Dementia patients in the United States continue to be prescribed stimulant medications known to carry serious risks, despite long-standing safety warnings, according to new research. The study, set to be published January 12, in the peer-reviewed journal JAMA, highlights ongoing concerns around medication use in older adults with cognitive decline.

While overall prescribing of these drugs has fallen over the years, the decline has not been even. Among all Medicare beneficiaries, usage dropped from 20 percent to 16 percent over the nine-year study period. Yet individuals with cognitive impairment remain more likely to receive these medications, even though they are particularly susceptible to harmful side effects.

What Is Dementia?

Dementia is an umbrella term used to describe a significant decline in mental function that interferes with daily life. It affects memory, thinking, and reasoning, and can also influence mood, behavior, and personality. Dementia is not a single illness but a syndrome caused by different conditions, most commonly Alzheimer’s disease.

Symptoms tend to worsen gradually, making everyday activities such as communication, decision-making, and self-care increasingly difficult. While there is no cure, certain treatments can help manage symptoms, according to the National Institute on Aging.

“Although the downward trend in prescribing was a positive sign, by 2021, more than two-thirds of patients who were still receiving these medications had no clear clinical reason documented for their use,” said senior author Dr. John N. Mafi, associate professor-in-residence of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, as per Scitech Daily. “This points to persistently high levels of prescribing that may be unnecessary and potentially harmful.”

He added, “Compared to patients with normal cognitive function, older adults with cognitive impairment were more likely to be prescribed these drugs, even though they face a greater risk of adverse effects. These findings highlight major gaps in care quality and safety that affect millions of older Americans.”

Unsafe Medications Being Prescribed To Dementia Patients

For the study, researchers linked survey information from the Health and Retirement Study with Medicare fee-for-service claims data. They reviewed prescribing patterns for potentially inappropriate central nervous system, or CNS-active, medications between January 1, 2013, and December 31, 2021. Older adults were divided into three groups: those with normal cognition, those with cognitive impairment without dementia, and those diagnosed with dementia.

The medications assessed were grouped into five categories: antidepressants with strong anticholinergic effects, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.

Higher Use Among Those With Cognitive Impairment

Clear differences emerged across the three cognitive groups. CNS-active medications were prescribed to 17 percent of older adults with normal cognition. This figure rose to nearly 22 percent among those with cognitive impairment but no dementia. Among individuals living with dementia, about one in four received these medications.

Looking more closely at specific drug types among all Medicare fee-for-service beneficiaries, trends varied. Benzodiazepine use declined from 11.4 percent to 9.1 percent. Prescriptions for non-benzodiazepine hypnotics, commonly used to treat sleep problems, dropped sharply from 7.4 percent to 2.9 percent. In contrast, antipsychotic use increased from 2.6 percent to 3.6 percent. Rates of anticholinergic antidepressant prescribing remained unchanged at 2.6 percent throughout the study period, while barbiturate use saw a slight decrease from 0.4 percent to 0.3 percent.

Signs of Progress Alongside Ongoing Concerns

Prescriptions backed by a clear clinical justification declined slightly, from 6 percent in 2013 to 5.5 percent in 2021. At the same time, prescriptions considered likely inappropriate fell more noticeably, dropping from 15.7 percent to 11.4 percent. Much of this improvement was linked to reduced use of benzodiazepines and sleep medications, along with fewer inappropriate prescriptions overall.

The researchers acknowledged several limitations. The analysis did not include data from Medicare Advantage plans, some clinical details such as agitation may not have been captured, and the study focused on how frequently these medications were prescribed rather than how long patients remained on them.

“CNS-active medications can be appropriate in certain situations,” said Dr. Annie Yang, a scholar in the National Clinician Scholars Program at Yale University, as per Scitech Daily, who led the study while training as a UCLA internal medicine resident. “But it is essential for older patients and their caregivers to work closely with their doctors to confirm that these drugs are truly necessary. When they are not, care teams should explore other treatment options and consider whether it may be safe to gradually reduce or discontinue the medication.”

A major international study has revealed that 99% of heart attacks, strokes, and serious cardiovascular events are linked to just four common health risk factors: high blood pressure, high cholesterol, elevated blood sugar, and tobacco use.

The research drew on data from more than 9 million adults in the United States and South Korea, making it one of the largest studies of its kind. Published in 2025, the findings underscore the vital role of early prevention and lifestyle management in reducing cardiovascular risk, as per NDTV.

Even among younger women under 60, a group generally considered at lower risk, over 95% of heart attacks, strokes, and other major cardiovascular events were connected to at least one of these four factors.

High Blood Pressure Leads The Risk

High blood pressure, or hypertension, stood out as the biggest contributor, affecting more than 93% of people who suffered a heart attack, stroke, or heart failure.

“We believe this study demonstrates very clearly that exposure to one or more of these preventable risk factors before major cardiovascular events is nearly universal,” said senior author Dr. Philip Greenland, professor of cardiology at Northwestern University Feinberg School of Medicine.

He added, “The focus now should be on controlling these modifiable factors rather than chasing other less treatable or non-causal risks.”

How Can High Cholesterol Lead To Diabetes?

High cholesterol can trigger heart attacks by contributing to plaque buildup, or atherosclerosis, along the walls of arteries, as per Mayo Clinic. This buildup narrows the arteries and limits blood flow to the heart. If a plaque ruptures, it can cause a blood clot to form, fully blocking the artery. This prevents oxygen-rich blood from reaching the heart muscle, resulting in tissue damage or death, often in the coronary arteries.

How Does Elevated Sugar Lead To Diabetes?

Consuming too much sugar harms blood vessels, triggers inflammation, and contributes to weight gain, high blood pressure, and poor cholesterol levels. Together, these effects speed up plaque buildup (atherosclerosis) in the arteries, limiting blood flow and sharply increasing the risk of a heart attack.

Excess sugar is converted into fat, raises triglyceride levels, lowers “good” HDL cholesterol, and can lead to insulin resistance, creating a cluster of metabolic problems, known as metabolic syndrome—that directly strain the heart.

Early Detection and Management Are Key

The results highlight the urgent need for regular health checks, early screening, and proactive management of common conditions to prevent life-threatening heart problems.

Greenland and his team also point out that their findings challenge earlier reports suggesting cardiovascular events can occur without risk factors. They argue that previous studies may have missed subtle conditions or overlooked risk factors that were below clinical thresholds.

In a related editorial, Duke University cardiologist Dr. Neha Pagidipati, who was not involved in the study, stresses that addressing these health risks early is critical to preventing severe and potentially fatal cardiovascular outcomes.

A smartphone app called Are You Dead? has rapidly climbed the charts in China, striking a chord with young adults who live alone in fast-growing urban centres. The app asks users to regularly confirm that they are still alive, and in recent weeks it has become the country’s most downloaded paid application.

Its stark idea may sound unsettling, but that very premise appears to be what draws people in. Beyond its novelty, the app reflects a deeper issue, showing how living alone, along with rising mental health concerns, is increasingly being viewed as a public health issue.

What Is Are You Dead?

An app named “Are You Dead?” hardly sounds inviting at first glance. Still, for many people who live by themselves, it has turned out to be more comforting than alarming. Its strength lies neither in flashy features nor complex technology, but in how plainly it speaks to a fear most people keep to themselves.

The app, known as Sileme in Chinese, was launched in May and has already become the most downloaded paid app in the country. It is designed for those who live alone and worry about what could happen if they fall ill, meet with an accident, or suddenly collapse with no one nearby to help. For users without close family or regular social contact, this fear is not abstract. It is part of everyday life.

The idea behind the app is straightforward. Users are required to check in every two days by tapping a large button to confirm they are okay. If they fail to do so, the app alerts a pre-selected emergency contact, signalling that something may be wrong.

When it first launched in May last year, the app attracted little attention. That changed dramatically in recent weeks, as large numbers of young people living alone in Chinese cities began downloading it.

On the Apple App Store, the app is described as a “lightweight safety tool designed for people who live alone, offering quiet protection through regular check-ins and emergency contact features to make solo living feel safer.”

Who Is Are You Dead For?

Are You Dead? refers to itself as a “safety companion” for people who live alone, whether due to work, education, or a personal preference for living independently. It is aimed at those vulnerable to social isolation, including students, working professionals, and older adults living by themselves in cities. According to the Chinese media outlet Global Times*, China may have as many as 200 million single-person households by 2030, underlining why digital tools like this are finding a ready audience.

How Living Alone Can Lead To Increased Health Concerns

Living alone can affect health in several ways, mainly through loneliness and reduced social contact. These factors are linked to higher risks of depression, anxiety, cognitive decline, heart disease, stroke, diabetes, weakened immune function, and even early death. Living alone can also influence daily habits, increasing the likelihood of falls, poor nutrition, smoking, and unsafe alcohol use, particularly among older adults, while making it harder to manage existing health conditions.

When people think about staying healthy, they usually focus on diet, exercise, and sleep. The role of social connection in protecting health is often overlooked. Loneliness, and the rise in stress hormones like cortisol that often comes with it, can quietly take a toll on the body.

“We clearly understand how sitting too much, smoking, and obesity contribute to chronic disease,” says psychologist Amy Sullivan, PsyD. “Loneliness should also be seen as a risk factor for long-term health problems.”

Health risks linked to loneliness include:

• High blood pressure.
• Cold and flu.
• Cardiovascular disease.
• Stroke.
• Type 2 diabetes.
• Dementia.
• Anxiety.
• Depression.
• Suicide and self-harm.
• Premature death.

“We know how stress affects the body, and loneliness is a powerful form of stress,” adds psychologist Adam Borland, PsyD, as cited by the Cleveland Clinic. “When people feel lonely, they are less likely to care for themselves properly, and that can eventually lead to serious health problems.”

Been feeling a certain tightness across your chest, wheezing or coughing uncontrollably? Your lung health may be at risk

Dr Killol Patel, a board certified pulmonologist in New Jersey, explains that respiratory symptoms are common when running in cold weather due to a lack of moisture in the air and lung spasms.

He said: "The moist lining of your nose and mouth normally warms and moistens inhaled air before it goes to the lungs. But when it’s dry and cold and you’re breathing fast during exercise, the air may not get as conditioned.

"That can lead to not only coughing and wheezing, but trouble catching your breath, chest tightness and the urge to cut your run short."

The lungs have a defensive natural protective mechanism known as bronchospasm which activates whenever the organ detects a sense a potential irritant or damage. "When you breathe in air that’s dry and cold, your lungs may spasm as a means of protection. They think there’s something noxious in the air," he elaborated.

Those suffering from respiratory issues such as exercise-induced asthma or have irritated or inflamed airways may experience worse symptoms of bronchospasm, Dr Patel warns.

The expert said: "In those cases, your lungs are already on edge, so there’s no buffer. Exercising in the cold, dry air can take you over the edge more quickly. Your heart may then start racing, and your body tells you to stop. Mucus may also build up to clog your airways."

What Can You Do To Protect Your Lungs?

Dr Patel advises staying warm and dry through moisture-wicking layers for comfort. The expert adds that runners should consider covering their nose and mouth with a scarf or mask as they start moving.

“It creates a small bubble of warmer air to breathe,” Dr. Patel says. (Once you acclimate, however, you may not need it anymore, he adds.)

He also recommends hydrating well before starting a run as dehydration can make you "more prone to bronchospasms, especially people with asthma".

Dr Patel suggests avoiding smoggy routes and dirty areas as pollution as well as germs can further amplify symptoms and worsen the situation. “If it’s cold on top of that, [poor air quality] can make breathing and symptoms worse,” he told Hackensack Meridian Health.

A 2023 Journal of Allergy and Clinical Immunology study suggests that when the temperature inside the nose drops in cold weather, it may hamper the nose’s first-line, natural defense mechanism against viruses that cause upper respiratory infections and make the body more prone to illnesses.

Do Breathing Exercises Help?

• Warm up your airways
• Inhale through your nose rather than your mouth
• Slow down your pace and focus on rhythmic breathing

Lastly, Dr Patel advises avoiding tobacco smoke and air pollutants (both indoors and out) and getting regular health checkups.