People with cognitive impairment frequently have multiple comorbidities, and polypharmacy is highly prevalent, affecting nearly half of individuals with mild cognitive impairment and dementia. The use of potentially inappropriate medications (PIMs), including those specifically problematic for cognitive impairment (PIMcog), increases with the total number of medications and may exacerbate cognitive symptoms or increase the risk of adverse drug events. However, the prevalence of polypharmacy and PIMcog use among patients diagnosed with MCI or dementia in Norwegian specialist outpatient clinics has not been described.

The proportion of very elderly people in the German population is steadily increasing. As a result, their specific needs-for example, with regard to regional healthcare and support structures-are becoming increasingly important. This article introduces the current issue with an overview of the living conditions and health status of people aged 80 and over.First, the population group is described based on demographic characteristics. Women clearly predominate among the very elderly; furthermore, gender-specific differences are evident in terms of income, remaining life expectancy, and marital status. Their share of the population varies regionally-in some cases considerably-and is linked to the respective region's development potential. The proportion of very old people in the population is particularly high in structurally weak and low-income regions.Based on the representative Gesundheit 65+ study (Robert Koch Institute, RKI) and D80+ study (ceres), key data on the health status of the very elderly are presented. The article addresses subjective health, health limitations, diseases and multimorbidity, need for care, and dementia. The health data, which also highlight gender-specific differences and health inequalities, point to fields of action that should be addressed in order to ensure equal living conditions. Structurally weak regions in particular face major challenges in providing the necessary care and health infrastructure for a dignified life in old age.

Critical distal tracheal stenosis caused by a massive goiter poses a major airway challenge in which tracheal intubation and positive-pressure ventilation may fail, potentially leading to severe hypoxia during induction. We report the case of an 88-year-old woman with dementia who underwent thyroidectomy for severe distal tracheal compression caused by a large goiter. Preoperative imaging demonstrated near-critical tracheal narrowing measuring 4 × 9 mm over a 5-cm segment. Awake fiberoptic intubation was not feasible due to severe cognitive impairment and recurrent episodes of acute respiratory distress, making an awake technique dependent on spontaneous ventilation unreliable. A structured multidisciplinary airway strategy was developed, including anesthesiologists, surgeons, and clinical engineers, with a cardiovascular surgeon present in the operating room and extracorporeal life support (ECLS) prepared with immediate availability and readiness for rapid deployment as a rescue option. Within this strategy, transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) was used as an oxygenation technique during apnea. Despite ineffective mask ventilation with high airway pressures, THRIVE at 70 L/min maintained oxygen saturation at 100% throughout a 12-minute apneic period and facilitated successful bronchoscopic placement of a 4.5 mm endotracheal tube beyond the stenosis. This case demonstrates that THRIVE, when used as part of a structured airway management strategy, may help maintain oxygenation in a high-risk, difficult airway where conventional ventilation techniques fail.

Recently, the incidence of thyroid diseases has been on the rise. While standardized diagnosis and treatment generally yield excellent prognoses, the association between thyroid disorders and cognitive function remains a topic of significant interest. Cognitive function includes memory, language, visuospatial ability and executive function. Cognitive dysfunction refers to the impairment of one or more of the above, including mild cognitive impairment (MCI) and dementia. More and more studies have shown that thyroid disease is associated with cognitive dysfunction. Clinically, some patients present with noticeable symptoms such as memory loss and inattention, which severely impede their daily social functioning. There is a consensus on the view that thyroid hormone deficiency during the neonatal or embryonic period can cause disorders in the central nervous system, resulting in severe cognitive impairment such as persons with congenital hypothyroidism, but there is disagreement on the relationship between adult thyroid diseases, including clinical hyperthyroidism, hypothyroidism, subclinical hyperthyroidism, subclinical hypothyroidism and cognitive dysfunction. The inconsistencies in research conclusions are attributed to complex factors. Differences in age stratification constitute an important confounding factor for thyroid-related cognitive impairment; various neuropsychological assessment tools show obvious discrepancies in the sensitivity of detecting cognitive damage, which can directly affect the evaluation of research outcomes. Meanwhile, methodological heterogeneity among studies is also a key inducement for the inconsistent findings on the association between clinical thyroid dysfunction and cognitive function in adults. Therefore, this article mainly reviews the relationship and research progress between thyroid function and cognitive dysfunction in adults. From this review, we conclude that obvious thyroid dysfunction is obviously related to cognitive function, mainly focusing on attention and memory. Treatment would improve cognition to some extent, but wouldn't fully restore it. The relationship between subclinical thyroid dysfunction and cognitive function is still of important significantly.

Despite widespread development of prognostic risk stratification tools, their implementation in Australian healthcare remains poorly characterised. This review identified tools implemented for adults aged ≥40 years and examined their real-world use. Following PRISMA and SWiM guidelines, MEDLINE, EMBASE, Web of Science, PsycINFO, and CINAHL Plus were searched from inception to 20th February 2026. Eligible studies reported implementation of a risk stratification tool in Australian healthcare and health, functional, or implementation outcomes. The Mixed Methods Appraisal Tool assessed study quality. Of 7115 records screened, 21 studies were included across primary care, hospitals, residential aged care, and community services. Interventions included electronic decision support, multifactorial assessments, structured clinical protocols, and AI-enabled screening. Studies that focused on early implementation outcomes (acceptability, feasibility, and adoption) rarely examined sustainability, penetration, and cost. Risk stratification tools are feasible and acceptable across Australian healthcare settings, but few are implemented as part of routine care.

Neuromodulation techniques in the gamma frequency range, such as chronic 40 Hz sensory stimulation, have gained attention for their potential to impact and preserve cognitive function in the context of neurodegenerative disorders such as Alzheimer's disease (AD). This hypothesis and theory article aims to examine the overlap in biological phenotypes between gamma stimulation techniques and to propose a theoretical mechanism of action that may help to inform future empirical investigations. In Part 1, we provide a neuromodulatory framework related to a multifaceted novelty/salience circuit consisting of phasic activation of hind-, mid-, and basal forebrain nuclei, especially the locus coeruleus (LC); the release of norepinephrine (NE); the activation of cholinergic, dopaminergic, and serotonergic nuclei; and downstream modulation of the neurogliavascular unit through astrocyte-dependent pathways in order to reduce neuroinflammation, increase blood and glymphatic flow, promote synaptic plasticity and myelination, and improve hippocampal-dependent memory. We suggest various falsifiable experiments and testable modifications to stimulation paradigms based on this hypothesis. In Part 2, we review and explore the role of these hind- and midbrain nuclei and neuromodulators in terms of learning, allostatic load, consciousness, and sleep. To strengthen the initial hypothesis and highlight the significance of this proposed circuit, we cite observations of altered gamma oscillations across a variety of neuropsychiatric disorders, as well as speculate on the role of brainstem nuclei in current and potential treatments. This portion aims to emphasize the critical importance of the neural circuit proposed, its involvement in conscious experience, and to potentially inform future neuropsychiatric research and disease modeling, as well as indications for LC-NE or gamma frequency-based interventions. Part 3, in order to explain the significant impact of 40 Hz stimulation on Alzheimer's disease and neurodegeneration, explores a hypothetical functional framework for the core role of the LC-NE system in novelty, evolutionary drive, and management of allostatic load, its potential role in vertebrate aging, and a hypothesis for LC-NE dysfunction and depletion as a significant upstream modulator of the development of amyloid plaques and Alzheimer's disease, respectively. The goal of this work is to motivate future empirical investigations into 40 Hz stimulation paradigms and biomarkers proposed, studies assessing the role of the LC-NE system in the conduction of consciousness and alterations in neuropsychiatric disorders discussed, and into the potential role of the LC in vertebrate aging and the development of Alzheimer's disease.