Geriatrics/Aging
- Clinical PracticeVOL. 390 No. 1, Jan 04, 2024
Navigating and Communicating about Serious Illness and End of Life
N Engl J Med 2024; 390:63-69Conversations about prognosis are difficult for patients and clinicians. Clinicians should partner with patients as they integrate prognostic information into goals and end-of-life decisions.
- Original ArticleVOL. 390 No. 1, Jan 04, 2024
Brief Report: Ultrasound Blood–Brain Barrier Opening and Aducanumab in Alzheimer’s Disease
N Engl J Med 2024; 390:55-62In three patients with Alzheimer’s disease, focused ultrasound was applied with aducanumab therapy. Reduction in amyloid was greater in treated regions than in matched contralateral regions over 6 months.
- EditorialVOL. 390 No. 1, Jan 04, 2024
Sounding Out the Blood–Brain Barrier
N Engl J Med 2024; 390:82-85This editorial describes the science behind a trial involving a breach of the blood−brain barrier to deliver drugs to the brain.
- PerspectiveVOL. 389 No. 25, Dec 21, 2023
Fundamentals of Medical Ethics: Deciding for Patients Who Have Lost Decision-Making Capacity — Finding Common Ground in Medical Ethics
N Engl J Med 2023; 389:2309-2312How can clinicians help surrogates make difficult decisions for incapacitated loved ones? And what criteria should surrogates use in making those decisions?
- Videos in Clinical MedicineVOL. 389 No. 25, Dec 21, 2023
Medial Branch Blocks and Radiofrequency Ablation for Low Back Pain from Facet Joints
N Engl J Med 2023; 389:e53This video reviews the indications for medial branch blocks and radiofrequency ablation for chronic low back pain from facet joints.
- EditorialVOL. 389 No. 25, Dec 21, 2023
Fundamentals of Medical Ethics — A New Perspective Series
N Engl J Med 2023; 389:2392-2394The editors announce a new Perspective series exploring key ethical questions facing medicine today; the hope is that medical ethics can keep pace with the evolution — and revolutions — in medicine itself.
- PerspectiveVOL. 389 No. 24, Dec 14, 2023
Something for Sleep
N Engl J Med 2023; 389:2218-2219When a long-time patient, seeking to restore her hard-won sense of control after being diagnosed with an incurable cancer, requests a prescription for Seconal, what should her physician do?
- EditorialVOL. 389 No. 24, Dec 14, 2023
Continued Progress in the Development of Safe and Effective RSV Immunizations
N Engl J Med 2023; 389:2289-2290Before 2023, there were no immunizing tools to protect older adults and all infants from illness and death due to respiratory syncytial virus (RSV). In 2023, two RSV vaccines for older adults, one of which is also approved for use in pregnant persons, and a long-acting monoclonal antibody to protect...
- Original ArticleVOL. 389 No. 24, Dec 14, 2023
Efficacy and Safety of an mRNA-Based RSV PreF Vaccine in Older Adults
N Engl J Med 2023; 389:2233-2244In a placebo-controlled, phase 2–3 trial, one dose of mRNA-1345 led to a lower incidence of RSV disease among adults 60 years of age or older. Solicited local and systemic adverse reactions occurred more often with the vaccine.
- PerspectiveVOL. 389 No. 21, Nov 23, 2023
Intention to Treat: Alzheimer’s Update, Part 2 — ITT Episode 21
N Engl J Med 2023; 389:e43This podcast episode explores the current state of research on the multiple likely mechanisms of Alzheimer’s disease as well as promising treatments and diagnostics.
- Clinical PracticeVOL. 389 No. 21, Nov 23, 2023
Postmenopausal Osteoporosis
N Engl J Med 2023; 389:1979-1991Screening for osteoporosis is recommended in postmenopausal women on the basis of age and risk factors. Treatment approaches are determined by T score and the presence or risk of fracture.
- Original ArticleVOL. 389 No. 20, Nov 16, 2023
Arginine or Hypertonic Saline–Stimulated Copeptin to Diagnose AVP Deficiency
N Engl J Med 2023; 389:1877-1887Testing with hypertonic-saline stimulation was superior to testing with arginine stimulation in the diagnosis of arginine vasopressin deficiency.
- Original ArticleVOL. 389 No. 20, Nov 16, 2023
Two Phase 3 Trials of Gantenerumab in Early Alzheimer’s Disease
N Engl J Med 2023; 389:1862-1876In two randomized trials, the use of gantenerumab (an anti-A
β monoclonal antibody) did not lead to slower clinical decline than placebo over 116 weeks among persons with early Alzheimer’s disease. - EditorialVOL. 389 No. 20, Nov 16, 2023
What the Gantenerumab Trials Teach Us about Alzheimer’s Treatment
N Engl J Med 2023; 389:1918-1920An amyloid hypothesis1 for Alzheimer’s disease posits that amyloid-beta (A
β ) peptides cleaved from Aβ precursor protein trigger a neurodegenerative cascade, causing cognitive and functional impairment. The peptides have various lengths, ranging from monomers to self-assembled soluble oligomers, insoluble fibrils, and extracellular deposits, or plaques. Any of these species... - EditorialVOL. 389 No. 20, Nov 16, 2023
Testing for Arginine Vasopressin Deficiency
N Engl J Med 2023; 389:1920-1921Accurate classification of patients with hypotonic polyuria is essential because management differs for the three main causes1: arginine vasopressin (AVP) deficiency (formerly called central diabetes insipidus), AVP resistance (also known as nephrogenic diabetes insipidus),2 and primary polydipsia, in which excess fluid intake suppresses AVP secretion. Primary...
- PerspectiveVOL. 389 No. 19, Nov 09, 2023
Intention to Treat: Alzheimer’s Update, Part 1 — ITT Episode 20
N Engl J Med 2023; 389:e33In this podcast episode, host Rachel Gotbaum talks with a patient with early-onset Alzheimer’s disease and two dementia experts about frustrations with the current state of Alzheimer’s care.
- Original ArticleVOL. 389 No. 19, Nov 09, 2023
Actionable Genotypes and Their Association with Life Span in Iceland
N Engl J Med 2023; 389:1741-1752This study examines the relationship of pathogenic and likely pathogenic variants for which preventive or therapeutic measures are available to life span and specific causes of death.
- Original ArticleVOL. 389 No. 19, Nov 09, 2023
Decolonization in Nursing Homes to Prevent Infection and Hospitalization
N Engl J Med 2023; 389:1766-1777Nursing home residents are often colonized with antibiotic-resistant bacteria. In this trial involving 28 nursing homes, decolonization with chlorhexidine and povidone–iodine reduced the risk of hospitalization for infection.
- EditorialVOL. 389 No. 19, Nov 09, 2023
Ten Years of Incidental, Secondary, and Actionable Findings
N Engl J Med 2023; 389:1813-1814In 2013, as sequencing tests that evaluated the genome or its coding regions (the exome) became available to aid in the diagnosis of suspected genetic disorders, the American College of Medical Genetics and Genomics (ACMG) issued a guideline1 that included a set of medically important genes to be...
- EditorialVOL. 389 No. 19, Nov 09, 2023
Universal Decolonization in Nursing Homes — Apparent Benefits but Feasible?
N Engl J Med 2023; 389:1815-1816Nursing homes house a population most at risk for prolonged colonization with multidrug resistant organisms (MDROs) owing to the residents’ older age, repeat health care and antibiotic exposures, and ongoing contact with other persons with colonization.1 Although nursing homes pose a perfect opportunity for the cultivation and continued...