Geriatric Update Apr 7, 2025
The CDC reports 609 confirmed measles cases, up from 483 last week. In Ohio, the Dept of Health reports 10 cases.
Herpes zoster (HZ), shingles was associated with higher long-term risk of subjective cognitive decline (SCD) compared with individuals with no history of HZ 14-34% depending on a subgroup of the 149,327 participants from three large cohorts-the Nurses' Health Study (NHS), NHSII, and Health Professionals Follow-Up Study. The mechanisms is through neuroinflammation, compromised immunity or direct neuronal injury.
Recent headlines read that shingles vaccine reduced dementia by 20% and various vaccines reduced dementia by 35%, but the numbers are more nuanced.
Zostavax vaccine (the live attenuated virus vaccine, no longer available) eligibility in Wales was determined by a cutoff birth date September 1 2013 in Wales, with those born before 2 September 1933 ineligible and those born within 1 year thereafter eligible, which resulted in 47% vaccinated of eligible vs 0% ineligible. A new dementia diagnosis was reduced over a follow-up period of 7 years by 3.5% (95% confidence interval (CI) = 0.6–7.1, P = 0.019), a 20.0% (95% CI = 6.5–33.4) relative reduction. Another analysis of the same cohort zostavax reduced new mild cognitive impairment diagnosis by 1.5% over 9 years in those without prior dementia diagnosis.
Shingrix, the recombinant vaccine replaced the recombinant vaccines in October 2017 and was associated with lower risks of dementia than were two other vaccines commonly used in older people: influenza and tetanus-diphtheria-pertussis vaccines, and a 17% increase in diagnosis-free time over 6 years, translating into 164 additional days lived without a diagnosis of dementia in those subsequently affected. These shingles studies are summarized in a 3 min video.
Waist circumference was shown to be a stronger marker than body mass index (BMI) for the risk of developing obesity-related cancers among 339,190 Swedes (average age, 51.4 years). In men, a waist circumference increase of approximately 11 cm was associated with a 25% higher risk of developing obesity-related cancers, whereas a BMI increase of 3.7 kg/m2 corresponded to a 19% increased risk. Among women, the associations between waist circumference and BMI with obesity-related cancers were weaker and similar to each other.
Semaglutide reduced outcomes (a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) in persons >50 years old, with type 2 diabetes and atherosclerotic cardiovascular disease, chronic kidney disease, or both, (hazard ratio, 0.86; 95% confidence interval, 0.77 to 0.96; P = 0.006).
Preoperative macular thickness of the right eye was associated with 1.6 higher odds of delirium (95% CI 1.093-2.322). 40 of 169 patients (24%) developed postoperative delirium, and these patients had displayed a greater mean macular thickness (283.35 µm) of the right eye at their preoperative assessment than the patients who did not experience postoperative delirium (273.84 µm). The right retina shows more reliable measurements.
While butter is worse than plant oils, oils are not created equal. Linoleic acid, an omega-6 fatty acid (in contrast to omega-3), found in seed oils such as soybean and safflower oil, and animal products including pork and eggs, specifically enhances the growth of hard-to-treat “triple negative” breast cancer. The mechanism is through activating a major growth pathway in tumor cells by binding to a protein called FABP5, particularly abundant in triple neg, but not in other hormone-sensitive subtypes. FABP5 causes the assembly and activation of mTORC1, a major regulator of cell metabolism and cancer cell growth. In a mouse model of triple-negative breast cancer, a diet high in linoleic acid enhanced tumor growth.
In 234 Chinese patients with posterior stroke, alteplase 4.5-24 hours after stroke showed better functional independence at 90 days than the 117 randomized to standardized treatment (89.6% vs. 72.6%; adjusted risk ratio, 1.16; 95% CI, 1.03 to 1.30; P=0.01). The incidence of symptomatic intracranial hemorrhage within 36 hours was 1.7% in the alteplase group and 0.9% in the standard treatment group. At 90 days, death was 5.2% in the alteplase group and 8.5% in the control group.
A pacemaker the size of a rice kernel is bioresorbable with an onboard power supply and a wireless, optical control mechanism with electrotherapy and temporary cardiac pacing capabilities. The extremely small sizes allows minimally invasive implantation, including percutaneous injection and endovascular delivery. Studies demonstrate effective pacing in mouse, rat, porcine, canine and human cardiac models at both single-site and multi-site locations. Pairing with a skin-interfaced wireless device allows autonomous, closed-loop operation upon detection of arrhythmias.
Cardiovascular (CV) deaths were reduced by atorvastatin during a 16-year follow-up by about ¼ depending on outcome. Over such a long time, the complication was that 2/3 of patients in both arms were taking statins, which likely diluted the effect.
The gap in survival between the top and bottom wealth quartiles was wider in the United States than in Europe. Survival among the participants in the top wealth quartiles in northern and western Europe and southern Europe appeared to be higher than that among the wealthiest Americans. Survival in the wealthiest U.S. quartile appeared to be similar to that in the poorest quartile in northern and western Europe.
Over a mean follow-up of about 11 years, suicide accounted for 0.3% of all cohort deaths, and was greater among individuals who lived alone and had depression (1.2%) or anxiety (0.7%).
Wishing our Jewish colleagues a Happy Passover, starting this Saturday.
