It's an era of breakthroughs in Alzheimer's research, yet for many clinicians, it's also a time of profound uncertainty. We are currently navigating competing definitions of the disease, multiple new biomarkers coming on market seemingly every week, and the clinical rollout of new amyloid antibodies.

How do we translate this rapid-fire science into daily practice? On this week's GeriPal podcast, we sit down with dementia experts Halima Amjad, Barak Gaster, and Heather Whitson. We dive deep into:

• The evolving definitions of Alzheimer's disease. Does someone have Alzheimer's disease if you have only an abnormal biomarker as defined by the Alzheimer's Association, or is amyloid pathology necessary but not sufficient to define Alzheimer's as per the International Working Group (IWG) recommendations?

• Where do blood-based biomarkers for Alzheimer's fit into the diagnostic workup, and should they be used at all in primary care? FYI - here is my take on that question in a recent JAMA IM article titled "The Limited Role of Alzheimer's Disease Blood-Based Biomarkers in Primary Care."

• What's the role of amyloid antibodies in the care of individuals with Alzheimer's disease, including who to use them on?

We covered a lot and discussed some of these resources that you can do a deeper dive on:

• Blood-based biomarker resources

• • JAMA article on Blood-Based Biomarkers for Alzheimer's Disease: Preventing Unintended Consequences

  • Alzheimer's Dementia article on Blood-based biomarkers for detecting Alzheimer's disease pathology in cognitively impaired individuals within specialized care settings: A systematic review and meta-analysis

  • JAMA IM article on The Limited Role of Alzheimer Disease Blood-Based Biomarkers in Primary Care

• Appropriate use recommendations for amyloid antibodies

• • Donanemab: Appropriate use recommendations

  • Lecanemab: Appropriate Use Recommendations

• Primary Care Resources

• • Cognition in Primary Care program

  • A JAGS article on "Large Health System Quality Improvement Intervention Providing Training and Tools to Improve Detection of Cognitive Impairment in Primary Care"

• Other resources

• • AGS's new online curriculum for Alzheimer's Disease

By Eric Widera

Today we're doing something different. Today, dear listeners, you get two podcasts for the price of one! (OK, our podcasts are both free, but you get the idea).

We're joined today by Chris Comeaux, host of TCN Talks, a podcast about leadership, strategy, innovation, and the future of serious illness care, and author of The Anatomy of Leadership. We are also joined by TCN Talks' frequent guest host Cordt Kassner, CEO of Hospice Analytics, which provides in depth data on hospice quality, utilization, and access, and publisher of Hospice and Palliative Care Today, a daily email about the hottest stories and news in the field.

This is an "ask us anything" style podcast in which we get to ask each other questions. Our discussions focus on concerning trends in hospice, Ira Byock's white paper, concerning trends in hospice, certificate of need, danger of losing a generation of junior researchers and hope in the form of ASCENT, various measures of hospice quality including Cordt's National Hospice Locator, which ranks all area hospice by quality, unlike CMS's Hospice Care Compare, which only has star ratings for about 30% of hospices.

Hospice and palliative care are going through a tough growth period, and sometimes being real with your friends and colleagues in your field means tough love. Love hurts. And no, I'm not attempting the Nazareth version!

-Alex Smith

Philippe Pinel remarked in 1800 that "It is an art of no little importance to administer medicines properly, but it is an art of much greater and more difficult acquisition to know when to suspend or altogether to omit them." This insight remains profoundly relevant today, especially in hospice care, where inappropriate prescribing is a common issue. Studies show that 20%–70% of hospice patients receive at least one unnecessary medication near the end of life, including drugs like antihypertensives, statins, and vitamins.

In this episode of the GeriPal Podcast, we tackle the pressing topic of deprescribing at the end of life with expert guests Jennifer Tjia, Jon Furuno, and Simon Mooijaart. The conversation focuses on identifying medications that should almost always be discontinued—such as statins, osteoporosis meds, finasteride, and vitamins, which offer minimal benefit for patients with limited life expectancy. We also delve into more nuanced cases, such as antithrombotics, which present complex decisions that challenge clinicians, particularly when prognosis spans the many weeks to months range.

Finally, we explore practical strategies for engaging patients and families in deprescribing conversations. Our guests highlight tools such as the FRAME mnemonic (Focus on the goals of care, Review current medications, Assess each medication's risk/benefit, Minimize the medication burden, and Evaluate regularly) and the Goal Concurrent Prescribing tool, which helps ensure medication decisions align with patients' values and end-of-life priorities.

By: Eric Widera

Other resources discussed in the podcast

• Prevalence and Factors Associated With Receiving a Prescription for Antithrombotic Therapy on Hospice Admission," JAGS. 2025

• Discontinuation of Anticoagulants and Occurrence of Bleeding and Thromboembolic Events in Vitamin K Antagonist Users with a Life-limiting Disease. 2025

• Effects of the discontinuation of antihypertensive treatment on neuropsychiatric symptoms and quality of life in nursing home residents with dementia (DANTON): a multicentre, open-label, blinded-outcome, randomised controlled trial. 2024

• Perspectives on deprescribing in palliative care. Expert Review of Clinical Pharmacology. 2023

• Developing a decision support tool for the continuation or deprescribing of antithrombotic therapy in patients receiving end-of-life care: Results of a European Delphi study. Thrombosis Research. 2025

• Human-Centered Design Development and Acceptability Testing of a Goal Concordant Prescribing Program in Hospice. JPM 2025

• Reduction of Antihypertensive Treatment in Nursing Home Residents. NEJM 2025