Health experts are talking about…

…whether long-term effects after stroke are predictable. A simple test of thinking skills, taken soon after a stroke, may help determine how well people will recover over the next three years. It could help doctors decide who would benefit most from a more aggressive approach to improve long-term health, and who will require additional help performing everyday tasks of daily living, like bathing and dressing.

For the study, 274 people in Germany and France, who had suffered a stroke within the previous seven days, were given the Montreal Cognitive Assessment, a common way to assess thinking and reasoning. Researchers divided the stroke sufferers into two groups—those with no thinking and memory problems and those showing cognitive impairment. All were retested for thinking and memory skills, as well as for movement and ability to complete daily-living tasks, at six months, one year and three years after their strokes.

Those who scored higher on the initial screening were less likely to have problems with cognitive impairment, motor skills and routine tasks over the next three years, even when researchers accounted for the severity of the stroke. Most of the people in this study had minor strokes, and the analysis did not include anyone with an existing diagnosis of dementia. It’s not clear how well the screening will work for people who experience a more severe stroke, but researchers believe that conducting this type of screening soon after the attack provides another tool for identifying those who may need more intensive, long-term intervention.

…what consumers need to know about Medicare and Medicare Advantage enrollment. Some important changes are on the horizon for both Medicare and Medicare Advantage for 2019, so the time to do your homework is now.

For traditional Medicare, open enrollment ended December 7. Premiums are rising slightly for most enrollees. Part B, which pays for doctor visits and most tests, is increasing by $1.50 per month. Part A, which covers hospital costs, is free for most beneficiaries. Deductibles—what you have to pay out of pocket before insurance picks up the tab—are increasing by $24 for Medicare Part A; the Part B annual deductible is going up $2.

If you have Part D prescription coverage, you could spend less on drugs in 2019. Some Medicare drug plans have a coverage gap, known as the donut hole. For 2018, after you and your drug plan spent $3,750 on covered drugs, you reached the donut hole. After that, you paid more for prescriptions until you reached the “catastrophic” level of $5,000. At that point, your costs dropped for the remainder of the year. New regulations, effective in January, close the coverage gap for brand-name drugs in 2019 and for generic drugs in 2020. Eventually, everyone will pay, on average, 25 percent of the cost of their drugs.

Another change: if you get medications in a physician’s office or outpatient clinic under Part B (like oral cancer drugs, injectable osteoporosis medications or drugs used with an infusion pump), you may now have to try step therapy. It requires enrollees to try one or more similar, lower-cost drugs to treat their conditions before the plan covers a higher-priced medication.

If you have Medicare Advantage (Part C) rather than traditional Medicare, and you stay with your current plan, you should see your premium drop slightly—by about $1.81, according to the Centers for Medicare and Medicaid. Also, starting in 2019, there’s a new Medicare Advantage (MA) open-enrollment period, from January 1 through March 31 every year. This expanded enrollment period gives you a one-time opportunity each year to do several things: sign up for an MA plan; change from one MA plan to another; drop your MA plan and return to original Medicare; or sign up for a stand-alone, Medicare Part D, prescription-drug plan.

Previously, it was not an option to switch to a different Medicare Advantage plan outside of a fall open-enrollment period unless you had a special circumstance (like losing your spouse’s group health coverage), and Part D enrollment was only permitted during specific times of the year.

Also starting in 2019, Medicare Advantage plans are allowed to offer extra benefits to help people with certain conditions avoid unnecessary trips to the emergency room or help them remain at home or in the community. Depending on the plan, benefits might include adult day care services, home and bathroom safety devices, in-home and caregiver support services, transportation to and from medical appointments, and home-based palliative care.

Some Medicare Advantage plans are recalculating the way you share the costs and receive services if you have diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure, a history of stroke, high blood pressure, coronary artery disease, opioid addiction or high cholesterol. Some plans have reduced the out-of-pocket costs you’ll pay, and others are covering additional services specific to the type of condition you have.

…why “you’re only as old as you feel” may be truer than you think. Feeling younger than your actual age could mean your brain is aging more slowly than the brains of your peers who feel their age or older.

Researchers wanted to find out whether our feelings about our age, known as subjective age, are just an attitude or if they reflect how our bodies are actually aging.

Scientists used MRI scans to examine the volume of gray matter in regions of the brains of 258 people, whose average age was 67.8. Loss of gray matter can show declining brain health. Study participants also had their cognitive ability assessed and answered questions about how old they felt and their overall physical and mental health. Depression, physical health or personality can play a role in subjective age.

The study found that the brains of those who felt younger had more gray-matter volume in key regions than the brains of people who felt their age or older, even after factors like personality, depression symptoms or health status were accounted for. This “younger brain” group also scored higher on memory tests, said they were in better health and had fewer depressive symptoms than the “older brain” group.

People who feel older may be able to sense the aging process in their brains, because decreased gray matter makes memory and thinking tasks more challenging. It’s also possible that those who feel younger are more physically and mentally active. Researchers suggest that if you feel older than you are, it may be time to reassess your lifestyle to achieve better brain health.

…why the link between vision and memory “breaks” with age. What we see has a direct effect on how our brains form memories. But the older we get, the weaker that connection becomes, say Canadian researchers.

When we view and process details of an object in front of us, activity in certain parts of the brain increases, and a memory forms. But this activity decreases the more often we see the object, signaling that this information is no longer new.

In a small study comparing the eye movements and memories of younger and older adults (ages 19 to 28 and 64 to 79 respectively), scientists discovered that older people don’t build up memories the same way as younger adults. So even if elders have seen an object many times, it can remain unfamiliar if their brain hasn’t created a memory for it.

Participants looked at pictures of faces on a screen, some of which were shown more than once. When the researchers tracked eye movements and brain activity, they found that the older adults had more eye movements than the younger ones but had less brain activity. That meant their eyes and brains were taking in different information. Researchers concluded that the links needed to form a memory appeared to be broken in the older group. Finding a practical way to track this type of visual processing could help doctors pick up signs of dementia sooner.

The study was published in the October 2018 issue of the journal Neuropsychologia.