Geriatric Update Feb 26, 2024
This comprehensive paper on long COVID showed multiple potential pathogenic pathways, including persistence of the virus or its components in tissue reservoirs; autoimmune or an unchecked, dysregulated immune response; mitochondrial dysfunction; vascular (endothelial) and/or neuronal inflammation; and microbiome dysbiosis. Vaccine reduces the risk of long COVID by about 40%, treatment with Paxlovid by 26% and starting metformin within 7 days of infection by 41%.
Cataract surgery in 88 mild cognitive impairment (MCI) patients, age 86.7, showed significant improvement from before to after surgery in the MMSE score (25.65 ± 1.03 vs. 27.08 ± 1.99, p < 0.001), no difference in patients with dementia.
Selenium was deficient in 89% of Hashimotos thyroiditis patients, and supplementation is associated with improvements in key thyroid measures. 1 Brazil nut contains the daily RDA of selenium, caution: too little and too much selenium has been associated with cancer.
Thiamine deficiency has been known to cause beriberi and dementia since 1929 when the Nobel prize was awarded. This study showed a J-shaped relationship between dietary thiamine intake and the 5-year decline rate in global and composite cognitive scores: 4.24 (95% CI: 2.22 to 6.27) points in global score (27 point test) and 0.49 (95% CI: 0.23 to 0.76) standard units in the composite score. The inflection point was 0.68 mg/day and a minimal risk at 0.60–1.00 mg/day of dietary thiamine intake.
In 586 deceased individuals, age 90.9, with data on lifestyle factors, cognitive testing proximate to death, and a complete neuropathologic evaluation, over 24 years, more than 88% of positive cognitive scores were directly associated with lifestyle, and only approximately 12% were affected by the presence of amyloid plaques. A healthy lifestyle was the main determinant of good cognition prior to death regardless of dementia pathology in the brain. The authors posit that “lifestyle choices may provide a cognitive reserve to maintain cognitive abilities in older adults.”
In a Network Meta-analysis of 8467 patients, age 79.8 years: brexpiprazole and risperidone were found efficacious in reducing agitation and/or aggression in patients with dementia. Brexipiprazole is likely not covered by insurance due to cost, but both carry black boxed warning and require informed consent.
Among 353 patients (299 ischemic stroke and 54 transient ischemic attacks), median age, 67, one third had sleep disordered breathing and higher subsequent death or cerebro-cardiovascular events, hazard ratio, 2.25 [95% CI, 1.12–4.50]). In the subgroup of 58 patients with A-fib, half had SDB, but not higher risk of death. (hazard ratio, 1.64 [95% CI, 0.62–4.36]), but the sample size may have been too small to reach statistical significance. Either way, we should have a low threshold for sleep studies on patients after stroke.
A Chinese study randomized 224 patients age 60.7, with poststroke motor aphasia to acupuncture and found significant improvements in language function, quality of life, and neurological impairment from week 6 of treatment to the end of follow-up at 6 months, over sham acupuncture.
A 12-month randomized trial of 60 min 4 times a week of Tai Chi intervention was more effective than the same amount of time of aerobic exercise in reducing SBP, with a mean change of -7.01 mm Hg in the Tai Chi group vs -4.61 mm Hg in the aerobic exercise group.
In this population-based cohort study of 3.2 million people who initiated opioid treatment, risk of serious fall events significantly increased with age and within the first 28 days of starting. It was highest among those >85 years (adjusted incident rate ratio, 6.35; 95% CI, 6.20-6.51) compared to 18-44 yo.
Self reported walking limitations were associated with fractures. Little walking limitation among women: hazard ratio [HR], 1.32; 95% CI, 1.23-1.41; among men: HR, 1.46; 95% CI, 1.34-1.60; a lot of limitation among women: HR, 1.60; 95% CI, 1.49-1.71; among men: HR, 2.03; 95% CI, 1.86-2.22).
This Cochrane review showed no benefit from nutritional interventions for preventing and treating pressure ulcers.
In this cohort study with 6692 participants, age 63, receipt of supplemental nutritional assistance program (SNAP) benefits was associated with a 13.6% reduction in nonadherence to antihypertensive medications among food-insecure patients with hypertension but not among their food-secure counterparts.
While cannabis seems to alleviate anxiety in the short term, it worsens it in the long term (adjusted Hazard Ratio [aHR] 3.69 95% CI 3.57–3.82) over 3 years, and more so in young men (aHR 5.67 95% CI 5.19–6.21).
Deep brain stimulation has been used for Parkinson’s, this report describes its use for intractable depression.
The International Stroke Conference had 2 practice changing presentations (scroll down in the link for abstracts):
Keeping stroke patients flat improves collateral perfusion: In large vessel occlusion stroke, early neurologic deterioration of 2 points or more on the NIHSS score occurred in just 1 of 45 patients (2.2%) in the group who were laid flat compared with 26 of 47 patients (55.3%) of the group whose heads were raised to 30 degrees (P < .001). A larger deterioration (4 or more points on the NIHSS score) showed similar results, one patient in the zero degrees group (2.2%) vs 20 patients (42.5%) in the 30 degrees group (P < .001). Improvements in the NIHSS score 24 hours after thrombectomy occurred in 87% vs 61% of patients (P =.008) and at 7 days or discharge in 87% vs 68% (P = .045).
Black women who develop high blood pressure before age 35 have a threefold increased risk of having a midlife stroke, in 59,000 US participants since 1990s. Those who develop hypertension before age 45 have twice the risk of stroke.
