The question doctors could ask to estimate death risk in old patients

 Your competent? doctor is responsible for getting you walking properly so you don't have a higher mortality risk! Is your doctor up to that task? 

NO? So, you will get him/her fired then, right?

My doctor knew nothing about recovery and did nothing. Which is why my gait is still screwed up; 15 degree leftward angle of left foot, no push-off, no free swinging lower leg, hyperextension of left knee.

The question doctors could ask to estimate death risk in old patients

“Do you have trouble walking?” could be one of the most important questions doctors could ask older patients to evaluate their mortality risk, according to a new large-scale research review.

Healthcare systems worldwide seek to find simple ways to identify older adults with a high need for hospitalisation.

Hospitals also need to assess whether their healthcare response is distributed according to need rather than social position.

Previous studies have established that grip strength, gait, and balance can predict the risk of chronic diseases in older people.

Now, a new study reveals that walking difficulty can also be a practical sign of higher mortality risk and health need.

In the research, scientists assessed data from six of the world’s largest ageing studies, including health information from older adults living in China, England, the United States, South Korea, Mexico, and continental Europe.

The studies collectively followed hundreds of thousands of older adults using comparable questionnaires, which included questions about walking difficulty.

By analysing this data, scientists could probe whether walking difficulty indeed determined health status in older people across economies, cultures, and health systems.

“Walking difficulty is inexpensive to ascertain and widely harmonisable across ageing cohorts, but its value as a denominator for healthcare equity assessment has been less well characterised,” researchers wrote.

They found that walking difficulty could be used to identify populations with substantially greater measured health need.

Scientists found that older adults who reported walking difficulty faced nearly double the death risk during follow-up than those who walked comfortably.

“Walking difficulty was associated with morbidity, falls, depressive symptoms, disability, and hospitalisation,” they wrote in the study published in the journal BMC Medicine.

“In clinical and community-facing settings, the value of a walking-difficulty question lies in its simplicity rather than in technological precision. It can be asked quickly, requires no equipment, and identifies a group in which multi-morbidity, depressive symptoms, falls, disability, and hospitalisation are more common,” researchers explained.

However, they caution that the study does not estimate a causal effect of walking difficulty.

“Taken within these boundaries, walking difficulty offers a practical way to move from risk recognition to health-system auditing in older populations,” researchers said.

“It identifies a high-need group using a low-cost functional question and makes it possible to ask whether response among those with evident need remains socially patterned,” they explained.

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Association of the hemoglobin glycation index with the large-artery atherosclerosis subtype in ischemic stroke: a dual-cohort study

 Ask your competent? doctor what protocol from this will prevent mortality! If the protocol doesn't exist; DEMAND YOUR DOCTOR CREATE ONE!

Association of the hemoglobin glycation index with the large-artery atherosclerosis subtype in ischemic stroke: a dual-cohort study

• 

  Xinyu Tong 1,2†

• J

  Jianxiong Gu 1†

• C

  Chuxin Lyu 3

• Y

  Yichun Zhao 1

• L

  Lei Chen 4

• T

  Tianzhi Ren 2

• H

  Haoxin Wu 2*

• L

  Lei Yu 1*

• Y

  Ying Rui 1*

• 1. Department of Neurology, Wuxi Affiliated Hospital of Nanjing University of Chinese Medicine, Wuxi, China

• 2. College of Traditional Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China

Abstract

Background: 

The hemoglobin glycation index (HGI) reflects discordance between measured HbA1c and glucose-predicted HbA1c, but in acute ischemic stroke (IS) it may also capture stress-hyperglycemia-related fasting plasma glucose (FPG) elevation. We examined the association of HGI with large-artery atherosclerosis (LAA) and in-hospital mortality.

Methods: 

We retrospectively analyzed 4,500 IS patients from MIMIC-IV and 330 patients from an external clinical cohort. HGI was calculated using cohort-specific FPG-HbA1c regression equations. Multivariable logistic regression and restricted cubic spline analyses assessed associations with LAA and mortality. Boruta feature selection, exploratory Mendelian randomization (MR), and post hoc stress hyperglycemia ratio (SHR) sensitivity analyses were also performed.

Results: 

Lower HGI was independently associated with higher LAA risk in both cohorts (MIMIC-IV: OR = 0.579, p < 0.001; clinical cohort: OR = 0.599, p < 0.001), with an L-shaped nonlinear pattern. In MIMIC-IV, lower HGI was also associated with higher in-hospital mortality (OR = 0.488, p < 0.001). HGI showed the highest Boruta feature importance among measured baseline variables. HGI and SHR were strongly inversely correlated in both cohorts (Spearman’s ρ = −0.711 and −0.723; both p < 0.001), and higher SHR showed directionally consistent associations with adverse outcomes. MR did not provide significant genetic evidence linking HGI to LAA.

Conclusion: 

Low HGI was associated with higher LAA risk and in-hospital mortality in IS. This signal overlaps with stress-hyperglycemia-related FPG-HbA1c discordance; therefore, HGI may be useful for risk stratification but should not be interpreted as an independent causal glycation phenotype.

More at link.

Coffee & Chronic Disease Risk — What A New Sweeping Review Concludes by mindbodygreen

 Of course I'm going to live longer drinking coffee. Currently at 70, will easily get to 100 assuming I'm not too careless in my travels! I'm way over the 3.5 cups because I want to ensure no dementia or Parkinsons, give me EXACT amounts and I'll reduce my consumption.

Coffee & Chronic Disease Risk — What A New Sweeping Review Concludes

What Your Naps Might Be Saying About Your Health as You Age by mindbodygreen

 Your competent? doctor better have a more nuanced view of napping other than it leads to higher mortality risk! Like solving why it is occurring rather than just spouting lazy crapola!

• napping (13 posts to August 2014)

What Your Naps Might Be Saying About Your Health as You Age

Infections Linked to Increased Frailty and Mortality Risk in Older Adults: Study

 You have enough problems with frailty post stroke so make sure your competent? doctor prevents infections. 

• frailty (30 posts to January 2018)
• infection (19 posts to February 2012)
• 30% infection post stroke (1 post to May 2019)

Infections Linked to Increased Frailty and Mortality Risk in Older Adults: Study

Smoking Linked to Lower Parkinson’s Risk but Higher Mortality

 Have your competent? doctor EXPLAIN EXACTLY HOW THEY ARE GOING TO PREVENT Parkinsons! They've known of the problem for years! Are they still incompetent in having done nothing?

Parkinson’s Disease May Have Link to Stroke March 2017

Smoking Linked to Lower Parkinson’s Risk but Higher Mortality

Summary: A large-scale study of over 410,000 adults reveals a complex relationship between smoking and neurological health. Published in Neurology, the research found that individuals who were currently smoking had a lower risk of developing Parkinson’s disease compared to those who had quit.

However, the study strongly emphasizes that quitting smoking significantly lowers the overall risk of death. The findings suggest that the potential “protective” association with Parkinson’s is tied specifically to current smoking status rather than long-term history, highlighting a need for targeted therapies that mimic these effects without the lethal risks of tobacco.

Key Facts

• The Parkinson’s Paradox: Persistent smokers had the lowest risk of Parkinson’s; those who quit (sustained or recent) had a 60% to 61% higher risk of developing the disease.
• Mortality Trade-off: While quitters faced a higher Parkinson’s risk, they had a significantly lower risk of death (17% lower for sustained quitters) compared to persistent smokers.
• Current Status Matters: Relapsed smokers (those who quit but started again) had a Parkinson’s risk similar to persistent smokers, suggesting the association is linked to active smoking.
• Massive Study Scale: The research followed 410,000 adults in South Korea for an average of nine years, tracking smoking changes across multiple health screenings.
• No “Safe” Smoking: Researchers warn that the risks of smoking—including cancer and heart disease—far outweigh any observed neurological associations, and these results should not encourage smoking.

Source: AAN

A new study of smokers finds that currently smoking is associated with a lower risk of developing Parkinson’s disease, but quitting smoking was associated with a lower risk of death.

The study was published on February 25, 2026, in Neurology.

The study does not prove that smoking prevents Parkinson’s; it only shows an association.

Researchers are investigating the link between active smoking and reduced Parkinson’s risk, while emphasizing that quitting smoking is essential for overall longevity and health. Credit: Neuroscience News

“The severe health risks of smoking cannot be overlooked, as it remains a leading cause of preventable death and contributes to heart disease, cancer and chronic lung disorders,” said study author Jun-Hyuk Lee, MD, PhD, of Eulji University School of Medicine in Seoul, South Korea.

“While our study found smokers who quit showed a higher risk of Parkinson’s disease than those who were currently smoking, it also found they had a lower risk of death. The health benefits of quitting smoking remain substantial and clear.”

The study involved more than 410,000 adults in South Korea who were smokers at the beginning of the study. Their average age was 52, and they were followed for an average of nine years.

Participants completed health screenings at the start of the study, about two years later, and then another two years later. They were asked how much and how often they smoked.

Researchers divided participants into four groups: persistent smokers who never quit, relapsed smokers who quit a couple years into the study but then resumed smoking, recent quitters who smoked the first four years of the study and then quit, and sustained quitters who quit early in the study and never resumed smoking.

During the study, 1,794 people developed Parkinson’s disease: 0.33% of persistent smokers, 0.41% of relapsed smokers, 0.67% of recent quitters and 0.71% of sustained quitters.

Also, 31,203 people died, including 7.24% of persistent smokers, 8.09% of relapsed smokers, 8.76% of recent quitters and 7.91% of sustained quitters.

After adjusting for factors such as income level, alcohol use and physical activity, researchers found that persistent smokers had the lowest risk of developing Parkinson’s disease. Recent quitters and sustained quitters had a 60% to 61% higher risk of Parkinson’s compared to persistent smokers. Relapsed smokers had a risk similar to persistent smokers.

When looking at risk of death, researchers found that sustained quitters had a 17% lower risk of death and recent quitters had a 3% lower risk compared to persistent smokers. Relapsed smokers had the same rate as persistent smokers.

“Overwhelming evidence from multiple previous studies shows quitting smoking is much better for long-term health overall,” Lee said.

“Our study suggests a lower risk of Parkinson’s is not necessarily associated with how long someone smokes, but rather if they are currently smoking. Future studies are needed to better understand which components of smoking contribute to the reduced risk, and to develop safe and targeted therapies that replicate the effects of smoking for Parkinson’s without the harmful health consequences.”

A limitation of the study was that data was self-reported, so people providing responses may not have recalled all information accurately. Also, the participants were mostly Korean male participants, so results may not be generalizable to women or other populations.

Key Questions Answered:

Q: Does smoking actually prevent Parkinson’s?

A: The study shows an association, but it doesn’t prove cause-and-effect. While active smokers in the study had lower rates of Parkinson’s, the biological reason isn’t fully understood yet. It might be a specific chemical in tobacco, or it could be related to how “addictive” brains are wired differently.

Q: Should I keep smoking to avoid Parkinson’s?

A: Absolutely not. Even with a lower Parkinson’s risk, persistent smokers in the study had the highest risk of death. Quitting smoking is still the single best thing you can do for your heart, lungs, and overall lifespan.

Q: What is the “secret ingredient” in cigarettes that helps the brain?

A: That’s the multi-million dollar question. Scientists are trying to isolate which components of tobacco might be helping neurons so they can create safe, targeted medications that offer protection without the cancer-causing smoke.

Editorial Notes:

• This article was edited by a Neuroscience News editor.
• Journal paper reviewed in full.
• Additional context added by our staff.

About this Parkinson’s disease research news

Author: Renee Tessman
Source: AAN
Contact: Renee Tessman – AAN
Image: The image is credited to Neuroscience News

Original Research: The findings will appear in Neurology

Do Statins Really Raise Vascular Hospitalization Risk in Dementia?

 I guess you'll have to ask your competent? doctor. Lower mortality risk, but higher hospitalization risk! A conundrum for your doctor to interpret. 

Do Statins Really Raise Vascular Hospitalization Risk in Dementia?

Statin use has been linked to higher rates of cardiovascular or cerebrovascular hospitalization in older adults with dementia, results of a large observational study suggest. 

However, small event numbers and several limitations warrant cautious interpretation, the researchers note. With this in mind, the investigators, led by Sonia Lech, PhD, Department of Psychiatry and Neurosciences, Charité-Universitätsmedizin, Berlin, Germany, recommend that clinicians consider individualized risk–benefit assessment when considering statin use in this patient population.

This finding was also unexpected. In earlier research using the same nursing home cohort, the investigators found that statin use in residents with dementia was associated with significantly lower mortality — a contrast they note in their paper.

The findings ran counter to the group’s original hypothesis. Their prior study, published in February 2024, showed a 20% reduction in all-cause mortality among statin users with dementia, the authors noted, yet the current analysis did not show a corresponding reduction in cardiovascular or cerebrovascular hospitalizations. 

“This suggests that while statins may contribute to a reduction in mortality risk, they do not necessarily translate into a reduced rate of hospitalizations due to cardiovascular and cerebrovascular events” in this population, they write. The study was published online November 17 in the journal Stroke.

Research Gap

Statins are well established for primary and secondary prevention of cardiovascular and cerebrovascular disease, but evidence for their benefit in people with dementia has been lacking, even though cardiovascular and cerebrovascular disease are major causes of morbidity and mortality in this population. 

“There is currently no research published evaluating the effect of statin use in [people with dementia] on cardiovascular and cerebrovascular outcomes; thus, there is a lack of evi­dence to support guidelines for the care of [people with dementia],” the investigators note.

In an effort to fill this knowledge gap, the investigators examined statin use and a potential link to hospitalization due to these events among nursing home residents with and without dementia.

The researchers analyzed insurance claims from 96,162 nursing home residents in Germany, including 58,900 people with dementia (mean age, 83.4 years; 69.8% female) and 37,262 without dementia (mean age, 82.2 years; 66.9% female). Participants were further categorized as statin users or nonusers before outcomes were compared. 

The study’s primary outcome was hospitalization due to cardiovascular or cerebrovascular disease events. Researchers adjusted for age, sex, care level, cardiovascular disease, cerebrovascular disease, other medical and psychiatric conditions, comorbidities, medications, and number of hospital admissions.

During an average observation period of 2.3 years, there were 4528 hospitalizations among individuals with dementia. Of these, 2621 occurred in those using statins.

In this group of individuals, statin use was associated with an increased risk for hospitalization compared with nonuse (hazard ratio [HR] 1.06; 95% CI, 1.01-1.12; P = .023).

Frailty a Factor?

This elevated risk suggests statins “may increase the cerebrovascular and neurodegenerative pathological processes in the already vulnerable brain of patients with dementia,” the investigators write.

Such patients, they add, “may represent an inherently frail survivor population” who “might be more susceptible to complications or comorbidities that necessitate hospitalization.”

The possibility that frailty rather than statin use explains the increased risk for hospitalization can’t entirely be ruled out, they noted.

Moderate- and high-intensity statin use was associated with a higher risk for hospitalization compared with nonuse (HR, 1.15; 95% CI, 1.07-1.23; P < .001 for moderate-intensity statins; and HR, 1.55; 95% CI, 1.15-2.10; P = .005 for high-intensity statins). Notably, there was no such association with low-intensity statin use.

Among residents with dementia and no history of atherosclerotic cardiovascular disease (ASCVD), statin use was also linked to an increased risk for hospitalization (HR, 1.30; 95% CI, 1.12-1.52; P < .001), a pattern not observed in those with prior ASCVD.

The risk for hospitalization was also higher among individuals newly prescribed statins compared with nonusers. However, in sensitivity analyses, applying an 18-month exposure lag substantially reduced this association.

In the group without dementia, there were 2450 hospitalizations due to cardiovascular and cerebrovascular events during an average observation period of 2.0 years. Of these, 1431 events occurred among statin users.

Compared with statin nonusers, the only significant associations between statin use and hospitalization in this group were seen with high-intensity statins (P = .029) and with newly prescribed statins (P < .001). However, as in the dementia cohort, sensitivity analyses showed that applying a lagged exposure window attenuated these risks.

Potential Limitations

Because statins are often prescribed for secondary prevention after events such as myocardial infarction or stroke, patients who receive them may already be at higher baseline risk for subsequent events, a pattern that can lead to reverse causation bias, the authors noted.

They noted that the use of cardiovascular medications such as diuretics, nitrates, and alpha-receptor blockers did not change the results. They also pointed out that antipsychotic medication use — known to increase cardiovascular and cerebrovascular risk — could not account for the differences between those with and without dementia, as usage rates of antipsychotic meds were similar in both groups.

The study’s limitations include the relatively small number of cardiovascular and cerebrovascular events, which may have reduced the statistical power of the analyses, and the results could be influenced by factors unrelated to statin use, such as differences in access to care or in preferences around hospitalization.

In addition, dementia diagnoses were drawn from administrative codes rather than clinical adjudication, raising the possibility of misclassification. In addition, the investigators had no information on dementia severity — a key determinant of hospitalization risk. These gaps, they noted, limit the extent to which the findings can be interpreted as reflecting true differences in event risk.

They note that more research is needed before any definitive conclusions can be drawn but add that the findings warrant “cautious consideration of statin use in people with dementia.”

The study was funded by Siftung Charité as part of the Berlin Institute of Health (BIH) visiting professorship grant to author Sevil Yasar, PhD, MD, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, MD. The authors report no relevant financial relationships. 

Credits

Lead image: iStock/Getty Images

Medscape Medical News © 2025 WebMD, LLC

Send comments and news tips to news@medscape.net.

Cite this: Do Statins Really Raise Vascular Hospitalization Risk in Dementia? - Medscape - November 25, 2025.

Serum creatinine-to-albumin ratio as a prognostic marker for short- and long-term mortality in critically ill stroke patients: a MIMIC-IV study

Biomarkers DO NOTHING FOR RECOVERY! Because you don't have recovery protocols mapped to the problems found. Can't anyone in stroke think at all?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

Send me personal hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name(If you can't stand by your name don't bother replying anonymously) and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHY you aren't working on 100% recovery protocols with NO EXCUSES!

 Serum creatinine-to-albumin ratio as a prognostic marker for short- and long-term mortality in critically ill stroke patients: a MIMIC-IV study

Dong Sun^1†Sichun Chen^1†Ying Bi¹Shuang Wu¹Yu Xie¹Renwei Zhang¹Lei Zhang¹Bitang Dan¹Huagang Li¹Yang Liu²Yumin Liu¹Bin Mei^1*Li Zou^1*

• ¹Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
• ²Economics and Management School of Wuhan University, Wuhan, Hubei, China

Introduction: Stroke remains a leading cause of mortality and disability worldwide, with critically ill patients facing particularly poor outcomes. Existing prognostic markers often fail to capture the full spectrum of metabolic and nutritional disturbances in stroke. The serum creatinine-to-albumin ratio (sCAR), reflecting renal function and nutritional status, may offer improved mortality prediction for the intensive care unit (ICU)-admitted stroke patients.

Methods: This retrospective cohort study used the MIMIC-IV database (v2.2) to analyze 2,819 adult stroke patients admitted to the ICU. Patients were stratified into low- and high-sCAR groups based on an optimal cutoff of 0.419. Predictive performance was assessed using Cox regression, Kaplan–Meier survival analysis, and ROC and RCS curve modeling.

Results: Patients in the high sCAR group (≥0.419) demonstrated significantly higher short- and long-term mortality, including 28-day (31.7% vs. 16.7%, p < 0.001) and 1-year mortality (51.0% vs. 27.6%, p < 0.001). Multivariate Cox regression confirmed that elevated sCAR was independently associated with increased mortality risk at all endpoints, including 28-day (HR = 2.68, 95% CI: 2.28–3.14, p < 0.001) and 1-year (HR = 3.01, 95% CI: 2.61–3.47, p < 0.001). ROC analysis showed sCAR outperformed traditional markers, with an AUC of 0.618 for 28-day mortality and 0.639 for 1-year mortality. RCS curves revealed a non-linear association between sCAR and mortality risk, with thresholds indicating elevated risk for both short- and long-term outcomes.

Conclusion: The sCAR is a powerful and clinically relevant biomarker for mortality prediction in critically ill stroke patients. By integrating renal and nutritional assessments, sCAR enhances early risk stratification and supports individualized ICU management.