Dementia Screening Tool (DST) App Review

In a busy primary care practice, providers frequently encounter patients or their family members who request dementia screening. Although my current clinic has a neurologist and neuropsychologist available, a fully functional dementia clinic is probably not available to most community-based primary care providers.

So how does a busy primary care provider screen for dementia? There are many validated screening tools including the Mini-Cog, MoCA, MMSE, SLUMS, and AD8, among others. Here at iMedicalApps, we have reviewed a number of geriatrics apps, including many from the American Geriatrics Society (AGS) — Geriatrics at Your Fingertips,Multimorbidity/MCC GEMS, iGeriatrics, and AGS GEMS — that contain some of these tools.

Last year, I reviewed the app AlzDxRx which helps providers screen, diagnose, and manage patients with Alzheimer’s disease and contains several tools, including the Mini-Cog. However, it did not contain the SLUMS or MoCA, as these are proprietary screening tools. Subsequently, we favorably reviewed a dedicated SLUMS app called eSLUMS. Now another dementia screening called the Dementia Screening Tool (DST) is available for iOSand Android devices. The Dementia Screening Toolis an approved medical device and was developed in Germany by Dr. Sebastian Horn. The author’s website claims a sensitivity of 97% for the DST.

The DST app does not contain references for any of its content or references for DST compared to Mini-Cog, MoCA, MMSE, SLUMS, etc. But this info is widely available in other medical references. The DST reportedly has a sensitivity/specificity greater than MMSE and is on par with the MoCA and Mini-Cog. The app is essentially a “calculator app” and has some limited information on “next steps,” “results interpretation,” etc.

Overall, the Dementia Screening Test (DST) is an excellent addition to the growing library of dementia screeners available in the app stores. While it’s designed for patient and/or informant use, it can be used by providers as well.

Likes

• Brings the DST “medical device” to iOS and Android devices
• Data input and clock drawing tests work well on a mobile device
• Available for Android

Dislikes

• No information on evidence for DST compared to other screening tools or references
• Expensive
• Explanation of results is incomplete

https://www.medpagetoday.com/blogs/kevinmd/77789

Judge Shelves Suit to Declare ObamaCare Constitutional

Maryland Attorney General Brian Frosh’s (D) lawsuit seeking to have the Affordable Care Act (ACA) declared constitutional cannot go forward unless the Trump administration fails to enforce the healthcare law, a federal judge ruled Friday.

“It is a bedrock principle that Article III of the … Constitution limits judicial power to ‘actual, ongoing cases or controversies,'” wrote Judge Ellen Lipton Hollander of the U.S. District Court for the District of Maryland. “The State points to the President’s rhetoric, his legislative agenda, his regulatory agenda, and his litigation positions to demonstrate that he might possibly terminate enforcement of the ACA. But, its claim consists of little more than supposition and conjecture about President Trump’s possible actions.”

“In effect, the State proclaims that the sky is falling,” Hollander wrote. “But, falling acorns, even several of them, do not amount to a falling sky. Moreover, the State has not pointed to any actual threat by the President to terminate enforcement of the ACA … In my view, the State’s allegations are speculative and thus deficient … Therefore, at this point in time, I must dismiss the case for lack of standing.”

The lawsuit, known as State of Maryland v. United States of America, was filed in September in the U.S. District Court for the District of Maryland. It alleges that President Trump has indicated he won’t enforce the ACA and that disruption of ACA enforcement will lead to higher uncompensated care costs. Arguments in the case were presented this past December.

In her decision, Hollander did leave open the door for the case to be re-opened. “Although the State’s claim is not justiciable at this juncture, its claim may become ripe for review in the future, if its alleged injury ‘move[s] from the speculative to the concrete’,” she wrote. “In that circumstance … the State would be entitled to revive the litigation.”

The Maryland lawsuit is a mirror image of Texas v. United States, the anti-ACA suit filed by 20 Republican state attorneys general. In that case, the judge in December ruled the ACA unconstitutional because Congress, in 2017, eliminated the penalty uninsured individuals were required to pay as part of the so-called individual mandate. With the mandate effectively gone, the ACA could no longer stand, the Texas judge said. (That decision is on hold while the case is appealed, and the Trump administration said it will continue to enforce the ACA in the meantime.)

Hollander’s ruling “simply [means] that we must wait to pursue our case,” Frosh said in a statement Friday. “We will resume this litigation immediately if the President breaks his promise of continued enforcement or when the stay of the Texas Court’s decision is lifted.”

https://www.medpagetoday.com/publichealthpolicy/repeal-and-replace/77791

Zimmer Biomet PT Raised to $150 at Jefferies; Train is Finally Leaving Station

: Jefferies analyst Raj Denhoy

https://www.streetinsider.com/Analyst+Comments/Zimmer+Biomet+%28ZBH%29+PT+Raised+to+%24150+at+Jefferies%3B+Train+is+Finally+Leaving+the+Station/15069000.html

Amgen Takeover of Alexion Pharma ‘Could Make Sense’ – Piper Jaffray

Piper Jaffray biotech analyst Christopher Raymond thinks an Amgen (NASDAQ: AMGN) takeover of Alexion Pharma (NASDAQ: ALXN) “could make sense.”

https://www.streetinsider.com/Analyst+Comments/Amgen+%28AMGN%29+Takeover+of+Alexion+Pharma+%28ALXN%29+Could+Make+Sense+-+Piper+Jaffray/15067398.html

Amarin (AMRN): New Survey Offers Insight Into Vascepa Market Opportunity

Amarin’s (AMRN) Vascepa is currently approved to treat around 3.8 million Americans with high triglycerides, as an adjunct to diet. In the first quarter, the company will submit an application to the FDA that could expand Vascepa’s sales many times over, by including cardiac-event reductions for the enormous population of patients on statin therapy with high triglyceride levels. In other words, Amarin can make it rain for investors if the FDA expands Vascepa’s label and opens the door for millions of new potential patients to this therapy.

Indeed, after surveying 50 physicians (36% PCPs, 32% endocrinologists and 32% cardiologists) regarding Vascepa, Cantor analyst Louise Chen says the results underscore his belief that the market opportunity is underappreciated.

Ahead of what she expects to be an acceleration in the uptake of Vascepa in 2019+, Chen reiterates an Overweight rating on Amarin stock with a price target of $35, which represents a potential upside of 104% from where the stock is currently trading.

“~52% of physicians noted the high triglyceride patients they see have CV risk factors beyond what can be mitigated by cholesterol management. The REDUCE-IT study positions Vascepa to be the first drug to cost-effectively help address CV risk beyond cholesterol management. Results were presented at AHA and published in NEJM. AMRN is pursuing label expansion and additional patents for Vascepa,” Chen stated. “Most doctors ready to use more Vascepa now. The doctors in our survey said they would increase their usage of Vascepa by ~100% YOY. The data from the REDUCE-IT trial is the key driver. The NEJM publication was also noted as a highly impactful. Finally, the majority of doctors said the VITAL and ASCEND studies also helped drive increased usage of Vascepa. Only 23% said they would wait for label expansion. If this is accurate, AMRN’s forecast sales forecast for 2019 could prove conservative. AMRN expects net revenue to increase by >50% in 2019 to ~$350MM. This assumes no benefit from label expansion.”

Bottom line: “We think the REDUCE-IT data are just the beginning of a new paradigm to treat CV disease. The market is a lot bigger than anticipated, in our view. Before going generic, statins sold $34B+/year. Even the highest estimates do not assume anything close to this for Vascepa and omega-3s.”

https://www.smarteranalyst.com/analyst-insights/amarin-amrn-new-survey-offers-insight-into-vascepa-market-opportunity/

Orthofix acquires Options Medical, terms not disclosed

Orthofix Medical announced that it has acquired the business of Options Medical, a medical device distributor based in Florida. Under the terms of the agreement, employees of Options Medical became employees of Orthofix effective February 1.

https://thefly.com/landingPageNews.php?id=2858021

Cutting Edge Neuro-Technology Helps Fine Tune Ads For This Year’s Super Bowl

Super Bowl Sunday is the best day of the year for both die-hard football fans and companies looking to capitalize on the largest television audience of the year.

With millions of dollars at stake, CBS2’s Scott Rapoport took a look at some of the new technology being used to measure which commercial will win the advertising game.

For many viewers the commercials are the real draw during the big game and this year, major brands are spending more than ever to grab our attention.

“Every 30 seconds of air time is five and a half million dollars,” Spencer Gerrol, founder and CEO of SPARK Neuro, said, “You don’t have time to waste a single second.”

It’s not easy for every brand to hit it out of the park, so more and more marketers are employing the help of an Electroencephalogram (EEG), which gauges just what will strike the fancy of the some 100 million people expected to tune in on Sunday.

“We work with the biggest brands,” Gerrol said. “(We) optimize the engagement of their content before it even airs.”

SPARK Neuro is a neuroanalytics company at the forefront of this technology.

“Your brain is constantly releasing electrical impulses and we’re reading all of those electrical impulses,” Gerrol said. “So when we look at the ad, we look for where are the peaks, where are the times that you were incredibly excited, incredibly attentive and where are the times when we may have lost you?”

Based on the information gathered, the ad is then refined.

“By the time you see it, you enjoy it,” Gerrol said.

The process is much more accurate, he says, than asking people for their opinion.

“If we had a focus group, we would have a lot of people piling on with whatever somebody in the room who seemed popular said,” Gerrol said.

Scott Rapoport gave it a spin, and Gerrol says his biggest reaction was a shot of actress Rebel Wilson playing the part of Amazon Alexa.

“I’m saying you found this to be enjoyable for whatever reason,” Gerrol quipped.

Cutting Edge Neuro-Technology Helps Fine Tune Ads For This Year’s Super Bowl