- N Engl J Med 2022; 386:e54
Although the Covid pandemic drew renewed attention to problems in U.S. nursing homes, the underlying issues with long-term care are long-standing. Susan Mitchell moderates a Perspective Roundtable about shortcomings and possible solutions.
- N Engl J Med 2021; 385:2017-2019
Aducanumab’s price can inform the drug-pricing policy debate because it responds to key features of the market environment for physician-administered drugs: Medicare’s reimbursement formula, payment to physicians for infused drugs, and cost-sharing requirements.
- N Engl J Med 2021; 385:2019-2021
CMS is considering whether and under what circumstances Medicare will pay for aducanumab for Alzheimer’s disease. A restrictive coverage determination could save the federal government money, but it would also shift substantial costs to states.
- N Engl J Med 2021; 385:856-857
The FDA decision to grant accelerated approval to aducanumab for Alzheimer’s disease fits squarely in the accelerated approval pathway, which was created to allow patients with a serious or life-threatening disease earlier access to a potentially important treatment.
- N Engl J Med 2021; 385:771-774
The FDA’s accelerated approval of aducanumab represents a landmark moment, though the drug’s road to the clinic has been rocky and contentious. The hope is that despite its limitations, this first-in-class drug will open the door to more efficacious therapies.
- N Engl J Med 2021; 385:769-771
Given the scientific, regulatory, and clinical implications of the accelerated FDA approval of aducanumab for Alzheimer’s disease, it’s essential to consider beta-amyloid’s suitability as a surrogate end point. Doing so casts doubt on the wisdom of the decision.
- N Engl J Med 2021; 385:372-373
Dementia occurs in a range of progressive neurodegenerative brain disorders, including Alzheimer’s disease, dementia with Lewy bodies, Parkinson’s disease dementia, vascular dementia, and frontotemporal dementia, each classified according to their respective neuropathological characteristics. Dementia is clinically defined by cognitive and functional impairments and is often associated with behavioral and psychological...
- N Engl J Med 2021; 385:309-319
The serotonin-receptor modulator pimavanserin reduces psychosis in patients with Parkinson’s disease. In a randomized discontinuation trial involving patients with psychosis related to several types of dementia, the frequency of relapse over a period of 26 weeks was 13% with pimavanserin and 28% with placebo.
- N Engl J Med 2021; 384:1762-1763
An estimated 50 million people worldwide have dementia, mostly due to Alzheimer’s disease. The inexorable progression of Alzheimer’s disease exerts a huge toll on patients, families, and society, costing approximately $1 trillion annually, an amount that is likely to increase with the growing number of elderly people. It is no...
- N Engl J Med 2021; 384:1691-1704
A phase 2 trial of donanemab, an antibody that targets amyloid deposited in the brain, showed a better composite score for cognition and for the ability to perform activities of daily living than placebo at 76 weeks in patients with early Alzheimer’s disease. Results for secondary outcomes were generally similar...
- N Engl J Med 2021; 384:1350-1358
A 70-year-old man with bipolar disorder was evaluated because of depressed mood, suicidal ideation, and gait disturbance. One month earlier, he had been voluntarily hospitalized for depression. In the following weeks, he had worsening gait instability and urinary incontinence. Diagnostic tests were performed.
- N Engl J Med 2020; 383:2666-2675
A 62-year-old man with a history of Waldenström’s macroglobulinemia presented with memory loss, personality changes, and odd behavior. One year earlier, he had received diagnoses of attention deficit–hyperactivity disorder, adjustment disorder, and avoidant personality traits. A diagnosis was made.
- N Engl J Med 2020; 383:1974-1983
A 59-year-old woman with type 1 diabetes and a 2-year history of cognitive decline presented with obtundation. There was diffuse, symmetric hypointensity in the brain on T2-weighted images and abnormal susceptibility signal throughout the basal ganglia, thalami, dentate nuclei, and cortical surfaces of the cerebral hemispheres on susceptibility-weighted images. A...
- N Engl J Med 2020; 383:1564-1576
Autophagy is a complex process of intracellular degradation of senescent or malfunctioning organelles. Dysregulated autophagy is associated with certain cancers, neurodegenerative diseases, immune dysfunction, and aging. Therapies aimed at regulating autophagy are being developed.
A Half-Century of Progress in Health: The National Academy of Medicine at 50: Health in Aging — Past, Present, and FutureN Engl J Med 2020; 383:1293-1296
Increases in life expectancy necessitate new scientific understanding of how to both extend and enhance health over the course of our longer lives. Accumulated evidence has laid the groundwork for a new era of prevention and health promotion for an extended health span.
- N Engl J Med 2020; 382:2487-2489
Physicians who care for aging adults may soon be overwhelmed with patients with dementia, but only a small minority of seniors are being screened for it, in part because of stigma. But there are rich resources available for developing person-centered dementia care.
Enabling Healthful Aging for All — The National Academy of Medicine Grand Challenge in Healthy LongevityN Engl J Med 2019; 381:1699-1701
Recognizing that aging presents a defining challenge for this century, the National Academy of Medicine is launching a Healthy Longevity Global Grand Challenge, an international effort directed at improving health, productivity, and quality of life for older people.
- N Engl J Med 2019; 380:1476-1478
Some trials fail because the experimental treatment proves to be no different than a control or standard intervention. Others fail because of unacceptable side effects. In this issue of the Journal, an article by Egan et al.1 and a letter to the editor by Henley et...
- N Engl J Med 2019; 380:1408-1420
In a randomized trial, patients with brain amyloid deposition but no dementia who received a β-site amyloid precursor protein–cleaving enzyme 1 inhibitor had no benefit with respect to clinical outcomes and worsening on some measures of cognition and daily function.
- N Engl J Med 2019; 380:705-707
Neither medicine nor society is prepared for the eventuality that most of us will outlive our driving life expectancy. To clinicians, driving may not seem like a medical problem, yet it is intertwined with health, medical care, and patient well-being on multiple levels.