Efficacy and predictors of cognitive stimulation therapy combined with pharmacotherapy for mild-to-moderate Alzheimer’s disease: a randomized controlled trial

IntroductionAlzheimer’s disease (AD) is associated with progressive cognitive decline, functional impairment, and reduced quality of life. Although pharmacological treatments such as cholinesterase inhibitors and memantine are commonly used, their clinical benefits remain limited and heterogeneous. Cognitive stimulation therapy (CST) may provide additional benefits when combined with standard pharmacotherapy. This randomized controlled trial (RCT) aimed to evaluate the clinical efficacy of modified CST combined with standard drug therapy on cognitive function, activities of daily living, and quality of life in patients with mild-to-moderate AD and to explore key predictors of CST efficacy using a multivariate regression model.MethodsThis evaluator-blinded randomized controlled trial enrolled 80 patients with mild-to-moderate Alzheimer’s disease (AD), who were randomly assigned in a 1:1 ratio to either the modified CST plus standard pharmacotherapy group (study group, n = 40) or the standard pharmacotherapy-alone group (control group, n = 40).The modified CST program comprised 14 weekly 45-minute sessions. The primary endpoint was the change in the Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) score from baseline to post-intervention. Secondary measures included the Activities of Daily Living (ADL) scale and the Quality of Life in Alzheimer’s disease (QOL-AD) questionnaire. Data were analyzed using an intention-to-treat (ITT) approach. Independent predictors of treatment efficacy were identified using a two-stage screening strategy (univariate screening and stepwise regression).ResultsA total of 75 patients completed the study, and 80 were included in the ITT analysis. After 14 weeks of intervention, baseline-adjusted ANCOVA showed that the study group had significantly better post-intervention ADAS-Cog scores than the control group. The adjusted mean difference in ADAS-Cog score was -3.28 points (95% CI: -3.72 to -2.83; P < 0.001), favoring the study group. Significant baseline-adjusted between-group differences were also observed for ADL (adjusted mean difference = -4.93, 95% CI: -8.39 to -1.47; P = 0.006) and QOL-AD (adjusted mean difference = 2.69, 95% CI: 1.01 to 4.37; P = 0.002), both favoring the study group. Higher years of education (β = -0.54, P < 0.001), regular physical activity (β = -0.28, P = 0.003), higher baseline Mini-Mental State Examination (MMSE) scores (β = -0.22, P = 0.001), and active hobbies (β = -0.20, P = 0.002) were significant independent predictors of CST efficacy.DiscussionModified CST combined with medication significantly delays cognitive decline and improves QOL-AD in patients with mild-to-moderate AD. Educational attainment, lifestyle factors, and cognitive reserve are key determinants of CST efficacy. Relevant institutions should develop targeted enhancement protocols for patients with lower educational levels or insufficient cognitive reserves when implementing CST.Trial RegistrationChinese Clinical Trial Registry, identifier ChiCTR2600118654, https://www.chictr.org.cn.

Suicide and suicidal behavior in the gulf cooperation council countries: a Systematic Review of behavioral patterns, sociocultural determinants, and structural vulnerabilities

Suicide and suicidal behavior in the Gulf Cooperation Council (GCC) countries remain underrepresented in empirical research, largely due to cultural stigma, legal prohibitions, and systematic underreporting. The behavioral and sociocultural determinants of suicidal behavior in these contexts—where rapid modernization intersects with Islamic normative frameworks and large-scale labor migration—have received particularly limited systematic attention. This review synthesizes available evidence on the prevalence, behavioral patterns, risk factors, and structural determinants of suicidal behavior across Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Following PRISMA 2020 guidelines, we searched PubMed, Scopus, ScienceDirect, Web of Science, and Google Scholar for primary research published between 2000 and 2025. Fifty studies (34 GCC-specific and 16 contextual/comparative) met the inclusion criteria. Methodological quality was appraised using the Newcastle–Ottawa Scale, JBI checklists, the Mixed Methods Appraisal Tool, and the AACODS checklist. The review protocol was registered on the Open Science Framework (DOI: 10.17605/OSF.IO/RZXY7; URL: https://osf.io/rzxy7/). The findings were organized into six dimensions: (1) suicide prevalence, risk factors, and associated behaviors; (2) cultural and religious influences; (3) mental health of specific at-risk populations; (4) healthcare and support services; (5) migrant worker vulnerabilities; and (6) research trends. Reported suicide rates in the GCC range from 1.5 to 4.2 per 100,000 but likely underestimate the true prevalence due to forensic misclassification and stigma. Migrant workers constitute a high-risk subgroup, with suicidal ideation reaching 68% among those facing acute financial distress. Islamic religiosity is associated with lower suicide mortality but simultaneously deters help-seeking by stigmatizing mental distress. Interpreted through a Durkheimian lens, these findings position suicidal behavior in the GCC as a social fact shaped by weakened social integration and normative fragmentation under rapid modernization. Effective prevention requires culturally adapted behavioral interventions that integrate labor welfare reforms with community-based mental health strategies.

Cliramitug for depletion of cardiac amyloid transthyretin: long-term follow-up of the NI006-101 trial

Nature Medicine, Published online: 26 June 2026; doi:10.1038/s41591-026-04487-3

In an open-label extension study of the NI006-101 trial, in which patients with transthyretin amyloidosis cardiomyopathy were treated with the monoclonal antibody cliramitug, which targets misfolded transthyretin, long-term follow-up for a median of 29.3 months showed favorable safety, further reduction in cardiac amyloid burden and improvements in structural, functional and biomarker endpoints.

Heat waves mess with your brain. Scientists are trying to figure out why.

It’s been hot in London this week. Really hot. A dangerous heat wave has hit Western Europe. Yesterday, the UK recorded its highest ever June temperature at 36.1 °C (about 97 °F). But as the weather app on my phone confirmed, it felt like 39 °C.

It’s frightening that we are seeing such temperatures in the UK in June. According to the Met Office, the country’s national weather and climate service, June temperatures peaked at an average 19 °C (66 °F) in England between 1991 and 2020. Across Europe, the heat wave is likely to cause thousands of deaths. There will be other awful consequences for agriculture, infrastructure, and the health system.

But this week I want to look at what the heat does to our minds and brains. Personally, I’ve found it almost impossible to think straight. The heat is distracting and my mind is foggy. I dread to think about the conditions of people who work outdoors, in even hotter regions.

It’s not just exhaustion and confusion. The effects of heat on the brain can be deadly. And researchers are still trying to figure out why.

Studies have confirmed that as temperatures rise, people seem to get more irritable and more violent. Most of these studies are based on associations, though. It’s difficult to directly study how a heat wave might affect our thinking, says Catherine Thompson, a cognitive psychologist at Liverpool Hope University. 

She has been studying the effects of extreme heat on firefighters instead. It’s easier to measure people’s cognitive skills before and after they undergo scheduled training that involves entering a burning building.  

It’s early days, but the team found that firefighters found it harder to focus and control their attention immediately after heat exposure—something people in heat waves can empathize with, I’m sure. 

The firefighters’ skills returned to normal after 20 minutes or so of cooling down. But they’d experienced just 15 minutes of intense heat exposure. Thompson doesn’t know what the effects of living through a days-long heat wave might be—or how long they’ll last. Figuring that out might involve shipping cognitive test kits to thousands of people during the few days’ notice of an impending heat wave. “My guess [is] that no one’s done it because it’s just so difficult to do,” says Thompson. 

Still, researchers can learn about some of the impacts of heat waves through studies after the fact. And those studies suggest that the heat seems to have more disastrous outcomes for people with mental-health disorders. 

Those outcomes become apparent when temperatures rise above what is considered typical for a given region. “There seems to be a correlation where the hotter it gets, especially during the hottest times of the year, the worse the mental-health outcomes,” says Joshua Wortzel, who directs the Heat-Mind Lab at Hartford HealthCare in Connecticut.

In a study published in 2023, Emma Lawrence at the University of Oxford, who studies the effect of climate change on mental health, and her colleagues reviewed the evidence linking mental-health outcomes to ambient outdoor temperatures. They found that during heat waves, there was a 9.7% increase in the rate of hospital admissions for people with such conditions. 

“People who live with mental-health conditions are among the most susceptible to the physical impacts of heat,” says Lawrence. People with schizophrenia were found to have been three times more likely to die during the record-breaking heat wave that affected Canada in 2021, for example.

In order to protect people, we need a better understanding of the mechanisms underlying these effects. After all, a lot of things change when it’s very, very hot. Some people may end up stuck indoors, avoiding outdoor play and exercise, and it can be difficult to get a good night of sleep, for example. Sleep, socializing, and exercise are all really important for our mental health. 

But whether unusual heat does something specific to our brains is, as Wortzel puts it, “the million-dollar question.”

Research in lab animals suggests that excessive heat can alter the way chemical signals work in our brain. The levels of neurotransmitters like serotonin, for example, seem to increase when rats and mice are exposed to high temperatures, according to multiple studies. The heat may also interfere with the way networks in our brains communicate with each other. It might affect the way oxygen reaches our brain cells.

“There are so many biological reasons why brains may be negatively affected by heat,” says Wortzel.

Emerging research suggests that for whatever reason, children and young people are among the most vulnerable. In research published earlier this week, Wortzel and his colleagues saw a 2.97% increase in the suicide rate among people in the US aged 15 to 24 for every 1 °C increase in average monthly temperature. That’s more than double the increase seen in people over the age of 24 (which is concerning in its own right).

Other work hints that heat exposure might have long-term consequences for children’s brain development. Babies who were exposed to either extreme heat or cold appeared to have altered white matter by the time they were nine to 12 years old—although it’s not clear how these impacts might affect an individual child.

“It seems that extreme temperature exposure for very young children may affect their brain development,” says Lawrence, who spoke to me from Oxford. She was meant to be in London for Climate Action Week, but her event, which focused on extreme heat, ended up being canceled … owing to the extreme heat.

We are living through the effects of climate change. And that brings a new urgency to the question of how heat affects our brains. Children born in 2020 are predicted to experience around seven times the number of heat waves their grandparents did, says Lawrance. “[We] need to be serious about adapting to a warming world.”

This article first appeared in The Checkup, MIT Technology Review’s weekly biotech newsletter. To receive it in your inbox every Thursday, and read articles like this first, sign up here.

AI Framework Surfaces New CAR T Target with Multi‑Cancer Potential

A new study in Cell describes an AI‑enabled strategy that could accelerate the search for next‑generation CAR T cell targets—an enduring bottleneck in expanding the therapy beyond blood cancers. The work, titled AI‑driven discovery of GPNMB CAR T cells as a multi‑cancer therapy,” was led by researchers at the Perelman School of Medicine at the University of Pennsylvania and Penn’s Abramson Cancer Center, with collaborators at the Icahn School of Medicine at Mount Sinai and RWTH Aachen University.

The Penn team developed a human‑in‑the‑loop AI framework designed to systematically nominate antigens suitable for CAR T cell therapy. Rather than replacing expert judgment, the system integrates large language models (LLMs) with single-cell RNA sequencing datasets from human skin cancer and healthy tissue to generate and refine target lists that scientists then evaluate experimentally.

The challenge is well known: while CAR T therapies have transformed treatment for several hematologic malignancies, identifying safe, selective targets in solid tumors remains slow and labor‑intensive. “Discovering a good CAR target is like trying to find a needle in a haystack, except the haystack keeps growing as more sequencing data becomes available,” said lead author Daniel Baker, PhD, who completed the work under the mentorship of Carl June, MD, and Zoltan Arany, MD, PhD. LLMs, Baker added, excel at scanning broad datasets, while human experts “go deep”—a complementary pairing the team sought to formalize.

To test the framework, the researchers focused on skin cancer, integrating four publicly available single‑cell RNA‑seq datasets with additional public resources. More than 10,000 potential antigens were filtered using criteria relevant to CAR T design, including tumor composition, tissue specificity, and clinical feasibility. Multiple LLMs then repeatedly simulated target nomination—1,000 independent runs—to reduce noise and mitigate hallucinations. The resulting consensus list was reviewed by the team, who selected Glycoprotein non-metastatic melanoma protein B (GPNMB) as the top candidate.

The researchers then engineered a GPNMB‑directed CAR T cell and validated its activity across several preclinical models. In mouse studies, the CAR T cells eliminated tumors not only in melanoma—the original focus of the dataset—but also in monoblastic leukemia and colorectal adenocarcinoma, suggesting broader therapeutic potential. These findings align with the paper’s highlight that GPNMB is expressed across a wide range of tumor types.

The full framework is included in the methods section to enable adoption by other groups. The Penn team plans to apply the approach to additional cancer types and continue advancing the GPNMB CAR T candidate toward potential clinical translation.

According to June, “this study represents one of the first uses of large language models in the field of cell and gene therapy, including CAR T cell therapy.” The framework is intentionally modular and disease‑agnostic, designed to accommodate new datasets and future LLMs as they evolve. Arany emphasized the broader implications: “This is only the tip of the iceberg, as agentic AI is on the rise.

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Antibiotics Trigger Protein Sharing Among Bacteria, Aiding Persister Cells

New research headed by scientists at Baylor College of Medicine suggests that when bacteria are under antibiotic attack, it is not “every man for himself.” The team developed a genetic system in Escherichia coli to track how the cells transferred proteins between them. The results indicated that bacterial populations work as a team to survive antibiotics, pooling their resources and helping quiescent or dormant cells survive. Using different techniques, including high-resolution imaging, the team found that antibiotic treatment induced the transfer of proteins between different E. coli strains, and between E. coli and other species of bacteria.

They discovered that antibiotics stimulate bacteria to differentiate into groups of what they describe as vesicle-producing, and protein-receiving cells, and that antibiotic “persisters” with reduced protein synthesis acquire proteins released by their neighbors. The discoveries may help to explain why some bacteria are hard to eliminate, and also point to potential future approaches to improve antibiotic effectiveness.

“Antibiotics are designed to kill bacteria or stop them from growing,” said Christophe Herman, PhD, professor of molecular and human genetics and of molecular virology and microbiology at Baylor. “Yet many times, antibiotics leave behind a small group of survivors. These survivors are not genetically resistant; instead, they temporarily shut down certain parts of their metabolism, entering a dormant-like state that allows them to endure treatment and later regrow. Understanding how survivors form and remain is a major challenge in fighting persistent infections.”

Herman is senior and co-corresponding author of the team’s published paper in Science,” (“Antibiotics stimulate protein transfer to persister cells,”) in which the team further explained, “Protein uptake enhanced the antibiotic persistence of recipient cells, revealing that vesicle exchange promotes bacterial survival during antibiotic treatment.”

Scientists have long known that bacteria can help each other resist antibiotics by sharing genes that provide antibiotic resistance. But as the authors pointed out, “Whereas horizontal gene transfer is known to spread antibiotic resistance genes, far less is understood about the mechanisms and effects of horizontal protein transfer.”

Antibiotic treatment stimulates vesicle production, so for their current study, Herman and colleagues investigated whether bacteria could also directly share proteins. Previous studies had indicated that bacteria can share proteins, but the experimental evidence was not clear. “To directly measure horizontal transfer, we constructed a genetic system in Escherichia coli consisting of a donor and a recipient strain.”

First author Alice X. Wen, a Baylor McNair Scholar in the Medical Scientist Training Program (MD/PhD), working in the Herman lab, further explained, “To detect protein transfer, we designed a sensitive system using the bacterium Escherichia coli. We engineered one group of bacteria (donors) to make a special enzyme called Cre, and another group of the same bacteria (recipients) to contain a genetic ‘switch’ that could only flip if Cre protein entered the recipient.”

Using this system, investigators discovered that when donor and recipient bacteria were grown together, protein transfer occurred but was rare under normal conditions. In contrast, when the bacteria were exposed to low, non-lethal levels of antibiotics, protein transfer increased by thousands of times. “We then investigated how proteins were moving from one cell to another,” Wen said. “We found that the transfer still occurred when donor cells were removed, leaving behind only the liquid in which they had grown. This ruled out direct cell-to-cell contact and pointed to something released into the environment.”

By combining biochemical techniques and advanced microscopy, the team discovered that the proteins were transported by tiny membrane vesicles. These structures, which look like tiny bubbles, are made of bacterial membrane that pinch off from cells and float freely. “Bacterial membrane vesicles, which contain proteins, have been proposed as mediators of horizontal protein transfer,” they pointed out. “Additionally, antibiotic treatment stimulates vesicle production.”

Looking closer at their experimental system, the team found that the recipient cells showed strong signs of dormancy—these cells slowed down protein production, reduced their metabolism, and activated genes associated with persistence, such as HipA. “Recipient cells with high HipA activity were more likely to take up protein-carrying vesicles and survive antibiotic treatment,” Wen said. “When HipA was removed, both protein uptake and survival dropped.”

Protein transfer also helped dormant bacteria survive exposure to lethal antibiotic doses after vesicle transfer; that is, exposing cells to an increased concentration of vesicles before antibiotic treatment led to increased survival. “Protein uptake enhanced the antibiotic persistence of recipient cells, revealing that vesicle exchange promotes bacterial survival during antibiotic treatment,” the authors stated. The results suggested that transferred proteins helped dormant cells endure stress while their own protein production was shut down. “Uptake of key proteins, such as ribosomal components, metabolic enzymes, or DNA repair factors, from active neighbors may help persisters endure proteome-damaging stress despite reduced protein synthesis.”

Herman said, “Our study shows that antibiotics cause a genetically identical group of bacteria to differentiate into two distinct groups: donor cells that respond by releasing protein-filled vesicles, and recipient cells that become dormant but capable of taking up proteins from incoming vesicles, which helps them survive,” Herman said. “This teamwork allows vulnerable members of a bacterial population to persist in the face of a potentially deadly antibiotic attack.”

The researchers are interested in identifying the proteins in vesicles that contribute to recipient persistence. Understanding donor-recipient interactions among bacteria opens new doors in the fight against chronic and persistent infections. In conclusion, the authors stated that their work “… reveals that antibiotics stimulate the differentiation of bacteria into distinct groups of vesicle-producing and protein-receiving cells, which allows antibiotic persisters with decreased protein synthesis to acquire proteins secreted from active neighbors. New strategies to eliminate persisters could be developed by inhibiting or hijacking horizontal protein transfer.”

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New ACIP charter broadens criteria for members, calls for review of alternatives to vaccines

A new charter for the panel that advises the Centers for Disease Control and Prevention on vaccine use substantially refocuses the responsibilities of the committee, downplaying its role in recommending the use of new vaccines and giving it responsibility to assess alternatives for disease prevention.

Whereas previous iterations of the committee’s charter stressed the importance of vaccine research-relevant experience in the selection of its members, the new version, posted to the CDC’s website on Thursday, merely stipulates that the panel as a whole should “represent a balanced range of scientific, clinical, and public health expertise relevant to the Committee’s mission” — a broad umbrella under which people with little experience in vaccines or vaccination policy might conceivably fit.

Read the rest…

Young Adults’ Perspectives on an Ecological Momentary Intervention for Drinking to Cope: Qualitative Study

<strong>Background:</strong> Young adults have high rates of mental health problems, such as mood or anxiety symptoms, and high rates of problematic drinking. Many young adults who undergo psychiatric hospitalization to address depression and anxiety symptoms also engage in risky drinking and tend to drink to cope with negative emotions. However, in many cases, treatment programs focusing on mood and anxiety symptoms often fail to adequately address problematic alcohol use in young adults. <strong>Objective:</strong> This study aimed to address this treatment gap by investigating patient perspectives on a potential ecological momentary intervention mobile app. Researchers used qualitative methods to gather perspectives of young adults hospitalized for psychiatric care on their use of drinking to cope with negative emotions and their feedback for a prospective app designed to suggest healthy coping strategies when participants report low mood and cravings to drink. <strong>Methods:</strong> We recruited a total of 12 young adults admitted to a partial hospitalization program to participate in a qualitative interview. To be eligible, participants needed to be aged 18-25 years and report drinking at least once weekly, binge drinking at least once monthly, drinking to cope with negative emotions, and depression and/or anxiety symptoms. <strong>Results:</strong> Qualitative analysis of our data resulted in 4 major themes. These included (1) motivations to use substances, (2) healthy coping, (3) general reactions to the proposed app, and (4) suggestions for the app. Participants generally had insight about their use of alcohol to cope and were able to identify several motivations for drinking; the most frequent motivations were to alleviate anxiety and depression, although many participants noted drinking to cope with other emotions, such as guilt or loneliness. Participants overall had positive responses to the prospective intervention and reported that they would appreciate the portability of a digital intervention in helping them “step down” from higher levels of psychiatric care. Participants also made several valuable suggestions about content, features, and usability, such as suggesting ways to “gamify” the app to increase use. <strong>Conclusions:</strong> This feedback will be crucial in designing and testing an ecological momentary intervention designed to reduce drinking to cope in young adults hospitalized for psychiatric care.