is decreased to 1.64 (95% CI 1.49, 1.80).
Initiation of glucose lowering drugs (GLD) was evaluated in 60,000 patients age 65, and showed lower risk of dementia with GLP-1, HR of 0.67 (95% CI, 0.47-0.96) and SGLT-2 meds, HR of 0.57 (95% CI, 0.43-0.75). There was no difference between GLP-1 and SGLT-2, but no other GLDs showed a benefit.
GLP-1 meds have numerous benefits:
Reduce knee osteoarthritis pain through
Weight loss,
Reduced inflammation and apoptosis
Improve glycemic control.
Lower tobacco and alcohol abuse
Reduce obstructive sleep apnea, apnea-hypopnea index, hypoxemic load, and improved sleep quality
Reduce liver fibrosis progression, suggesting a hepatoprotective effect.
Reduce kidney failure through nephroprotective effects
Reduce risk of stroke
Reduce dementia
Reduce cardiovascular risk and
Reduce heart failure
The test for microtubule-binding region of tau containing the residue 243 (MTBR-tau243), a biomarker of tau tangles in the brain may be a more accurate measure of tau pathology than other established biomarkers. In a previous study cerebrospinal fluid levels of MTBR-tau243 correlate closely with tau tangles in the brain. Investigators used the blood MTBR-tau243 test to successfully distinguish between patients at different stages of AD progression and identify whether cognitive decline was likely due to AD or some other cause.
Dr. Topol summarized research on p-Tau217 and showed that the test consistently outperforms the others for accuracy and specificity in predicting Alzheimer’s disease is as good or superior to cerebrospinal fluid tests and as accurate as tau-PET scans in people who are cognitively unimpaired. It can even be used to stage the disease in lieu of tau PET scans and changes in pTau-217 occur earlier than abnormal findings on a PET scan. Two studies show reduction with exercise, one with p-Tau217 and the other with p-Tau181, which correlates closely with p-Tau217 and a study reported at the annual American Academy of Neurology meeting last week. The test for p-Tau217 is currently the only commercially available test for tau, costs $200, and is being used for clinical trials of new drugs to prevent Alzheimer’s disease, but may not be as useful in people age >80 because treatment would not make a difference.
Statins appeared to reduce the risk for hepatocellular carcinoma (3.8% vs 8.0%) and hepatic decompensation (10.6% vs 19.5%) over 10 years among 16,501 patients with chronic liver disease.
The risk of atherosclerotic cardiovascular disease increases with advancing age. Elevated LDL-cholesterol and non-HDL-cholesterol levels remain predictive of incident atherosclerotic cardiovascular events among individuals older than 75 years. While some studies have shown a decline in cognition with statins, the preponderance of literature indicates neutral or even protective statin-related cognitive effects. The American Geriatrics Society guideline recommends patient-centered approach should be taken when considering primary prevention strategies for older adults, and deprescribing of lipid-lowering agents may be appropriate for select patients >75 years with life-limiting diseases.
Hearing loss is associated with decreased activity and this study tested hearing interventions. Among 847 participants (mean age 76.2 years), total activity counts (measured by accelerometer) declined by 2.7% annually, and active minutes/day declined by 2.1% annually over 3 years in both hearing intervention and health education control groups. Activity patterns also became more fragmented over time. The authors did not control for cognitive decline, as brain failure is associated with declining hearing and declining physical activity.
Women with overactive bladder who underwent urodynamics plus comprehensive clinical assessment (CCA) had outcomes not superior to those of women who underwent CCA alone (23.6% vs 22.7%; adjusted odds ratio, 1.12; P = .60).
People drinking eight or more alcoholic drinks a week have a 133% increased risk of hyaline arteriolosclerosis, a thickening and narrowing of the small arteries that feed the brain (OR 2.33, 95% CI 1.50–3.63). Compared with participants who never consumed alcohol, moderate (odds ratio [OR] 1.60, 95% CI 1.19–2.15, p = 0.001), heavy (OR 2.33, 95% CI 1.50–3.63, p < 0.001), and former heavy (OR 1.89, 95% CI 1.41–2.54, p < 0.001) use was associated. Alcohol consumption was also associated with neurofibrillary tangles, but only with heavy (OR 1.41, 95% CI 1.10–2.30, p = 0.012) and former heavy (OR 1.31, 95% CI 1.02–1.68, p = 0.029) use in 1,781 participants (mean age 75 years).
In 90 patients with recurrent diverticulitis, it recurred in 16% of the surgery group at 4 years versus 92% of the conservative group. Among those randomized to conservative treatment, 14 of 44 (32%) underwent sigmoid resection within 4 years.
Patients with hypoparathyroidism should be monitored for osteoporosis. One third of postmenopausal women and men over age 50 with chronic hypoparathyroidism had osteoporosis by low bone mineral density or fracture and 4% had both.
Of the 4 magnesium products, studies suggest that magnesium L-threonate stands out when it comes to supporting brain health through improved synaptic plasticity because it crosses the blood-brain barrier more effectively than others. Magnesium glycinate helps in promoting muscle relaxation and improving sleep quality. The amino acid glycine has calming properties. Magnesium citrate is poorly absorbed and works by drawing water into the intestines, which can help to soften stools and promote regular bowel movements. Magnesium oxide is also poorly absorbed and works as a laxative, but if cost is an issue, this is better for insufficient dietary intake (dark green leafy vegetables) than none.
Cancer-associated venous thromboembolism was treated as effectively with low dose apixaban as with high dose. Of 1766 randomized patients, age 69, recurrence occurred in 18 patients (cumulative incidence, 2.1%) in the reduced-dose apixaban 2.5 mg twice a day group and in 24 (cumulative incidence, 2.8%) in the full-dose, apixaban 5 mg twice a day group (adjusted subhazard ratio, 0.76; 95% confidence interval [CI], 0.41 to 1.41; P=0.001 for noninferiority). Also, there was lower bleeding risk and nonsignificant mortality reduction 17.7% in the reduced-dose group and 19.6% in the full-dose group (adjusted hazard ratio, 0.96; 95% CI, 0.86 to 1.06).
Methylene blue therapy, in combination with ACT, is safe and effective against tropical malaria, particularly strong against gametocytes. It is also used as an antidote for nitrite or aniline poisoning, where it helps convert methemoglobin back into functional hemoglobin, thereby ensuring an oxygen supply to the body.
Methylene blue and its derivatives have been unsuccessfully investigated as potential treatments for numerous conditions, including stroke, bipolar disorder, Parkinson’s disease, and Alzheimer’s disease, but in a large study involving 890 participants, it did not perform better than placebo.
The German Pharmacists’ Associations (ABDA) strongly advises against methylene blue dispensing in pharmacies.
