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A new Alzheimer's study suggests where you live can affect the odds of a diagnosis

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A new Alzheimer's study suggests where you live can affect the odds of a diagnosis

Medical instruments are pictured at the Actors Fund’s Al Hirschfeld Free Health Clinic on March 23, 2011, in New York City. Researchers found that the odds of getting a formal dementia diagnosis in the U.S. differed based on location.

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In the United States, it’s estimated that about 7 million people are living with Alzheimer’s disease and related dementias. But the number of people with a formal diagnosis is far less than that. Now, a new study suggests the likelihood of getting a formal diagnosis may depend on where a person lives.

Researchers at the University of Michigan and Dartmouth College found that diagnosis rates vastly differ across the country and those different rates could not simply be explained by dementia risk factors, like if an area has more cases of hypertension, obesity and diabetes.

The reasons behind the disparity aren’t clear, but researchers speculate that stigma as well as access to primary care or behavioral neurological specialists may impact the odds of getting a formal diagnosis.

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“We tell anecdotes about how hard it is to get a diagnosis and maybe it is harder in some places. It’s not just your imagination. It actually is different from place to place,” said Julie Bynum, the study’s lead author and a geriatrician at the University of Michigan Medical School.

Those differences may have potential consequences. That’s because a formal diagnosis of Alzheimer’s opens up access to treatments that may slow down the brain changes associated with the disease. Without that formal diagnosis, patients also would not be eligible for clinical trials or insurance coverage for certain medications. Even in cases of dementia where treatment is not an option, a diagnosis can also help in the planning for a patient’s care.

The findings, published last week in the journal Alzheimer’s & Dementia, emerged from two main questions: What percent of older adults are being diagnosed with dementia across communities in the U.S.? And is the percent we see different from what we would expect?

To answer these questions, researchers used Medicare and demographics data to create two maps. The first displayed the percentage of people receiving a formal diagnosis in each hospital referral region (HRR), which divides the country into 306 areas based on where people are likely to seek treatment. The second estimated what the percentage should be in each HRR based on health risk factors and race.

What they discovered was that the two maps were vastly different, with parts of the Great Plains and Southwest seeing less diagnosis than expected. For example, a person in Wichita Falls, Texas, may have twice the likelihood of getting a diagnosis than a person living in Minot, N.D.

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“Even within a group of people who are all 80, depending on where you live, you might be twice as likely to actually get a diagnosis,” Bynum said.

It’s difficult to say for certain if an area is under-diagnosing, because researchers compared each HRR to the national diagnosis average instead of the actual number of cases in each community, she added.

But the findings shed new light on why dementia diagnosis is more prevalent in some areas than others — and that it does not simply have to do with an individual’s risk factors alone, but also access to health care resources and education on the disease.

Erin Abner, an epidemiologist at the University of Kentucky who was not involved in the study, said the results were not surprising and that there are many barriers to diagnosis.

“Where we live is a powerful influence on our brain health,” she said. “It is very difficult for adults in many parts of the country to access behavioral neurological specialist care — in many cases waiting lists to be seen are months or even years long.”

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For some, language and cultural differences can also impact access to care.

Diagnosing Alzheimer’s can be a long process that includes cognitive and neuropsychological assessments, as well as tests showing the presence of amyloid plaques in the brain. Bynum hopes the findings will help draw attention to the role that health care systems have on diagnosis rates and finding people who may be living with dementia under the radar.

“This other component of what the health care system and our public health system might do in informing and educating populations, that’s also relevant and important,” Bynum said. “And in some ways, we can fix that.”

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Donald Trump has no ‘phase two’ plan for Iran war, says US senator

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Donald Trump has no ‘phase two’ plan for Iran war, says US senator

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Man accused of plot to assassinate Trump testifies Iran pressured him, says Biden and Haley were other possible targets

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Man accused of plot to assassinate Trump testifies Iran pressured him, says Biden and Haley were other possible targets

The allegation sounded like the stuff of spy movies: A Pakistani businessman trying to hire hit men, even handing them $5,000 in cash, to kill a U.S. politician on behalf of Iran ‘s powerful paramilitary Revolutionary Guard.

It was true, and potential targets of the 2024 scheme included now-President Donald Trump, then-President Joe Biden and former presidential candidate and ex-U.N. Ambassador Nikki Haley, the man told jurors at his attempted terrorism trial in New York on Wednesday. But he insisted his actions were driven by fear for loved ones in Iran, and he figured he’d be apprehended before anything came of the scheme.

“My family was under threat, and I had to do this,” the defendant, Asif Merchant, testified through an Urdu interpreter. “I was not wanting to do this so willingly.”

Merchant said he had anticipated getting arrested before anyone was killed, intended to cooperate with the U.S. government and had hoped that would help him get a green card.

U.S. authorities were, indeed, on to him – the supposed hit men he paid were actually undercover FBI agents – and he was arrested on July 12, 2024, a day before an unrelated attempt on Trump’s life in Butler, Pennsylvania.  During a search, investigators said they found a handwritten note that contained the codewords for the various aspects of the plot, CBS News previously reported

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Merchant did sit for voluntary FBI interviews, but he ultimately ended up with a trial, not a cooperation deal.

“You traveled to the United States for the purpose of hiring Mafia members to kill a politician, correct?” Assistant U.S. Attorney Nina Gupta asked during her turn questioning Merchant Wednesday in a Brooklyn federal court.

“That’s right,” Merchant replied, his demeanor as matter-of-fact as his testimony was unusual.

The trial is unfolding amid the less than week-old Iran war, which killed Iranian Supreme Leader Ayatollah Ali Khamenei in a strike that Trump summed up as “I got him before he got me.” Jurors are instructed to ignore news pertaining to the case.

The Iranian government has denied plotting to kill Trump or other U.S. officials.

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Merchant, 47, had a roughly 20-year banking career in Pakistan before getting involved in an array of businesses: clothing, car sales, banana exports, insulation imports. He openly has two families, one in Pakistan and the other in Iran – where, he said, he was introduced around the end of 2022 to a Revolutionary Guard intelligence operative. They initially spoke about getting involved in a hawala, an informal money transfer system, Merchant said.

Merchant testified that his periodic visits to the U.S. for his garment business piqued the interest of his Revolutionary Guard contact, who trained him on countersurveillance techniques.

The U.S. deems the Revolutionary Guard a “foreign terrorist organization.” Formally called the Islamic Revolutionary Guard Corps, the force has been prominent in Iran under Khamenei.

Merchant said the handler told him to seek U.S. residents interested in working for Iran. Then came another assignment: Look for a criminal to arrange protests, steal things, do some money laundering, “and maybe have somebody murdered,” Merchant recalled.

“He did not tell me exactly who it is, but he told me – he named three people: Donald Trump, Joe Biden and Nikki Haley,” he added.

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In 2024, multiple sources familiar with the investigation told CBS News Merchant planned to assassinate current and former government officials across the political spectrum.

Merchant allegedly sketched out the plot on a napkin inside his New York hotel room, prosecutors said, and told the individual “that there would be ‘security all around’ the person” they were planning to kill.

“No other option”

After U.S. immigration agents pulled Merchant aside at the Houston airport in April 2024, searched his possessions and asked about his travels to Iran, he concluded that he was under surveillance. But still he researched Trump rally locations, sketched out a plot for a shooting at a political rally, lined up the supposed hit men and scrambled together $5,000 from a cousin to pay them a “token of appreciation.”

This image provided by the Justice Department, contained in the complaint supporting the arrest warrant, shows Asif Merchant. 

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He even reported back to his Revolutionary Guard contact, sending observations – fake, Merchant said – tucked into a book that he shipped to Iran through a series of intermediaries.

Merchant said he “had no other option” than to play along because the handler had indicated that he knew who Merchant’s Iranian relatives were and where they lived.

In a court filing this week, prosecutors noted that Merchant didn’t seek out law enforcement to help with his purported predicament before he was arrested. He testified that he couldn’t turn to authorities because his handler had people watching him.

Prosecutors also said that in his FBI interviews, Merchant “neglected to mention any facts that could have supported” an argument that he acted under duress.

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Merchant told jurors Wednesday that he didn’t think agents would believe his story, because their questions suggested “they think that I’m some type of super-spy.”

“And are you a super-spy?” defense lawyer Avraham Moskowitz asked.

“No,” Merchant said. “Absolutely not.”

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Satellite images show Iran school strike hit more buildings than earlier reported

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Satellite images show Iran school strike hit more buildings than earlier reported

The bombing of an Iranian elementary school that killed some 165 people, many of them schoolgirls, included more targets near the school than has been initially reported, a review of commercial satellite imagery by NPR has found.

The images suggest that the school was hit on Saturday as part of a precision airstrike on a neighboring Iranian military complex — and that it may have been struck as a result of outdated targeting information.

The new images come from the company Planet and are of the city of Minab, located in southeastern Iran. They show that a health clinic and other buildings near the school were also struck. Three independent experts confirmed NPR’s analysis of the additional strike points.

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The strike points “look like pretty clean detonation centroids,” said Corey Scher, a postdoctoral researcher at the Conflict Ecology laboratory at Oregon State University.

“These certainly appear like detonation sites,” agreed Scher’s colleague, Oregon State associate professor Jamon Van Den Hoek.

Jeffrey Lewis, a professor at Middlebury College who specializes in satellite imagery, said the imagery was consistent with a precision airstrike.

The images show “very precise targeting,” Lewis told NPR. “Almost all the buildings [in the compound] are hit.”

A satellite image of an Iranian Revolutionary Guard compound taken on March 4.

A satellite image of an Iranian Revolutionary Guard compound taken on March 4, several days after an airstrike destroyed a school on the edge of the compound. The image reveals that half a dozen other buildings in addition to the school were struck.

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Iranian state media said 165 people died in the bombing, which struck a girls’ school. The school was located within less than 100 yards of the perimeter of an Iranian Revolutionary Guard naval base, according to satellite images and publicly available information. The clinic was also located within the base perimeter, although both facilities had been walled off from the base.

Israel has denied involvement. “We are not aware at the moment of any IDF operation in that area,” Israel Defense Forces spokesperson Nadav Shoshani told NPR on Monday. “I don’t know who’s responsible for the bombing.”

At a press conference Wednesday morning, U.S. Defense Secretary Pete Hegseth said that the U.S. is looking into what happened at the school. “All I know, all I can say, is that we’re investigating that,” Hegseth said. “We, of course, never target civilian targets.”

Given Minab’s location in the southeastern part of Iran, Lewis believes it’s more likely the U.S. would have conducted the strike than Israel. As one gets farther south and east in Iran, “a strike is much more likely to be a U.S. strike than an Israeli strike because of the type of munitions and the geographic location,” he said.

Esmail Baghaei, the spokesman for Iran’s Foreign Ministry, called the strike “deliberate” and said that the U.S. and Israel bombed the school in part to tie up Iranian forces in the region with rescue efforts. “To call the attack on the girls school merely a ‘war crime’ does not capture the sheer evil and depravity of such a crime,” he said.

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But Lewis said it’s more likely that the strike was the result of an error. Satellite images show that the school and clinic buildings were both once part of the base. The school was separated from the base by a wall between 2013 and 2016. The clinic was walled off between 2022 and 2024.

Lewis believes it’s possible American military planners had not updated their target sets.

“There are thousands of targets across Iran, and so there will be teams in the United States and Israel that are responsible for tracking those targets and updating them,” he said. “It’s possible that the target didn’t get updated.”

The Pentagon did not immediately respond to NPR’s request for additional information about the strike.

NPR’s Arezou Rezvani and NPR’s RAD team contributed to this report.

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