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‘Compelling’ Results for AI EEG to Predict Functional Outcomes
DENVER —
After relevant cofactors were controlled for, higher seizure burden correlated with poorer functional outcomes. All of the patients in the study were being monitored as part of their standard of care owing to suspicion of seizures or because they were at risk for seizures, said study investigator Masoom Desai, MD, with the Department of Neurology, University of New Mexico, Albuquerque. The results were “compelling,” she said.
“Our study addresses the critical need for automation in monitoring epileptic activity and seizure burden,” Dr. Desai added during a press briefing at the 2024 annual meeting of the American Academy of Neurology (AAN).
A Pivotal Shift
“Several decades of research have highlighted the significant correlation between seizure burden and unfavorable outcomes both in adult and pediatric populations,” said Dr. Desai.
However, the traditional method of manually interpreting EEGs to identify seizures and their associated burden is a “complex and time-consuming process that can be subject to human error and variability,” she noted.
POC EEG is a rapid-access, reduced-montage EEG system that, when paired with an automated machine learning tool called Clarity (Ceribell, Inc; Sunnyvale, CA), can monitor and analyze seizure burden in real time.
The algorithm incorporates a comprehensive list of EEG features that have been associated with outcomes. It analyzes EEG activity every 10 seconds from all EEG channels and calculates a seizure burden in the past 5 minutes for the patient. The higher the seizure burden, the more time the patient has spent in seizure activity.
Among 344 people with POC EEG (mean age, 62 years, 45% women) in the SAFER-EEG trial, 178 (52%) had seizure burden of zero throughout the recording and 41 (12%) had suspected status epilepticus (maximum seizure burden ≥ 90%).
Before adjustment for clinical covariates, there was a significant association between high seizure burden and unfavorable outcomes.
Specifically, 76% of patients with a seizure burden of 50% or greater had an unfavorable modified Rankin Scale score of 4 or greater at discharge and a similar proportion was discharged to long-term care facilities, she noted.
After adjustment for relevant clinical covariants, patients with a high seizure burden (≥ 50 or > 90%) had a fourfold increase in odds of an unfavorable modified Rankin Scale score compared with those with no seizure burden.
High seizure burden present in the last quarter of the recording was particularly indicative of unfavorable outcomes (fivefold increased odds), “suggesting the critical timing of seizures and its impact on patient prognosis,” Dr. Desai noted.
‘Profound Implications’
“The implications of our research are profound, indicating a pivotal shift towards integrating AI and machine learning-guided automated EEG interpretation in management of critically ill patients with seizures,” she added.
“As we move forward, our research will concentrate on applying this advanced tool in clinical decision making in clinical practice, examining how it can steer treatment decisions for patients, with the ultimate goal of enhancing patient care and improving outcomes for those affected by these neurological challenges,” Dr. Desai said.
Briefing moderator Paul M. George, MD, PhD, chair of the AAN science committee, noted that this abstract was one of three featured at the “top science” press briefing themed “advancing the limits of neurologic care,” because it represents an “innovative method” of using new technology to improve understanding of neurologic conditions.
Dr. George said this technology “could be particularly useful in settings with few clinical specialists. It will be exciting to see as this unfolds, where it can guide maybe the ED doctor or primary care physician to help improve patient care.”
On that note, Dr. George cautioned that it’s still “early in the field” of using AI to guide decision-making and it will be important to gather more information to confirm that “machine learning algorithms can help guide physicians in treating patients with neurologic conditions.”
Funding for the study was provided by the University of Wisconsin-Madison and Ceribell, Inc. Dr. Desai received funding from Ceribell for this project. Dr. George has no relevant disclosures.
A version of this article appeared on Medscape.com.
DENVER —
After relevant cofactors were controlled for, higher seizure burden correlated with poorer functional outcomes. All of the patients in the study were being monitored as part of their standard of care owing to suspicion of seizures or because they were at risk for seizures, said study investigator Masoom Desai, MD, with the Department of Neurology, University of New Mexico, Albuquerque. The results were “compelling,” she said.
“Our study addresses the critical need for automation in monitoring epileptic activity and seizure burden,” Dr. Desai added during a press briefing at the 2024 annual meeting of the American Academy of Neurology (AAN).
A Pivotal Shift
“Several decades of research have highlighted the significant correlation between seizure burden and unfavorable outcomes both in adult and pediatric populations,” said Dr. Desai.
However, the traditional method of manually interpreting EEGs to identify seizures and their associated burden is a “complex and time-consuming process that can be subject to human error and variability,” she noted.
POC EEG is a rapid-access, reduced-montage EEG system that, when paired with an automated machine learning tool called Clarity (Ceribell, Inc; Sunnyvale, CA), can monitor and analyze seizure burden in real time.
The algorithm incorporates a comprehensive list of EEG features that have been associated with outcomes. It analyzes EEG activity every 10 seconds from all EEG channels and calculates a seizure burden in the past 5 minutes for the patient. The higher the seizure burden, the more time the patient has spent in seizure activity.
Among 344 people with POC EEG (mean age, 62 years, 45% women) in the SAFER-EEG trial, 178 (52%) had seizure burden of zero throughout the recording and 41 (12%) had suspected status epilepticus (maximum seizure burden ≥ 90%).
Before adjustment for clinical covariates, there was a significant association between high seizure burden and unfavorable outcomes.
Specifically, 76% of patients with a seizure burden of 50% or greater had an unfavorable modified Rankin Scale score of 4 or greater at discharge and a similar proportion was discharged to long-term care facilities, she noted.
After adjustment for relevant clinical covariants, patients with a high seizure burden (≥ 50 or > 90%) had a fourfold increase in odds of an unfavorable modified Rankin Scale score compared with those with no seizure burden.
High seizure burden present in the last quarter of the recording was particularly indicative of unfavorable outcomes (fivefold increased odds), “suggesting the critical timing of seizures and its impact on patient prognosis,” Dr. Desai noted.
‘Profound Implications’
“The implications of our research are profound, indicating a pivotal shift towards integrating AI and machine learning-guided automated EEG interpretation in management of critically ill patients with seizures,” she added.
“As we move forward, our research will concentrate on applying this advanced tool in clinical decision making in clinical practice, examining how it can steer treatment decisions for patients, with the ultimate goal of enhancing patient care and improving outcomes for those affected by these neurological challenges,” Dr. Desai said.
Briefing moderator Paul M. George, MD, PhD, chair of the AAN science committee, noted that this abstract was one of three featured at the “top science” press briefing themed “advancing the limits of neurologic care,” because it represents an “innovative method” of using new technology to improve understanding of neurologic conditions.
Dr. George said this technology “could be particularly useful in settings with few clinical specialists. It will be exciting to see as this unfolds, where it can guide maybe the ED doctor or primary care physician to help improve patient care.”
On that note, Dr. George cautioned that it’s still “early in the field” of using AI to guide decision-making and it will be important to gather more information to confirm that “machine learning algorithms can help guide physicians in treating patients with neurologic conditions.”
Funding for the study was provided by the University of Wisconsin-Madison and Ceribell, Inc. Dr. Desai received funding from Ceribell for this project. Dr. George has no relevant disclosures.
A version of this article appeared on Medscape.com.
DENVER —
After relevant cofactors were controlled for, higher seizure burden correlated with poorer functional outcomes. All of the patients in the study were being monitored as part of their standard of care owing to suspicion of seizures or because they were at risk for seizures, said study investigator Masoom Desai, MD, with the Department of Neurology, University of New Mexico, Albuquerque. The results were “compelling,” she said.
“Our study addresses the critical need for automation in monitoring epileptic activity and seizure burden,” Dr. Desai added during a press briefing at the 2024 annual meeting of the American Academy of Neurology (AAN).
A Pivotal Shift
“Several decades of research have highlighted the significant correlation between seizure burden and unfavorable outcomes both in adult and pediatric populations,” said Dr. Desai.
However, the traditional method of manually interpreting EEGs to identify seizures and their associated burden is a “complex and time-consuming process that can be subject to human error and variability,” she noted.
POC EEG is a rapid-access, reduced-montage EEG system that, when paired with an automated machine learning tool called Clarity (Ceribell, Inc; Sunnyvale, CA), can monitor and analyze seizure burden in real time.
The algorithm incorporates a comprehensive list of EEG features that have been associated with outcomes. It analyzes EEG activity every 10 seconds from all EEG channels and calculates a seizure burden in the past 5 minutes for the patient. The higher the seizure burden, the more time the patient has spent in seizure activity.
Among 344 people with POC EEG (mean age, 62 years, 45% women) in the SAFER-EEG trial, 178 (52%) had seizure burden of zero throughout the recording and 41 (12%) had suspected status epilepticus (maximum seizure burden ≥ 90%).
Before adjustment for clinical covariates, there was a significant association between high seizure burden and unfavorable outcomes.
Specifically, 76% of patients with a seizure burden of 50% or greater had an unfavorable modified Rankin Scale score of 4 or greater at discharge and a similar proportion was discharged to long-term care facilities, she noted.
After adjustment for relevant clinical covariants, patients with a high seizure burden (≥ 50 or > 90%) had a fourfold increase in odds of an unfavorable modified Rankin Scale score compared with those with no seizure burden.
High seizure burden present in the last quarter of the recording was particularly indicative of unfavorable outcomes (fivefold increased odds), “suggesting the critical timing of seizures and its impact on patient prognosis,” Dr. Desai noted.
‘Profound Implications’
“The implications of our research are profound, indicating a pivotal shift towards integrating AI and machine learning-guided automated EEG interpretation in management of critically ill patients with seizures,” she added.
“As we move forward, our research will concentrate on applying this advanced tool in clinical decision making in clinical practice, examining how it can steer treatment decisions for patients, with the ultimate goal of enhancing patient care and improving outcomes for those affected by these neurological challenges,” Dr. Desai said.
Briefing moderator Paul M. George, MD, PhD, chair of the AAN science committee, noted that this abstract was one of three featured at the “top science” press briefing themed “advancing the limits of neurologic care,” because it represents an “innovative method” of using new technology to improve understanding of neurologic conditions.
Dr. George said this technology “could be particularly useful in settings with few clinical specialists. It will be exciting to see as this unfolds, where it can guide maybe the ED doctor or primary care physician to help improve patient care.”
On that note, Dr. George cautioned that it’s still “early in the field” of using AI to guide decision-making and it will be important to gather more information to confirm that “machine learning algorithms can help guide physicians in treating patients with neurologic conditions.”
Funding for the study was provided by the University of Wisconsin-Madison and Ceribell, Inc. Dr. Desai received funding from Ceribell for this project. Dr. George has no relevant disclosures.
A version of this article appeared on Medscape.com.
FROM AAN 2024
Probiotic–Vitamin D Combo May Boost Cognition in Schizophrenia
Co-administration of a probiotic and vitamin D significantly improved cognitive function in patients with schizophrenia, results from a double-blind randomized controlled trial suggested.
The combination also led to favorable changes in total cholesterol, fasting blood sugar, and a marker of inflammation.
“Targeting the microbiota-gut-brain axis with probiotic and vitamin D might provide a novel approach to promote mental health,” investigators led by Gita Sadighi, MD, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, wrote.
The study was published online in Neuropsychopharmacology Reports.
Cognitive Boost
The research includes data on 70 adults with schizophrenia who were on stable antipsychotic medication for at least 6 months. Half took a capsule containing five different probiotic strains plus 400 IU of vitamin D daily for 12 weeks, and half took a matching placebo capsule.
Primary outcomes were disease severity and cognitive function, measured at baseline, every 2 weeks during the trial, and again at the end of the study. Measurement tools included the Positive and Negative Syndrome Scale (PANSS) for disease severity and the 30-point Montreal Cognitive Assessment (MoCA) for cognitive function.
Secondary outcomes were lipid profile, body mass index, gastrointestinal problems, serum C-reactive protein (CRP), and erythrocyte sedimentation rate.
A total of 69 patients completed the trial, and no adverse effects were observed during the study period.
The marginal mean MoCA score increased by 1.96 units in the probiotic/vitamin D group compared with the placebo group during the study period, indicating significant improvement in cognitive function (P = .004).
In addition, the percentage of patients with a MoCA score of ≥ 26 (indicating normal cognition) increased significantly in the supplement group (P = .031), while there were no significant changes in the placebo group (P = .625).
The probiotic/vitamin D supplement was associated with a reduction in the PANSS score by 2.82 units compared with placebo, but the difference between groups was not statistically significant (P = .247).
The supplement group also saw a significant decrease in total cholesterol (P = .011), fasting blood sugar (P = .009), and CRP (P < .001).
Promising ‘Suggestive’ Evidence
Reached for comment, Roger McIntyre, MD, professor of psychiatry and pharmacology and head of the Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, Ontario, Canada, told this news organization that people living with schizophrenia have “significant impairment in general cognitive functions that can be debilitating and impair quality of life.”
This study provides “suggestive evidence” that the combination of probiotics and vitamin D is safe and effective in the treatment of cognitive dysfunction and “provides hope for persons with the lived experience. However, larger rigorous randomized control trials are needed to confirm these findings,” said Dr. McIntyre, who was not part of the study.
Also weighing in, Christopher M. Palmer, MD, assistant professor of psychiatry at Harvard Medical School in Boston, Massachusetts, noted that many researchers are focusing on the gut-brain connection and its role in a range of neuropsychiatric disorders, including schizophrenia.
“The gut microbiome appears to play a role in a range of factors that can impact brain function, including levels of inflammation, blood sugar, insulin signaling, and neurotransmitter production within the digestive tract,” said Dr. Palmer, who was not involved in the trial. “All of these factors can impact the brain, and in particular, brain metabolism, which increasingly is thought to play a key role in schizophrenia and other neuropsychiatric conditions.”
The new study builds on prior work in important ways, Dr. Palmer added. For example, he noted, earlier research did not show a benefit of probiotics alone.
“One of the challenges with probiotic research is the type of probiotic used. There are single-strain versions and multi-strain versions,” Dr. Palmer said. “This study used a probiotic containing five different bacterial species, so it’s possible that prior studies didn’t use the ideal type of probiotic. Combining the probiotic with vitamin D may also play a critical role.”
The new work replicates findings from a 2019 study in people with schizophrenia who received a four-strain probiotic plus vitamin D or a placebo for 12 weeks, he noted.
“The patients who got the probiotic plus vitamin D experienced improvement in psychiatric symptoms and improvement in three of the same biomarkers used in this study (reductions in total cholesterol, fasting blood sugar, and CRP),” Dr. Palmer said.
Like Dr. McIntyre, Dr. Palmer noted that larger clinical trials are needed before a treatment recommendation can be made.
“We also need to better understand which probiotics to use and the optimal dose of vitamin D supplementation,” he said. “In the meantime, however, patients may want to discuss this research with their clinicians to see if this might be something to consider in their own treatment.”
The study had no funding source. The authors and Dr. McIntyre had no relevant disclosures. Dr. Palmer is the author of the book Brain Energy published by Penguin Random House.
A version of this article appeared on Medscape.com.
Co-administration of a probiotic and vitamin D significantly improved cognitive function in patients with schizophrenia, results from a double-blind randomized controlled trial suggested.
The combination also led to favorable changes in total cholesterol, fasting blood sugar, and a marker of inflammation.
“Targeting the microbiota-gut-brain axis with probiotic and vitamin D might provide a novel approach to promote mental health,” investigators led by Gita Sadighi, MD, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, wrote.
The study was published online in Neuropsychopharmacology Reports.
Cognitive Boost
The research includes data on 70 adults with schizophrenia who were on stable antipsychotic medication for at least 6 months. Half took a capsule containing five different probiotic strains plus 400 IU of vitamin D daily for 12 weeks, and half took a matching placebo capsule.
Primary outcomes were disease severity and cognitive function, measured at baseline, every 2 weeks during the trial, and again at the end of the study. Measurement tools included the Positive and Negative Syndrome Scale (PANSS) for disease severity and the 30-point Montreal Cognitive Assessment (MoCA) for cognitive function.
Secondary outcomes were lipid profile, body mass index, gastrointestinal problems, serum C-reactive protein (CRP), and erythrocyte sedimentation rate.
A total of 69 patients completed the trial, and no adverse effects were observed during the study period.
The marginal mean MoCA score increased by 1.96 units in the probiotic/vitamin D group compared with the placebo group during the study period, indicating significant improvement in cognitive function (P = .004).
In addition, the percentage of patients with a MoCA score of ≥ 26 (indicating normal cognition) increased significantly in the supplement group (P = .031), while there were no significant changes in the placebo group (P = .625).
The probiotic/vitamin D supplement was associated with a reduction in the PANSS score by 2.82 units compared with placebo, but the difference between groups was not statistically significant (P = .247).
The supplement group also saw a significant decrease in total cholesterol (P = .011), fasting blood sugar (P = .009), and CRP (P < .001).
Promising ‘Suggestive’ Evidence
Reached for comment, Roger McIntyre, MD, professor of psychiatry and pharmacology and head of the Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, Ontario, Canada, told this news organization that people living with schizophrenia have “significant impairment in general cognitive functions that can be debilitating and impair quality of life.”
This study provides “suggestive evidence” that the combination of probiotics and vitamin D is safe and effective in the treatment of cognitive dysfunction and “provides hope for persons with the lived experience. However, larger rigorous randomized control trials are needed to confirm these findings,” said Dr. McIntyre, who was not part of the study.
Also weighing in, Christopher M. Palmer, MD, assistant professor of psychiatry at Harvard Medical School in Boston, Massachusetts, noted that many researchers are focusing on the gut-brain connection and its role in a range of neuropsychiatric disorders, including schizophrenia.
“The gut microbiome appears to play a role in a range of factors that can impact brain function, including levels of inflammation, blood sugar, insulin signaling, and neurotransmitter production within the digestive tract,” said Dr. Palmer, who was not involved in the trial. “All of these factors can impact the brain, and in particular, brain metabolism, which increasingly is thought to play a key role in schizophrenia and other neuropsychiatric conditions.”
The new study builds on prior work in important ways, Dr. Palmer added. For example, he noted, earlier research did not show a benefit of probiotics alone.
“One of the challenges with probiotic research is the type of probiotic used. There are single-strain versions and multi-strain versions,” Dr. Palmer said. “This study used a probiotic containing five different bacterial species, so it’s possible that prior studies didn’t use the ideal type of probiotic. Combining the probiotic with vitamin D may also play a critical role.”
The new work replicates findings from a 2019 study in people with schizophrenia who received a four-strain probiotic plus vitamin D or a placebo for 12 weeks, he noted.
“The patients who got the probiotic plus vitamin D experienced improvement in psychiatric symptoms and improvement in three of the same biomarkers used in this study (reductions in total cholesterol, fasting blood sugar, and CRP),” Dr. Palmer said.
Like Dr. McIntyre, Dr. Palmer noted that larger clinical trials are needed before a treatment recommendation can be made.
“We also need to better understand which probiotics to use and the optimal dose of vitamin D supplementation,” he said. “In the meantime, however, patients may want to discuss this research with their clinicians to see if this might be something to consider in their own treatment.”
The study had no funding source. The authors and Dr. McIntyre had no relevant disclosures. Dr. Palmer is the author of the book Brain Energy published by Penguin Random House.
A version of this article appeared on Medscape.com.
Co-administration of a probiotic and vitamin D significantly improved cognitive function in patients with schizophrenia, results from a double-blind randomized controlled trial suggested.
The combination also led to favorable changes in total cholesterol, fasting blood sugar, and a marker of inflammation.
“Targeting the microbiota-gut-brain axis with probiotic and vitamin D might provide a novel approach to promote mental health,” investigators led by Gita Sadighi, MD, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran, wrote.
The study was published online in Neuropsychopharmacology Reports.
Cognitive Boost
The research includes data on 70 adults with schizophrenia who were on stable antipsychotic medication for at least 6 months. Half took a capsule containing five different probiotic strains plus 400 IU of vitamin D daily for 12 weeks, and half took a matching placebo capsule.
Primary outcomes were disease severity and cognitive function, measured at baseline, every 2 weeks during the trial, and again at the end of the study. Measurement tools included the Positive and Negative Syndrome Scale (PANSS) for disease severity and the 30-point Montreal Cognitive Assessment (MoCA) for cognitive function.
Secondary outcomes were lipid profile, body mass index, gastrointestinal problems, serum C-reactive protein (CRP), and erythrocyte sedimentation rate.
A total of 69 patients completed the trial, and no adverse effects were observed during the study period.
The marginal mean MoCA score increased by 1.96 units in the probiotic/vitamin D group compared with the placebo group during the study period, indicating significant improvement in cognitive function (P = .004).
In addition, the percentage of patients with a MoCA score of ≥ 26 (indicating normal cognition) increased significantly in the supplement group (P = .031), while there were no significant changes in the placebo group (P = .625).
The probiotic/vitamin D supplement was associated with a reduction in the PANSS score by 2.82 units compared with placebo, but the difference between groups was not statistically significant (P = .247).
The supplement group also saw a significant decrease in total cholesterol (P = .011), fasting blood sugar (P = .009), and CRP (P < .001).
Promising ‘Suggestive’ Evidence
Reached for comment, Roger McIntyre, MD, professor of psychiatry and pharmacology and head of the Mood Disorders Psychopharmacology Unit, University of Toronto, Toronto, Ontario, Canada, told this news organization that people living with schizophrenia have “significant impairment in general cognitive functions that can be debilitating and impair quality of life.”
This study provides “suggestive evidence” that the combination of probiotics and vitamin D is safe and effective in the treatment of cognitive dysfunction and “provides hope for persons with the lived experience. However, larger rigorous randomized control trials are needed to confirm these findings,” said Dr. McIntyre, who was not part of the study.
Also weighing in, Christopher M. Palmer, MD, assistant professor of psychiatry at Harvard Medical School in Boston, Massachusetts, noted that many researchers are focusing on the gut-brain connection and its role in a range of neuropsychiatric disorders, including schizophrenia.
“The gut microbiome appears to play a role in a range of factors that can impact brain function, including levels of inflammation, blood sugar, insulin signaling, and neurotransmitter production within the digestive tract,” said Dr. Palmer, who was not involved in the trial. “All of these factors can impact the brain, and in particular, brain metabolism, which increasingly is thought to play a key role in schizophrenia and other neuropsychiatric conditions.”
The new study builds on prior work in important ways, Dr. Palmer added. For example, he noted, earlier research did not show a benefit of probiotics alone.
“One of the challenges with probiotic research is the type of probiotic used. There are single-strain versions and multi-strain versions,” Dr. Palmer said. “This study used a probiotic containing five different bacterial species, so it’s possible that prior studies didn’t use the ideal type of probiotic. Combining the probiotic with vitamin D may also play a critical role.”
The new work replicates findings from a 2019 study in people with schizophrenia who received a four-strain probiotic plus vitamin D or a placebo for 12 weeks, he noted.
“The patients who got the probiotic plus vitamin D experienced improvement in psychiatric symptoms and improvement in three of the same biomarkers used in this study (reductions in total cholesterol, fasting blood sugar, and CRP),” Dr. Palmer said.
Like Dr. McIntyre, Dr. Palmer noted that larger clinical trials are needed before a treatment recommendation can be made.
“We also need to better understand which probiotics to use and the optimal dose of vitamin D supplementation,” he said. “In the meantime, however, patients may want to discuss this research with their clinicians to see if this might be something to consider in their own treatment.”
The study had no funding source. The authors and Dr. McIntyre had no relevant disclosures. Dr. Palmer is the author of the book Brain Energy published by Penguin Random House.
A version of this article appeared on Medscape.com.
FROM NEUROPSYCHOPHARMACOLOGY REPORTS
Vocal Biomarkers a Tell for Mental Health Status?
A smartphone-based tool that tracks mental health status by detecting changes in voice may complement traditional psychiatric assessments and improve an individual’s ability to self-monitor depressive and other mental health symptoms, new research suggested.
Investigators used the Mental Fitness Vocal Biomarker (MFVB) scoring algorithm, which is incorporated into a smartphone voice journaling application, to detect increased or decreased risk for elevated mental health symptom severity by analyzing 30-second free speech voice recordings for specific vocal patterns previously linked to mental health.
“While the MFVB tool is not intended to diagnose or treat mental health conditions, these findings provide a robust initial foundation upon which to further explore its potential in personalized wellness tracking, which has so far not yet been able to extend measurement of physical health to mental wellbeing,” reported the researchers, led by Erik Larsen, PhD, with Boston-based Sonde Health, which developed the tool.
The study was published online in Frontiers in Psychiatry.
Eight Vocal Features
The potential value of vocal biomarkers for mental health assessment has gained increasing attention.
“Somebody that is depressed often sounds more monotone; they may have less inflection in their voice and speak slower with less energy, which can be recognized in voice recordings,” Dr. Larsen told this news organization.
“This is an area which has received quite a bit of research in the last few decades to find out what specific aspects of acoustics and rhythm of speech could point to conditions like depression,” Dr. Larsen said.
In the current study, the researchers set out to validate the ability of the MFVB platform to detect mental health symptoms.
With the tool, users record their thoughts and feelings as a 30-second voice journal. The tool analyzes the recordings for eight vocal features previously shown to be relevant to mental health. These include jitter, shimmer, pitch variability, energy variability, vowel space, phonation duration, speech rate, and pause duration.
The tool calculates a real-time MFVB score ranging from 0 to 100. A score of 80-100 is defined as “excellent” and 70-79 as “good,” while a score of 0-69 is categorized as “pay attention.” It was trained on more than 1 million voice samples to optimize performance across a diverse range of cultures, languages, and socioeconomic groups.
The current study included 104 outpatient psychiatric patients (73% women) with anxiety-related diagnoses, trauma, and stress-related disorders or depressive disorders. The cohort was mostly made up of White, non-Hispanic young adults. Patients with a history of substance abuse or who were taking psychiatric medications that may affect voice and speech were excluded.
During the 4-week study period, participants conducted 1336 app sessions with voice recordings, resulting in an average of 12.8 sessions per participant, or 3.2 per week.
MFVB scores were cross-referenced against the results of participants’ M3 Checklist, a clinically validated mental health assessment tool.
Over a period of 2 weeks, participants were twice as likely to report elevated mental health symptoms if their MFVB scores remained in the “pay attention” range vs in the “excellent” range, the researchers found.
The effect was more pronounced in those who used the app more frequently, with frequent users 8.5 times more likely to show elevated symptoms.
The correlation between MFVB scores and established mental health assessments was “not only statistically significant but also meaningful for participants,” researchers wrote. Subgroup analyses suggest the app works best for depression and stress- and trauma-related disorders.
The tool provides psychiatric outpatients with “immediate quantitative feedback on their mental health symptom severity,” the researchers noted.
In their paper, the investigators caution that the results highlight the “general ability” of MFVB score categories to differentiate mental health symptom severity levels but do not distinguish what type of symptoms these may be, such as depression, anxiety, or posttraumatic stress disorder.
In a statement, study investigator Lindsey Venesky, PhD, psychologist and clinical director at the Cognitive Behavior Institute in Pittsburgh, noted that the ability to collect mental health data from patients between clinic visits “could transform how we monitor symptoms and optimize treatment plans.”
“Voice-based health tracking technology can provide accurate insights into a client’s mental health status over time and can do so seamlessly and unobtrusively, with little added effort for clients,” Dr. Venesky said.
Need for Replication, Validation
Commenting on the findings, John Torous, MD, director of the division of digital psychiatry at Beth Israel Deaconess Medical Center, Boston, noted that “over the last 20 years, there has been a lot of interest in voice biomarkers, yet somehow that research has never been translated into mainstream clinical care.”
Voice biomarkers are “relevant and have potential” in mental health, he noted. The findings in this study are “interesting, but they need to be thoroughly externally replicated and validated to show that these biomarkers are valid and reliable,” Dr. Torous added.
Changes in voice are part of the mental status exam, Dr. Torous said, “but it’s only one piece of information that we collect in a clinical assessment of many pieces of information.”
Dr. Torous also cautioned that “as a practicing psychiatrist, it can be tricky to be given new data if you don’t know how to interpret it or what it means. An important step would be education, outreach, and resources for physicians to learn about potential voice biomarkers.”
The authors received internal financial support for the research, authorship, and/or publication of this article. The pilot phase of the study at St. Joseph’s Healthcare Hamilton was partially supported through Mitacs Accelerate International, Canada. Dr. Larsen and three coauthors are employed by Sonde Health. Dr. Torous had no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
A smartphone-based tool that tracks mental health status by detecting changes in voice may complement traditional psychiatric assessments and improve an individual’s ability to self-monitor depressive and other mental health symptoms, new research suggested.
Investigators used the Mental Fitness Vocal Biomarker (MFVB) scoring algorithm, which is incorporated into a smartphone voice journaling application, to detect increased or decreased risk for elevated mental health symptom severity by analyzing 30-second free speech voice recordings for specific vocal patterns previously linked to mental health.
“While the MFVB tool is not intended to diagnose or treat mental health conditions, these findings provide a robust initial foundation upon which to further explore its potential in personalized wellness tracking, which has so far not yet been able to extend measurement of physical health to mental wellbeing,” reported the researchers, led by Erik Larsen, PhD, with Boston-based Sonde Health, which developed the tool.
The study was published online in Frontiers in Psychiatry.
Eight Vocal Features
The potential value of vocal biomarkers for mental health assessment has gained increasing attention.
“Somebody that is depressed often sounds more monotone; they may have less inflection in their voice and speak slower with less energy, which can be recognized in voice recordings,” Dr. Larsen told this news organization.
“This is an area which has received quite a bit of research in the last few decades to find out what specific aspects of acoustics and rhythm of speech could point to conditions like depression,” Dr. Larsen said.
In the current study, the researchers set out to validate the ability of the MFVB platform to detect mental health symptoms.
With the tool, users record their thoughts and feelings as a 30-second voice journal. The tool analyzes the recordings for eight vocal features previously shown to be relevant to mental health. These include jitter, shimmer, pitch variability, energy variability, vowel space, phonation duration, speech rate, and pause duration.
The tool calculates a real-time MFVB score ranging from 0 to 100. A score of 80-100 is defined as “excellent” and 70-79 as “good,” while a score of 0-69 is categorized as “pay attention.” It was trained on more than 1 million voice samples to optimize performance across a diverse range of cultures, languages, and socioeconomic groups.
The current study included 104 outpatient psychiatric patients (73% women) with anxiety-related diagnoses, trauma, and stress-related disorders or depressive disorders. The cohort was mostly made up of White, non-Hispanic young adults. Patients with a history of substance abuse or who were taking psychiatric medications that may affect voice and speech were excluded.
During the 4-week study period, participants conducted 1336 app sessions with voice recordings, resulting in an average of 12.8 sessions per participant, or 3.2 per week.
MFVB scores were cross-referenced against the results of participants’ M3 Checklist, a clinically validated mental health assessment tool.
Over a period of 2 weeks, participants were twice as likely to report elevated mental health symptoms if their MFVB scores remained in the “pay attention” range vs in the “excellent” range, the researchers found.
The effect was more pronounced in those who used the app more frequently, with frequent users 8.5 times more likely to show elevated symptoms.
The correlation between MFVB scores and established mental health assessments was “not only statistically significant but also meaningful for participants,” researchers wrote. Subgroup analyses suggest the app works best for depression and stress- and trauma-related disorders.
The tool provides psychiatric outpatients with “immediate quantitative feedback on their mental health symptom severity,” the researchers noted.
In their paper, the investigators caution that the results highlight the “general ability” of MFVB score categories to differentiate mental health symptom severity levels but do not distinguish what type of symptoms these may be, such as depression, anxiety, or posttraumatic stress disorder.
In a statement, study investigator Lindsey Venesky, PhD, psychologist and clinical director at the Cognitive Behavior Institute in Pittsburgh, noted that the ability to collect mental health data from patients between clinic visits “could transform how we monitor symptoms and optimize treatment plans.”
“Voice-based health tracking technology can provide accurate insights into a client’s mental health status over time and can do so seamlessly and unobtrusively, with little added effort for clients,” Dr. Venesky said.
Need for Replication, Validation
Commenting on the findings, John Torous, MD, director of the division of digital psychiatry at Beth Israel Deaconess Medical Center, Boston, noted that “over the last 20 years, there has been a lot of interest in voice biomarkers, yet somehow that research has never been translated into mainstream clinical care.”
Voice biomarkers are “relevant and have potential” in mental health, he noted. The findings in this study are “interesting, but they need to be thoroughly externally replicated and validated to show that these biomarkers are valid and reliable,” Dr. Torous added.
Changes in voice are part of the mental status exam, Dr. Torous said, “but it’s only one piece of information that we collect in a clinical assessment of many pieces of information.”
Dr. Torous also cautioned that “as a practicing psychiatrist, it can be tricky to be given new data if you don’t know how to interpret it or what it means. An important step would be education, outreach, and resources for physicians to learn about potential voice biomarkers.”
The authors received internal financial support for the research, authorship, and/or publication of this article. The pilot phase of the study at St. Joseph’s Healthcare Hamilton was partially supported through Mitacs Accelerate International, Canada. Dr. Larsen and three coauthors are employed by Sonde Health. Dr. Torous had no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
A smartphone-based tool that tracks mental health status by detecting changes in voice may complement traditional psychiatric assessments and improve an individual’s ability to self-monitor depressive and other mental health symptoms, new research suggested.
Investigators used the Mental Fitness Vocal Biomarker (MFVB) scoring algorithm, which is incorporated into a smartphone voice journaling application, to detect increased or decreased risk for elevated mental health symptom severity by analyzing 30-second free speech voice recordings for specific vocal patterns previously linked to mental health.
“While the MFVB tool is not intended to diagnose or treat mental health conditions, these findings provide a robust initial foundation upon which to further explore its potential in personalized wellness tracking, which has so far not yet been able to extend measurement of physical health to mental wellbeing,” reported the researchers, led by Erik Larsen, PhD, with Boston-based Sonde Health, which developed the tool.
The study was published online in Frontiers in Psychiatry.
Eight Vocal Features
The potential value of vocal biomarkers for mental health assessment has gained increasing attention.
“Somebody that is depressed often sounds more monotone; they may have less inflection in their voice and speak slower with less energy, which can be recognized in voice recordings,” Dr. Larsen told this news organization.
“This is an area which has received quite a bit of research in the last few decades to find out what specific aspects of acoustics and rhythm of speech could point to conditions like depression,” Dr. Larsen said.
In the current study, the researchers set out to validate the ability of the MFVB platform to detect mental health symptoms.
With the tool, users record their thoughts and feelings as a 30-second voice journal. The tool analyzes the recordings for eight vocal features previously shown to be relevant to mental health. These include jitter, shimmer, pitch variability, energy variability, vowel space, phonation duration, speech rate, and pause duration.
The tool calculates a real-time MFVB score ranging from 0 to 100. A score of 80-100 is defined as “excellent” and 70-79 as “good,” while a score of 0-69 is categorized as “pay attention.” It was trained on more than 1 million voice samples to optimize performance across a diverse range of cultures, languages, and socioeconomic groups.
The current study included 104 outpatient psychiatric patients (73% women) with anxiety-related diagnoses, trauma, and stress-related disorders or depressive disorders. The cohort was mostly made up of White, non-Hispanic young adults. Patients with a history of substance abuse or who were taking psychiatric medications that may affect voice and speech were excluded.
During the 4-week study period, participants conducted 1336 app sessions with voice recordings, resulting in an average of 12.8 sessions per participant, or 3.2 per week.
MFVB scores were cross-referenced against the results of participants’ M3 Checklist, a clinically validated mental health assessment tool.
Over a period of 2 weeks, participants were twice as likely to report elevated mental health symptoms if their MFVB scores remained in the “pay attention” range vs in the “excellent” range, the researchers found.
The effect was more pronounced in those who used the app more frequently, with frequent users 8.5 times more likely to show elevated symptoms.
The correlation between MFVB scores and established mental health assessments was “not only statistically significant but also meaningful for participants,” researchers wrote. Subgroup analyses suggest the app works best for depression and stress- and trauma-related disorders.
The tool provides psychiatric outpatients with “immediate quantitative feedback on their mental health symptom severity,” the researchers noted.
In their paper, the investigators caution that the results highlight the “general ability” of MFVB score categories to differentiate mental health symptom severity levels but do not distinguish what type of symptoms these may be, such as depression, anxiety, or posttraumatic stress disorder.
In a statement, study investigator Lindsey Venesky, PhD, psychologist and clinical director at the Cognitive Behavior Institute in Pittsburgh, noted that the ability to collect mental health data from patients between clinic visits “could transform how we monitor symptoms and optimize treatment plans.”
“Voice-based health tracking technology can provide accurate insights into a client’s mental health status over time and can do so seamlessly and unobtrusively, with little added effort for clients,” Dr. Venesky said.
Need for Replication, Validation
Commenting on the findings, John Torous, MD, director of the division of digital psychiatry at Beth Israel Deaconess Medical Center, Boston, noted that “over the last 20 years, there has been a lot of interest in voice biomarkers, yet somehow that research has never been translated into mainstream clinical care.”
Voice biomarkers are “relevant and have potential” in mental health, he noted. The findings in this study are “interesting, but they need to be thoroughly externally replicated and validated to show that these biomarkers are valid and reliable,” Dr. Torous added.
Changes in voice are part of the mental status exam, Dr. Torous said, “but it’s only one piece of information that we collect in a clinical assessment of many pieces of information.”
Dr. Torous also cautioned that “as a practicing psychiatrist, it can be tricky to be given new data if you don’t know how to interpret it or what it means. An important step would be education, outreach, and resources for physicians to learn about potential voice biomarkers.”
The authors received internal financial support for the research, authorship, and/or publication of this article. The pilot phase of the study at St. Joseph’s Healthcare Hamilton was partially supported through Mitacs Accelerate International, Canada. Dr. Larsen and three coauthors are employed by Sonde Health. Dr. Torous had no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
Infant Microbiome Development Minimally Affected by Diet, but Metabolite Profiles Differ
TOPLINE:
Diet has only a marginal impact on microbiome development in infancy, although metabolite profiles differ between breast- and formula-fed infants; circadian rhythm of the gut microbiome is detectable as early as 2 weeks after birth.
METHODOLOGY:
- A randomized, controlled interventional trial compared microbiota development in 210 newborns who were exclusively breastfed or received one of four formulas: Un-supplemented formula, Bifidobacterium-supplemented formula, galacto-oligosaccharide (GOS)-supplemented, or formula containing GOSs and bifidobacteria. Exclusively breastfed infants served as a reference group to evaluate the impact of infant formula feeding.
- Researchers tracked the infants’ microbiota and metabolite profiles in response to the different feeding modes via stool samples collected periodically during the first 1-2 years of life.
- They also made note of the time of day that the stool sample was collected to assess 24-hour oscillations of the microbiome in relation to dietary exposure.
TAKEAWAY:
- Global microbiota assembly of infants is primarily affected by age and less so by diet. All infants showed a gradual increase in gut microbe diversity, and at 24 months, there was no observable difference between the groups.
- However, gut metabolite profiles differed significantly between exclusively formula-fed and exclusively breastfed infants. None of the supplemented formulas were able to fully recreate the breast milk-related microbial environment.
- GOS-supplemented formula was more effective at promoting sustained levels of bifidobacteria than formula containing bifidobacteria.
- Metabolic and bacterial profiling revealed 24-hour fluctuations and circadian networks as early as 2 weeks after birth. Infant microbes maintained circadian rhythms when grown in continuous culture, even in the absence of external light or host cues, suggesting an intrinsic clock mechanism in bacteria.
IN PRACTICE:
“Our findings warrant the need for further analysis of circadian fluctuations of both bacteria and metabolites and their functional role in contributing to the benefits of infant nutrition,” the study authors wrote.
SOURCE:
The study was published online April 2 in Cell Host & Microbe.
LIMITATIONS:
The group size for exclusively formula-fed infants was limited, and the explicit contribution of breast milk, relative to infant formula, to bacterial rhythms remains unclear. A possible limitation of the circadian analysis is that the number of fecal samples collected during the night was lower than during the daytime and decreased with age.
DISCLOSURES:
This research was supported by Töpfer GmbH, the German Research Foundation, the Joint Programming Initiative of the European Union, and the German Ministry of Education and Research. The authors had disclosed no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
Diet has only a marginal impact on microbiome development in infancy, although metabolite profiles differ between breast- and formula-fed infants; circadian rhythm of the gut microbiome is detectable as early as 2 weeks after birth.
METHODOLOGY:
- A randomized, controlled interventional trial compared microbiota development in 210 newborns who were exclusively breastfed or received one of four formulas: Un-supplemented formula, Bifidobacterium-supplemented formula, galacto-oligosaccharide (GOS)-supplemented, or formula containing GOSs and bifidobacteria. Exclusively breastfed infants served as a reference group to evaluate the impact of infant formula feeding.
- Researchers tracked the infants’ microbiota and metabolite profiles in response to the different feeding modes via stool samples collected periodically during the first 1-2 years of life.
- They also made note of the time of day that the stool sample was collected to assess 24-hour oscillations of the microbiome in relation to dietary exposure.
TAKEAWAY:
- Global microbiota assembly of infants is primarily affected by age and less so by diet. All infants showed a gradual increase in gut microbe diversity, and at 24 months, there was no observable difference between the groups.
- However, gut metabolite profiles differed significantly between exclusively formula-fed and exclusively breastfed infants. None of the supplemented formulas were able to fully recreate the breast milk-related microbial environment.
- GOS-supplemented formula was more effective at promoting sustained levels of bifidobacteria than formula containing bifidobacteria.
- Metabolic and bacterial profiling revealed 24-hour fluctuations and circadian networks as early as 2 weeks after birth. Infant microbes maintained circadian rhythms when grown in continuous culture, even in the absence of external light or host cues, suggesting an intrinsic clock mechanism in bacteria.
IN PRACTICE:
“Our findings warrant the need for further analysis of circadian fluctuations of both bacteria and metabolites and their functional role in contributing to the benefits of infant nutrition,” the study authors wrote.
SOURCE:
The study was published online April 2 in Cell Host & Microbe.
LIMITATIONS:
The group size for exclusively formula-fed infants was limited, and the explicit contribution of breast milk, relative to infant formula, to bacterial rhythms remains unclear. A possible limitation of the circadian analysis is that the number of fecal samples collected during the night was lower than during the daytime and decreased with age.
DISCLOSURES:
This research was supported by Töpfer GmbH, the German Research Foundation, the Joint Programming Initiative of the European Union, and the German Ministry of Education and Research. The authors had disclosed no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
TOPLINE:
Diet has only a marginal impact on microbiome development in infancy, although metabolite profiles differ between breast- and formula-fed infants; circadian rhythm of the gut microbiome is detectable as early as 2 weeks after birth.
METHODOLOGY:
- A randomized, controlled interventional trial compared microbiota development in 210 newborns who were exclusively breastfed or received one of four formulas: Un-supplemented formula, Bifidobacterium-supplemented formula, galacto-oligosaccharide (GOS)-supplemented, or formula containing GOSs and bifidobacteria. Exclusively breastfed infants served as a reference group to evaluate the impact of infant formula feeding.
- Researchers tracked the infants’ microbiota and metabolite profiles in response to the different feeding modes via stool samples collected periodically during the first 1-2 years of life.
- They also made note of the time of day that the stool sample was collected to assess 24-hour oscillations of the microbiome in relation to dietary exposure.
TAKEAWAY:
- Global microbiota assembly of infants is primarily affected by age and less so by diet. All infants showed a gradual increase in gut microbe diversity, and at 24 months, there was no observable difference between the groups.
- However, gut metabolite profiles differed significantly between exclusively formula-fed and exclusively breastfed infants. None of the supplemented formulas were able to fully recreate the breast milk-related microbial environment.
- GOS-supplemented formula was more effective at promoting sustained levels of bifidobacteria than formula containing bifidobacteria.
- Metabolic and bacterial profiling revealed 24-hour fluctuations and circadian networks as early as 2 weeks after birth. Infant microbes maintained circadian rhythms when grown in continuous culture, even in the absence of external light or host cues, suggesting an intrinsic clock mechanism in bacteria.
IN PRACTICE:
“Our findings warrant the need for further analysis of circadian fluctuations of both bacteria and metabolites and their functional role in contributing to the benefits of infant nutrition,” the study authors wrote.
SOURCE:
The study was published online April 2 in Cell Host & Microbe.
LIMITATIONS:
The group size for exclusively formula-fed infants was limited, and the explicit contribution of breast milk, relative to infant formula, to bacterial rhythms remains unclear. A possible limitation of the circadian analysis is that the number of fecal samples collected during the night was lower than during the daytime and decreased with age.
DISCLOSURES:
This research was supported by Töpfer GmbH, the German Research Foundation, the Joint Programming Initiative of the European Union, and the German Ministry of Education and Research. The authors had disclosed no relevant conflicts of interest.
A version of this article appeared on Medscape.com.
Oncologists Voice Ethical Concerns Over AI in Cancer Care
TOPLINE:
Most respondents, for instance, said patients should not be expected to understand how AI tools work, but many also felt patients could make treatment decisions based on AI-generated recommendations. Most oncologists also felt responsible for protecting patients from biased AI, but few were confident that they could do so.
METHODOLOGY:
- The US Food and Drug Administration (FDA) has for use in various medical specialties over the past few decades, and increasingly, AI tools are being integrated into cancer care.
- However, the uptake of these tools in oncology has raised ethical questions and concerns, including challenges with AI bias, error, or misuse, as well as issues explaining how an AI model reached a result.
- In the current study, researchers asked 204 oncologists from 37 states for their views on the ethical implications of using AI for cancer care.
- Among the survey respondents, 64% were men and 63% were non-Hispanic White; 29% were from academic practices, 47% had received some education on AI use in healthcare, and 45% were familiar with clinical decision models.
- The researchers assessed respondents’ answers to various questions, including whether to provide informed consent for AI use and how oncologists would approach a scenario where the AI model and the oncologist recommended a different treatment regimen.
TAKEAWAY:
- Overall, 81% of oncologists supported having patient consent to use an AI model during treatment decisions, and 85% felt that oncologists needed to be able to explain an AI-based clinical decision model to use it in the clinic; however, only 23% felt that patients also needed to be able to explain an AI model.
- When an AI decision model recommended a different treatment regimen than the treating oncologist, the most common response (36.8%) was to present both options to the patient and let the patient decide. Oncologists from academic settings were about 2.5 times more likely than those from other settings to let the patient decide. About 34% of respondents said they would present both options but recommend the oncologist’s regimen, whereas about 22% said they would present both but recommend the AI’s regimen. A small percentage would only present the oncologist’s regimen (5%) or the AI’s regimen (about 2.5%).
- About three of four respondents (76.5%) agreed that oncologists should protect patients from biased AI tools; however, only about one of four (27.9%) felt confident they could identify biased AI models.
- Most oncologists (91%) felt that AI developers were responsible for the medico-legal problems associated with AI use; less than half (47%) said oncologists or hospitals (43%) shared this responsibility.
IN PRACTICE:
“Together, these data characterize barriers that may impede the ethical adoption of AI into cancer care. The findings suggest that the implementation of AI in oncology must include rigorous assessments of its effect on care decisions, as well as decisional responsibility when problems related to AI use arise,” the authors concluded.
SOURCE:
The study, with first author Andrew Hantel, MD, from Dana-Farber Cancer Institute, Boston, was published last month in JAMA Network Open.
LIMITATIONS:
The study had a moderate sample size and response rate, although demographics of participating oncologists appear to be nationally representative. The cross-sectional study design limited the generalizability of the findings over time as AI is integrated into cancer care.
DISCLOSURES:
The study was funded by the National Cancer Institute, the Dana-Farber McGraw/Patterson Research Fund, and the Mark Foundation Emerging Leader Award. Dr. Hantel reported receiving personal fees from AbbVie, AstraZeneca, the American Journal of Managed Care, Genentech, and GSK.
A version of this article appeared on Medscape.com.
TOPLINE:
Most respondents, for instance, said patients should not be expected to understand how AI tools work, but many also felt patients could make treatment decisions based on AI-generated recommendations. Most oncologists also felt responsible for protecting patients from biased AI, but few were confident that they could do so.
METHODOLOGY:
- The US Food and Drug Administration (FDA) has for use in various medical specialties over the past few decades, and increasingly, AI tools are being integrated into cancer care.
- However, the uptake of these tools in oncology has raised ethical questions and concerns, including challenges with AI bias, error, or misuse, as well as issues explaining how an AI model reached a result.
- In the current study, researchers asked 204 oncologists from 37 states for their views on the ethical implications of using AI for cancer care.
- Among the survey respondents, 64% were men and 63% were non-Hispanic White; 29% were from academic practices, 47% had received some education on AI use in healthcare, and 45% were familiar with clinical decision models.
- The researchers assessed respondents’ answers to various questions, including whether to provide informed consent for AI use and how oncologists would approach a scenario where the AI model and the oncologist recommended a different treatment regimen.
TAKEAWAY:
- Overall, 81% of oncologists supported having patient consent to use an AI model during treatment decisions, and 85% felt that oncologists needed to be able to explain an AI-based clinical decision model to use it in the clinic; however, only 23% felt that patients also needed to be able to explain an AI model.
- When an AI decision model recommended a different treatment regimen than the treating oncologist, the most common response (36.8%) was to present both options to the patient and let the patient decide. Oncologists from academic settings were about 2.5 times more likely than those from other settings to let the patient decide. About 34% of respondents said they would present both options but recommend the oncologist’s regimen, whereas about 22% said they would present both but recommend the AI’s regimen. A small percentage would only present the oncologist’s regimen (5%) or the AI’s regimen (about 2.5%).
- About three of four respondents (76.5%) agreed that oncologists should protect patients from biased AI tools; however, only about one of four (27.9%) felt confident they could identify biased AI models.
- Most oncologists (91%) felt that AI developers were responsible for the medico-legal problems associated with AI use; less than half (47%) said oncologists or hospitals (43%) shared this responsibility.
IN PRACTICE:
“Together, these data characterize barriers that may impede the ethical adoption of AI into cancer care. The findings suggest that the implementation of AI in oncology must include rigorous assessments of its effect on care decisions, as well as decisional responsibility when problems related to AI use arise,” the authors concluded.
SOURCE:
The study, with first author Andrew Hantel, MD, from Dana-Farber Cancer Institute, Boston, was published last month in JAMA Network Open.
LIMITATIONS:
The study had a moderate sample size and response rate, although demographics of participating oncologists appear to be nationally representative. The cross-sectional study design limited the generalizability of the findings over time as AI is integrated into cancer care.
DISCLOSURES:
The study was funded by the National Cancer Institute, the Dana-Farber McGraw/Patterson Research Fund, and the Mark Foundation Emerging Leader Award. Dr. Hantel reported receiving personal fees from AbbVie, AstraZeneca, the American Journal of Managed Care, Genentech, and GSK.
A version of this article appeared on Medscape.com.
TOPLINE:
Most respondents, for instance, said patients should not be expected to understand how AI tools work, but many also felt patients could make treatment decisions based on AI-generated recommendations. Most oncologists also felt responsible for protecting patients from biased AI, but few were confident that they could do so.
METHODOLOGY:
- The US Food and Drug Administration (FDA) has for use in various medical specialties over the past few decades, and increasingly, AI tools are being integrated into cancer care.
- However, the uptake of these tools in oncology has raised ethical questions and concerns, including challenges with AI bias, error, or misuse, as well as issues explaining how an AI model reached a result.
- In the current study, researchers asked 204 oncologists from 37 states for their views on the ethical implications of using AI for cancer care.
- Among the survey respondents, 64% were men and 63% were non-Hispanic White; 29% were from academic practices, 47% had received some education on AI use in healthcare, and 45% were familiar with clinical decision models.
- The researchers assessed respondents’ answers to various questions, including whether to provide informed consent for AI use and how oncologists would approach a scenario where the AI model and the oncologist recommended a different treatment regimen.
TAKEAWAY:
- Overall, 81% of oncologists supported having patient consent to use an AI model during treatment decisions, and 85% felt that oncologists needed to be able to explain an AI-based clinical decision model to use it in the clinic; however, only 23% felt that patients also needed to be able to explain an AI model.
- When an AI decision model recommended a different treatment regimen than the treating oncologist, the most common response (36.8%) was to present both options to the patient and let the patient decide. Oncologists from academic settings were about 2.5 times more likely than those from other settings to let the patient decide. About 34% of respondents said they would present both options but recommend the oncologist’s regimen, whereas about 22% said they would present both but recommend the AI’s regimen. A small percentage would only present the oncologist’s regimen (5%) or the AI’s regimen (about 2.5%).
- About three of four respondents (76.5%) agreed that oncologists should protect patients from biased AI tools; however, only about one of four (27.9%) felt confident they could identify biased AI models.
- Most oncologists (91%) felt that AI developers were responsible for the medico-legal problems associated with AI use; less than half (47%) said oncologists or hospitals (43%) shared this responsibility.
IN PRACTICE:
“Together, these data characterize barriers that may impede the ethical adoption of AI into cancer care. The findings suggest that the implementation of AI in oncology must include rigorous assessments of its effect on care decisions, as well as decisional responsibility when problems related to AI use arise,” the authors concluded.
SOURCE:
The study, with first author Andrew Hantel, MD, from Dana-Farber Cancer Institute, Boston, was published last month in JAMA Network Open.
LIMITATIONS:
The study had a moderate sample size and response rate, although demographics of participating oncologists appear to be nationally representative. The cross-sectional study design limited the generalizability of the findings over time as AI is integrated into cancer care.
DISCLOSURES:
The study was funded by the National Cancer Institute, the Dana-Farber McGraw/Patterson Research Fund, and the Mark Foundation Emerging Leader Award. Dr. Hantel reported receiving personal fees from AbbVie, AstraZeneca, the American Journal of Managed Care, Genentech, and GSK.
A version of this article appeared on Medscape.com.
Chronic Pain Linked to Accelerated Brain Aging
, new research showed.
Using structural MRI data from more than 9000 adults with knee osteoarthritis (KOA) from the UK Biobank, investigators developed a brain age model to compare an individual’s brain age with their chronological age. Those with KOA showed a much faster rate of brain aging than healthy individuals.
The acceleration in brain aging was largely driven by the hippocampus and predicted memory decline and incident dementia during follow-up. Researchers identified a gene highly expressed in glial cells as a possible genetic factor for accelerated brain aging.
“We demonstrate the accelerated brain aging and cognitive decline in chronic musculoskeletal pain, in particular knee osteoarthritis, and provide a neural marker for early detection and intervention,” said co-first author Jiao Liu, PhD candidate, Chinese Academy of Sciences, Beijing.
“We are interested to know how to slow down the aging brain in chronic musculoskeletal pain patients. Proper exercise and lifestyle may reduce the risk,” Dr. Liu said.
The study was published online in Nature Mental Health.
Common Condition
CMP affects more than 40% of the world’s population and has been shown to have a harmful impact on cognitive function, although the exact mechanisms remain unclear. Prior research suggests that inflammatory markers associated with brain aging are higher in patients with CMP, suggesting a link between brain aging and CMP.
To investigate further, researchers explored patterns of brain aging in healthy cohorts and cohorts with four common types of CMP — chronic knee pain, chronic back pain, chronic neck pain, and chronic hip pain.
Using their brain age model, investigators observed significantly increased brain aging, or “predicted age difference,” only in individuals with KOA (P < .001). The observation was validated in an independent dataset (P = .020), suggesting a pattern of brain aging acceleration specific to KOA.
This acceleration was primarily driven by key brain regions involved in cognitive processing, including hippocampus and orbitofrontal cortex, and was correlated with longitudinal memory decline and dementia risk.
These data also suggest that the SLC39A8 gene, which is highly expressed in glial cells, might be a key genetic factor underpinning this acceleration.
“We not only revealed the specificity of accelerated brain aging in knee osteoarthritis patients, but importantly, we also provided longitudinal evidence suggesting the ability of our brain aging marker to predict future memory decline and increased dementia risk,” corresponding author Yiheng Tu, PhD, also with Chinese Academy of Sciences, Beijing, said in a news release.
A Future Treatment Target?
Commenting on this research, Shaheen Lakhan, MD, PhD, a neurologist and researcher based in Miami, noted that in this study, people with KOA showed signs of “faster brain aging on scans. Think of it as your brain wearing a disguise, appearing older than its actual years,” Dr. Lakhan said.
“Inflammation, a key player in osteoarthritis, might be playing a double agent, wreaking havoc not just on your joints but potentially on your memory too. Researchers even identified a specific gene linked to both knee pain and faster brain aging, hinting at a potential target for future treatments,” he added.
“Importantly, the increased risk of cognitive decline and dementia associated with chronic pain is likely one of many factors, and probably not a very high one on its own,” Dr. Lakhan noted.
The “good news,” he said, is that there are many “well-established ways to keep your brain sharp. Regular exercise, a healthy diet, and staying mentally stimulated are all proven strategies to reduce dementia risk. Think of chronic pain management as another tool you can add to your brain health toolbox.”
Support for the study was provided by the STI-2030 Major Project, the National Natural Science Foundation of China, the Scientific Foundation of the Institute of Psychology, Chinese Academy of Sciences, and the Young Elite Scientist Sponsorship Program by the China Association for Science and Technology. Dr. Liu and Dr. Lakhan had no relevant disclosures.
A version of this article appeared on Medscape.com.
, new research showed.
Using structural MRI data from more than 9000 adults with knee osteoarthritis (KOA) from the UK Biobank, investigators developed a brain age model to compare an individual’s brain age with their chronological age. Those with KOA showed a much faster rate of brain aging than healthy individuals.
The acceleration in brain aging was largely driven by the hippocampus and predicted memory decline and incident dementia during follow-up. Researchers identified a gene highly expressed in glial cells as a possible genetic factor for accelerated brain aging.
“We demonstrate the accelerated brain aging and cognitive decline in chronic musculoskeletal pain, in particular knee osteoarthritis, and provide a neural marker for early detection and intervention,” said co-first author Jiao Liu, PhD candidate, Chinese Academy of Sciences, Beijing.
“We are interested to know how to slow down the aging brain in chronic musculoskeletal pain patients. Proper exercise and lifestyle may reduce the risk,” Dr. Liu said.
The study was published online in Nature Mental Health.
Common Condition
CMP affects more than 40% of the world’s population and has been shown to have a harmful impact on cognitive function, although the exact mechanisms remain unclear. Prior research suggests that inflammatory markers associated with brain aging are higher in patients with CMP, suggesting a link between brain aging and CMP.
To investigate further, researchers explored patterns of brain aging in healthy cohorts and cohorts with four common types of CMP — chronic knee pain, chronic back pain, chronic neck pain, and chronic hip pain.
Using their brain age model, investigators observed significantly increased brain aging, or “predicted age difference,” only in individuals with KOA (P < .001). The observation was validated in an independent dataset (P = .020), suggesting a pattern of brain aging acceleration specific to KOA.
This acceleration was primarily driven by key brain regions involved in cognitive processing, including hippocampus and orbitofrontal cortex, and was correlated with longitudinal memory decline and dementia risk.
These data also suggest that the SLC39A8 gene, which is highly expressed in glial cells, might be a key genetic factor underpinning this acceleration.
“We not only revealed the specificity of accelerated brain aging in knee osteoarthritis patients, but importantly, we also provided longitudinal evidence suggesting the ability of our brain aging marker to predict future memory decline and increased dementia risk,” corresponding author Yiheng Tu, PhD, also with Chinese Academy of Sciences, Beijing, said in a news release.
A Future Treatment Target?
Commenting on this research, Shaheen Lakhan, MD, PhD, a neurologist and researcher based in Miami, noted that in this study, people with KOA showed signs of “faster brain aging on scans. Think of it as your brain wearing a disguise, appearing older than its actual years,” Dr. Lakhan said.
“Inflammation, a key player in osteoarthritis, might be playing a double agent, wreaking havoc not just on your joints but potentially on your memory too. Researchers even identified a specific gene linked to both knee pain and faster brain aging, hinting at a potential target for future treatments,” he added.
“Importantly, the increased risk of cognitive decline and dementia associated with chronic pain is likely one of many factors, and probably not a very high one on its own,” Dr. Lakhan noted.
The “good news,” he said, is that there are many “well-established ways to keep your brain sharp. Regular exercise, a healthy diet, and staying mentally stimulated are all proven strategies to reduce dementia risk. Think of chronic pain management as another tool you can add to your brain health toolbox.”
Support for the study was provided by the STI-2030 Major Project, the National Natural Science Foundation of China, the Scientific Foundation of the Institute of Psychology, Chinese Academy of Sciences, and the Young Elite Scientist Sponsorship Program by the China Association for Science and Technology. Dr. Liu and Dr. Lakhan had no relevant disclosures.
A version of this article appeared on Medscape.com.
, new research showed.
Using structural MRI data from more than 9000 adults with knee osteoarthritis (KOA) from the UK Biobank, investigators developed a brain age model to compare an individual’s brain age with their chronological age. Those with KOA showed a much faster rate of brain aging than healthy individuals.
The acceleration in brain aging was largely driven by the hippocampus and predicted memory decline and incident dementia during follow-up. Researchers identified a gene highly expressed in glial cells as a possible genetic factor for accelerated brain aging.
“We demonstrate the accelerated brain aging and cognitive decline in chronic musculoskeletal pain, in particular knee osteoarthritis, and provide a neural marker for early detection and intervention,” said co-first author Jiao Liu, PhD candidate, Chinese Academy of Sciences, Beijing.
“We are interested to know how to slow down the aging brain in chronic musculoskeletal pain patients. Proper exercise and lifestyle may reduce the risk,” Dr. Liu said.
The study was published online in Nature Mental Health.
Common Condition
CMP affects more than 40% of the world’s population and has been shown to have a harmful impact on cognitive function, although the exact mechanisms remain unclear. Prior research suggests that inflammatory markers associated with brain aging are higher in patients with CMP, suggesting a link between brain aging and CMP.
To investigate further, researchers explored patterns of brain aging in healthy cohorts and cohorts with four common types of CMP — chronic knee pain, chronic back pain, chronic neck pain, and chronic hip pain.
Using their brain age model, investigators observed significantly increased brain aging, or “predicted age difference,” only in individuals with KOA (P < .001). The observation was validated in an independent dataset (P = .020), suggesting a pattern of brain aging acceleration specific to KOA.
This acceleration was primarily driven by key brain regions involved in cognitive processing, including hippocampus and orbitofrontal cortex, and was correlated with longitudinal memory decline and dementia risk.
These data also suggest that the SLC39A8 gene, which is highly expressed in glial cells, might be a key genetic factor underpinning this acceleration.
“We not only revealed the specificity of accelerated brain aging in knee osteoarthritis patients, but importantly, we also provided longitudinal evidence suggesting the ability of our brain aging marker to predict future memory decline and increased dementia risk,” corresponding author Yiheng Tu, PhD, also with Chinese Academy of Sciences, Beijing, said in a news release.
A Future Treatment Target?
Commenting on this research, Shaheen Lakhan, MD, PhD, a neurologist and researcher based in Miami, noted that in this study, people with KOA showed signs of “faster brain aging on scans. Think of it as your brain wearing a disguise, appearing older than its actual years,” Dr. Lakhan said.
“Inflammation, a key player in osteoarthritis, might be playing a double agent, wreaking havoc not just on your joints but potentially on your memory too. Researchers even identified a specific gene linked to both knee pain and faster brain aging, hinting at a potential target for future treatments,” he added.
“Importantly, the increased risk of cognitive decline and dementia associated with chronic pain is likely one of many factors, and probably not a very high one on its own,” Dr. Lakhan noted.
The “good news,” he said, is that there are many “well-established ways to keep your brain sharp. Regular exercise, a healthy diet, and staying mentally stimulated are all proven strategies to reduce dementia risk. Think of chronic pain management as another tool you can add to your brain health toolbox.”
Support for the study was provided by the STI-2030 Major Project, the National Natural Science Foundation of China, the Scientific Foundation of the Institute of Psychology, Chinese Academy of Sciences, and the Young Elite Scientist Sponsorship Program by the China Association for Science and Technology. Dr. Liu and Dr. Lakhan had no relevant disclosures.
A version of this article appeared on Medscape.com.
FROM NATURE MENTAL HEALTH
Three Distinct MS Subtypes Identified
, a new study suggests.
With further validation, determining a patient’s blood “immune signature,” or endophenotype, before starting immunomodulatory therapy may help predict clinical disease trajectories and lead to more personalized treatment decisions, investigators said.
“The characterization of an endophenotype at timepoints of diagnosis will help to determine likely trajectory of the disease course but also will help to refine the chosen immune therapy,” said Heinz Wiendl, MD, professor and chair, Department of Neurology, University of Münster, Germany. “This is a rationale way of precision medicine for the future.”
The study was published online in Science Translational Medicine.
Degenerative and Inflammatory Subtypes
MS is a highly heterogeneous disorder with different clinical manifestations and disease trajectories, making it a challenge to manage. Whether this heterogeneity is reflected by discrete immune signatures in the blood has been unclear.
To investigate, Dr. Wiendl and a multicenter team comprehensively analyzed the immunological properties of blood samples collected from 309 patients with early MS and an independent validation cohort of 232 patients with early MS.
In both cohorts, they found that cellular immune signatures split into three distinct immunological endophenotypes, dubbed E1, E2, and E3.
E1 is characterized by alterations in the CD4 T-cell compartment, with increases in inflammatory cytokines, namely interleukin-17A (IL-17A), IL-22, and granulocyte-macrophage colony-stimulating factor, as well as earlier structural brain damage, more severe disease, and higher disability.
Alterations in natural killer cells are a hallmark of the E2 subtype, while alterations in the CD8 T cells dominate the E3 subtype.
The different subtypes were associated with distinct clinical disease trajectories. E3 patients displayed a pattern reflecting higher inflammatory disease activity, as illustrated by a higher relapse rate (≥ 2) within the first year from baseline and more frequent use of highly active disease-modifying therapies as first immunomodulatory treatment.
E3 patients also had higher numbers of gadolinium-enhancing lesions at baseline, a higher conversion rate from clinically isolated syndrome to relapsing-remitting MS, and rapid disability accrual within 2 years after baseline.
This endophenotype was also associated with an increase in total cell numbers within the cerebrospinal fluid and intrathecal immunoglobulin (Ig) G synthesis at baseline.
E1 patients had a higher degree of early structural brain damage and disease severity, including disability and impaired evident at baseline, and increased serum neurofilament light and increased intrathecal IgM synthesis at baseline.
“According to these different patterns of disease trajectories, we therefore termed these subsets degenerative E1 and inflammatory E3. Overall, although some of the clinical and paraclinical parameters partially overlapped, our analysis reveals that distinct immunological endophenotypes might have predictive value with regard to clinically relevant disease trajectories,” the researchers wrote.
Toward Personalized Care
In addition, during up to 4-year follow-up of some patients, they observed that patients with the inflammatory E3 endophenotype treated with interferon-beta exhibited higher disease progression and MRI activity relative to E3 patients receiving other therapies. These differential effects of interferon-beta were not observed in the other endophenotypes.
With further study and refinement, the hope is to make this test a “clinical reality,” Dr. Wiendl said.
Commenting on the findings, Kimberly O’Neill, MD, clinical instructor, Department of Neurology, NYU Grossman School of Medicine, New York City, noted that people with MS can have “a broad variety of disease course and outcomes ranging from mild to a very severe and life-altering disease course. At this point, we are not great at predicting who is going to be on which path and also which medication is right for each patient.
“Research like this gives us hope for a more personalized precision medicine in MS,” said Dr. O’Neill, who was not part of the study. “The ideal world would be to have a blood test that could tell their disease course and which treatments will work for an individual patient, but we are certainly not there yet.”
Also providing an outside perspective, Mary Rensel, MD, director of wellness and pediatric MS at the Cleveland Clinic Mellen Center for MS, Cleveland, said, “Precision medicine is our goal and dream in MS care — to be able to do a blood test and know what medicine a patient may or may not respond to and save them years of ongoing symptoms or the risk of disability. This study is a great start.”
Support for this research was provided by grants from the Federal Ministry of Education and Research, the German Research Council, and the Hermann and Lilly Schilling Foundation. Disclosures for study authors are listed with the original article. Dr. O’Neill and Dr. Rensel had no relevant disclosures.
A version of this article appeared on Medscape.com.
, a new study suggests.
With further validation, determining a patient’s blood “immune signature,” or endophenotype, before starting immunomodulatory therapy may help predict clinical disease trajectories and lead to more personalized treatment decisions, investigators said.
“The characterization of an endophenotype at timepoints of diagnosis will help to determine likely trajectory of the disease course but also will help to refine the chosen immune therapy,” said Heinz Wiendl, MD, professor and chair, Department of Neurology, University of Münster, Germany. “This is a rationale way of precision medicine for the future.”
The study was published online in Science Translational Medicine.
Degenerative and Inflammatory Subtypes
MS is a highly heterogeneous disorder with different clinical manifestations and disease trajectories, making it a challenge to manage. Whether this heterogeneity is reflected by discrete immune signatures in the blood has been unclear.
To investigate, Dr. Wiendl and a multicenter team comprehensively analyzed the immunological properties of blood samples collected from 309 patients with early MS and an independent validation cohort of 232 patients with early MS.
In both cohorts, they found that cellular immune signatures split into three distinct immunological endophenotypes, dubbed E1, E2, and E3.
E1 is characterized by alterations in the CD4 T-cell compartment, with increases in inflammatory cytokines, namely interleukin-17A (IL-17A), IL-22, and granulocyte-macrophage colony-stimulating factor, as well as earlier structural brain damage, more severe disease, and higher disability.
Alterations in natural killer cells are a hallmark of the E2 subtype, while alterations in the CD8 T cells dominate the E3 subtype.
The different subtypes were associated with distinct clinical disease trajectories. E3 patients displayed a pattern reflecting higher inflammatory disease activity, as illustrated by a higher relapse rate (≥ 2) within the first year from baseline and more frequent use of highly active disease-modifying therapies as first immunomodulatory treatment.
E3 patients also had higher numbers of gadolinium-enhancing lesions at baseline, a higher conversion rate from clinically isolated syndrome to relapsing-remitting MS, and rapid disability accrual within 2 years after baseline.
This endophenotype was also associated with an increase in total cell numbers within the cerebrospinal fluid and intrathecal immunoglobulin (Ig) G synthesis at baseline.
E1 patients had a higher degree of early structural brain damage and disease severity, including disability and impaired evident at baseline, and increased serum neurofilament light and increased intrathecal IgM synthesis at baseline.
“According to these different patterns of disease trajectories, we therefore termed these subsets degenerative E1 and inflammatory E3. Overall, although some of the clinical and paraclinical parameters partially overlapped, our analysis reveals that distinct immunological endophenotypes might have predictive value with regard to clinically relevant disease trajectories,” the researchers wrote.
Toward Personalized Care
In addition, during up to 4-year follow-up of some patients, they observed that patients with the inflammatory E3 endophenotype treated with interferon-beta exhibited higher disease progression and MRI activity relative to E3 patients receiving other therapies. These differential effects of interferon-beta were not observed in the other endophenotypes.
With further study and refinement, the hope is to make this test a “clinical reality,” Dr. Wiendl said.
Commenting on the findings, Kimberly O’Neill, MD, clinical instructor, Department of Neurology, NYU Grossman School of Medicine, New York City, noted that people with MS can have “a broad variety of disease course and outcomes ranging from mild to a very severe and life-altering disease course. At this point, we are not great at predicting who is going to be on which path and also which medication is right for each patient.
“Research like this gives us hope for a more personalized precision medicine in MS,” said Dr. O’Neill, who was not part of the study. “The ideal world would be to have a blood test that could tell their disease course and which treatments will work for an individual patient, but we are certainly not there yet.”
Also providing an outside perspective, Mary Rensel, MD, director of wellness and pediatric MS at the Cleveland Clinic Mellen Center for MS, Cleveland, said, “Precision medicine is our goal and dream in MS care — to be able to do a blood test and know what medicine a patient may or may not respond to and save them years of ongoing symptoms or the risk of disability. This study is a great start.”
Support for this research was provided by grants from the Federal Ministry of Education and Research, the German Research Council, and the Hermann and Lilly Schilling Foundation. Disclosures for study authors are listed with the original article. Dr. O’Neill and Dr. Rensel had no relevant disclosures.
A version of this article appeared on Medscape.com.
, a new study suggests.
With further validation, determining a patient’s blood “immune signature,” or endophenotype, before starting immunomodulatory therapy may help predict clinical disease trajectories and lead to more personalized treatment decisions, investigators said.
“The characterization of an endophenotype at timepoints of diagnosis will help to determine likely trajectory of the disease course but also will help to refine the chosen immune therapy,” said Heinz Wiendl, MD, professor and chair, Department of Neurology, University of Münster, Germany. “This is a rationale way of precision medicine for the future.”
The study was published online in Science Translational Medicine.
Degenerative and Inflammatory Subtypes
MS is a highly heterogeneous disorder with different clinical manifestations and disease trajectories, making it a challenge to manage. Whether this heterogeneity is reflected by discrete immune signatures in the blood has been unclear.
To investigate, Dr. Wiendl and a multicenter team comprehensively analyzed the immunological properties of blood samples collected from 309 patients with early MS and an independent validation cohort of 232 patients with early MS.
In both cohorts, they found that cellular immune signatures split into three distinct immunological endophenotypes, dubbed E1, E2, and E3.
E1 is characterized by alterations in the CD4 T-cell compartment, with increases in inflammatory cytokines, namely interleukin-17A (IL-17A), IL-22, and granulocyte-macrophage colony-stimulating factor, as well as earlier structural brain damage, more severe disease, and higher disability.
Alterations in natural killer cells are a hallmark of the E2 subtype, while alterations in the CD8 T cells dominate the E3 subtype.
The different subtypes were associated with distinct clinical disease trajectories. E3 patients displayed a pattern reflecting higher inflammatory disease activity, as illustrated by a higher relapse rate (≥ 2) within the first year from baseline and more frequent use of highly active disease-modifying therapies as first immunomodulatory treatment.
E3 patients also had higher numbers of gadolinium-enhancing lesions at baseline, a higher conversion rate from clinically isolated syndrome to relapsing-remitting MS, and rapid disability accrual within 2 years after baseline.
This endophenotype was also associated with an increase in total cell numbers within the cerebrospinal fluid and intrathecal immunoglobulin (Ig) G synthesis at baseline.
E1 patients had a higher degree of early structural brain damage and disease severity, including disability and impaired evident at baseline, and increased serum neurofilament light and increased intrathecal IgM synthesis at baseline.
“According to these different patterns of disease trajectories, we therefore termed these subsets degenerative E1 and inflammatory E3. Overall, although some of the clinical and paraclinical parameters partially overlapped, our analysis reveals that distinct immunological endophenotypes might have predictive value with regard to clinically relevant disease trajectories,” the researchers wrote.
Toward Personalized Care
In addition, during up to 4-year follow-up of some patients, they observed that patients with the inflammatory E3 endophenotype treated with interferon-beta exhibited higher disease progression and MRI activity relative to E3 patients receiving other therapies. These differential effects of interferon-beta were not observed in the other endophenotypes.
With further study and refinement, the hope is to make this test a “clinical reality,” Dr. Wiendl said.
Commenting on the findings, Kimberly O’Neill, MD, clinical instructor, Department of Neurology, NYU Grossman School of Medicine, New York City, noted that people with MS can have “a broad variety of disease course and outcomes ranging from mild to a very severe and life-altering disease course. At this point, we are not great at predicting who is going to be on which path and also which medication is right for each patient.
“Research like this gives us hope for a more personalized precision medicine in MS,” said Dr. O’Neill, who was not part of the study. “The ideal world would be to have a blood test that could tell their disease course and which treatments will work for an individual patient, but we are certainly not there yet.”
Also providing an outside perspective, Mary Rensel, MD, director of wellness and pediatric MS at the Cleveland Clinic Mellen Center for MS, Cleveland, said, “Precision medicine is our goal and dream in MS care — to be able to do a blood test and know what medicine a patient may or may not respond to and save them years of ongoing symptoms or the risk of disability. This study is a great start.”
Support for this research was provided by grants from the Federal Ministry of Education and Research, the German Research Council, and the Hermann and Lilly Schilling Foundation. Disclosures for study authors are listed with the original article. Dr. O’Neill and Dr. Rensel had no relevant disclosures.
A version of this article appeared on Medscape.com.
FROM SCIENCE TRANSLATIONAL MEDICINE
New Quality Measure Improves Follow-Up for CRC Screening
the developers said.
As part of their work, the researchers conducted a retrospective study of 20,581 adults aged 50-75 years from 38 health systems that showed that fewer than half (48%) had a follow-up colonoscopy within 180 days of an initial abnormal SBT for CRC.
“The low follow-up rates to an abnormal SBT were initially surprising,” first author Elizabeth L. Ciemins, PhD, MPH, MA, Research and Analytics, American Medical Group Association (AMGA), Alexandria, Virginia, told this news organization.
“However, once we interviewed clinicians and learned that this was not a measure they were tracking, along with their own incorrect assumptions of a much higher follow-up rate, the low rates made sense. As is commonly said, ‘you can’t change what you don’t measure,’” she said.
The CRC screening completion measure the researchers propose “builds on and addresses an important shortcoming in an existing measure and will help ensure complete screening for CRC,” they noted in their JAMA Network Open paper.
The key elements of the follow-up measure are the date and result of a SBT and the date of the follow-up colonoscopy — if it occurred, Dr. Ciemins explained.
“Currently, health systems are not consistently tracking this measure, but they have the data elements to do so, especially if they are doing colonoscopies in-house,” she said.
Field testing showed that use of this new measure is “feasible, valid, and reliable,” the authors said. Dr. Ciemins believed this CRC screening completion measure could be widely implemented.
“Three AMGA member health systems feasibility tested the data elements and found that they could reliably abstract the required elements from electronic health records (EHRs),” she told this news organization.
The researchers are currently testing the measure among 20 AMGA member health systems, that are submitting quarterly data on a version of the specified measure.
“Advancing this measure as a quality performance measure could significantly increase the early detection of CRC, thereby improving health and ultimately saving lives,” the authors concluded in their paper.
The Right Direction, But Questions Remain
The coauthors of a linked commentary said this research highlights the “suboptimal” rates of a timely follow-up colonoscopy after positive SBT results. They applauded the authors for “focusing attention on a meaningful approach to measuring high-quality CRC screening and providing guidance for standardized measurement.”
However, several questions arise from this study, “including whether 6 months is the ideal interval for colonoscopy completion after a positive SBT result, where this measure fits in the context of existing CRC screening measures, and how to implement it in practice,” Jennifer K. Maratt, MD, with Indiana University School of Medicine, Indianapolis, and coauthors wrote.
“This measure alone does not address all the gaps in the screening process, nor does it address barriers to colonoscopy completion, but it points us in the right direction for measuring the success of screening programs,” Dr. Maratt and her colleagues added.
The study was supported by a grant from the AARP. The authors and editorial writers had no relevant disclosures.
A version of this article appeared on Medscape.com.
the developers said.
As part of their work, the researchers conducted a retrospective study of 20,581 adults aged 50-75 years from 38 health systems that showed that fewer than half (48%) had a follow-up colonoscopy within 180 days of an initial abnormal SBT for CRC.
“The low follow-up rates to an abnormal SBT were initially surprising,” first author Elizabeth L. Ciemins, PhD, MPH, MA, Research and Analytics, American Medical Group Association (AMGA), Alexandria, Virginia, told this news organization.
“However, once we interviewed clinicians and learned that this was not a measure they were tracking, along with their own incorrect assumptions of a much higher follow-up rate, the low rates made sense. As is commonly said, ‘you can’t change what you don’t measure,’” she said.
The CRC screening completion measure the researchers propose “builds on and addresses an important shortcoming in an existing measure and will help ensure complete screening for CRC,” they noted in their JAMA Network Open paper.
The key elements of the follow-up measure are the date and result of a SBT and the date of the follow-up colonoscopy — if it occurred, Dr. Ciemins explained.
“Currently, health systems are not consistently tracking this measure, but they have the data elements to do so, especially if they are doing colonoscopies in-house,” she said.
Field testing showed that use of this new measure is “feasible, valid, and reliable,” the authors said. Dr. Ciemins believed this CRC screening completion measure could be widely implemented.
“Three AMGA member health systems feasibility tested the data elements and found that they could reliably abstract the required elements from electronic health records (EHRs),” she told this news organization.
The researchers are currently testing the measure among 20 AMGA member health systems, that are submitting quarterly data on a version of the specified measure.
“Advancing this measure as a quality performance measure could significantly increase the early detection of CRC, thereby improving health and ultimately saving lives,” the authors concluded in their paper.
The Right Direction, But Questions Remain
The coauthors of a linked commentary said this research highlights the “suboptimal” rates of a timely follow-up colonoscopy after positive SBT results. They applauded the authors for “focusing attention on a meaningful approach to measuring high-quality CRC screening and providing guidance for standardized measurement.”
However, several questions arise from this study, “including whether 6 months is the ideal interval for colonoscopy completion after a positive SBT result, where this measure fits in the context of existing CRC screening measures, and how to implement it in practice,” Jennifer K. Maratt, MD, with Indiana University School of Medicine, Indianapolis, and coauthors wrote.
“This measure alone does not address all the gaps in the screening process, nor does it address barriers to colonoscopy completion, but it points us in the right direction for measuring the success of screening programs,” Dr. Maratt and her colleagues added.
The study was supported by a grant from the AARP. The authors and editorial writers had no relevant disclosures.
A version of this article appeared on Medscape.com.
the developers said.
As part of their work, the researchers conducted a retrospective study of 20,581 adults aged 50-75 years from 38 health systems that showed that fewer than half (48%) had a follow-up colonoscopy within 180 days of an initial abnormal SBT for CRC.
“The low follow-up rates to an abnormal SBT were initially surprising,” first author Elizabeth L. Ciemins, PhD, MPH, MA, Research and Analytics, American Medical Group Association (AMGA), Alexandria, Virginia, told this news organization.
“However, once we interviewed clinicians and learned that this was not a measure they were tracking, along with their own incorrect assumptions of a much higher follow-up rate, the low rates made sense. As is commonly said, ‘you can’t change what you don’t measure,’” she said.
The CRC screening completion measure the researchers propose “builds on and addresses an important shortcoming in an existing measure and will help ensure complete screening for CRC,” they noted in their JAMA Network Open paper.
The key elements of the follow-up measure are the date and result of a SBT and the date of the follow-up colonoscopy — if it occurred, Dr. Ciemins explained.
“Currently, health systems are not consistently tracking this measure, but they have the data elements to do so, especially if they are doing colonoscopies in-house,” she said.
Field testing showed that use of this new measure is “feasible, valid, and reliable,” the authors said. Dr. Ciemins believed this CRC screening completion measure could be widely implemented.
“Three AMGA member health systems feasibility tested the data elements and found that they could reliably abstract the required elements from electronic health records (EHRs),” she told this news organization.
The researchers are currently testing the measure among 20 AMGA member health systems, that are submitting quarterly data on a version of the specified measure.
“Advancing this measure as a quality performance measure could significantly increase the early detection of CRC, thereby improving health and ultimately saving lives,” the authors concluded in their paper.
The Right Direction, But Questions Remain
The coauthors of a linked commentary said this research highlights the “suboptimal” rates of a timely follow-up colonoscopy after positive SBT results. They applauded the authors for “focusing attention on a meaningful approach to measuring high-quality CRC screening and providing guidance for standardized measurement.”
However, several questions arise from this study, “including whether 6 months is the ideal interval for colonoscopy completion after a positive SBT result, where this measure fits in the context of existing CRC screening measures, and how to implement it in practice,” Jennifer K. Maratt, MD, with Indiana University School of Medicine, Indianapolis, and coauthors wrote.
“This measure alone does not address all the gaps in the screening process, nor does it address barriers to colonoscopy completion, but it points us in the right direction for measuring the success of screening programs,” Dr. Maratt and her colleagues added.
The study was supported by a grant from the AARP. The authors and editorial writers had no relevant disclosures.
A version of this article appeared on Medscape.com.
Smartphone App Detects Early Signs of Frontotemporal Dementia
, new research showed.
Cognitive tests administered remotely on the phone “showed similar findings as our gold standard in-clinic cognitive tests and brain imaging,” said study investigator Adam M. Staffaroni, PhD, with the Memory and Aging Center, University of California San Francisco.
“We also provided evidence that these assessments may be useful for detecting early symptoms of the disease at a level that is on par, or perhaps slightly better, than our gold standard in-person tests,” Dr. Staffaroni said.
The study was published online in JAMA Network Open.
Tough to Diagnose
Although relatively rare, FTD is the top cause of dementia in patients younger than 60 years. Patients are usually diagnosed relatively late in the disease because they are young and because their symptoms may be mistaken for psychiatric disorders.
In addition, behavioral and motor symptoms of FTD can make it hard for families to get to an academic center for in-clinic assessments, making remote assessments a huge need.
Dr. Staffaroni and colleagues with the ALLFTD Consortium partnered with software company Datacubed Health to develop the ALLFTD-mApp, which includes cognitive, motor, and speech tasks.
They assessed the reliability and validity of the app, against standard in-clinic assessments, in 350 individuals (mean age, 54 years; 58% women; mean education level, 16.5 years).
Among the 329 individuals with data on disease stage, 195 (59%) were asymptomatic or had preclinical FTD, 66 (20%) had prodromal FTD, and 68 (21%) had symptomatic FTD with a range of clinical syndromes.
The smartphone app showed “moderate to excellent” reliability within a single administration (ie, internally consistent) and across repeated assessments (ie, test-retest reliability), the researchers reported.
Validity was supported by association of smartphones tests with disease severity, criterion-standard neuropsychological tests, and brain volume, they noted.
Of Great Interest
They also reported that a composite of brief smartphone tests accurately distinguished dementia from cognitively unimpaired participants, screening out participants without symptoms, and detected prodromal FTD with greater sensitivity than the Montreal Cognitive Assessment.
“This tool is currently being used in several research studies. The remote aspect of this technology is important because it could allow researchers to collect data more frequently, which may give them a more accurate picture of the disease. Furthermore, researchers can be more inclusive in their study designs and include participants who otherwise might have difficulty traveling to academic centers for standard in-person visits,” said Dr. Staffaroni.
“Because the app appears sensitive to early stages of the disease, it could be also used as a screening tool, possibly alongside other remote data collection, to help identify participants that might be appropriate for a clinical trial. At this point, these technologies are not ready for clinical use and require additional research studies to understand their clinical utility,” he cautioned.
Commenting on the study, Walter Kukull, PhD, director of the National Alzheimer’s Coordinating Center at the University of Washington in Seattle, noted that “remote direct and indirect testing/telemetry are of great interest to the field and are being examined carefully in comparison to in-person means both for validity and possibly earlier recognition.”
This research was supported by grants from the National Institutes of Health, the Association for Frontotemporal Degeneration, the Bluefield Project to Cure FTD, the Rainwater Charitable Foundation, and the Larry L. Hillblom Foundation. Dr. Staffaroni reported being a coinventor of four ALLFTD mobile application tasks (not analyzed in the current study); receiving licensing fees from Datacubed Health and research support from the National Institute on Aging of the NIH, Bluefield Project to Cure FTD, the Alzheimer’s Association, the Larry L. Hillblom Foundation, and the Rainwater Charitable Foundation; and consulting for Alector Inc., Eli Lilly and Company Prevail Therapeutics, Passage Bio Inc, and Takeda Pharmaceuticals. Dr. Kukull participated in the ALLFTD Consortium.
A version of this article appeared on Medscape.com.
, new research showed.
Cognitive tests administered remotely on the phone “showed similar findings as our gold standard in-clinic cognitive tests and brain imaging,” said study investigator Adam M. Staffaroni, PhD, with the Memory and Aging Center, University of California San Francisco.
“We also provided evidence that these assessments may be useful for detecting early symptoms of the disease at a level that is on par, or perhaps slightly better, than our gold standard in-person tests,” Dr. Staffaroni said.
The study was published online in JAMA Network Open.
Tough to Diagnose
Although relatively rare, FTD is the top cause of dementia in patients younger than 60 years. Patients are usually diagnosed relatively late in the disease because they are young and because their symptoms may be mistaken for psychiatric disorders.
In addition, behavioral and motor symptoms of FTD can make it hard for families to get to an academic center for in-clinic assessments, making remote assessments a huge need.
Dr. Staffaroni and colleagues with the ALLFTD Consortium partnered with software company Datacubed Health to develop the ALLFTD-mApp, which includes cognitive, motor, and speech tasks.
They assessed the reliability and validity of the app, against standard in-clinic assessments, in 350 individuals (mean age, 54 years; 58% women; mean education level, 16.5 years).
Among the 329 individuals with data on disease stage, 195 (59%) were asymptomatic or had preclinical FTD, 66 (20%) had prodromal FTD, and 68 (21%) had symptomatic FTD with a range of clinical syndromes.
The smartphone app showed “moderate to excellent” reliability within a single administration (ie, internally consistent) and across repeated assessments (ie, test-retest reliability), the researchers reported.
Validity was supported by association of smartphones tests with disease severity, criterion-standard neuropsychological tests, and brain volume, they noted.
Of Great Interest
They also reported that a composite of brief smartphone tests accurately distinguished dementia from cognitively unimpaired participants, screening out participants without symptoms, and detected prodromal FTD with greater sensitivity than the Montreal Cognitive Assessment.
“This tool is currently being used in several research studies. The remote aspect of this technology is important because it could allow researchers to collect data more frequently, which may give them a more accurate picture of the disease. Furthermore, researchers can be more inclusive in their study designs and include participants who otherwise might have difficulty traveling to academic centers for standard in-person visits,” said Dr. Staffaroni.
“Because the app appears sensitive to early stages of the disease, it could be also used as a screening tool, possibly alongside other remote data collection, to help identify participants that might be appropriate for a clinical trial. At this point, these technologies are not ready for clinical use and require additional research studies to understand their clinical utility,” he cautioned.
Commenting on the study, Walter Kukull, PhD, director of the National Alzheimer’s Coordinating Center at the University of Washington in Seattle, noted that “remote direct and indirect testing/telemetry are of great interest to the field and are being examined carefully in comparison to in-person means both for validity and possibly earlier recognition.”
This research was supported by grants from the National Institutes of Health, the Association for Frontotemporal Degeneration, the Bluefield Project to Cure FTD, the Rainwater Charitable Foundation, and the Larry L. Hillblom Foundation. Dr. Staffaroni reported being a coinventor of four ALLFTD mobile application tasks (not analyzed in the current study); receiving licensing fees from Datacubed Health and research support from the National Institute on Aging of the NIH, Bluefield Project to Cure FTD, the Alzheimer’s Association, the Larry L. Hillblom Foundation, and the Rainwater Charitable Foundation; and consulting for Alector Inc., Eli Lilly and Company Prevail Therapeutics, Passage Bio Inc, and Takeda Pharmaceuticals. Dr. Kukull participated in the ALLFTD Consortium.
A version of this article appeared on Medscape.com.
, new research showed.
Cognitive tests administered remotely on the phone “showed similar findings as our gold standard in-clinic cognitive tests and brain imaging,” said study investigator Adam M. Staffaroni, PhD, with the Memory and Aging Center, University of California San Francisco.
“We also provided evidence that these assessments may be useful for detecting early symptoms of the disease at a level that is on par, or perhaps slightly better, than our gold standard in-person tests,” Dr. Staffaroni said.
The study was published online in JAMA Network Open.
Tough to Diagnose
Although relatively rare, FTD is the top cause of dementia in patients younger than 60 years. Patients are usually diagnosed relatively late in the disease because they are young and because their symptoms may be mistaken for psychiatric disorders.
In addition, behavioral and motor symptoms of FTD can make it hard for families to get to an academic center for in-clinic assessments, making remote assessments a huge need.
Dr. Staffaroni and colleagues with the ALLFTD Consortium partnered with software company Datacubed Health to develop the ALLFTD-mApp, which includes cognitive, motor, and speech tasks.
They assessed the reliability and validity of the app, against standard in-clinic assessments, in 350 individuals (mean age, 54 years; 58% women; mean education level, 16.5 years).
Among the 329 individuals with data on disease stage, 195 (59%) were asymptomatic or had preclinical FTD, 66 (20%) had prodromal FTD, and 68 (21%) had symptomatic FTD with a range of clinical syndromes.
The smartphone app showed “moderate to excellent” reliability within a single administration (ie, internally consistent) and across repeated assessments (ie, test-retest reliability), the researchers reported.
Validity was supported by association of smartphones tests with disease severity, criterion-standard neuropsychological tests, and brain volume, they noted.
Of Great Interest
They also reported that a composite of brief smartphone tests accurately distinguished dementia from cognitively unimpaired participants, screening out participants without symptoms, and detected prodromal FTD with greater sensitivity than the Montreal Cognitive Assessment.
“This tool is currently being used in several research studies. The remote aspect of this technology is important because it could allow researchers to collect data more frequently, which may give them a more accurate picture of the disease. Furthermore, researchers can be more inclusive in their study designs and include participants who otherwise might have difficulty traveling to academic centers for standard in-person visits,” said Dr. Staffaroni.
“Because the app appears sensitive to early stages of the disease, it could be also used as a screening tool, possibly alongside other remote data collection, to help identify participants that might be appropriate for a clinical trial. At this point, these technologies are not ready for clinical use and require additional research studies to understand their clinical utility,” he cautioned.
Commenting on the study, Walter Kukull, PhD, director of the National Alzheimer’s Coordinating Center at the University of Washington in Seattle, noted that “remote direct and indirect testing/telemetry are of great interest to the field and are being examined carefully in comparison to in-person means both for validity and possibly earlier recognition.”
This research was supported by grants from the National Institutes of Health, the Association for Frontotemporal Degeneration, the Bluefield Project to Cure FTD, the Rainwater Charitable Foundation, and the Larry L. Hillblom Foundation. Dr. Staffaroni reported being a coinventor of four ALLFTD mobile application tasks (not analyzed in the current study); receiving licensing fees from Datacubed Health and research support from the National Institute on Aging of the NIH, Bluefield Project to Cure FTD, the Alzheimer’s Association, the Larry L. Hillblom Foundation, and the Rainwater Charitable Foundation; and consulting for Alector Inc., Eli Lilly and Company Prevail Therapeutics, Passage Bio Inc, and Takeda Pharmaceuticals. Dr. Kukull participated in the ALLFTD Consortium.
A version of this article appeared on Medscape.com.
FROM JAMA NETWORK OPEN
Heat Exposure Tied to Acute Immune Changes
In this study, blood work from volunteers was examined for immune biomarkers, and the findings mapped against environmental data.
“With rising global temperatures, the association between heat exposure and a temporarily weakened response from the immune system is a concern because temperature and humidity are known to be important environmental drivers of infectious, airborne disease transmission,” lead author Daniel W. Riggs, PhD, with the Christina Lee Brown Envirome Institute, University of Louisville in Louisville, Kentucky, said in a news release.
“In this study, even exposure to relatively modest increases in temperature were associated with acute changes in immune system functioning indexed by low-grade inflammation known to be linked to cardiovascular disorders, as well as potential secondary effects on the ability to optimally protect against infection,” said Rosalind J. Wright, MD, MPH, who wasn’t involved in the study.
“Further elucidation of the effects of both acute and more prolonged heat exposures (heat waves) on immune signaling will be important given potential broad health implications beyond the heart,” said Dr. Wright, dean of public health and professor and chair, Department of Public Health, Mount Sinai Health System.
The study was presented at the American Heart Association (AHA) Epidemiology and Prevention | Lifestyle and Cardiometabolic Scientific Sessions 2024.
High Temps Hard on Multiple Organs
Extreme-heat events have been shown to increase mortality, and excessive deaths due to heat waves are overwhelmingly cardiovascular in origin. Many prior studies only considered ambient temperature, which fails to capture the actual heat stress experienced by individuals, Dr. Riggs and colleagues wrote.
They designed their study to gauge how short-term heat exposures are related to markers of inflammation and the immune response.
They recruited 624 adults (mean age 49 years, 59% women) from a neighborhood in Louisville during the summer months, when median temperatures over 24 hours were 24.5 °C (76 °F).
They obtained blood samples to measure circulating cytokines and immune cells during clinic visits. Heat metrics, collected on the same day as blood draws, included 24-hour averages of temperature, net effective temperature, and the Universal Thermal Climate Index (UTCI), a metric that incorporates temperature, humidity, wind speed, and ultraviolet radiation, to determine the physiological comfort of the human body under specific weather conditions.
The results were adjusted for multiple factors, including sex, age, race, education, body mass index, smoking status, anti-inflammatory medication use, and daily air pollution (PM 2.5).
In adjusted analyses, for every five-degree increase in UTCI, there was an increase in levels of several inflammatory markers, including monocytes (4.2%), eosinophils (9.5%), natural killer T cells (9.9%), and tumor necrosis factor-alpha (7.0%) and a decrease in infection-fighting B cells (−6.8%).
Study Raises Important Questions
“We’re finding that heat is associated with health effects across a wide range of organ systems and outcomes, but this study helps start to get at the ‘how,’” said Perry E. Sheffield, MD, MPH, with the Departments of Pediatrics and Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai in New York City, who wasn’t involved in the study.
Dr. Sheffield said the study raises “important questions like, Does the timing of heat exposure matter (going in and out of air-conditioned spaces for example)? and Could some people be more vulnerable than others based on things like what they eat, whether they exercise, or their genetics?”
The study comes on the heels of a report released earlier this month from the World Meteorological Organization noting that climate change indicators reached record levels in 2023.
“The most critical challenges facing medicine are occurring at the intersection of climate and health, underscoring the urgent need to understand how climate-related factors, such as exposure to more extreme temperatures, shift key regulatory systems in our bodies to contribute to disease,” Dr. Wright told this news organization.
The study was supported by grants from the National Institute of Environmental Health Sciences. Dr. Riggs, Dr. Wright, and Sheffield had no relevant disclosures.
A version of this article appeared on Medscape.com.
In this study, blood work from volunteers was examined for immune biomarkers, and the findings mapped against environmental data.
“With rising global temperatures, the association between heat exposure and a temporarily weakened response from the immune system is a concern because temperature and humidity are known to be important environmental drivers of infectious, airborne disease transmission,” lead author Daniel W. Riggs, PhD, with the Christina Lee Brown Envirome Institute, University of Louisville in Louisville, Kentucky, said in a news release.
“In this study, even exposure to relatively modest increases in temperature were associated with acute changes in immune system functioning indexed by low-grade inflammation known to be linked to cardiovascular disorders, as well as potential secondary effects on the ability to optimally protect against infection,” said Rosalind J. Wright, MD, MPH, who wasn’t involved in the study.
“Further elucidation of the effects of both acute and more prolonged heat exposures (heat waves) on immune signaling will be important given potential broad health implications beyond the heart,” said Dr. Wright, dean of public health and professor and chair, Department of Public Health, Mount Sinai Health System.
The study was presented at the American Heart Association (AHA) Epidemiology and Prevention | Lifestyle and Cardiometabolic Scientific Sessions 2024.
High Temps Hard on Multiple Organs
Extreme-heat events have been shown to increase mortality, and excessive deaths due to heat waves are overwhelmingly cardiovascular in origin. Many prior studies only considered ambient temperature, which fails to capture the actual heat stress experienced by individuals, Dr. Riggs and colleagues wrote.
They designed their study to gauge how short-term heat exposures are related to markers of inflammation and the immune response.
They recruited 624 adults (mean age 49 years, 59% women) from a neighborhood in Louisville during the summer months, when median temperatures over 24 hours were 24.5 °C (76 °F).
They obtained blood samples to measure circulating cytokines and immune cells during clinic visits. Heat metrics, collected on the same day as blood draws, included 24-hour averages of temperature, net effective temperature, and the Universal Thermal Climate Index (UTCI), a metric that incorporates temperature, humidity, wind speed, and ultraviolet radiation, to determine the physiological comfort of the human body under specific weather conditions.
The results were adjusted for multiple factors, including sex, age, race, education, body mass index, smoking status, anti-inflammatory medication use, and daily air pollution (PM 2.5).
In adjusted analyses, for every five-degree increase in UTCI, there was an increase in levels of several inflammatory markers, including monocytes (4.2%), eosinophils (9.5%), natural killer T cells (9.9%), and tumor necrosis factor-alpha (7.0%) and a decrease in infection-fighting B cells (−6.8%).
Study Raises Important Questions
“We’re finding that heat is associated with health effects across a wide range of organ systems and outcomes, but this study helps start to get at the ‘how,’” said Perry E. Sheffield, MD, MPH, with the Departments of Pediatrics and Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai in New York City, who wasn’t involved in the study.
Dr. Sheffield said the study raises “important questions like, Does the timing of heat exposure matter (going in and out of air-conditioned spaces for example)? and Could some people be more vulnerable than others based on things like what they eat, whether they exercise, or their genetics?”
The study comes on the heels of a report released earlier this month from the World Meteorological Organization noting that climate change indicators reached record levels in 2023.
“The most critical challenges facing medicine are occurring at the intersection of climate and health, underscoring the urgent need to understand how climate-related factors, such as exposure to more extreme temperatures, shift key regulatory systems in our bodies to contribute to disease,” Dr. Wright told this news organization.
The study was supported by grants from the National Institute of Environmental Health Sciences. Dr. Riggs, Dr. Wright, and Sheffield had no relevant disclosures.
A version of this article appeared on Medscape.com.
In this study, blood work from volunteers was examined for immune biomarkers, and the findings mapped against environmental data.
“With rising global temperatures, the association between heat exposure and a temporarily weakened response from the immune system is a concern because temperature and humidity are known to be important environmental drivers of infectious, airborne disease transmission,” lead author Daniel W. Riggs, PhD, with the Christina Lee Brown Envirome Institute, University of Louisville in Louisville, Kentucky, said in a news release.
“In this study, even exposure to relatively modest increases in temperature were associated with acute changes in immune system functioning indexed by low-grade inflammation known to be linked to cardiovascular disorders, as well as potential secondary effects on the ability to optimally protect against infection,” said Rosalind J. Wright, MD, MPH, who wasn’t involved in the study.
“Further elucidation of the effects of both acute and more prolonged heat exposures (heat waves) on immune signaling will be important given potential broad health implications beyond the heart,” said Dr. Wright, dean of public health and professor and chair, Department of Public Health, Mount Sinai Health System.
The study was presented at the American Heart Association (AHA) Epidemiology and Prevention | Lifestyle and Cardiometabolic Scientific Sessions 2024.
High Temps Hard on Multiple Organs
Extreme-heat events have been shown to increase mortality, and excessive deaths due to heat waves are overwhelmingly cardiovascular in origin. Many prior studies only considered ambient temperature, which fails to capture the actual heat stress experienced by individuals, Dr. Riggs and colleagues wrote.
They designed their study to gauge how short-term heat exposures are related to markers of inflammation and the immune response.
They recruited 624 adults (mean age 49 years, 59% women) from a neighborhood in Louisville during the summer months, when median temperatures over 24 hours were 24.5 °C (76 °F).
They obtained blood samples to measure circulating cytokines and immune cells during clinic visits. Heat metrics, collected on the same day as blood draws, included 24-hour averages of temperature, net effective temperature, and the Universal Thermal Climate Index (UTCI), a metric that incorporates temperature, humidity, wind speed, and ultraviolet radiation, to determine the physiological comfort of the human body under specific weather conditions.
The results were adjusted for multiple factors, including sex, age, race, education, body mass index, smoking status, anti-inflammatory medication use, and daily air pollution (PM 2.5).
In adjusted analyses, for every five-degree increase in UTCI, there was an increase in levels of several inflammatory markers, including monocytes (4.2%), eosinophils (9.5%), natural killer T cells (9.9%), and tumor necrosis factor-alpha (7.0%) and a decrease in infection-fighting B cells (−6.8%).
Study Raises Important Questions
“We’re finding that heat is associated with health effects across a wide range of organ systems and outcomes, but this study helps start to get at the ‘how,’” said Perry E. Sheffield, MD, MPH, with the Departments of Pediatrics and Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai in New York City, who wasn’t involved in the study.
Dr. Sheffield said the study raises “important questions like, Does the timing of heat exposure matter (going in and out of air-conditioned spaces for example)? and Could some people be more vulnerable than others based on things like what they eat, whether they exercise, or their genetics?”
The study comes on the heels of a report released earlier this month from the World Meteorological Organization noting that climate change indicators reached record levels in 2023.
“The most critical challenges facing medicine are occurring at the intersection of climate and health, underscoring the urgent need to understand how climate-related factors, such as exposure to more extreme temperatures, shift key regulatory systems in our bodies to contribute to disease,” Dr. Wright told this news organization.
The study was supported by grants from the National Institute of Environmental Health Sciences. Dr. Riggs, Dr. Wright, and Sheffield had no relevant disclosures.
A version of this article appeared on Medscape.com.