In the News

JAMA Insights Commentary Journal of the American Medical Association, September 26, 2023 Commentary by David Carr, MD, and Ganesh Muneshwar Babulal, PhD

What’s Interesting about this article?

• The older adult (>65 years) population in the US will increase to 88 million by 2050 and represent at least 23% of all drivers.
• Compared with younger drivers, older adults experience decreases in visual, cognitive, and motor functions, resulting in a 2.5 times higher risk of a crash death for those aged 75-79 years old, and a 5-times higher risk for those 80 years or older.
• More than 90% of crashes are due to human error. Innovations in electronic automotive technologies may increase the safety of older drivers.
• Autonomous/driverless cars may represent the ultimate solution to unsafe older drivers.

JournalDoc Comments:

• “Taking away the car keys” is one of the most dreaded and difficult challenges for children of older drivers.
• Clinicians have an ethical “duty to warn” and notify state license agencies if they are aware of impairments or medications of older patients who refuse to stop driving.
• Loss of driving privileges affects the independence of older adults and may result in increased loneliness and depression.
• Mandatory cognitive and motor skills assessment prior to license renewal may be one possible solution.

Link to Article in PubMed Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.

The New England Journal of Medicine, August 17, 2023

Study Design: Randomized controlled Study (RCT) with 604 patients

What’s Interesting about this article?

• The MIND diet is a hybrid of the Mediterranean and DASH diets with some modifications to include foods thought to reduce the risk of Alzheimer’s disease.
• This was a 3-year two site study involving older adults without cognitive impairment but with a family history of dementia.
• There was no significant difference in cognition or MRI outcomes in the MIND group and the control group at three years.

JournalDoc Comments:

• 94% of the trial participants completed the study, which indicates an exceptionally high level of adherence.
• It would be wonderful to have a dietary option for prevention of cognitive decline or Alzheimer’s, but dietary studies are difficult to complete because of lack of adherence or reliable food diaries. The MIND diet represents the best attempt to date, combining the proven benefits of both the Mediterranean and DASH diets.

Link to article in PubMed

Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.

Annals of Internal Medicine, September 2023

Study Design: Pooled Analysis of 5 Randomized Controlled Trials with Two Years of Individual Patient Data

What’s Interesting about this article?

• Weight Gain and Hypertension are well known adverse events of treatment with high dose glucocorticoids.
• This study provides solid evidence that low dose steroids over two years resulted in small increase in weight (one kg.) and no increase in blood pressure.

JournalDoc Comments:

• As mentioned in an accompanying AIM editorial, the “pendulum swings back” on the risks of low dose steroids in treating rheumatoid arthritis on a chronic basis.
• Previous observational studies appear to have overstated the impact on weight and blood pressure.
• Steroids are effective and low-cost drugs, and these findings may decrease patient and physician concerns over adverse effects in R.A. and potentially other chronic diseases.

Link to article in Pub Med

Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.

Clinical Decisions Commentary

New England Journal of Medicine, August 17, 2023

Clinical Vignette followed by Pro and Con Expert Commentary

What’s Interesting about this article?

• The clinical case vignette involved a healthy 13-year-old boy with a normal physical exam and no history of concussions or heart problems. The father played football and enjoyed the camaraderie and competition but wonders if it is safe for his son to participate.
• Recent news reports on high-profile cases of chronic traumatic encephalopathy following repeated football concussions has both parents and physicians concerned about the dangers of this sport in high school students.
• The argument for participation states that there are multiple benefits of regular exercise and participation is sports, and that high-quality studies have found no association between participation in collision sports such as football and adverse changes in cognition or depression.
• The argument against participation states that there is no accepted evidence of the risk of CTE in a 13-year-old playing football, but the risk is not zero. A decision to play involves a discussion of risk benefit trade-offs and risk tolerance with family and youth.

JournalDoc Comments:

• Evaluation of risk should involve size and weight of boy, the position that he wants to play and head-to-head collision probability, and size and weight of competitors who will be playing opposite his position.
• If parents and boy have low risk tolerance and other non-contact sport options are available (tennis, swimming), it is probably best not to play football.
• If family and youth are willing to accept some degree of risk and post-concussion protocols are in place for the team, may be reasonable for youth to play and re-evaluate each year based on individual experience.

Link to article in PubMed

Disclaimer: Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.

“The TRAILBLAZER-ALZ 2 Randomized Clinical Trial”

Journal of the American Medical Association (JAMA), July 17, 2023

Study Design and Number of Patients: RCT with 1736 participants in 277 medical centers in 8 countries; 18-month phase 3 trial

What’s Interesting about this article?

• Deposition of beta amyloid in the brain is an early event in Alzheimer disease, leading to neurofibrillary tangles and plaque composed of tau protein.
• Donanemab is a monoclonal antibody directed at amyloid and tau complexes.
• In this study, Donanemab significantly slowed clinical progression in those with early symptomatic Alzheimer disease at 76 weeks.

JournalDoc Comments:

• As mentioned in an accompanying JAMA editorial, this drug may “usher in a new era in Alzheimer therapy”.
• Removal of amyloid plaques may lessen the worsening of the disease, but is not a “cure”; so the modest clinical benefits must be balanced against adverse effects and the cost of the drug. Are amyloid and tau the cause of the disease, or just the result of damage to neurons?

Link to article in PubMed

Disclaimer:  Article of the Week selections by JournalDoc physicians are independent, unbiased and have no commercial conflict of interest. JournalDoc does not support or endorse the findings or opinions expressed in the article. Findings in the article may need to be supported by further research and/or the consensus of experts.