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Hear Ye! Hear Ye! Read All About It...updates from the American Geriatrics Society Annual Scientific Meeting 2025



Last week, I had the opportunity to attend the American Geriatrics Society's Annual Scientific Meeting in the Windy City...Chicago! It was a great experience and I wanted to share some of the themes, updates, & resources I came across.


I think the big theme was that geriatrics takes TIME. I know it sounds hokey, and maybe confusing, but hear me out. In managing geriatrics syndromes, illnesses affecting older adults, and other issues applicable to the older adult population, physicians need time.


Why is that?


Well, when it comes to the many medical and other issues impacting older adults- high blood pressure, high cholesterol, cardiac interventions, diabetes care, dementia, falls, depression, surgical care, hospitalization & complications, discharge planning/transitions of care, preventative medicine, screening, and advance care planning, the conference highlighted the key factors geriatricians take into consideration when coming up with plans and recommendations for patients.

  • Medical Conditions

  • Functional Status- what can the patient do for him/herself and what needs assistance

  • Cognitive Status

  • Psychological/Emotional Status

  • Social Factors- support networks, access to care, resources, community

  • Life Expectancy/Time to Benefit of the medical intervention

  • Patient Priorities- what are the goals for care?


By incorporating all of this into decisions, one can see how geriatricians are the real experts in managing patients holistically. Older adults are a very heterogeneous population and you can't just simply apply an algorithm for one problem to their care because so many things can be impacted by just one change. And the conversations needed to help patients/families/care partners understand all of this can't be done meaningfully in a brief visit- it takes time, for each appointment and over the long-run.

I also got to attend several sessions on dementia. The advances in science in this field have been pretty amazing, and we are very slowly beginning to understand some basics of an extremely complicated condition. However, we are still far from a cure and even definite reversibility, The main changes or advances are specific to MCI or early/mild ALZHEIMER"s Disease, not the other dementias or patients with moderate-advanced dementia. That being said, the following approach to dementia can help pave a clearer path-


The first step is to establish if this is dementia or mild cognitive impairment (MCI), and that can be done by a geriatrician or neurologist. Remember, dementia is a set of cognitive impairments that progress gradually over time, and that these cognitive impairments result in problems for the patient to independently manage themselves. With MCI, you have the cognitive impairments, but patients are still able to manage their day to day affairs on their own for the most part. Patients with MCI do have a risk of progressing to dementia over time. I have some prior posts that talk about dementia more specifically and am happy to post more if there is interested.


Once the diagnosis of dementia vs MCI is established, the next step is to start looking at the specific cause- is it Alzheimer's Disease, Lewy Body Dementia, Frontotemporal Dementia, Parkinson's Dementia, etc.? For the most part, this differentiation is made clinically based on what symptoms the patient has, the findings on physical and mental status exams, cognitive screens, and basic imaging of the brain (especially MRI). If there's still some question, neuropsychological testing can be very helpful as well. However, the big change that has come forth is specifically with Alzheimer's Disease. There are now specific blood tests and imaging procedures that can help clarify if Alzheimer's Disease is present. This path has to be navigated very carefully and if blood testing and specific imaging are considered appropriate, it might help to have an evaluation at a specialized center- usually at an academic medical center. Remember, these tests are very specific to Alzheimer's Disease, and mostly helpful for patients with MCI or very mild/early dementia. Once a patient has reached a moderate or advanced stage of Alzheimer's Disease, or if they have another type of dementia, these tests & new treatments don't help. And, most of the time, when patients present for an evaluation of dementia, they are already in the moderate or advanced state.


If MCI or early/mild Alzheimer's Disease are diagnosed, then the patient can consider an evaluation for treatment with the new monoclonal antibodies (Lecanemab = Leqembi; Donanemab = Kinsula). These medications act on the immune system to reduce the amount of abnormal amyloid protein deposits in the brain. They are indicated only for MCI or early to mild Alzheimer's type dementia. A couple of things to remember about them that make things complex:

  • They have to be given by intravenous infusion- either every 2 weeks or every 4 weeks for 18 months, and it remains unclear how long a patient will need treatment after that.

  • The outcomes are research study based scales of cognitive status. There is some evidence that they can slow down the progression of memory loss by about 6 months, but we don't have evidence as to whether this is continued beyond. Also, there's some evidence indicating that the benefits are pretty similar to what you get from the oral medication, Donepezil (Aricept) which has been around for a long time. Finally, whether these results are clinically meaningful to the patient, the care partners, or the providers is not clear yet either.

  • Patients need to have regular MRI scans during the treatment course to look for certain concerning side effects- specifcally brain swelling and/or bleeding. Many times these side effects are without symptoms, but if they are severe, it can be devastating.

  • Patients currently on blood thinners or anticoagulants (e.g. Plavix, Xarelto, Eliquis) or who may need a blood thinner in the future are not appropriate for these treatments because of the increased risk of bleeding.


So, the take home message for me was that, unless I'm seeing a patient with MCI or very early/mild Alzheimer's type dementia, not much has changed, And even for the patient with MCI or early/mild Alzheimer's dementia, there are a lot of complex things to navigate that may not really prove to be very helpful in the long-run.


The things that are helpful in the long-run for patients living with dementia are:

  • Support & education, especially for their care partners.

  • Advance Care Planning- clarifying their goals of care & priorities as early on as possible.

  • Looking into options for socialization, physical activity, & cognitive engagement.

  • Planning for patient safety.

  • Monitoring their ability to participate independently in decision making & setting up supports and safety nets to help them when/if it becomes impaired.

  • Adjusting the treatment & management of other chronic conditions as the dementia evolves.

  • Learning early about behavioral strategies to help with distressing symptoms of dementia. Medications don't help- the studies show it, and they come with a LOT of bad side effects and risks.


And to wrap things up, here are some resources/websites/links that came up during the conference and can help with several of the topics/themes mentioned in the post...


Phew! That's a lot of information there, but I hope you find it helpful. And as always, I'm happy to help you or your loved one tackles some of these challenges in geriatrics- just reach out & we can figure it out!



 
 
 

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