2 Minute Medicine Rewind October 13, 2025
1. In this cohort of older adults, traumatic brain injury (TBI) in later life was associated with an increased incidence of dementia.
Evidence Rating Level: 2 (Good)
Traumatic brain injuries (TBI) have become increasingly common in the elderly population in Canada, particularly those resulting from falls. TBIs are diagnosed when a patient presents after a direct head injury along with either loss of consciousness, post-traumatic amnesia, disorientation, or neurologic deficits. TBI in older adults is associated with increased costs and a greater burden on the healthcare system. Older adults who experienced a TBI often experience unique challenges, such as cognitive decline, increasing their need for care. While TBI is a known risk factor for dementia in middle-aged individuals, its impact on those over 65 remains understudied. To address the gaps, this retrospective study aimed to assess the association between late-life TBI and dementia risk and care needs, and to identify social determinants of health that contribute to poorer outcomes. 132,113 individuals (mean age of TBI age group, 77.2, SD [7.7]). Individuals with a new TBI had a greater rate of developing dementia compared to those without. There was a higher incidence of dementia in those with TBI in the first 5 years (HR 1.69, 95% CI, 1.66 to 1.72), and after 5 years (HR 1.56, 95% CI 1.53 to 1.59). Late-life TBI was associated with an increased use of publicly funded home care (HR 1.30, 95% CI 1.29 to 1.31) and long-term care admission (HR 1.45, 95% CI 1.42 to 1.47). Dementia was more common in older females from low-income neighbourhoods compared to their male counterparts (29.0% vs 24.7%). Overall, the incidence of late-life TBI was associated with increased risk of developing dementia, usage of publicly funded home care, and admission to a long-term care facility.
Self-Help App for Depression in People With Intellectual Disabilities: A Randomized Clinical Trial
1. In this randomized clinical trial, the use of a smartphone self-help app was associated with increased self-esteem and quality of life, and a decrease in depressive symptoms in individuals with intellectual disabilities (IDs).
Evidence Rating Level: 1 (Excellent)
Intellectual disabilities (IDs) affect a small portion of the population, and around 34% of these individuals also experience mental health issues, especially depression, anxiety, and psychosis. These conditions are underdiagnosed due to diagnostic overshadowing and reliance on self-reporting. Although cognitive behavioural therapy is helpful, access to mental health care in this population is limited. One possible effective treatment alternative is smartphone-based interventions. This randomized clinical trial tested a self-help app called Happy, designed to reduce depression and boost self-esteem in people with IDs. This study aimed to assess the extent to which the app was accepted and whether it could improve mental well-being. 99 participants were randomized 1:1 to the intervention group (n=50) or the waiting list control group (n=49). Among the included participants, 93 completed the postintervention assessment. The intervention group had a significantly greater reduction in depressive symptoms compared to the control group (F1, 97 = 7.52, P = .007) with a medium effect size (np2=0.072). The intervention group also showed improvements in quality of life (QoL) (F1,97 = 5.09; ηp2 = 0.050 [small to medium effect]) (P = .03) and self-esteem (F1,97 = 17.94; ηp2 = 0.156 [large effect]) (P < .001). Overall, this randomized clinical trial found that this self-help was effective in reducing depressive symptoms and improving self-esteem and quality of life in individuals with IDs.
A Hybrid Chatbot to Promote Pneumococcal Vaccination Among Older Adults: A Randomized Clinical Trial
1. This randomized clinical trial found that a hybrid chatbot was more effective than the standard intervention at increasing pneumococcal vaccine (PV) uptake in older adults living in Hong Kong.
Evidence Rating Level: 1 (Excellent)
People 65 years or older have an increased risk of pneumococcal disease (PD) and invasive PD (IPD); however, only 35% received the recommended pneumococcal vaccination (PV) in 2023. While previous interventions, such as phone calls and home visits, have improved vaccine uptake, these are resource-intensive and thus more difficult to implement. This study tested a more reasonable solution: a hybrid chatbot combining rule-based messaging with AI-powered Q&A, tailored to users’ readiness to get vaccinated. This randomized clinical trial compared the effectiveness of a hybrid chatbot with a standard online chatbot in increasing PV uptake among older Hong Kong residents. The primary outcome of the study was self-reported PV uptake, measured after completing the intervention. After meeting eligibility criteria, 374 individuals were included in the study, and randomly assigned to either the hybrid intervention (n=187) or the standard intervention (n=187) (mean [SD] age of both groups 69.6 [3.1] years). In the intention to treat analysis, the intervention group had a significantly higher PV uptake rate compared to the standard intervention group (29.4% vs 18.7%, relative risk, 1.57 [95% CI, 1.08-2.28]; absolute risk reduction, 0.11 [95% CI, 0.02-0.19]; and number needed to treat, 9.4 [95% CI, 5.2-47.7]; P = .01). This randomized clinical trial supported the efficacy of a hybrid chatbot compared to a standard chatbot-delivered intervention in increasing PV uptake in older individuals in Hong Kong.
Physical Activity, Gut Microbiota, and the Risk of Dyslipidemia in a Community‐Based Cohort Study
1. In this cohort of adults, moderate-to-vigorous physical activity (MVPA) was associated with a decreased risk of developing dyslipidemia while also promoting gut microbial diversity, while sedentary behaviour was associated with an increased risk.
Evidence Rating Level: 1 (Excellent)
Atherosclerotic cardiovascular disease is a leading cause of death globally, and dyslipidemia is a major modifiable risk factor. Physical activity (PA) is known to improve lipid levels and is protective for overall cardiovascular health. Although PA on its own is effective, sedentary behaviour is harmful, even if one meets exercise guidelines. Some previous studies suggest that less sedentary behaviour may improve cholesterol levels; however, few studies have investigated how moderate-to-vigorous physical activity (MVPA) and sedentary time together affect dyslipidemia risk. To address this research gap, this study aimed to investigate how MVPA and sedentary behaviour influence dyslipidemia risk. A total of 306 incident cases of dyslipidemia were diagnosed over a median time of 4 years. There was an inverse association between total physical activity (TPA) and dyslipidemia risk (per 1‐SD increase, HR, 0.88 [95% CI, 0.79–0.98], P=0.026). Participants in the highest levels of MVPA had a 29% lower risk of developing dyslipidemia compared to those with the lowest levels of MVPA (HR 0.71; 95% CI: 0.52-0.96; P=0.03). Prolonged sedentary time was linked to a 63% greater risk of developing dyslipidemia for those in the highest sedentary group compared to those in the lowest (HR 1.63; 95% CI: 1.19-2.22; P=0.002). Compared to those with longer sedentary periods and lower PA, the risk of dyslipidemia was 30% lower in those with short sedentary periods and high PA (HR: 0.70; 95% CI: 0.50-0.98), about the same in those with short sedentary periods and low PA (HR: 0.99; 95% CI: 0.71-1.37), and 17% lower in those with longer sedentary periods but high PA (HR: 0.83; 95% CI: 0.60-1.16). In the low MVPA group, microbial ⍺-diversity decreased (P=0.024), and low and high MVPA groups had significant shifts in β-diversity (P≤0.005). In summary, this prospective cohort study found that MVPA weakens the association between sedentary time and the risk of dyslipidemia, while also influencing gut microbiota diversity in richness in this population of adults.
1. In a group of individuals with liver cirrhosis, a 12-week diet rich in plant and dairy proteins was associated with improved liver disease severity, even though inflammatory markers and oxidative stress levels did not significantly change.
Evidence Rating Level: 1 (Excellent)
Cirrhosis is the final stage of all chronic liver disease, marked by liver scarring, nodular regeneration, and dysfunction. It can range from compensated (mild) to decompensated (severe) and often leads to complications such as sarcopenia (muscle breakdown) through disruption of energy metabolism, and a higher risk of mortality. This occurs due to inflammation through increased amounts of tumour necrosis factor alpha (TNF-α), interleukin 1 (IL-1), and interleukin 6 (IL-6), along with increased oxidative stress. Combined, these promote muscle loss and liver cell damage through the production of reactive oxygen species (ROS). As such, prioritizing nutrition is essential to prevent complications, with current guidelines recommending high-protein, high-calorie diets. Emerging evidence suggests that plant and dairy proteins may reduce inflammation more effectively compared to standard diets; however, human studies are limited. To address this knowledge gap, this randomized controlled trial was designed to evaluate the effects of a plant- and dairy-based diet on inflammation and oxidative stress markers in patients with liver cirrhosis. A total of 46 participants were included, with 23 assigned to a plant- and dairy-based diet, and 23 assigned to a standard isocaloric diet. At baseline, both groups had similar body measurements. Throughout the study, only the intervention group experienced a significant decrease in body weight; however, the difference was borderline significant after adjusting for baseline values and fiber intake. There were no significant changes in body mass index (BMI), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), or skinfold thickness in the area of the triceps muscle (TSF) (p>0.05). Baseline serum levels of high-sensitive C-reactive protein (hs-CRP), TNF-α, IL-6, total oxidant status (TOS), and total antioxidant capacity (TAC) were similar between the two groups and did not significantly change during the study (p>0.05). This study found that a diet rich in plant and dairy proteins significantly decreased the Model for End-Stage Liver Disease (MELD) score (p<0.05).
Image: PD
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