Geriatric Update Jan 22, 2024
In 21% of 1611 participants, age 55 years, treated with Paxlovid within 4 weeks of COVID infection, followed for 5.5 months, no difference in long COVID development was found.
Simnotrelvir is an oral 3-chymotrypsin–like protease inhibitor that shortened the time to sustained resolution of Covid-19 symptoms vs. placebo to 180.1 hours vs. 216.0 hours.
Another oral antiviral, VV116 (known as mindeudesivir) is a deuterated remdesivir hydrobromide with improved oral bioavailability and potent anti-SARS-CoV-2 activity. It led to reduction in time to sustained clinical symptom resolution compared with placebo among 1296 patients (HR 1·17, 95% CI 1·04–1·33; p=0·0009).
Of 564 patients with COVID and decreased renal function <30 mg/dl, 211 patients were treated with remdesivir and did not result in significant nephrotoxicity or hepatotoxicity..
In Europe 33-50% are keeping up with COVID boosters, in the US it is 17%. This study calculated that if Europeans kept up to date, 17.8% of severe COVID outcomes, hospitalization and death, could be prevented.
In American adolescents vaccine efficacy is higher with shorter time since Pfizer vaccine than longer 75-92%, and the risk for cardiac complications was lower in the vaccinated group.
Post-pandemic memory T-cell response to SARS-CoV-2 is durable, broadly targeted, and cross-reactive to variants.
7% of American adults had experienced long COVID at some point.
The CDC reports 5035 patients have died of long COVID but this is likely an underestimate due to underdiagnosis. This is a guidance for certifying deaths due to COVID-19.
In Geriatric and other news,
Of 5,515 individual outpatients ages 18-64 years, 510 were vaccinated with high dose and 557 were vaccinated with standard dose flu vaccine and 81% were unvaccinated. Adjusted influenza vaccine efficacy estimates were 37% overall, 40% for high and 35% for standard dose vaccines against medically attended outpatient influenza during the 2018-2020 seasons.
Multivitamin and minerals (MVM) benefit global cognition [mean difference (95% CI) = 0.07 standard deviation units, SU (0.03, 0.11); P = 0.0009] and episodic memory [mean difference (95% CI) = 0.06 SU (0.03, 0.10); P = 0.0007]; the magnitude of effect on global cognition was equivalent to reducing cognitive aging by 2 years. My theory is via prevention of vitamin B-12 deficiency. I recommend all my patients >50yo take a MVM daily to prevent vitamin D and B-12 deficiency, both are common in older adults.
Cataract surgery significantly increases cognitive test scores in older patients with mild cognitive impairment (MCI). And significantly more in the MCI than in the dementia group (odds ratio, 2.85; 95% confidence interval, 1.02–7.97; and p = 0.046).
Higher triglyceride levels were associated with lower dementia risk in the entire ASPREE cohort (hazard ratio [HR] with doubling of triglyceride: 0.82, 95% CI 0.72–0.94). Findings were similar in the subcohort of participants with APOE-ε4 genetic data (n = 13,976) and in the UK Biobank cohort (HR was 0.82 and 0.83, respectively, all p ≤ 0.01). Higher triglycerides were also associated with slower decline in composite cognition and memory over time (p ≤ 0.05).
Active commuting of 45 min a day walking or cycling to work and home improves cognition and reaction time by raising dopamine levels. Dopamine also accelerates time to ejaculation, a problem in some older men.
Dopamine fasting is a concept of stopping addictive behaviors for a month. Although the first 2 weeks are difficult, the author finds that many patients feel better and more motivated after 4 weeks. It is not recommended to anyone who has repeatedly and unsuccessfully tried to quit a drug on their own nor anyone for whom withdrawal is life-threatening.
Remission of diabetes from weight loss through 12 year intensive lifestyle intervention vs. diabetes support and education reduced chronic kidney disease by 33% and cardiovascular disease by 40%.
Wearable ultrasound was made possible by linking it via wireless communication with a transducer in a laptop. Motion artifact is compensated using machine learning to calculate the best view of 32 channels of the 4-MHz, linear array probe, which insonates to a depth of 78 mm.
Belgian children aged 4 to 6 years followed since birth, showed that shorter distance to residential green space within walking distance, 1km, were associated with higher bone mineral density and a lower risk of having low bone density.
A bit shorter this week as I am in Germany for my mom’s 90th birthday. Attached is a photo of her with one of 4 different cakes she baked and decorated in anticipation of a large family invasion….
