"You can't properly assess for delirium when someone already has dementia."
Wrong.
New meta-analysis (Keane et al. 2026): 4AT shows 88% sensitivity, 79% specificity in dementia populations.
5 studies. 1,304 patients. International data.
#delirium #dementia
Proud to join ~500 other MN docs in signing on to this @nejm.org piece.
Proud of my colleagues. Proud of Ben Trappey for signing his name to it and taking the inevitable heat from some quarters.
Stand up and be counted 💪🏼💪🏼
Solid advice from @glaucomflecken.bsky.social
youtube.com/shorts/z4dy0...
I usually see 8-10 pts per clinic shift. In the last 2 wks I've seen fewer...total. They're cancelling, not scheduling, ¬ coming in.
They're scared to leave home; risk being harassed, taken, or worse; leaving medical needs uncared for.
That's not making us safe.
That's making us inhumane.
Statement from the family of Alex Pretti: "We are heartbroken but also very angry. Alex was a kindhearted soul who cared deeply for his family and friends and also the American veterans whom he cared for as an ICU nurse at the Minneapolis VA hospital. Alex wanted to make a difference in this world. Unfortunately he will not be with us to see his impact. I do not throw around the hero term lightly. However his last thought and act was to protect a woman. The sickening lies told about our son by the administration are reprehensible and disgusting. Alex is clearly not holding a gun when attacked by Trump’s murdering and cowardly ICE thugs. He has his phone in his right hand and his empty left hand is raised above his head while trying to protect the woman ICE just pushed down all while being pepper sprayed. Please get the truth out about our son. He was a good man.”
NEW
Statement from the family of Alex Pretti:
Not until the last few weeks.
There was not a dangerous situation here. There was not a problem to be solved. The problem was manufactured and a dangerous situation has been created by those who wanted to make it.
Leading to fear, chaos, and fatal consequences.
I've lived in MN since I was born. I've lived in the suburbs, I have lived in the cities. I've taken the train, driven, cycled all over.
I've always felt safe, always felt my friends and family were living in safe places. I have never had concerns going to downtown Minneapolis or St. Paul.
...something, something...taxation without representation...
The Gerontologist, 2025, 65(S1), S60–S67 https://doi.org/10.1093/geront/gnaf222 Advance access publication: 1 October 2025 Supplement: Healthy Brain Initiative (HBI) and Building Our Largest Dementia Infrastructure (BOLD): Dementia as a Public Health Imperative: Forum Advancing inclusive brain health and dementia care for people with intellectual and developmental disabilities: a public health framework Beth Marks, PhD, RN, Jasmina Sisirak, PhD, MPH, Matthew P. Janicki, PhD, Kathryn P. Service, RN, MS, FNP-BC, Karen Watchman, PhD
People with intellectual & developmental disabilities are at higher risk of #dementia but face significant barriers to care.
The authors propose a public health framework to address this intersection of #disability & brain health.
academic.oup.com/gerontologis... #medsky
After this week, it's hard to explain why this feels so different. We've heard and read about so many abuses from this govt.
But we saw this.
I'm reminded of these words from West Wing (and I know it's not a perfect comparison)
youtu.be/0qoj7ICwU6w?...
Grammar aside - the intent and depravity of the statement shouldn't be lost
Coverage by
- ACA. Constantly attacked. Just became wildly more expensive
- Medicaid and CHIP. Literally gutted by 'BBB'
- VforC. Especially important in rural/underserved areas where we've seen closures d/t Medicaid cuts
Not just children!
This change is also ableist and ageist.
High # of admissions I had to the hospital and post-acute care because of Flu A and RSV just this week.
➡️Mostly older adults. Who often have more severe cases
➡️Many with dementia who cannot easily treat or manage on their own
Children will die with RFK Jr.'s new vaccine recommendations. We're NOT doing the "experts disagree" game. The US vaccine schedule was painstakingly constructed through a deep & thorough process by experts with unquestionable expertise. This is policy by fiat. It is pre-meditated murder. 1/
And, for an administration that was supposed to be about cutting everyday costs 🙄, beyond the direct health impacts of these perverse "recommendations,"
This is just ridiculously expensive.
www.cdc.gov/mmwr/volumes...
This OpEd, by the inspirational @drdemetre.bsky.social in today’s @washingtonpost.com, is one of the best pieces of science writing of 2025
I’ll be assigning it to my students next semester in my class on ‘policy writing—turning evidence into public health action’
Thx Ed, for the free access link👇
Quite the long-game strategy to solve the geriatrician shortage 🫤🙄
Let me introduce you to prices in medicine:
Financial toxicity: a common problem affecting patient care and health - PMC
pmc.ncbi.nlm.nih.gov/articles/PMC...
I'm told that Roger Marshall is a medical doctor, like with a degree and everything, and yet every single time he opens his mouth to discuss health care it's like they pulled a random guy out of the beer line at a Royals game.
My patients are very aware of prices. Often more so than me.
Especially older adults on fixed incomes.
Because of that awareness, true, in the short term, they may not spend as much f.e. Medicare dollars.
🚨By forgoing necessary care🚨
LMFTFY:
👉 CDC panel Defies Experts with Hep B vaccine vote.
Grateful for the clear messages coming from @ameracadpeds.bsky.social @idsainfo.bsky.social @apha.org
Flowchart of study subjects: 193,510 age 65+ who started quetiapine, trazodone or mirtazapine -> 17,703 eligible included, including 375 on quetiapine -> after 1:4 propensity matching: 1500 on trazodone and 1500 on mirtazapine.
1- Insomnia in older adults can be difficult to address. CBT-insomnia is the gold standard - and the safest intervention.
Yet low-dose quetiapine is being used more to treat insomnia. How safe is it?
The authors of this study sought to find out.
#medsky
link.springer.com/article/10.1...
Probability of delirium associated with the proportion of each physician's admissions that include a first-generation antihistamine prescription, using mixed effects logistic regression. The red line represents the effect estimate and the gray shading represents the 95% confidence interval.
Prescribing 1st-generation antihistamines (e.g., diphenhydramine, hydroxyzine, meclizine) to hospitalized older adults is associated w/ ⬆️risk of delirium, according to this study of 328k inpatient admissions in Canada.
Just don't do it!
#medsky
agsjournals.onlinelibrary.wiley.com/doi/full/10....
Annual decline in global cognition, memory, and executive function in SNAP users and non-users by race/ethnicity.
Good social policy has health benefits.
In an analysis of the Health & Retirement Study, participating in SNAP is assoc w/ slower cognitive decline in adults 50+ yo.
However, the protective effect was less in Black & Hispanic adults.
#medsky
agsjournals.onlinelibrary.wiley.com/doi/full/10....
Ageism is pervasive in media coverage of political figures.
While raising concern about cognition may be reasonable, conflating age with cognitive or other impairments, is not.
“Since 1998, independent researchers have conducted more than 40 high-quality studies involving over 5.6 million people. The conclusion is clear and unambiguous: There’s no link between vaccines and autism." -Dr. Susan Kressly, AAP President on recent changes to the CDC's website
The New England Journal of Medicine (@nejm.org) and the Center for Infectious Disease Research and Policy (@cidrap.bsky.social) will share regular public health alerts - information formerly provided by the CDC MMWR.
#medsky
www.statnews.com/2025/10/21/c...
