Can we prevent age-related cognitive decline, and perhaps even head off Alzheimer's disease and related dementias before they start?

Pharmaceutical companies are spending billions searching for a magic bullet pill to answer that question. But what if the solution requires more than a single drug? What if real prevention demands a multi-domain approach that combines targeted diet, exercise, social engagement, and vascular risk factor management among other things?

On today's episode, we explore multi-domain interventions for cognitive risk reduction with two leading experts:

• Laura D. Baker, PhD, Co-PI and first author of the US POINTER study.

• Ellen Binder, MD, Co-PI and senior author of the rrAD Trial.

The key multi-component trials discussed in this episode include:

• FINGER Trial (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability

• SMARRT Trial (Systematic Multi-Domain Alzheimer's Risk Reduction Trial -> Check out our previous GeriPal episode on SMARRT

• US POINTER Study (US Study to Protect Brain Health Through Lifestyle Intervention to Reduce Risk)

• rrAD Trial (Risk Reduction for Alzheimer's Disease)

My key takeaway from this conversation? We now have compelling evidence that actively modifying lifestyle risk factors can preserve, and even improve brain health as we age. That makes this episode's song choice all the more fitting: "Get On Your Feet."

In 1987, lovastatin became the first FDA-approved statin in the United States. Four decades later, statins are among the most frequently prescribed medications nationwide, with atorvastatin topping the overall list. Now, updated guidelines have expanded statin eligibility to cover nearly every older adult.

On today's episode, we are joined by experts Tim Anderson, Rita Redberg, and Mike Rich to discuss when to start, and when to stop, statin therapy in older adults.

Topics we talk about on starting and stopping statins in older adults include:

• Updates and changes for statin use in older adults in the new 2026 Guideline on the Management of Dyslipidemia including:

• • The transition to the new PREVENT (Predicting Risk of Cardiovascular Disease EVENTs) equations.

  • Raising the target age for 10-year ASCVD risk estimation from 75 to 79.

  • Lowering ASCVD risk threshold categories: Low (<3.0%), Borderline (3.0% to <5.0%), Intermediate (5.0% to <10.0%), and High (10.0%).

• Clinical Implications of these new guidlines:

• • A new study led by Tim Anderson reveals that over 93% of adults aged 70–79 now meet the criteria for primary prevention statins.

• Does the STAREE trial change anything?

• • The STAREE trial showed a 30% reduction in major cardiovascular events with atorvastatin in older adults, yet found no significant improvement in disability-free survival or all-cause mortality.

• Statin Discontinuation Trials: Should we change our practice now that the SAGA/SITE trial showed stopping statins in older adults who have been on them for more than a year had no impact on mortality, quality of life, cognitive function, functional status, symptom burden, and adverse events.

• Lastly, while we didnt talk about it, this is another great RCT on statin discontinuation in individuals nearing the end of life, finding no significant difference in 60-day mortality or 1-year cardiovascular event risk between statin discontinuation and continuation.

When you think of palliative care pharmacotherapy, you probably think about the tried-and-true mainstays of our field like morphine, haloperidol, and senna. But the landscape of palliative symptom management is rapidly evolving, with hot new drug classes and rediscovered old-school opioids (and not just buprenorphine!)

On today's episode of the GeriPal Podcast, we sit down with three expert palliative care clinical pharmacists, Max Stevenson, Alex McPherson, and Nisha Iyer, to talk about 5 hot new drugs (or rediscovered):

1. Suzetrigine: It works for bunions (at least as well as opioids, maybe?), but can it work in palliative care? My take-home point here is that its not ready for prime time, but you may have a different take after listening.

2. Levorphanol: The forgotten opioid that looks a lot like methadone but more NMDA. Should we bring it back to the living? Maybe if it were cheaper (why does an old drug cost this much?)

3. Tapentadol: Basically a better version of tramadol (aka Tamadont) that combines mu-opioid agonism with norepinephrine reuptake inhibition. Expensive but our guests varied in the potential benefit here.

4. Dual Orexin Receptor Antagonists (DORAs): Rerouting sleep management away from sedating Z-drugs and benzodiazepines to these new agents seems reasonable (again if cost was no concern) given that they appear safer (check out this JAGS article on DORAs and the risk of falls)

5. GLP-1 Receptor Agonists: Wait, GLP1's in palliative care (not just stopping it when we get consults for weight loss)? There may be a couple reasons to consider…

Also check out some of these podcasts that we talked about in this episode:

• Gabapentinoids – Gabapentin and Pregabalin: Tasce Bongiovanni, Donovan Maust and Nisha Iyer

• Tramadon't: a podcast with David Juurlink about the dangers of Tramadol

• Buprenorphine Use in Serious Illness: A Podcast with Katie Fitzgerald Jones, Zachary Sager and Janet Ho

• All the Questions You Had About Opioids But Were Afraid To Ask: A Podcast with Mary Lynn McPherson