Speaker 1 00:00:13 Welcome back to the Weekly Dose from Patient Care Online, where we bring you the top clinical updates your colleagues are reading each week. In this episode, we'll take a deep dive into stories spanning cognitive health, reproductive care, hospice prescribing, Alzheimer diagnostics, and lifestyle risk factors. We start with new evidence that smoking cessation may meaningfully slow cognitive decline even when it happens later in life. Across three large cohorts from England, the United States and Europe, investigators matched more than 4700 adults who quit smoking with continuing smokers and tracked memory and verbal fluency over time. In the six years after quitting, memory declines, slowed by about 20% and verbal fluency declined by roughly 50%. That translated into 3 to 4 months less memory decline and about six months less fluency decline per year of aging compared with those who continued smoking. The findings reinforced that the cognitive harms of smoking are not fixed, and that quitting mid or late life still brings measurable benefits. Our second story looks at long term outcomes after structured Larc counseling in primary care.

Speaker 1 00:01:15 A three year follow up of the accord intervention found that women who received non-biased contraceptive counseling and streamlined access to Larc had substantially better outcomes than those receiving usual care. Larc continuation was higher 41% compared with 28%, and overall continuation of Larc methods outperformed non Larc options. Unintended pregnancies were cut in half and abortion rates were markedly lower in the intervention group. Satisfaction was also higher among Larc users. These findings support implementing structured counseling models in primary care, especially where access to reproductive health services is limited. Third, this week concerns about benzodiazepine and antipsychotic use in nursing home residents with dementia entering hospice. In a national analysis of more than 139,000 residents with Alzheimer disease and related dementias. New initiation of benzodiazepines or antipsychotics at the time of hospice enrollment was associated with higher 180 day mortality. Benzodiazepine initiation carried a 41% higher mortality risk, and antipsychotic initiation carried a 16% increase. Associations that remained consistent across sensitivity analyses. The authors emphasize the importance of careful risk benefit discussion when considering new CNS active medications in this population. Next. A major development in Alzheimer disease diagnostics for primary care.

Speaker 1 00:02:36 The FDA has cleared the first blood based biomarker test designed to support the initial evaluation of adults with cognitive decline in primary care settings. The Alexus p Tau 181 assay measures plasma phosphorylated tau and demonstrated a nearly 98% negative predictive value for ruling out AD associated amyloid pathology in a low prevalence early disease population for primary care clinicians. The test offers a minimally invasive tool to help determine which patients may not require more advanced imaging or invasive CSF testing, and which should be referred for specialist evaluation. And finally, new research adds clarity to the relationship between alcohol intake and dementia risk. A large pooled analysis from US and UK cohorts confirmed the familiar U-shaped association in observational data where heavy drinkers, non drinkers and individuals with alcohol use disorder showed higher dementia risk than light drinkers. But genetic analyses using Mendelian randomization painted a different picture. Once biases were accounted for, the apparent protective effect of light drinking disappeared. Instead, dementia risk rose steadily with increasing alcohol intake, even at low levels, the authors suggest. Any amount of alcohol may contribute to cognitive risk, and note that reducing alcohol use disorder prevalence could modestly reduce dementia incidence at a population level.

Speaker 1 00:03:56 That's it for this episode of the Weekly Dose podcast. For full coverage of these stories and more clinical updates, visit Patient Care Online. Thanks for listening and I'll see you next week.