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Same person, Different place: Twice the odds of a dementia diagnosis

With new medications on the market or in the works for Alzheimer’s disease and other kinds of dementia, a new study suggests that getting the diagnosis needed to access these new treatments may depend on where you live.
And the differences between regions of the country are even larger for people on the young end of the dementia-risk age range, ages 66 to 74, and for those who are Black or Hispanic.
In fact, the same person would have as much as twice the chance of getting a dementia diagnosis in some areas of the U.S. as in others, the study shows. The findings suggest that the chance of being diagnosed may be more about the health system than about individual factors that affect dementia risk.
A formal diagnosis is required for access to advanced new tests and treatments for dementia. Many of them aim to slow down the progression of dementia in its earliest stages, called mild cognitive impairment or mild Alzheimer’s disease.
The new study focuses on regional differences in “diagnostic intensity” of dementia — the kind of difference that exists even after all kinds of dementia risk factors and regional differences in population and health care are taken into account.
Performed by a team based at the University of Michigan, it’s published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
“These findings go beyond demographic and population-level differences in risk, and indicate that there are health system-level differences that could be targeted and remediated,” said Julie Bynum, M.D., M.P.H., the U-M Health geriatrician and health care researcher who led the study.
“The message is clear: from place to place the likelihood of getting your dementia diagnosed varies, and that may happen because of everything from practice norms for health care providers to individual patients’ knowledge and care-seeking behavior,” said Bynum, a professor of internal medicine at the U-M Medical School. “But the good news is, these are things we can act on once we know where to look.”
Bynum and her colleagues at U-M and the Dartmouth College Geisel School of Medicine did the study using data from the records of 4.8 million people who were covered by traditional Medicare and over the age of 66 in 2019.
They note that while nearly 7 million Americans currently have a diagnosis of dementia, millions more likely have symptoms but no formal diagnosis.
Insurance coverage for new biomarker tests, brain imaging scans and dementia-slowing medications depends on diagnosis. But even for those who don’t qualify for these, a confirmed diagnosis can be important for accessing specialized care and support for patients and their family members or friends who act as caregivers.
Going beyond risk factors: More about the study
Researchers have already found many factors that are linked to an individual’s higher risk of developing Alzheimer’s disease and other forms of dementia. These include years of high blood pressure, high cholesterol and tobacco or alcohol use, to lower levels of formal education, sleep and social interaction.
But the new study shows for the first time that the differences in diagnosis by region aren’t explained by differences in the dementia risk level of different populations.
It looked at diagnoses within each of 306 hospital referral regions developed for the Dartmouth Atlas of Health Care and used in many studies. Each HRR includes at least one hospital capable of doing advanced heart surgery and brain surgery; the researchers chose to use these regions because dementia diagnosis and advanced treatment also requires specialized services.
In all, 143,029 of the people in the total population used in the study were newly diagnosed with Alzheimer’s or another form of dementia in 2019. The rest of the 356,656 people who had that diagnosis in this population had been diagnosed before 2019.
That means that overall, about 7% of people covered by traditional Medicare have a dementia diagnosis at any given time, and 3% of this population is diagnosed each year, with an average age at diagnosis of about 83 years.
The researchers then calculated the regional rates of new diagnoses and total diagnosed individuals as of 2019 for each HRR. The prevalence of diagnosed dementia ranged from as low as 4% to as high as 14% depending on HRR, and the rate of new dementia diagnoses in 2019 ranged from 1.7% to 5.4%.
They then looked at rates for three age groups — 66 to 74, 75 to 84 and 85 and over — and for people identified as white, Black or Hispanic. They also included data about the percentage of the population in each HRR that had less than a high school education, that smoked, and that had obesity or diabetes — all risk factors for dementia.
They also incorporated information about the general intensity of all kinds of chronic disease diagnosis in each HRR.
By taking all these factors into account, the researchers were able to calculate a predicted rate of diagnosis for new and total Alzheimer’s and dementia cases for each HRR, and for individuals in each HRR. This is what they called diagnostic intensity.
Compared to the national average, people residing areas of the lowest-intensity are 28% less likely to be diagnosed, whereas those residing in areas of the highest-intensity are 36% more likely to be diagnosed.
The general concentration of diagnosed dementia cases was highest in the southern U.S., similar to the “stroke belt” of high risk for stroke and cardiovascular disease.
But the South was no longer a uniform hotbed of dementia diagnosis once the researchers adjusted for the other factors.
Implications for regional change
Bynum explains that the findings could reflect variations in clinical practices — for example, how often people are screened by their primary care physicians for early signs of dementia, or the availability of specialists to make a confirmed diagnosis.
Variation could also stem from cultural or personal differences in how likely a person is to seek care of any kind, to schedule an appointment specifically because of memory concerns, or to mention problems with memory or thinking proactively to a health care provider without being prompted during an existing appointment.
While the researchers can’t say for certain if the variation reflects underdiagnosis or overdiagnosis, they do say that the areas with lower-than-expected diagnosis rates for dementia could use the new findings to look at what barriers might stand in the way of someone getting diagnosed.
“The goal these days should be to identify people with cognitive issues earlier, yet our data show the younger age group of Medicare participants is the one with the most variation,” Bynum said. “For communities and health systems, this should be a call to action for spreading knowledge and increasing efforts to make services available to people. And for individuals, the message is that you may need to advocate for yourself to get what you need, including cognitive checks.”
She adds that Medicare covers a cognitive screening during each enrollee’s annual wellness visit.
She also notes that the recent launch of Medicare’s GUIDE model for dementia care may offer a path to improving care. The model incentivizes clinical practices to coordinate dementia care better and offer around-the-clock access to a trained provider.
In addition to Bynum, the study’s authors are Slim Benloucif and Jonathan Martindale of the U-M Department of Internal Medicine, A. James O’Malley of Dartmouth College and Matthew A. Davis, Ph.D., of the U-M School of Nursing and the U-M Medical School’s Department of Learning Health Sciences.
Bynum and Davis are members of the U-M Institute for Healthcare Policy and Innovation, and leaders of the Center to Accelerate Population Research in Alzheimer’s or CAPRA.
The study was funded by the National Institute on Aging of the National Institutes of Health (P01AG019783).
Full details about the diagnostic intensity rate and other data for each HRR will be available on the CAPRA website and at https://michmed.org/38XeZ .
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Early dark energy could resolve cosmology’s two biggest puzzles

A new study by MIT physicists proposes that a mysterious force known as early dark energy could solve two of the biggest puzzles in cosmology and fill in some major gaps in our understanding of how the early universe evolved.
Now, the MIT team has found that both puzzles could be resolved if the early universe had one extra, fleeting ingredient: early dark energy. Dark energy is an unknown form of energy that physicists suspect is driving the expansion of the universe today. Early dark energy is a similar, hypothetical phenomenon that may have made only a brief appearance, influencing the expansion of the universe in its first moments before disappearing entirely.
Some physicists have suspected that early dark energy could be the key to solving the Hubble tension, as the mysterious force could accelerate the early expansion of the universe by an amount that would resolve the measurement mismatch.
The MIT researchers have now found that early dark energy could also explain the baffling number of bright galaxies that astronomers have observed in the early universe. In their new study, reported in the Monthly Notices of the Royal Astronomical Society, the team modeled the formation of galaxies in the universe’s first few hundred million years. When they incorporated a dark energy component only in that earliest sliver of time, they found the number of galaxies that arose from the primordial environment bloomed to fit astronomers’ observations.
“You have these two looming open-ended puzzles,” says study co-author Rohan Naidu, a postdoc in MIT’s Kavli Institute for Astrophysics and Space Research. “We find that in fact, early dark energy is a very elegant and sparse solution to two of the most pressing problems in cosmology.”
The study’s co-authors include lead author and Kavli postdoc Xuejian (Jacob) Shen, and MIT professor of physics Mark Vogelsberger, along with Michael Boylan-Kolchin at the University of Texas at Austin, and Sandro Tacchella at the University of Cambridge.
Big city lights
Based on standard cosmological and galaxy formation models, the universe should have taken its time spinning up the first galaxies. It would have taken billions of years for primordial gas to coalesce into galaxies as large and bright as the Milky Way.
But in 2023, NASA’s James Webb Space Telescope (JWST) made a startling observation. With an ability to peer farther back in time than any observatory to date, the telescope uncovered a surprising number of bright galaxies as large as the modern Milky Way within the first 500 million years, when the universe was just 3 percent of its current age.
“The bright galaxies that JWST saw would be like seeing a clustering of lights around big cities, whereas theory predicts something like the light around more rural settings like Yellowstone National Park,” Shen says. “And we don’t expect that clustering of light so early on.”
For physicists, the observations imply that there is either something fundamentally wrong with the physics underlying the models or a missing ingredient in the early universe that scientists have not accounted for. The MIT team explored the possibility of the latter, and whether the missing ingredient might be early dark energy.
Physicists have proposed that early dark energy is a sort of antigravitational force that is turned on only at very early times. This force would counteract gravity’s inward pull and accelerate the early expansion of the universe, in a way that would resolve the mismatch in measurements. Early dark energy, therefore, is considered the most likely solution to the Hubble tension.
Galaxy skeleton
The MIT team explored whether early dark energy could also be the key to explaining the unexpected population of large, bright galaxies detected by JWST. In their new study, the physicists considered how early dark energy might affect the early structure of the universe that gave rise to the first galaxies. They focused on the formation of dark matter halos — regions of space where gravity happens to be stronger, and where matter begins to accumulate.
“We believe that dark matter halos are the invisible skeleton of the universe,” Shen explains. “Dark matter structures form first, and then galaxies form within these structures. So, we expect the number of bright galaxies should be proportional to the number of big dark matter halos.”
The team developed an empirical framework for early galaxy formation, which predicts the number, luminosity, and size of galaxies that should form in the early universe, given some measures of “cosmological parameters.” Cosmological parameters are the basic ingredients, or mathematical terms, that describe the evolution of the universe.
Physicists have determined that there are at least six main cosmological parameters, one of which is the Hubble constant — a term that describes the universe’s rate of expansion. Other parameters describe density fluctuations in the primordial soup, immediately after the Big Bang, from which dark matter halos eventually form.
The MIT team reasoned that if early dark energy affects the universe’s early expansion rate, in a way that resolves the Hubble tension, then it could affect the balance of the other cosmological parameters, in a way that might increase the number of bright galaxies that appear at early times. To test their theory, they incorporated a model of early dark energy (the same one that happens to resolve the Hubble tension) into an empirical galaxy formation framework to see how the earliest dark matter structures evolve and give rise to the first galaxies.
“What we show is, the skeletal structure of the early universe is altered in a subtle way where the amplitude of fluctuations goes up, and you get bigger halos, and brighter galaxies that are in place at earlier times, more so than in our more vanilla models,” Naidu says. “It means things were more abundant, and more clustered in the early universe.”
“A priori, I would not have expected the abundance of JWST’s early bright galaxies to have anything to do with early dark energy, but their observation that EDE pushes cosmological parameters in a direction that boosts the early-galaxy abundance is interesting,” says Marc Kamionkowski, professor of theoretical physics at Johns Hopkins University, who was not involved with the study. “I think more work will need to be done to establish a link between early galaxies and EDE, but regardless of how things turn out, it’s a clever — and hopefully ultimately fruitful — thing to try.”
“We demonstrated the potential of early dark energy as a unified solution to the two major issues faced by cosmology. This might be an evidence for its existence if the observational findings of JWST get further consolidated,” Vogelsberger concludes. “In the future, we can incorporate this into large cosmological simulations to see what detailed predictions we get.”
This research was supported, in part, by NASA and the National Science Foundation.
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Plant-derived secondary organic aerosols can act as mediators of plant-plant interactions

A new study published in Science reveals that plant-derived secondary organic aerosols (SOAs) can act as mediators of plant-plant interactions. This research was conducted through the cooperation of chemical ecologists, plant ecophysiologists and atmospheric physicists at the University of Eastern Finland.
The study showed that Scots pine seedlings, when damaged by large pine weevils, release VOCs that activate defences in nearby plants of the same species. Interestingly, the biological activity persisted after VOCs were oxidized to form SOAs. The results indicated that the elemental composition and quantity of SOAs likely determines their biological functions.
“A key novelty of the study is the finding that plants adopt subtly different defence strategies when receiving signals as VOCs or as SOAs, yet they exhibit similar degrees of resistance to herbivore feeding,” said Professor James Blande, head of the Environmental Ecology Research Group. This observation opens up the possibility that plants have sophisticated sensing systems that enable them to tailor their defences to information derived from different types of chemical cue.
“Considering the formation rate of SOAs from their precursor VOCs, their longer lifetime compared to VOCs, and the atmospheric air mass transport, we expect that the ecologically effective distance for interactions mediated by SOAs is longer than that for plant interactions mediated by VOCs,” said Professor Annele Virtanen, head of the Aerosol Physics Research Group. This could be interpreted as plants being able to detect cues representing close versus distant threats from herbivores.
The study is expected to open up a whole new complex research area to environmental ecologists and their collaborators, which could lead to new insights on the chemical cues structuring interactions between plants.
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Folded or cut, this lithium-sulfur battery keeps going

Most rechargeable batteries that power portable devices, such as toys, handheld vacuums and e-bikes, use lithium-ion technology. But these batteries can have short lifetimes and may catch fire when damaged. To address stability and safety issues, researchers reporting in ACS Energy Letters have designed a lithium-sulfur (Li-S) battery that features an improved iron sulfide cathode. One prototype remains highly stable over 300 charge-discharge cycles, and another provides power even after being folded or cut.
The team coated iron sulfide cathodes in different polymers and found in initial electrochemical performance tests that polyacrylic acid (PAA) performed best, retaining the electrode’s discharge capacity after 300 charge-discharge cycles. Next, the researchers incorporated a PAA-coated iron sulfide cathode into a prototype battery design, which also included a carbonate-based electrolyte, a lithium metal foil as an ion source, and a graphite-based anode. They produced and then tested both pouch cell and coin cell battery prototypes.
After more than 100 charge-discharge cycles, Wang and colleagues observed no substantial capacity decay in the pouch cell. Additional experiments showed that the pouch cell still worked after being folded and cut in half. The coin cell retained 72% of its capacity after 300 charge-discharge cycles. They next applied the polymer coating to cathodes made from other metals, creating lithium-molybdenum and lithium-vanadium batteries. These cells also had stable capacity over 300 charge-discharge cycles. Overall, the results indicate that coated cathodes could produce not only safer Li-S batteries with long lifespans, but also efficient batteries with other metal sulfides, according to Wang’s team.
The authors acknowledge funding from the National Natural Science Foundation of China; the Natural Science Foundation of Sichuan, China; and the Beijing National Laboratory for Condensed Matter Physics.
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