Geriatric Update March 4, 2024

A study of 112,964 UK participants after COVID infection, had a baseline cognitive assessment May 2020 to March 2022, and 1/3 had a follow-up online assessment August to December 2022. Those with unresolved persistent symptoms, ICU admission and early variants (probably because infection occurred before the vaccine was available), led to worse drop in cognitive outcomes. 

The CDC has updated its guidance and removed the 5 day isolation requirement because more than 98% of the U.S. population now has some degree of protective immunity against COVID-19 from vaccination, prior infection, or both, and vaccinations and treatments for COVID are widely available to prevent severe disease.

This article describes live coronavirus shedding over time with excellent graphs by variant and by symptoms, viral culture, PCR cycle time, and antigen test. It also endorsed antigen testing to look at infectivity.

Thank you, Dr. Binder for sharing this report about nose-picking and the authors surmising this leading to neuroinflammation, which leads to amyloid deposition and Alzheimer dis.  Dr. Binder also shared  the People magazine article b/c patients may come to the office inquiring if they’re at risk of Alzheimer disease if they have picked their nose.

The ptau-217 blood test was just as good as the FDA-approved cerebrospinal fluid tests at identifying people with amyloid buildup, with accuracy scores for all tests at 95% to 97%. In a secondary analysis, the researchers measured how well the tests determined the levels of tau tangles in the brain. In this, the ptau-217 blood test was superior to cerebrospinal fluid tests, with accuracy scores in the range of 95% to 98%.

The Medicare Part C Advantage (MA) plans justify a 17% higher cost to Medicare by offering benefits such as dental, but MA patients were more likely to delay dental care due to limited networks, use management, and high cost sharing (unadjusted difference, 2.8%; 95% CI, 1.4%-4.1%; P < .001) but overall dentist use was no different from regular Medicare.

Vision impairment in 2822 community-dwelling adults, age  78, is associated with depressive (odds ratio [OR], 1.81) and anxiety symptoms (OR, 1.74) and severe social isolation symptoms (OR, 2.01).

Daily cannabis use was associated with higher odds of cardiovascular outcomes in all, but even higher among never‐tobacco smokers. Daily cannabis use was also with myocardial infarction (aOR, 1.49 [95% CI, 1.03–2.15]), stroke (aOR, 2.16 [95% CI, 1.43–3.25]), and the composite of coronary heart disease, myocardial infarction, and stroke (aOR, 1.77 [95% CI, 1.31–2.40]).

You may have read that Viagra decreases Alzheimer’s. The adjusted HR in PDE5I initiators compared with nonuse was 0.82 (95% CI 0.72–0.93), but this went away after a 3 year lag period. The findings contradict those in a study that showed no link between the two.

The ptau-217 blood test was just as good as the FDA-approved cerebrospinal fluid tests at identifying people with amyloid buildup, with accuracy scores for all tests at 95% to 97%. In a secondary analysis, the researchers measured how well the tests determined the levels of tau tangles in the brain. In this, the ptau-217 blood test was superior to cerebrospinal fluid tests, with accuracy scores in the range of 95% to 98%.

FDA announced PFAS used in grease-proofing agents for food packaging no longer being sold in the U.S.

In 92,000 French participants with an average follow-up of 6.7 years, 2604 cancer cases were diagnosed. Depending on the emulsifier, carrageenans (E407), mono- and diglycerides of fatty acids (E471), pectins (E440), and sodium carbonate (E500), breast and prostate cancer incidence was associated as much as 45-48%. While this study doesn't establish cause and effect, it is easy to avoid emulsifiers, such as in salad dressing or ice cream, in our diet.

Heat exposure increased the risk of acute ischemic stroke (AIS) by 88%: 82,455 Chinese patients, age 65.8 years, at 91.5°F  (33.1°C) compared to the reference temperature 53.8°F (12.1 °C), up to a lag time of 10 hours (1.88; 95% CI, 1.65-2.13).

The highest hospital readmission rates within 180 days were observed among participants aged 90 years or older (36.8%; 95% CI, 28.3%-46.3%), those undergoing vascular surgery (45.8%; 95% CI, 37.7%-54.1%), and persons with frailty (36.9%; 95% CI, 30.8%-43.5%) or probable dementia (39.0%; 95% CI, 30.7%-48.1%). In age- and sex-adjusted models with death as a competing risk, the hazard ratios for hospital readmission within 180 days were 2.29 (95% CI, 1.70-3.09) for frailty and 1.58 (95% CI, 1.15-2.18) for probable dementia.

This is an excellent summary article on stretching that cites studies showing: strength building, reduced arterial stiffness, fewer injuries due to improved balance, and no performance impairment as long as not extremely long stretches, >60 sec.

The DEA holds drug take back days in the spring and in the fall for prescription pills. Cincinnati has partnered with Prevention FIRST to mail out bags in which concerned citizens can submit also non-prescription drugs and in forms other than pills. This grant runs through 2026.