Discover and read the best of Twitter Threads about #GeriTwitter
Most recents (4)
1- A thread on the value of treating #Alzheimer’s disease w/ monoclonal antibodies:
As I read through the recently published appropriate use guidelines for #lecanemab, I am struck by the infrastructure & resources that will be necessary.
#GeriTwitter
link.springer.com/article/10.142….
As I read through the recently published appropriate use guidelines for #lecanemab, I am struck by the infrastructure & resources that will be necessary.
#GeriTwitter
link.springer.com/article/10.142….
2- This table summarizes what medical centers need to safely administer lecanemab to people with Alzheimer’s disease.
Lecanemab is given via IV infusion every two weeks. This requires having an infusion center with the needed capacity & appropriately trained staff.
Lecanemab is given via IV infusion every two weeks. This requires having an infusion center with the needed capacity & appropriately trained staff.
3- Before treatment begins, you need to make a diagnosis.
You need clinicians skilled at diagnosing mild cognitive impairment & mild dementia.
These are usually neurologists but could be geriatricians or geriatric psychiatrists. There aren’t a ton of folks with this skillset.
You need clinicians skilled at diagnosing mild cognitive impairment & mild dementia.
These are usually neurologists but could be geriatricians or geriatric psychiatrists. There aren’t a ton of folks with this skillset.
1- Detailed & persuasive critique by Dr. @LonSchneiderMD of the #aducanumab esults recently published in the J of Prevention of #Alzheimers Disease.
#GeriTwitter
link.springer.com/article/10.142…
#GeriTwitter
link.springer.com/article/10.142…
@LonSchneiderMD 2- Note that the assn. between amyloid reduction & cognition goes in opposite directions in the 2 studies:
"High dose aducanumab was about as cognitively impairing in ENGAGE as it was beneficial in EMERGE [despite] both trials showing similar, substantial reductions in plaque."
"High dose aducanumab was about as cognitively impairing in ENGAGE as it was beneficial in EMERGE [despite] both trials showing similar, substantial reductions in plaque."
3- It's also possible that the slight cognitive improvement found with high-dose aducanumab in EMERGE was due in part to the greater worsening of cognition in the placebo group of EMERGE compared with the placebo group of ENGAGE.
1/8 A patient with compensated HFrEF (EF 35%) has positive orthostatics. He is not hypovolemic. What medication is reasonable to prescribe?
#MedTwitter #MedEd #FOAMed #NeuroTwitter #GeriTwitter
#MedTwitter #MedEd #FOAMed #NeuroTwitter #GeriTwitter
2/8
💥Fludrocortisone will increase ⬆️ RAAS and can cause volume overload, so you should avoid it here
💥 Caffeine and ibuprofen are last-line agents to manage orthostatic hypotension
💥 Midodrine is probably your best bet here
💥Fludrocortisone will increase ⬆️ RAAS and can cause volume overload, so you should avoid it here
💥 Caffeine and ibuprofen are last-line agents to manage orthostatic hypotension
💥 Midodrine is probably your best bet here
3/8 You prescribe midodrine 2.5 mg PO q8h and end up titrating it up to 5 mg PO q8h over the course of a few weeks. The patient shows you their BP log and you notice that their nighttime supine BPs are elevated. What do you do next?
1/5 A 78 yo F with no prior medical history p/w progressive pill-rolling tremor, shuffling gait, and dizziness upon standing. She takes no meds. Orthostatics are ➕. What is the likely cause of her orthostatic hypotension?
#MedTwitter #MedEd #FOAMEd #GeriTwitter #NeuroTwitter
#MedTwitter #MedEd #FOAMEd #GeriTwitter #NeuroTwitter
2/5 The answer is Parkinsonism! Parkinsonism is a synucleinopathy (the protein alpha-synuclein accumulates in neurons and glia) leading to autonomic dysfunction. Review this approach on orthostatic hypotension here: . Let's keep going.
3/5 She is diagnosed with Parkinsonism, and started on carbidopa-levodopa BID with improvement in symptoms. Her family has hired 24/7 caregivers who ensure her PO intake is adequate.
