Journal of Internal Medicine最新文献

{"title":"Evaluating the prevalence and severity of metabolic dysfunction-associated steatotic liver disease in patients with type 2 diabetes mellitus in primary care","authors":"Wile Balkhed,&nbsp;Martin Bergram,&nbsp;Fredrik Iredahl,&nbsp;Markus Holmberg,&nbsp;Carl Edin,&nbsp;Carl-Johan Carlhäll,&nbsp;Tino Ebbers,&nbsp;Pontus Henriksson,&nbsp;Christian Simonsson,&nbsp;Karin Rådholm,&nbsp;Gunnar Cedersund,&nbsp;Mikael Forsgren,&nbsp;Olof Dahlqvist Leinhard,&nbsp;Cecilia Jönsson,&nbsp;Peter Lundberg,&nbsp;Stergios Kechagias,&nbsp;Nils Dahlström,&nbsp;Patrik Nasr,&nbsp;Mattias Ekstedt","doi":"10.1111/joim.20103","DOIUrl":"10.1111/joim.20103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>The prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) has increased during the epidemic of obesity. Type 2 diabetes mellitus (T2DM) is associated with progressive MASLD. Therefore, many guidelines recommend screening for MASLD in patients with T2DM. Most studies in patients with MASLD have been conducted in specialist care. We investigated the prevalence and severity of MASLD in patients with T2DM from primary care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with T2DM were prospectively included from primary care facilities to undergo transient elastography with controlled attenuation parameter and whole-body magnetic resonance imaging (MRI) to assess liver fat, cardiac function, muscle composition, and distribution of body fat.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 308 participants, 59% had MASLD, 7% had suspected advanced fibrosis (transient elastography ≥ 10 kPa), and 1.9% had cirrhosis. The mean age was 63.9 ± 8.1 years; 37% were female, with no differences between the MASLD and the non-MASLD groups. Participants with MASLD had greater body mass index (31.1 ± 4.4 vs. 27.4 ± 4.1 kg/m², <i>p </i>&lt; 0.001) and a higher prevalence of obesity (60% vs. 21%, <i>p</i> &lt; 0.001). Obesity increased the risk of fibrotic MASLD eightfold, as confirmed by multivariable analysis. Participants with MASLD also had increased visceral and abdominal subcutaneous adipose tissue and muscle fat infiltration. On cardiac MRI, participants with MASLD had a lower left ventricular (LV) stroke volume index, a lower LV end-diastolic volume index, and an increased LV concentricity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this cohort of primary care patients with T2DM, 59% had MASLD, and 7% had suspected advanced fibrosis. Obesity was a strong predictor of fibrotic MASLD. MASLD was associated with alterations to the left ventricle and increased deposition of ectopic fat.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 3","pages":"173-187"},"PeriodicalIF":9.2,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144300781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective association between plasma amino acids and healthy aging in older adults","authors":"Damián González-Beltrán,&nbsp;Humberto Yévenes-Briones,&nbsp;Alberto Lana,&nbsp;Juan Cárdenas-Valladolid,&nbsp;Miguel Ángel Salinero-Fort,&nbsp;Fernando Rodríguez-Artalejo,&nbsp;Esther Lopez-Garcia,&nbsp;Francisco Félix Caballero","doi":"10.1111/joim.20105","DOIUrl":"10.1111/joim.20105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Most studies have compared plasma amino acids profiling across different age groups using a cross-sectional design, but no previous research has assessed the relationship between specific amino acid species and healthy aging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study aims to explore the relationship between plasma concentrations of nine amino acids and healthy aging in an older Spanish population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This longitudinal study uses data from the Seniors-ENRICA 2 Spanish cohort, which comprises community-dwelling individuals aged 65 and older. Plasma amino acid concentrations were measured at baseline and after a 5-year follow-up period (<i>n</i> = 859). Healthy aging has been defined as the delay on the onset of chronic conditions, optimal physical functioning, and no cognitive impairment. Multilevel mixed effect logistic models were used to examine the prospective association proposed, after adjusting for age, sex, socioeconomic status, and lifestyle behaviors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The baseline mean age of the participants was 70.9 years (standard deviation [SD] = 4.0), and 51.6% were men. In the fully adjusted models, lower plasma concentrations of alanine [odds ratios per 1-SD increase (95% confidence interval) = 0.78 (0.72, 0.86)], isoleucine [0.70 (0.63, 0.78)], leucine [0.78 (0.71, 0.86)], and valine [0.79 (0.71, 0.86)] were prospectively associated with healthy aging (<i>p</i>-value &lt; 0.001 in all cases). No significant associations were observed for glutamine, glycine, histidine, and aromatic amino acids.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Lower concentrations of alanine and branched-chain amino acids were prospectively associated with healthy aging in the older population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 2","pages":"123-134"},"PeriodicalIF":9.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"No association between sleep apnea, nocturnal blood pressure dipping, and cognitive performance among Swedish adults aged 50–65 years","authors":"Xiao Tan,&nbsp;Mirjam Ljunggren,&nbsp;Johan Sundström,&nbsp;Eva Lindberg","doi":"10.1111/joim.20104","DOIUrl":"10.1111/joim.20104","url":null,"abstract":"&lt;p&gt;Dear Editor,&lt;/p&gt;&lt;p&gt;Repeated breathing disruptions in obstructive sleep apnea (OSA) result in reduced oxygen supply to the brain and sleep deprivation. Previous studies have indicated that OSA is associated with impairments in several cognitive domains, including attention, executive function, and information processing speed [&lt;span&gt;1, 2&lt;/span&gt;]. This may be explained by the neurological damage caused by intermittent hypoxia, as executive function and reaction time are thought to be related to the severity of hypoxemia [&lt;span&gt;2&lt;/span&gt;]. However, a clinical trial has reported that continuous positive airway pressure treatment resulted in only mild and transient improvement in executive and frontal-lobe function in severe OSA, but not in mild or moderate OSA [&lt;span&gt;3&lt;/span&gt;]. This may be attributed to factors related to study design and participant selection, leading to a relatively low susceptibility to the neurocognitive effects of OSA and a reduced response to treatment, but it may also suggest the involvement of other underlying mechanisms. Normally, blood pressure (BP) decreases at nighttime, a phenomenon known as nocturnal BP dipping. However, when BP fails to decrease adequately or even increases, this is termed reduced or reverse dipping [&lt;span&gt;4&lt;/span&gt;]. Results from a longitudinal study revealed that less nocturnal BP dipping was associated with worse cognitive function, especially executive function [&lt;span&gt;5&lt;/span&gt;]. Reduced and reversed nocturnal BP dipping are particularly common among individuals with OSA [&lt;span&gt;6&lt;/span&gt;], highlighting a potentially mediating effect of BP dipping in the association between sleep apnea and cognitive impairment.&lt;/p&gt;&lt;p&gt;Therefore, we aimed to determine the relationship between OSA and cognitive impairment and explore the potential mediation of this relationship by reverse BP dipping. We analyzed data from the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS), a random sample of adults aged 50–64 years. The details of this cohort study are provided in the Supporting Information. In this study, we included 2973 participants with complete data on overnight sleep breathing measurements, 24-h ambulatory BP monitoring (ABPM), the Trail Making Test Part B (TMT-B), and relevant covariates. OSA was quantified by the Apnea–Hypopnea Index (AHI). Cognitive function was assessed by TMT-B, a timed executive function task requiring rapid alternation between connecting numbered and lettered circles, during the day after the overnight sleep breathing measurement [&lt;span&gt;7&lt;/span&gt;]. Classification of AHI, ABPM parameters, category of dippers, and TMT-B details are provided in the Supporting Information. To explore the dose–response association between severity of OSA or BP dipping and TMT-B, restricted cubic spline models with three knots (at the 5th, 50th, and 95th percentiles) were performed, adjusting for age, sex, BMI, alcohol consumption, and smoking.&lt;/p&gt;&lt;p&gt;Characteristics of the study population by sev","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 2","pages":"135-137"},"PeriodicalIF":9.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future of healthcare-associated infection surveillance: Automated surveillance and using the potential of artificial intelligence","authors":"Suzanne D. van der Werff,&nbsp;Stephanie M. van Rooden,&nbsp;Aron Henriksson,&nbsp;Michael Behnke,&nbsp;Seven J. S. Aghdassi,&nbsp;Maaike S. M. van Mourik,&nbsp;Pontus Nauclér","doi":"10.1111/joim.20100","DOIUrl":"10.1111/joim.20100","url":null,"abstract":"<p>Healthcare-associated infections (HAIs) are common adverse events, and surveillance is considered a core component of effective HAI reduction programmes. Recently, efforts have focused on automating the traditional manual surveillance process by utilizing data from electronic health record (EHR) systems. Using EHR data for automated surveillance, algorithms have been developed to identify patients with (ventilator-associated) pneumonia and (catheter-related) bloodstream, surgical site, (catheter-associated) urinary tract and <i>Clostridioides difficile</i> infections (sensitivity 54.2%–100%, specificity 63.5%–100%). Mostly methods based on natural language processing have been applied to extract information from unstructured clinical information. Further developments in artificial intelligence (AI), such as large language models, are expected to support and improve different aspects within the surveillance process; for example, more precise identification of patients with HAI. However, AI-based methods have been applied less frequently in automated surveillance and more frequently for (early) prediction, particularly for sepsis. Despite heterogeneity in settings, populations, definitions and model designs, AI-based models have shown promising results, with moderate to very good performance (accuracy 61%–99%) and predicted sepsis within 0–40 h before onset. AI-based prediction models detecting patients at risk of developing different HAIs should be explored further. The continuous evolution of AI and automation will transform HAI surveillance and prediction, offering more objective and timely infection rates and predictions. The implementation of (AI-supported) automated surveillance and prediction systems for HAI in daily practice remains scarce. Successful development and implementation of these systems demand meeting requirements related to technical capabilities, governance, practical and regulatory considerations and quality monitoring.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 2","pages":"54-77"},"PeriodicalIF":9.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20100","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preexisting symptoms increase the risk of developing long COVID during the SARS-CoV-2 pandemic","authors":"Vincent Lak,&nbsp;Helen Sjöland,&nbsp;Martin Adiels,&nbsp;Christina E. Lundberg,&nbsp;Josefina Robertson,&nbsp;Maria Åberg,&nbsp;Christian Alex,&nbsp;Martin Lindgren,&nbsp;Annika Rosengren","doi":"10.1111/joim.20102","DOIUrl":"10.1111/joim.20102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Long COVID is defined as otherwise unexplained symptoms following a SARS-CoV-2 infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine the prevalence of preexisting symptoms compatible with long COVID in individuals with a diagnosis of long COVID.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, observational study included the adult population (aged 18 years and older) in Region Västra Götaland, with at least one recorded healthcare contact between January 1, 2020, and November 30, 2023, from a regional database comprising all levels of healthcare contacts. Data on long COVID, relevant symptoms before and after the pandemic started (2016–2023), and SARS-CoV-2 infection status were extracted using the International Classification of Diseases version 10 (ICD-10) codes. Individuals who had been hospitalized due to a SARS-CoV-2 infection were considered separately.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Out of 1,415,885 individuals, 9202 (0.6%) had been diagnosed with long COVID. Among the non-hospitalized individuals, the record of at least one of the relevant symptoms was more common in those with long COVID compared to those without it (57.6% vs. 36.3% for men and 71.6% vs. 50.4% for women), already before January 1, 2020. Among individuals with any relevant symptom, the odds ratios (ORs) of having long COVID were OR = 2.28 (95% confidence interval [CI] = 2.10–2.48) for men and OR = 2.32 (95% CI = 2.18–2.48 for women) after adjusting for age group, obesity, asthma, and anxiety, compared with individuals without any relevant symptom.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Individuals diagnosed with long COVID had more healthcare contacts for relevant symptoms even before the pandemic compared to individuals without long COVID.</p>\u0000 </section>\u0000 </div>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 2","pages":"107-122"},"PeriodicalIF":9.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dad's legacy: Epigenetic reprogramming and paternal inflammatory memory in offspring health","authors":"Shamila D. Alipoor,&nbsp;Parisa Norouzitallab,&nbsp;Anita Öst,&nbsp;Maria Lerm","doi":"10.1111/joim.20094","DOIUrl":"10.1111/joim.20094","url":null,"abstract":"<p>Over the past decade, numerous reports have highlighted intergenerational and even transgenerational epigenetic effects resulting from parental exposure to diets, toxins, and stress. In many cases, these parentally induced phenotypes do not seem to confer an obvious benefit, making it challenging to understand the evolutionary drivers behind them. In this perspective, we discuss recent observations in humans and rodents indicating that a parental infection or vaccination can enhance the offspring's ability to cope with infections. Such parental priming of their offspring's immune system and cellular defense would provide immediate protection to the newborn, offering a clear evolutionary advantage. Here, focusing mainly on paternal effects, we propose that a parentally induced inflammatory memory in the offspring could be the underlying mechanism for many of the reported inter- and transgenerational effects. Sperm-borne RNA could be a triggering signal to initiate inflammatory pathways in early embryogenesis. This gene-regulatory state would then be maintained via epigenetic mechanisms throughout each mitosis and last for the individual's lifetime. The accumulating understanding that diet, stress, toxins, and infections affect offspring health raises important questions about public health policies. There is an urgent need to understand what consequences different exposures during sensitive time windows have on future generations.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 1","pages":"16-30"},"PeriodicalIF":9.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching Gentle Medicine","authors":"Benjamin Chin-Yee,&nbsp;Ezio Laconi,&nbsp;Jacob Stegenga","doi":"10.1111/joim.20101","DOIUrl":"10.1111/joim.20101","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 2","pages":"143-144"},"PeriodicalIF":9.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20101","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors reply: Six-fold increased risk of acute pancreatitis in alcohol-related liver disease compared to matched comparators","authors":"Ana Dugic,&nbsp;Hannes Hagström","doi":"10.1111/joim.20097","DOIUrl":"10.1111/joim.20097","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 1","pages":"51-52"},"PeriodicalIF":9.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding: Sixfold increased risk of acute pancreatitis in alcohol-related liver disease compared to matched comparators","authors":"Shih-Wei Lai,&nbsp;Kuan-Fu Liao","doi":"10.1111/joim.20096","DOIUrl":"10.1111/joim.20096","url":null,"abstract":"","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 1","pages":"49-50"},"PeriodicalIF":9.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144140874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing early detection of cognitive impairment in primary care to improve care for older adults","authors":"Nicole R. Fowler,&nbsp;Katherine A. Partrick,&nbsp;James Taylor,&nbsp;Michael Hornbecker,&nbsp;Kevin Kelleher,&nbsp;Malaz Boustani,&nbsp;Jeffrey L. Cummings,&nbsp;Tim MacLeod,&nbsp;Michelle M. Mielke,&nbsp;Jared R. Brosch,&nbsp;Janice Lee,&nbsp;Eli Shobin,&nbsp;James E. Galvin,&nbsp;Howard Fillit,&nbsp;Chinedu Udeh-Momoh,&nbsp;Deanna R. Willis","doi":"10.1111/joim.20098","DOIUrl":"10.1111/joim.20098","url":null,"abstract":"<p>Primary care is the ideal setting for early detection of mild cognitive impairment (MCI) and Alzheimer's disease and related dementias (ADRD), as it serves as the primary point of care for most older adults. With the growing aging population, reliance on specialists for detection and diagnosis is unsustainable, highlighting the need for primary care-led assessment. Recent research findings on successful brain health prevention strategies, AD diagnostic tools, and anti-amyloid treatments empower primary care to play a central role in early detection and intervention. Primary care-focused resources are being developed, including tools for cognitive assessments and materials designed to educate patients about brain health and initiate discussions on lifestyle modifications, thereby making early detection more feasible and efficient. Identifying risk factors early enables providers to implement interventions that can slow cognitive decline and improve outcomes for patients and caregivers. If left undetected and unmanaged, MCI and ADRD can lead to worse outcomes, including increased falls, hospitalizations, financial vulnerability, and caregiver stress. Early detection enables the identification of reversible causes of cognitive impairment, supports the management of comorbidities worsened by cognitive decline, mitigates safety risks, and can preserve quality of life. Importantly, primary care is essential for addressing ADRD-related health disparities that disproportionately affect racial minorities, rural populations, and those of lower socioeconomic status. With a focus on the United States healthcare system, this perspective addresses how implementing early detection practices into primary care can improve outcomes for patients and caregivers, reduce societal burdens, and promote health equity in ADRD care.</p>","PeriodicalId":196,"journal":{"name":"Journal of Internal Medicine","volume":"298 1","pages":"31-45"},"PeriodicalIF":9.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/joim.20098","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}