Art Walaszek, MD

Tabby cat with look of curiosity

Dewey relaxing on #Caturday

I love a good dark comedy about academia but this ain't it. Maybe the book is better.

Can a wealthy family change the course of a deadly brain disease? Inspired by the loss of their mother, they have poured millions into studying a key protein behind frontotemporal dementia. But all has not gone according to plan

Fascinating account of trying to find a cure for frontotemporal dementia (FTD): great advances in our understanding of one variant (mutations in GRN resulting in TDP43 proteinopathy) but no success yet with respect to treatment.

www.science.org/content/arti... #medsky

Cognition and/or physical function improved in 45% of older adults in the Health & Retirement Study.

“If you average everyone together, you see decline. But when you look at individual trajectories, you uncover a very different story. A meaningful percentage ... got better.” #medsky

Overheard on airplane: “You can solutionize it with our software.”

Danielle Turnipseed from @aamc.org now presenting on advocacy, including this very helpful slide on the “Ladder of Advocacy Engagement.”

Vote in every election Never miss a chance to vote. Every election - local, state, federal. If you can vote in the US, encourage those who can. Pro Tip: ask “what’s your plan to vote?”

I’m attending an excellent talk on advocacy by Dr. Kiki Kennedy at the annual meeting of the American Association of Directors of #Psychiatry Residency Training.

Here’s her slide recommending we encourage others to vote. #medsky

The VA has not filled vacant healthcare professional positions, resulting in:

1,500 fewer physicians
4,900 fewer nurses
14,000 total fewer

This is 5% of the VA's medical staff.

#medsky

Low-Dose Lithium for Mild Cognitive Impairment This pilot randomized clinical trial evaluates the feasibility, safety, and methodological considerations of low-dose lithium treatment in older adults with mild cognitive impairment.

Could low-dose lithium slow cognitive decline in people w/ mild cognitive impairment?

This pilot study did not find benefit.

But it was a small study with methodological issues and it could inform a more definitive study.

jamanetwork.com/journals/jam... #medsky

Mitski’s New Album Is a Dark Ode to Isolation On “Nothing’s About to Happen to Me,” a reclusive woman confronts the inhospitality of the world beyond her door.

A thoughtful review of the album by Hanif Abdurraqib in the @newyorker.com:

"There is a thin border between isolation and loneliness, and, even if you retreat from the world, you are still in it."

www.newyorker.com/culture/pop-...

Album cover: white cat with heterochromia about to be pounced on by a tabby cat.

Listening to #Mitski on this #Caturday. In addition to there being a cat on the cover art of "Nothing's About to Happen to Me," the album includes the songs "Cats" and "That White Cat."

Consensus Statement Psychiatry Recommendations for the Deprescribing of Psychotropic Medications A Consensus Statement From the American Society of Clinical Psychopharmacology Task Force Joseph F. Goldberg, MD, MSc1; Roger S. McIntyre, MD2; Holly A. Swartz, MD3 et al

When and how should psychotropic medications be deprescribed?

A new consensus statement offers guidance:

jamanetwork.com/journals/jam... #medsky

Kaplan–Meier survival curves for incident dementia by baseline sensory difficulty: (A) Vision difficulty, and (B) Hearing difficulty. Each survey round is separated by 1 year.

Vision difficulty & motor impairments (standing balance, gait speed, chair stands, grip strength) are associated w/ ⬆️dementia risk, in this longitudinal study of older adults followed up to 11 years.

agsjournals.onlinelibrary.wiley.com/doi/full/10.... #medsky

"The destruction that Kennedy has wrought in 1 year might take generations to repair, and there is little hope for US health and science while he remains at the helm."

www.thelancet.com/journals/lan... #medsky

and

9. Move toward global health equity. Justice demands that all people have access to the conditions for people to be healthy

Closing thoughts:

"Bill Foege was never content to be merely technically right. He understood that data alone do not move societies. People do."

6. Respect culture—culture matters. Interventions must be tailored to local contexts.

7. Seek strong leadership and management. Visionary and effective leadership guide collective action.

8. Mobilize political will. Policy reform and resources follow political commitment. ...

3. Coalitions are essential. Complex problems require partnerships across disciplines and sectors.

4. Avoid certainty. Humility and openness to new evidence prevent dogmatism.

5. Build in evaluation and continuous improvement. Programs must learn and adapt. ...

President Obama presenting Bill Foege with the Presidential Medal of Freedom.

Public health giant Bill Foege gave us "9 Lessons to Change the World":

1. This is a cause-and-effect world. Understanding the causes of a problem enables us to change its outcomes.

2. Know, share, and act on the truth. Transparency builds trust. ...

www.milbank.org/quarterly/op...

New Xbox Boss Is Worried About Birthrates, Says AI Will Save Us Five months ago Asha Sharma talked about how AI could turn around declining fertility rates

Yet another tech weirdo obsessed with fertility, now in charge of Xbox.

kotaku.com/xbox-microso...

It‘s unlikely that DORAs have lower abuse and withdrawal potential than ramelteon, doxepin & trazodone. This study was funded by the maker of a DORA and all but two co-authors are employees of the maker.

Tabby cat in a closet

Dewey among the bath towels. Happy #Caturday!

My advice:

Share your strawberries with your friends.

Predictors of a Gabapentinoid–Loop‐Diuretic Prescribing Cascade in U.S. Nursing Home Residents Among 23,544 older adult long-stay nursing home residents who initiated a gabapentinoid in the nursing home (2016–2022), 4.2% experienced a loop diuretic prescribing cascade within 90 days. Predictor...

Important warning about a risk of use of gabapentin and pregabalin in older adults:

1 in 20 nursing home residents who initiate gabapentinoids will receive a loop diuretic - for peripheral edema - within 3 months.

agsjournals.onlinelibrary.wiley.com/doi/full/10.... #medsky

Family Medicine: Spotlight on Methods

If you're interested in medical education research, the most recent issue of the journal Family Medicine has a collection of articles on research methods.

journals.stfm.org/familymedici... #medsky

Families facing a loved one’s cognitive decline need help planning for the future, including support to nurture their interpersonal relationships.

My latest thoughts on how best to support caregivers and their loved ones with #dementia ...

closler.org/lifelong-lea... #medsky @closler.bsky.social

Teach students to be builders, not critics (opinion) Eboo Patel calls on college educators to teach students how to build a better social order, not merely criticize the existing one.

I appreciate this perspective, difficult to maintain in challenging times:

Be architects of a better system, not arsonists of the current system.

www.insidehighered.com/views/2022/0...

"Offering solutions that reject science and public health pushes us backwards into a past of shorter lives and more variety in lethal illness."

#medsky

The study confirmed:

- dose-dependent ⬆️risk of abnormal liver transaminases (esp. with atorvastatin 80 mg/d)
- ⬆️risk of edema & urinary abnormalities (proteinuria, albuminuria) that did not depend on dose

Statins are quite safe: for most people, the cardiovascular benefits will outweigh the risks.

Effect of statin versus placebo on events listed in statin SmPCs (Summaries of Product Characteristics, i.e., product labels), subdivided by component parts.

I've heard patients & others raise concerns about possible negative cognitive effects of statins.

Good news:

A meta-analysis of 19 trials comparing statins w/ placebo (median f/u 4.5 years) did not find ⬆️risk of cognitive/memory impairment or #dementia.

www.thelancet.com/journals/lan... #medsky

3- The authors recommend:

"Physicians should be referred to as physicians, not providers."

"When describing professionals with varied credentials who care for patients, the terms clinicians or health care professionals, not providers, should be used."