Chief Medical Officer at Northwestern Medicine Central DuPage Hospital Dr. Kevin Most joins the Steve Cochran Show to discuss a groundbreaking tool for detecting Parkinson’s years before symptoms emerge, the importance of having an advocate during doctor visits, and the need to enhance treatment options for drug addiction.

Dr. Most’s Steve Cochran Show Notes: 

​​Identify Parkinson’s 7 years before symptoms??  Oculomics- a new diagnostic tool

1. The Eye is often called the window to the body
2. Oculomics an exciting new field where we use information from the eye to predict and monitor other illnesses
3. We use eye exams to identify propensity for high blood pressure, diabetes, cardiovascular disease, recently we have identified other signs of Alzheimer’s, MS and most recently schizophrenia
4. A study recently published using Artificial Intelligence and data on previous scans has identified subtle changes in retinal scans that may identify Parkinson’s patients many years before any symptoms are noted.
5. The study completed in the UK merged the data of 2 large studies, using scans of healthy individuals as well as those with Parkinson’s, identifying subtle changes that were only noted in the Parkinson’s patients.
6. Much of this data comes from Optical Coherence Tomography, known as OCT. This is a 3 D scan that can be done in less than a minute
7. The detail is amazing, down to a thousandth of a millimeter.
8. OCT is used to monitor eye health, looking at cells in the retina,
9. OCT scans are done by major eye clinics, such as Wheaton Eye Clinic
10. Often done every 2 years in patients which allows for eye health monitoring and allowing  the data base to grow and thus opens up more opportunities for diagnosing or predicting other diseases
11. Finding illnesses or disease before symptoms are noted will be the foundation for future care.
12. Allowing for medication, life style changes and other options to slow the progression of illness
13. This will be another tool for screening for illnesses well before symptoms are noted.
14. It only takes a few minutes and the cost is around $60, with many insurance companies covering the cost or a portion of it

Vaccines- we have talked a lot about vaccines over the past 2 years. We have also talked about RSV over the past year.  Unique vaccine was approved last week, not unique about the vaccine, but more about the intent

1. RSV is the leading cause of infections in children under 5 years of age, it is the most frequent cause of pneumonia in infants world wide
2. We see over 2 million cases of RSV in doctors offices and it is thought that this may be about 50% of the actual number of cases as many do not see a doctor.
3. Last year we had close to 100,000 hospitalizations for RSV in Children under the age of 5, and another 150,000 hospitalizations in adults over the age of 65
4. Until May of  this year we had no vaccine for RSV, when the vaccine for RSV was approved for individuals over the age of 60, thus covering one of the groups of our concern
5. This past week the FDA approved this same  vaccine with a unique focus on a population that can be severely impacted.
6. The RSV vaccine approved last week was for women who are pregnant and between 32-36 weeks gestation.
7. Are we concerned that the mother will get RSV??  —– No
8. This vaccine is given to the mother, so her immune system can make antibodies to RSV, which she passes to the unborn child.
9. The child when born now has the mothers antibodies to protect the baby from RSV infections from  birth to 6 months of age, the time they are most vulnerable to this contagious disease
10. Newborns have a very limited immune system when born, they have WBC to fight infections but their supply of antibodies has not been built up, and the immune system is not ready to produce antibodies well
11. Mothers who breast feed also pass important antibodies to the newborn, again giving them some protection

New test available for consumers for Alzheimer’s- first test available on line order

1. Quest Diagnostics is introducing a direct to consumer blood test for the detection of Alzheimer’s
2. The test will have a cost of $400 and will be a blood test drawn at a quest facility
3. You can order the test on line and be directed to a local site where the blood is drawn
4. The test is aimed at individuals with mild cognitive deficit or family history of AD
5. The test is then run and your results are sent to you via a secure portal
6. Results that are concerning will be given to the patient by a physician
7. Results are clearly explained, and you have a option to talk to a physician
8. The test will be looking at the biomarkers that are associated with the early detection of  Alzheimer’s, and give a risk score essentially
9. Currently close to 7 million diagnosed cases of AD in the US with expectations that the number will double in the next 20 years
10. Current diagnostic methods, such as MRI scans, cognitive tests, and physical examinations have limitations due to their need for specialized clinics and trained staff.
11. The hope is that this test will identify more individuals at an early stage and advance the treatment options available
12. Others feel this may also be used to identify people years before they have symptoms, thus placing them in a position of possible slowing the illness
13. There is concern that this test may lead to some “false Positive” cases, as we know that some individuals have amyloid in their brain yet have none of the signs of Alzheimer’s
14. The test may be a starting point and is certainly not a diagnostically conclusive test.
15. Historically we have had patients with symptoms, who then went on for conclusive testing, this may be a test that is done when minor symptoms are noted and much less costly than the other tests
16. Will this test be used to identify individuals who may then receive Leqembi, the drug that when given early has been shown to slow the progression of symptoms

August 31st International Overdose Awareness Day-  We need to understand the highly addictive nature of these drugs and the inadequate options we have for treatment

1. Worlds largest campaign to end overdose and the stigma around drug related overdose deaths
2. Overdose deaths are skyrocketing around the world as the increased use of drugs laced with fentanyl continues to rise
3. In 2021 the number of overdose deaths approached 110,000 in the US
4. This has occurred despite the awareness of the issue and the availability of Narcan
5. Narcan Nasal Spray is now available  over the counter without a prescription
6. Fentanyl is a synthetic opioid, that is highly addictive and  the deadliest drug threat we have in the US
7. Fentanyl is 50 times more potent than Heroin, and 100 times more potent than morphine
8. If it is so deadly why do dealers use it? Because it is so addictive, and when measured accurately it has a higher addiction rate
9. Fentanyl is mixed with cocaine, Xanax and counterfeit Adderall, a very small amount of fentanyl is deadly
10. What we need is often controversial
11. We need more treatment centers and options, many addicts do not have insurance so who will pay for treatment, thus the number of treatment options far outweigh the need
12. We need more awareness about overdoses and naloxone. This simple drug can be given by any bystander and be life saving
13. We need to provide fentanyl testing strips, so addicts can identify unsafe drugs, distribution of these gives another chance to engage with a healthcare worker to  discuss options
14. We need syringe exchange programs, understand that we will need to treat these individuals in hospitals with infections and HIV
15. We need more drug testing surveillance sites, to understand what is on the street and to make more people aware
16. We need safe consumption sites, that are supervised, allowing for more education and attempted treatment
17. We need more availability of Narcan, as it goes OTC the cost is around $50 for 2 doses ( often 2 doses are needed)- this is too expensive to have wide spread distribution
18. Narcan is currently available in some convenience stores and even in some vending machines for free