Geriatric Update Aug 26, 2024

Moderna and Novavax have shown good results with their combination vaccines for COVID and influenza A and B.  Pfizer and BioNTech did not meet the immunogenicity for influenza B in their combination. 

The FDA authorized emergency use of the monoclonal antibody pemivibart for pre-exposure prophylaxis of COVID-19 in >12 year olds, weighing >40 kg who are moderately or severely immunocompromised.

This study looked at the risk of depression and serious mental illness incidence in 3 cohorts related to COVID-19: 1 before vaccine availability (January 2020-June 2021) and 2 vaccinated and unvaccinated, (June-December 2021) among National Health Service England’s 18 million, avg age 49. Adjusted hazard ratios during weeks 1 through 4 after COVID-19 were: in the pre–vaccine availability cohort for depression 1.93 (95% CI, 1.88-1.98) and serious mental illness 1.49 (95% CI, 1.41-1.57); and in the unvaccinated cohort depression 1.79 (95% CI, 1.68-1.90) and serious mental illness 1.45 (95% CI, 1.27-1.65) compared with the vaccinated cohort for depression 1.16 (95% CI, 1.12-1.20) and serious mental illness 0.91 (95% CI, 0.85-0.98). Elevation in incidence was higher and persisted longer after hospitalization for COVID-19.

High normal blood sodium levels >142 mmol/l (=mEq/L), a marker of dehydration, in middle age was is associated with a 39% increased risk to develop chronic diseases, heart failure, dementia, chronic lung disease, stroke, diabetes, peripheral vascular disease and claudication, atrial fibrillation, and hypertension, (hazard ratio [HR] = 1.39, 95% confidence interval [CI]:1.18–1.63) and >144 mmol/l with 21% elevated risk of premature mortality (HR = 1.21, 95% CI:1.02–1.45). People with serum sodium >142 mmol/l had up to 50% higher odds to be older than their chronological age (OR = 1.50, 95% CI:1.14–1.96). A higher biological age was associated with an increased risk of chronic diseases (HR = 1.70, 95% CI:1.50–1.93) and premature mortality (HR = 1.59, 95% CI 1.39–1.83).

Intracranial atherosclerotic disease (ICAD) as measured on MRI, was associated with dementia over about 5.6 years, adjusted hazard ratio 1.41 for ICAD causing a stenosis of <50% or less, and 1.94 for ICAD causing a stenosis >50%. We can prevent and control atherosclerosis by reducing: blood pressure that prevents damage to blood vessels, cholesterol that prevents plaque buildup, and inflammation with diet and exercise.

Two studies showed a correlation between lifestyle choices, particularly an inflammatory diet and brain volume and dementia from the UK Biobank.  Patients with metabolic syndrome: large waist circumference, elevated triglyceride levels, high blood sugar levels, elevated blood pressure, and reduced HDL cholesterol levels, showed the more components the higher the risk for poorer cognition across all domains and lower brain volume.

A nutritional survey of 45 parameters identified an inflammatory diet: generally high in red meat, sugar, high-fat dairy, and processed foods with higher risk. Dementia risk was 31% lower, gray matter volume larger, and white matter hyperintensity volume smaller, among individuals with cardiometabolic disease who ate a low inflammatory diet compared to those in the tertile of high inflammatory diet.

A higher intake of heme iron may be linked to a 26% higher risk for developing type 2 diabetes compared with those in the lowest intake group, but not in those taking supplements or non-heme iron. Possibly because absorption of heme iron (15–35%)is greater than for non-heme iron 2% - 20%.

Higher vitamin B1, thiamine, intake decreased constipation by 23% (P = .034). Prevalence was 7.69% in the group with the highest B1 intake, 10.7% in the middle group, and 14.09% in the group with the lowest intake (P < .001). Low and high levels of thiamine can lead to dementia, so don’t overdo it.

Elinzanetant, a new neurokinin- 1 and 3 receptor antagonist for menopausal symptoms; 120 mg, for 26 weeks, improved vasomotor symptom severity and frequency by about 60%, a little <60% at 4 weeks and a little >60% at 12 weeks, placebo reduced symptoms by about 30%. Sleep disturbances and menopause-related quality of life improved at 12 weeks, and the safety profile was favorable in 2 stage 3 randomized trials of 633 postmenopausal participants aged 40 to 65 years.

This is an excellent podcast about anxiety (start at 4 min). I found deep breathing most helpful too, but over the years my experience showed that most of my patients could not do the counting method, then breathing deep enough to expand the abdomen worked well, it stimulates the diaphragm and vagus nerve that activates the parasympathetic nervous system.