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Anchor lead: Can a new form of brain imaging help spot Alzheimer’s disease earlier? Elizabeth Tracey reports
Alzheimer’s disease may be easier to stop if we diagnose the condition earlier. Gwenn Smith, a brain imaging expert at Johns Hopkins, and colleagues, have been working with a new imaging technique in conjunction with an existing one, to do just that.
Smith: The current study uses a methodology called magnetic resonance spectroscopy. We were able to look at two specific chemicals in the brain GABA and glutamate, one inhibitory and one excitatory, that complements what we can look at on the PET scan. We see a decrease in the two neurotransmitters GABA and glutamate, in parts of the brain where we see evidence of early pathology, in individuals at risk for memory decline. :29
Smith says that if ready for clinical prime time, monitoring changes in these neurotransmitters, which the brain uses for communication between neurons as well as other cells, could indicate that Alzheimer’s disease is beginning and interventions may be employed. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Who transmits HIV most often? Elizabeth Tracey reports
People who don’t even know they’re infected with HIV are the ones who spread the infection most in the United States, the Centers for Disease Control and Prevention has reported. Joseph Cofrancesco, an HIV expert at Johns Hopkins, says universal testing would help.
Cofrancesco: One easy science answer is everyone gets tested. And perhaps everybody even gets tested every year. But you can only do that if you can then offer those people who are positive treatment that they can afford or free. The whole system that allows them to follow up with to make sure the treatment is working and is safe for them and meets their life needs. And there’s so many other things we have to change which is the stigma, the stigma around being sexually active when you’re young, the stigma about using drugs, the stigma about men who have sex with men in certain communities. :33
Cofrancesco says routine universal testing would also help with reducing stigma, and perhaps should begin in adolescence and continue through the lifespan. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Would actual elimination of HIV be possible? Elizabeth Tracey reports
HIV infection can be eliminated in the US. That lofty goal was recently put forward by the Trump administration, and Joseph Cofrancesco, an HIV expert at Johns Hopkins, is cautiously optimistic.
Cofrancesco: I think it is absolutely feasible to eliminate transmission of HIV in the US and potentially in the world. In order to do that everyone has to be tested, those who are tested have to be able to be properly treated, so that means the stigma which still exists has to be addressed, the healthcare systems have to be able to not only give meds and make the meds affordable, but engage them in meaningful ways so they can stay controlled on their meds. Because U=U. undetectable equals uninfectious. :35
Cofrancesco notes that just eliminating HIV in the US won’t be permanent unless efforts are undertaken worldwide to employ the same measures, so he calls on the administration to keep up with global humanitarian commitments. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: FDA approval of a new treatment for depression has some applauding, Elizabeth Tracey reports
Esketamine is the name of a new drug given by nasal spray to help alleviate depression, recently approved by the FDA. Atsushi Kamiya, a depression expert at Johns Hopkins, says many clinicians are hopeful about the drug.
Kamiya: It’s possible this will be very exciting news for us. :04
Depression rates, along with suicidal thoughts and sometimes suicide attempts, are rising nationally.
Kamiya: There are more than 60 million people have a least one major depressive episode in their life, more than 30% will need an antidepressant. :14
Currently available antidepressants often work via a brain neurotransmitter called serotonin, and may take days to weeks to have an effect. Kamiya notes that ketamine, cousin to esketamine, seems to help alleviate depression very quickly, although questions about how durable the response will be remain. For now esketamine is used in people who aren’t responding to other treatments, but current research is examining the use of both ketamine and esketamine for use more broadly. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: A new study may help define the role of the Apple watch in a common heart condition, Elizabeth Tracey reports
Can an Apple watch be used to detect atrial fibrillation? That’s a very common heart condition many people describe as a fluttering, and it’s linked to strokes. Yes, an impressively large study revealed, finding such an issue in a surprising number of young participants. Erin Michos, a cardiologist at Johns Hopkins, says the real proof should emerge in a current study.
Michos: The next step in a study called the HEARTLINE study is to have a control arm. That study is going to enroll people over the age of 65 where atrial fibrillation is more common, and they’re going to randomize people to a watch versus no watch and then look at meaningful outcomes. Is there going to be a difference in stroke rate, in death rate, in bleeding rate, between having this device and not. The watch will be combined with the EKG app on the phone. :25
For now, Michos says much data needs to be collected and improvements made to both the device and the apps before they can reliably be used to monitor health conditions. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: What can you do to reduce your risk of cardiovascular disease? Elizabeth Tracey reports
If you’re concerned about your heart health you may be taking an aspirin every day. Now, according to new guidelines released by the American College of Cardiology, you probably shouldn’t if you’ve never had a heart problem in the past. Erin Michos, one of the guideline’s authors and a cardiologist at Johns Hopkins, explains.
Michos: In these guidelines aspirin got a bit of a de-emphasis. For healthy individuals, the risk of bleeding from aspirin may outweigh the benefits. Generally, at least healthy individuals, don’t need to take aspirin routinely for prevention of heart disease. Particularly those over the age of 70. Because of a study called the ESPRIT study where not only did aspirin not reduce heart attack rates in older adults but actually increased risk of bleeding and increased risk of death. :31
Michos says your best course is to talk with your cardiologist about your own cardiovascular disease risk, and develop an approach for prevention together. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: How have guidelines to prevent and manage cardiovascular disease changed? Elizabeth Tracey reports
Cardiovascular disease prevention guidelines have changed for the American College of Cardiology. Erin Michos, one author of the guidelines and a cardiologist at Johns Hopkins, says there’s a new emphasis.
Michos: They’re focused on social determinants of health, because it’s increasingly important that social inequalities are a key determinant of cardiovascular health. We can write all these guidelines, but if individuals don’t have safe places to exercise, healthy food sources, adequate health insurance, transportation to visits, if these social inequalities are not addressed it will be hard to implement the guidelines, and so that was really front and center of the guidelines, as well as we emphasized a team based approach to care. :31
Michos notes that the team includes primary care physicians, nurses, occupational and physical therapists and nutritionists, all of whom bring an expertise that’s needed to complete an individualized plan. At Johns Hopkins, I’m Elizabeth Tracey.
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