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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.
Spencer Platt/Getty Images
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Spencer Platt/Getty Images
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.
“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.
“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.”
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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Additional work by Jana Tauschinski
Oil and gas tanker location and destination data are from Kpler. The map shows the latest position for vessels with an active AIS signal on April 19–20, filtered by minimum capacity thresholds: crude tankers of at least 50,000 deadweight tonnage (DWT); oil product tankers of at least 55,000 DWT; oil/chemical tankers of at least 40,000 DWT; LNG carriers of at least 150,000 cubic metres; and LPG carriers of at least 50,000 cubic metres. Net fossil fuel import data by country are based on Ember analysis of the IEA World Energy Balances 2023.
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Roommate faces murder charges in deaths of 2 University of South Florida doctoral students
A 26-year-old man is facing two counts of first-degree murder in the deaths of two University of South Florida doctoral students who went missing last week, local authorities said Saturday.
The Hillsborough County Sheriff’s Office in Florida said that evidence presented to the state attorney’s office resulted in the charges against Hisham Abugharbieh, the roommate of Zamil Limon, one of the doctoral students.
Abugharbieh is accused of premediated murder with a weapon. He was arrested on Friday, the same day Limon was found dead.
The family of Nahida Bristy, the other doctoral student, told CBS News that police said she is also likely dead. That is based on the volume of blood discovered at Abugharbieh’s residence, which he shared with Limon.
“Police told us she is no longer with us,” Bristy’s brother, Zahid Prato, said early Saturday.
The family was told her body may never be found and police believe she may have been dismembered, according to Prato.
CBS News has reached out to police for more information.
Authorities said in a statement Saturday they were still searching for Bristy.
Limon’s remains were found on the Howard Franklin Bridge in Tampa Friday morning, Chief Deputy Joseph Maurer with the Hillsborough County Sheriff’s Office said. His cause of death was pending autopsy results.
Deputies with the sheriff’s office took Abugharbieh into custody on Friday after responding to a domestic violence call at a home in the Lake Forest Community, a neighborhood near USF’s Tampa campus, officials said. He also faces charges of domestic violence and evidence tampering, as well as a charge of failing to report a death to law enforcement.
Limon and Bristy, both 27, had last been seen in the Tampa area on April 16.
Limon was studying the use of AI in environmental science and was set to present his doctoral thesis this week, his family said. Bristy is studying chemical engineering.
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Rubio’s Absence From Iran Talks Highlights Stay-at-Home Role
When President Barack Obama negotiated a nuclear deal with Iran more than a decade ago, his point man was Secretary of State John Kerry. Over 20 months of talks, Mr. Kerry met with his Iranian counterpart on at least 18 different days, often several times per day.
High-level nuclear diplomacy was a natural role for the top U.S. diplomat. Secretaries of state traditionally take the lead on the country’s biggest diplomatic tasks, from arms control treaties to Israeli-Palestinian agreements.
But as President Trump prepares to send a delegation to the latest round of U.S.-Iran talks in Pakistan this weekend, his secretary of state, Marco Rubio, will remain where he often does: at home.
Mr. Rubio did not attend the last U.S. meeting with Iran earlier this month. Nor did he join several meetings held over the past year in Geneva and Doha. Mr. Rubio has also been absent from U.S. delegations abroad working to settle the war in Ukraine and Israel’s war in Gaza. Despite a long period of crisis and war in the region, he has not visited the Middle East since a brief stop in Israel last October.
In recent months, Mr. Rubio — consumed with his second role, as Mr. Trump’s national security adviser — has not traveled much at all.
During the Biden administration, Secretary of State Antony J. Blinken made 11 foreign trips from January 2024 to late April 2024, stopping in roughly three dozen cities, according to the State Department. So far this year, Mr. Rubio has visited six foreign cities, including a stop in Milan for the 2026 Winter Olympics.
Mr. Trump has outsourced much of his diplomacy to others, including his friend Steve Witkoff, a wealthy associate from the world of Manhattan real estate, and his son-in-law, Jared Kushner. Mr. Witkoff and Mr. Kushner have spearheaded diplomacy with Israel, Ukraine and Russia, as well as Iran, whose delegation they will meet for the second time this month in Islamabad, Pakistan’s capital.
Mr. Rubio’s distance from the trenches of diplomacy reflects his dual role on Mr. Trump’s national security team. For the past year, he has served as the White House national security adviser even while leading the State Department — the first person to do so since Henry A. Kissinger in the mid-1970s.
The secretary of state runs the State Department, overseeing U.S. diplomats and embassies worldwide, as well as Washington-based policymakers. Working from the White House, the national security adviser coordinates departments and agencies, including the State Department, to develop policy advice for the president.
The twin roles reflect Mr. Rubio’s influence with Mr. Trump, and offer him a way to maintain it. For Mr. Rubio, less time abroad means more time at the side of an impulsive president prone to making critical national security decisions at any moment.
As Mr. Witkoff, Mr. Kushner and Vice President JD Vance met with Iranian officials in Pakistan earlier this month, Mr. Rubio was at Mr. Trump’s side at an Ultimate Fighting Championship event, noted Emma Ashford, an analyst of U.S. diplomacy at the nonpartisan Stimson Center in Washington. “Rubio clearly prefers to stay close to Trump,” Ms. Ashford said.
Mr. Rubio accepted the national security adviser job on an acting basis last May after Mr. Trump reassigned the job’s previous occupant, Michael Waltz. But officials say that Mr. Rubio is expected to keep it indefinitely.
That arrangement is not inherently bad, Ms. Ashford added. And she noted that previous presidents had entrusted major diplomatic tasks to people other than the secretary of state. President Joseph R. Biden Jr. delegated his C.I.A. director, William J. Burns, to handle diplomacy with Russia and cease-fire negotiations between Israel and Hamas, for instance.
But she echoed the complaints by many current and former diplomats that Mr. Rubio seems less like someone performing both jobs than a national security adviser who sometimes shows up at the State Department. “I do think it’s to the detriment of the whole department of State and to America’s ability to conduct diplomacy in general that we effectively have the secretary of state position sitting vacant,” she said.
Tommy Pigott, a State Department spokesman, contested such claims. “Anyone trying to paint Secretary Rubio’s close coordination with the White House and other agencies as a negative could not be more wrong,” he said. “We now have an N.S.C. and State Department that are totally in sync, a goal that has eluded past administrations for decades.”
Mr. Rubio divides his time between the State Department and the White House, often spending time at both in the same day. In an interview with Politico last June, Mr. Rubio said he visited the State Department “almost every day.”
While there, he often meets with visiting dignitaries before returning to the White House. Last week, Mr. Rubio presided over a meeting at the State Department between Lebanese and Israeli officials that set the stage for a cease-fire in Lebanon.
His twin jobs “really do overlap in many cases,” he said. “In many cases you end up being in the same meetings or in the same places; there’s just one less person in there, if you think about it,” Mr. Rubio added. “A lot of people would come to Washington, for example, for meetings, and they’d want to meet with the national security adviser and then meet with me as secretary of state. Now they can do both in one meeting.”
Asked about his travel schedule during a news conference last December, Mr. Rubio said he had less reason to travel abroad because “we have a lot of leaders constantly coming here” to visit Mr. Trump at the White House. Mr. Rubio also joins Mr. Trump’s foreign trips in his capacity as national security adviser.
Many national security veterans call the arrangement unwise, saying that both jobs are extremely demanding and incompatible with one another.
It was not easy even for Mr. Kissinger, who had firmly established himself over more than four years as national security adviser before convincing President Richard M. Nixon to let him take on an additional role as secretary of state in 1973. (In a reversal of Mr. Rubio’s approach, Mr. Kissinger was in constant motion, including a round of Middle East shuttle diplomacy that kept him on the road for 33 straight days.)
“In general, it’s a mistake to combine those roles,” said Matthew Waxman, who held senior roles at the National Security Council, State Department and the Pentagon during the George W. Bush administration.
“That said, it’s not necessarily a bad thing that a dual-hatted Rubio is so offscreen right now,” Mr. Waxman added. “Especially while so much attention is focused on high-wire diplomacy with Iran, someone needs to manage foreign policy around the rest of the world.”
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