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By Nancy Lapid, Health Science Editor

Hello Health Rounds readers! While new drugs are finally available for treating early Alzheimer’s, predicting who will eventually develop the memory-robbing disease remains problematic. Today we feature a study that blood tests showing abnormal activation of certain brain cells in older people without symptoms may identify those who will develop dementia. We also highlight a multi-pronged approach that improves the odds of surviving a major brain bleed without significant disability. A third study provides reassurance that hospital care from a Doctor of Osteopathic Medicine (DO) will result in identical outcomes as care from an MD.

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In seniors without cognitive impairment, a new blood test may help identify those who will eventually develop Alzheimer’s disease. REUTERS/Christian Charisius.

In people ages 65 and older without signs of dementia, blood tests showing abnormal brain cell activity might help predict who will later develop Alzheimer’s disease, according to new research.

One well-known risk factor for Alzheimer’s disease – plaques in the brain composed of pieces of proteins called amyloids – can be detected with sophisticated imaging studies, but many people with these plaques never develop Alzheimer’s dementia.

By testing the blood of more than 1,000 cognitively unimpaired older people with and without amyloid buildup in the brain, researchers found only those with both amyloid burden and blood tests showing abnormal activation of brain cells called  astrocytes were at risk for eventually developing symptomatic Alzheimer’s disease, they reported on Monday in Nature Medicine.

Astrocytes protect other brain cells from inflammation due to conditions like infection, stroke, trauma, and diseases such as Alzheimer’s in which nerve cells stop working properly. In patients who are likely to develop Alzheimer’s dementia, astrocyte activity is probably increased before cognitive symptoms develop, the researchers said.

Looking for evidence of astrocyte reactivity in the blood along with testing for brain amyloid may become the optimal way to identify patients most at risk for progressing to Alzheimer’s disease, senior researcher Dr. Tharick Pascoal of the University of Pittsburgh School of Medicine said in a statement.

The new study’s results may also help researchers select participants in clinical trials testing new Alzheimer’s prevention drugs, the researchers said.

Read more about Alzheimer’s disease on Reuters.com

• Eisai, Biogen Alzheimer’s drug would cost US Medicare up to $5 bln a year
• After weight loss, Alzheimer’s may be next frontier for drugs like Ozempic
• Lilly drug slows Alzheimer’s by 35%
• Biogen trims pipeline programs to focus on Alzheimer’s drug

A new combination of treatments dramatically improves the odds of surviving a major brain bleed without significant disability, researchers reported at the European Stroke Organization Conference in Munich, Germany.

Intracranial hemorrhage accounts for about 25% of all strokes and affects roughly 3.4 million people each year. It’s the most deadly type of stroke, with 40% to 50% of patients dying within 30 days.

A lack of good treatments “has led to a pessimistic view that not much can be done for these patients,” Dr. Lili Song of The George Institute China said in a statement. 

Song and colleagues enrolled 7,000 patients in 144 hospitals in nine middle-income countries and one high-income country and randomly assigned them to receive usual care or a new “Care Bundle,” which included early intensive lowering of blood pressure, strict blood-sugar control, fever treatment, and rapid reversal of blood clotting dysfunction.

“Time is critical when treating this type of stroke, so we tested a combination of interventions to rapidly stabilize the condition of these patients to improve their outcomes,” senior researcher Craig Anderson of The George Institute for Global Health in New South Wales, Australia, said in a statement.

Six months later, the likelihood of a poor functional outcome or death was significantly lower in the Care Bundle group than in the usual-care group, according to a report published on Thursday in The Lancet.

For every 35 treated patients, the new protocol prevented one death, the researchers calculated.

Patients also had significantly better functional outcomes and quality of life at 6 months with the new treatment compared with usual care, they said.

“We estimate that if this protocol was universally adopted, it could save tens of thousands of lives each year around the world,” Anderson said.

Whether the letters after your doctor’s name are M.D. for Doctor of Medicine or D.O. – Doctor of Osteopathic Medicine – will not make a difference in the quality of care you receive, researchers have found.

Among older hospitalized patients, mortality rates, readmission rates, length of stay, and healthcare spending were virtually identical regardless of whether care was provided by physicians with MD or DO degrees, according to a report published on Monday in Annals of Internal Medicine.

Traditional, or allopathic, medical schools and osteopathic medical schools provide the same medical education. Osteopathic training adds a more holistic, hands-on component involving manipulation of the musculoskeletal system, for example use of stretching and massage to reduce pain or improve mobility.

Both types of physicians are licensed to practice medicine throughout the United States. Currently about 90% of practicing physicians hold MD degrees and 10% have DO degrees, but the latter group is growing at a faster rate. The number of osteopathic physicians grew by 72% between 2010 and 2020, compared with a 16% increase in MDs during the same period, the researchers note.

The authors of the new study reviewed data from Medicare and the American Hospital Association on roughly 329,500 people aged 65 and older. Roughly one in four had been treated by DOs.

The rates for the various outcomes were nearly identical. Patient mortality rates were 9.4% among those treated by MDs and 9.5% for those who saw DOs. Patient readmission rates were 15.7% vs 15.6%, respectively, healthcare spending was $1,004 vs $1,003, and average length of hospitalization was 4.5 days for both groups, the researchers found.

The study was not a randomized trial and so the results cannot be considered conclusive.

Still, the findings “should be reassuring for policymakers, medical educators, and patients,” the researchers said. “They suggest that any differences between allopathic and osteopathic medical schools, either in terms of educational approach or students who enroll, are not associated with differences in quality or costs of care, at least in the inpatient setting,” the researchers said.

This newsletter was edited by Bill Berkrot.

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