Geriatric Update Oct 14, 2024

Vitamin B2 (Riboflavin) intake at recommended daily allowance (RDA) based on 24-hour dietary recall interviews, was associated with better cognitive ability based on 3 assessment tests: Immediate Recall Test (IRT), odds Ratio = 0.77, 95% confidence interval: [0.65,0.92]; Animal Fluency Test (AFT), 0.75, [0.64,0.88]; and Digit Symbol Substitution Test (DSST), 0.72, [0.59,0.88] in 2893 individuals, mean age of 69. Moreover, vitamin B2 intake above the RDA reduced the risk of low cognitive performance (IRT, 0.66, [0.46,0.93]; AFT, 0.83, [0.62,1.11]; DSST, 0.65, [0.45,0.92]). I recommend a multivitamin for seniors for all my patients age >50 as thiamine, niacin, B6- and B-12 also have shown beneficial effects on cognition.

Proteomic signatures of healthy dietary patterns are associated with lower risks of major chronic diseases and mortality. The strongest evidence across dietary patterns is for vegetables, onions, garlic, sweet peppers, fruits, legumes, nuts, low fat dairy and tea.

The American Heart Association scientific statement discusses the mechanisms that link 3 prevalent cardiac diseases of adults: heart failure, atrial fibrillation (A-fib), and coronary heart disease to cognitive impairment. Inflammation, neurohormonal activation, sleep apnea, surgery and genetic predisposition contribute to the cognitive decline observed in people with heart failure. Effective treatment of A-fib may reduce cognitive decline, with anticoagulation, and catheter ablation may result in a greater reduction in dementia risk compared with antiarrhythmic therapy alone. For coronary heart disease, the mechanism seems to be inflammation, decreased cerebral blood flow, and high blood pressure that leads to vascular leakage of the blood brain barrier (BBB), and other neurovascular elements have an active role in the removal of toxic bioproducts, including amyloid-β and tau.  Neuroimmune mechanisms and oxidative stress, can increase the production of amyloid-β, which can promote vasoconstriction. What’s good for the heart is also good for the brain: The MIND diet and FINGER (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability), showed a benefit in neurocognitive performance at 2 years in favor of multidomain intervention, including diet, exercise, cognitive training, and vascular risk factor control.

Playing video games that involve physical activity ('exergaming') may help people with dementia and mild cognitive impairment when compared to no activity, but there is little evidence at present to suggest exergaming might help improve the ability of people with dementia and mild cognitive impairment to walk, keep their balance, or handle daily tasks like paying bills or going shopping.

Older adults who experience falls are at a higher risk of developing dementia within a year. The study found that 10.6% of patients who fell were diagnosed with dementia compared with 6.1% with other injuries (hazard ratio [HR], 1.21; 95% CI, 1.20-1.21; P < .001). Delirium during the visit for the fall was associated with an increased risk for future dementia diagnosis (HR, 1.66; 95% CI, 1.64-1.69; P < .001).

A new World Falls Guidelines algorithm categorized patients, age 78.7, better into fall risk groups. Timed Up and Go (TUG) test screening with a >10-s cut point (originally >15 s). The high fall risk group was older, had worse physiological profile scores, grip strength and balance, poorer mobility (TUG test), slower processing speed, greater fear of falling and depressive symptoms, and reduced quality of life compared to the low-risk group.

In patients with lung cancer, age, 65.5 years, 4.7 (video) and 4.9 (in-person) early palliative care encounters were not inferior in patient-reported quality-of-life scores were (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence), and no difference in in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions. Rate of caregiver participation was lower for video vs. in-person early palliative care visits (36.6% vs 49.7%; P < .001).

Seafood intake was independently associated with a lower risk for developing persistent tinnitus (ringing in the ears). Among participants who consumed one serving of fish per week, the risk for tinnitus was 13 percent lower; risk was 23 percent lower for those who consumed two to four servings per week and 21 percent lower for those who consumed five or more servings. Higher intakes of tuna fish, light-meat fish, and shellfish all were associated with lower risk (e.g., consumption of tuna at least once weekly: adjusted hazard ratio [aHR], 0.84; light-meat fish: aHR, 0.91; shellfish: aHR, 0.82). Fish oil supplement use was associated with a higher risk (aHRs, 1.09 and 1.12, respectively).

Resistance exercise [standardized mean difference (SMD) = - 0.68, 95% confidence interval (CI): - 0.90, - 0.46] and mind-body exercise (MBE; SMD = - 0.54, 95% CI: - 0.72, - 0.37) were the most effective forms of exercise for improving depression in older adults, followed by aerobic exercise (SMD = - 0.31, 95% CI: - 0.50, - 0.13) and mixed exercise (SMD = - 0.23, 95% CI: - 44, - 0.01). In addition, a U-shaped dose-response relationship was found between overall exercise dose and depression levels in older adults, and a significant response was seen after 390 metabolic equivalent (MET)-min/week.

During influenza season, among 299,881 Danish participants, age 52, those randomized to receive 1 of 6 intervention letters had higher vaccination, 39.6% vs usual care, 27.9% (P < .001). Each individual letter type significantly increased influenza vaccination with the largest effect sizes observed with a repeated letter sent 10 days after the initial letter (repeated letter, 41.8% vs usual care, 27.9%), and a letter emphasizing potential cardiovascular benefits of vaccination (cardiovascular gain, 39.8% vs usual care, 27.9%).

Medicare annual wellness visits diagnosed 21% more patients with mild cognitive impairment and got their diagnoses 76 days earlier than those who did not have a visit. This allows for more time of planning and placement selection while patients are still able to participate in decision making.

The Medicare $2 Drug List includes commonly prescribed meds such as lisinopril, amlodipine, atorvastatin, etc.