The Power of Positive Thinking

The Healing Power of Music: The John Hopkins Center for Music and Medicine

The Power of Positive Thinking | Johns Hopkins Medicine

Music has long been associated with mental, physical, and spiritual health. And someday soon, doctors may start prescribing their patients a dose of music to accompany more conventional medicine.

The Johns Hopkins Center for Music and Medicine, an interdepartmental collaboration between the School of Medicine and Peabody Conservatory, is actively exploring the science and therapeutic potential of music in medical care.

The Center, led by Alexander Pantelyat, M.D. and Sarah Hoover, D.M.A.

, leverages the expertise and experience of the School of Medicine and renowned performance training of the Peabody Institute—bringing together interdisciplinary partnerships and teams across the university.

Its dual vision is “to bring music and medicine together by making music and rhythm an integral part of treating neurological illness as well as improving the health of musicians worldwide.”

The Center has fostered a breadth of new research initiatives addressing how musicians can be healed, and how music and musicians can aid in healing. Hoover states, “It’s fascinating and powerful to think that music, something that has been floating around in our environment forever —that this natural, omnipresent human activity—has demonstrable benefit as treatment.”

Music as Medicine

Alongside its mission to provide care for musicians, a foremost initiative of the Center for Music and Medicine is the development of music and rhythm-based therapies that may improve quality of life and address symptoms of neurological conditions such as Alzheimer’s disease, Parkinson’s disease, and stroke.

Pantelyat states, “We aim to do rigorous Hopkins-quality research on music and rhythm-based interventions so that we can generate measurable data that will be ‘proof in the pudding’—not just an intuition that music helps but proof that music helps.”

Singing for Parkinson’s Disease

An accomplished musician and violinist himself, Pantelyat started by investigating the benefits of choral singing on Parkinson’s disease patients through his Parkinsonics program.

The 2015-2016 study—the first under the Center’s umbrella—brought together a small chorus to evaluate the effect of group vocal performance training and performance experience on Parkinson’s patients’ reported symptoms, such as volume and clarity of speech, and quality of life.

Over the course of 12 consecutive weeks, 32 participants met for weekly group singing classes under the direction of a choir director and social worker.

The choral program, which continues weekly as a community chorus in the same location, produced measurable outcomes in which “participants’ attention moves away from illness and toward creativity,” says Pantelyat. “Singing together in the group has helped increase participants’ vocal volume and clarity, rhythmic movement and confidence of emotional expression, while cultivating a sense of community.”

He added that the Parkinsonics program is a prime example of the Center’s overarching mission—to start with the research, and assuming its success, continue offering a community-based therapy that could be scaled worldwide.

Guitar for Parkinson’s Disease

Pantelyat’s research into music’s therapeutic potential continued with the Center for Music and Medicine’s Guitar-PD study.

The study, a collaboration with the International Arts + Mind Lab, examined the effects of six weeks of group guitar classes on quality of life, upper motor function, mood, and cognition.

Instruments were provided for each of the 26 participants for lessons in finger-style guitar tailored to accommodate the needs of Parkinson’s patients.

While results will be published in full this spring, initial outcomes included improvement across all participants in self-reported PDQ-39 scores—a standard validated questionnaire designed to assess quality of life for individuals with Parkinson’s disease.

 The questionnaire covers mobility, activities of daily living, emotional well-being, stigma and social support, cognition, communication and bodily support.

As in the Parkinsonics study, Guitar-PD also led to the establishment of continuing guitar classes at the Peabody Preparatory, known as PD Strummers.

Other parallel studies teaching Parkinson’s patients music have produced similar results.

Drum-PD examined a percussion-based approach, focusing on short-term effects of rhythmic auditory stimulation on gait and quality of life in Parkinsonian disorders.

A pilot study showed that after six weeks of twice-weekly West African drum circle classes, participants’ PDQ-39 scores improved significantly.

Bedside Music

The Center for Music and Medicine has also helped develop innovative and sustainable roles for performers in healthcare settings through its Creative Access and Sound Rounds programs.

 “The healthcare space is going to be a professional opportunity for performing artists in the very-near future,” says Hoover.

Programs such as Creative Access give musicians the opportunity to perform at area healthcare facilities, community organizations, and schools, while allowing patients—not to mention nurses and physicians—a music-based intervention consistently linked to positive, measurable outcomes.

“Over the last five to ten years, there really is a wealth of medical literature on various patients in the hospital where music-based interventions have been demonstrated to improve a number of measures,” says Pantelyat. “The ones that seem to consistently improve are pain levels, anxieties, and mood.”

He adds, “If we can demonstrate that a non-pharmacological intervention music can positively impact that pain and anxiety levels of these patients both before and after surgery that would be an important step forward for research in music-based intervention in the hospitals.”

Medicine for Musicians

The Center for Music and Medicine also studies treatment for musicians and performers, in Pantelyat’s words, by “doing the kind of research that would enable us to quantify musical performance with an eye toward trying to detect maladaptive performance habits before they turn into an injury.”

Of the afflictions that may uniquely affect musicians and performers, Pantelyat’s research has focused on musician’s dystonia, a motor disorder of the brain which results in difficulty coordinating fine movements. These are the kind of movements that are required for professional musicians, such as mouth placement for wind instrument players or finger dexterity for guitarists, pianists, or violinists.

Johns Hopkins Rehabilitation Network Clinic for Performing Artists at the Peabody Institute puts research to practice by providing physical, occupational, and speech-language therapy services to musicians and performers—a critical resource for those working through potentially career-ending ailments.

Working in Concert to Treat Patients

“This is an example to me of the whole being greater than the sum of its parts,” says Hoover.

The breadth of the Center’s programming is important to note. Pantelyat attests, “There are dozens of faculty members and students of various levels all across the university, both at the School of Medicine and Peabody, to the tune of over 80 people who have expressed their interest in one or more aspects of our mission at the Center for Music and Medicine.”

While there are organizations interested in fostering a dialogue between music and medicine, Hoover notes that there is “no other entity that links a major conservatory with a major medical hospital system and medical school,” positioning the Center for Music and Medicine as an exemplary model for interdisciplinary research and collaboration.

“What makes our center unique is that we aim to be the best from the standpoint of being able to generate measurable data,” says Pantelyat. “I hope in the next generation that we will have health insurance covering music-based intervention—music therapy—for patients with a variety of disorders so that I can give my patient a prescription for music.”

Written and reported by IAM Lab Contributor Samuel Garrett.  Samuel Garrett is a composer, musicologist, and researcher based in Baltimore, MD. 

Johns Hopkins Medicine Music


The Power of Positive Thinking

The Power of Positive Thinking | Johns Hopkins Medicine

Here’s heartwarming news: People with a family history of heart disease who also had a positive outlook were one-third less ly to have a heart attack or other cardiovascular event within five to 25 years than those with a more negative outlook.

That’s the finding from Johns Hopkins expert Lisa R. Yanek, M.P.H., and her colleagues. The finding held even in people with family history who had the most risk factors for coronary artery disease, and positive people from the general population were 13 percent less ly than their negative counterparts to have a heart attack or other coronary event.

Yanek and her team determined “positive” versus “negative” outlook using a survey tool that assesses a person’s cheerfulness, energy level, anxiety levels and satisfaction with health and overall life. But you don’t need a survey to assess your own positivity, says Yanek. “I think people tend to know how they are.”

Hope and Your Heart

The mechanism for the connection between health and positivity remains murky, but researchers suspect that people who are more positive may be better protected against the inflammatory damage of stress. Another possibility is that hope and positivity help people make better health and life decisions and focus more on long-term goals. Studies also find that negative emotions can weaken immune response.

What is clear, however, is that there is definitely a strong link between “positivity” and health. Additional studies have found that a positive attitude improves outcomes and life satisfaction across a spectrum of conditions—including traumatic brain injury, stroke and brain tumors.

Can You Boost Your Bright Side?

Although a positive personality is something we’re born with and not something we can inherently change, Yanek says, there are steps you can take to improve your outlook and reduce your risk of cardiovascular disease.

Simply smile more

A University of Kansas study found that smiling—even fake smiling—reduces heart rate and blood pressure during stressful situations. So try a few minutes of humor therapy when you’re stomping your feet waiting in line or fuming over a work or family situation. It’s difficult not to smile while watching a favorite funny video.

Practice reframing

Instead of stressing about a traffic jam, for instance, appreciate the fact that you can afford a car and get to spend a few extra minutes listening to music or the news, accepting that there is absolutely nothing you can do about the traffic.

Build resiliency

Resiliency is the ability to adapt to stressful and/or negative situations and losses. Experts recommend these key ways to build yours:

  • Maintain good relationships with family and friends.
  • Accept that change is a part of life.
  • Take action on problems rather than just hoping they disappear or waiting for them to resolve themselves. 


Cardiovascular (car-dee-oh-vas-cue-ler) disease: Problems of the heart or blood vessels, often caused by atherosclerosis—the build-up of fat deposits in artery walls—and by high blood pressure, which can weaken blood vessels, encourage atherosclerosis and make arteries stiff. Heart valve disorders, heart failure and off-beat heart rhythms (called arrhythmias) are also types of cardiovascular disease.

Immune response: How your immune system recognizes and defends itself against bacteria, viruses, toxins and other harmful substances. A response can include anything from coughing and sneezing to an increase in white blood cells, which attack foreign substances.


Keep Your Brain Young with Music

The Power of Positive Thinking | Johns Hopkins Medicine

Linkedin Pinterest Aging Well Age-Related Depression, Mood and Stress Maintaining a Healthy Mind as You Age

If you want to firm up your body, head to the gym. If you want to exercise your brain, listen to music.

“There are few things that stimulate the brain the way music does,” says one Johns Hopkins otolaryngologist. “If you want to keep your brain engaged throughout the aging process, listening to or playing music is a great tool. It provides a total brain workout.”

Research has shown that listening to music can reduce anxiety, blood pressure, and pain as well as improve sleep quality, mood, mental alertness, and memory.

Experts are trying to understand how our brains can hear and play music. A stereo system puts out vibrations that travel through the air and somehow get inside the ear canal. These vibrations tickle the eardrum and are transmitted into an electrical signal that travels through the auditory nerve to the brain stem, where it is reassembled into something we perceive as music.

Johns Hopkins researchers have had dozens of jazz performers and rappers improvise music while lying down inside an fMRI (functional magnetic resonance imaging) machine to watch and see which areas of their brains light up.

“Music is structural, mathematical and architectural. It’s relationships between one note and the next. You may not be aware of it, but your brain has to do a lot of computing to make sense of it,” notes one otolaryngologist.

Try It

When 13 older adults took piano lessons, their attention, memory and problem-solving abilities improved, along with their moods and quality of life. You don’t have to become a pro, just take a few lessons.

The power of music isn’t limited to interesting research. Try these methods of bringing more music—and brain benefits—into your life.

Jump-start your creativity

Listen to what your kids or grandkids listen to, experts suggest. Often we continue to listen to the same songs and genre of music that we did during our teens and 20s, and we generally avoid hearing anything that’s not from that era.

New music challenges the brain in a way that old music doesn’t. It might not feel pleasurable at first, but that unfamiliarity forces the brain to struggle to understand the new sound.

Recall a memory from long ago.

Reach for familiar music, especially if it stems from the same time period that you are trying to recall. Listening to the Beatles might bring you back to the first moment you laid eyes on your spouse, for instance.

Listen to your body

Pay attention to how you react to different forms of music, and pick the kind that works for you. What helps one person concentrate might be distracting to someone else, and what helps one person unwind might make another person jumpy.

Magnetic resonance imaging (MRI): A large machine that uses powerful magnets and radio waves to see inside your body. Un an X-ray, MRI testing does not use radiation.

If you undergo this test, you’ll lie on a narrow table that slides inside a tunnel-shaped scanner for about 30 to 60 minutes while health-care professionals watch from another room.

If you feel anxious in small, enclosed spaces, ask your physician about an open MRI that is not as close to the body.


Positive Thinking: What It Is, What It’s Not, and How to Do It

The Power of Positive Thinking | Johns Hopkins Medicine

Positive thinking, or an optimistic attitude, is the practice of focusing on the good in any given situation. It can have a big impact on your physical and mental health.

That doesn’t mean you ignore reality or make light of problems. It simply means you approach the good and the bad in life with the expectation that things will go well.

Many studies have looked at the role of optimism and positive thinking in mental and physical health. It’s not always clear which comes first: the mindset or these benefits. But there is no downside to staying upbeat.

Some physical benefits may include:

The mental benefits may include:

  • More creativity
  • Greater problem-solving skill
  • Clearer thinking
  • Better mood
  • Better coping skills
  • Less depression

When people in one study were exposed to the flu and common cold, those with a positive outlook were less ly to get sick and reported fewer symptoms.

During another study, women who were more optimistic were less ly to die from cancer, heart disease, stroke, respiratory disease, and infection.

And in a study of people over the age of 50, those who had more positive thoughts about aging lived longer. They also had less stress-related inflammation, which shows one possible link between their thoughts and health.

People with a positive outlook may be more ly to live a healthy lifestyle since they have a more hopeful view of the future. But researchers took that into account, and the results still held.

That all sounds great, right? But what if you’re naturally more pessimistic, meaning that you tend to expect the worst? No worries. It may help to see this positive thinking as a skill you can learn and benefit from, rather than a personality trait you either have or you don’t.

There’s research on this, too. In one experiment, adults who meditated daily on positive thoughts started feeling more upbeat emotions each day.

Other studies have shown that positive thinking helps people manage illness and eases depression, regardless of whether they are naturally optimistic or pessimistic.

Before you put positive thinking into practice, look for any negative thoughts that may be running through your mind. These include:

A bad filter. Do you overlook the good things about a situation and get wrapped up in the negatives? For example, you enjoy a fun dinner out with friends, but the restaurant gets your bill wrong at the end of the night. You leave feeling annoyed and frustrated, forgetting about the good time you had.

Taking the blame. Do you tend to take on the blame for something bad or disappointing that happens? For example, a friend declines an invitation from you, so you assume it’s because she doesn’t want to spend time with you.

Predicting disaster. This means you have one setback and then expect the worst to happen. For example, your car won’t start in the morning, so you think the rest of your day is destined to be doomed.

Black-and-white thinking. Do you see things as either good or bad, with no middle ground? In this mindset, if things aren’t perfect, they’re automatically bad.

When you notice a negative thought, try to stop it and shift your focus to the positive. Think rationally about the situation. If it helps you to let go, you can give yourself and those around you grace. (You can still hold them accountable for their actions.)

Your negative thoughts won’t go away overnight. But with practice, you can train yourself to have a more positive outlook. Remember, you aren’t overlooking the facts. You’re just including those that are good.

Once you have a handle on negative thinking, it’s time to play up the positive. Try these ways to do that:

Smile more. In a study, people who smiled (or even fake-smiled) while doing a stressful task felt more positive afterward than those who wore a neutral expression. You’ll benefit more if the smile is genuine, though. So look for humor and spend time with people or things that make you laugh.

Reframe your situation. When something bad happens that’s your control, instead of getting upset, try to appreciate the good parts of the situation. For example, instead of stressing about a traffic jam, recall how convenient it is to have a car. Use the time that you’re stuck behind the wheel to listen to music or a program you enjoy.

Keep a gratitude journal. This may sound cheesy, but when you sit down each day or week to write down the things you’re thankful for, you’re forced to pay attention to the good in your life. A study found that people who kept gratitude journals felt more thankful, positive, and optimistic about the future. They also slept better.

Picture your best possible future. Think in detail about a bright vision for your future — career, relationships, health, hobbies — and write it down. When you imagine your life going well, research suggests, you’ll be happier in the present.

Focus on your strengths. Each day for a week, think about one of your personal strengths, kindness, organization, discipline, or creativity.

Write down how you plan to use that strength in new ways that day. Then, act on it. People in a study who did that boosted their happiness and lowered their symptoms of depression at the end of the week.

Six months later, those benefits were still going strong.

With practice, you can add more positive thoughts to your life and enjoy the benefits that come with optimism.


The Journals of Gerontology: “Survival Advantage Mechanism: Inflammation as a Mediator of Positive Self-Perceptions of Aging on Longevity.”

American Journal of Epidemiology: “Optimism and Cause-Specific Mortality: A Prospective Cohort Study.”

The American Journal of Cardiology: “Effect of Positive Well-Being on Incidence of Symptomatic Coronary Artery Disease”

Clinical Psychology Review: “Optimism.”

Psychosomatic Medicine: “Positive emotional style predicts resistance to illness after experimental exposure to rhinovirus or influenza a virus.”

Psychological Science: “Optimistic Expectancies and Cell-Mediated Immunity: The Role of Positive Affect.”

Journal of Personality and Social Psychology: “Optimism is associated with mood, coping, and immune change in response to stress.”

Journal of Personality and Social Psychology: “Effects of optimism, pessimism, and trait anxiety on ambulatory blood pressure and mood during everyday life.”

Journal of Research and Reflections in Education: “Positive Thinking in Coping with Stress and Health outcomes: Literature Review.”

Pain: “Temporomandibular disorder and optimism: relationships to ischemic pain sensitivity and interleukin-6.”

Journal of Personality and Social Psychology: “Positive affect facilitates creative problem solving.”

Medical Decision Making: “The influence of positive affect on clinical problem solving.”

Journal of Clinical Psychology: “Worry changes decision making: The effect of negative thoughts on cognitive processing.”

Open Access Journal of Clinical Trials: “Randomized Controlled Trial of a Positive Affect Intervention to Reduce Stress in People Newly Diagnosed with HIV; Protocol and Design for the IRISS Study.”

Psycho-oncology: “A randomized pilot trial of a positive affect skill intervention (lessons in linking affect and coping) for women with metastatic breast cancer.”

Journal of Personality and Social Psychology: “Open Hearts Build Lives: Positive Emotions, Induced Through Loving-Kindness Meditation, Build Consequential Personal Resources.”

Mayo Clinic: “Positive thinking: Stop negative self-talk to reduce stress.”

Psychological Science: “Grin and bear it: the influence of manipulated facial expression on the stress response.”

Johns Hopkins Medicine: “The Power of Positive Thinking.”

The Greater Good Science Center at the University of California, Berkeley: “Greater Good in Action.”

Journal of Personality and Social Psychology: “Counting blessings versus burdens: an experimental investigation of gratitude and subjective well-being in daily life.”

American Psychologist: “Positive Psychology Progress: Empirical Validation of Interventions.”

© 2020 WebMD, LLC. All rights reserved.


What Is Behind the Psychology of Positive Thinking?

The Power of Positive Thinking | Johns Hopkins Medicine

Dougal Waters/Digital Vision/Getty Images

Do you tend to see the glass as half empty or half full? You have probably heard that question plenty of times. Your answer relates directly to the concept of positive thinking and whether you have a positive or negative outlook on life. Positive thinking plays an important role in positive psychology, a subfield devoted to the study of what makes people happy and fulfilled.

Research has found that positive thinking can aid in stress management and even plays an important role in your overall health and well-being.

“Most folks are about as happy as they make up their minds to be.” – Abraham Lincoln

What exactly is positive thinking? You might be tempted to assume that it implies seeing the world through rose-colored lenses by ignoring or glossing over the negative aspects of life. However, positive thinking actually means approaching life's challenges with a positive outlook.

Positive thinking does not necessarily mean avoiding or ignoring the bad things; instead, it involves making the most of the potentially bad situations, trying to see the best in other people, and viewing yourself and your abilities in a positive light.

Some researchers, including positive psychologist Martin Seligman, often frame positive thinking in terms of explanatory style. Your explanatory style is how you explain why events happened.

People with an optimistic explanatory style tend to give themselves credit when good things happen, but typically blame outside forces for bad outcomes.

They also tend to see negative events as temporary and atypical.

On the other hand, individuals with a pessimistic explanatory style often blame themselves when bad things happen, but fail to give themselves adequate credit for successful outcomes.

 They also have a tendency to view negative events as expected and lasting.

As you can imagine, blaming yourself for events outside of your control or viewing these unfortunate events as a persistent part of your life can have a detrimental impact on your state of mind.

Positive thinkers are more apt to use an optimistic explanatory style, but the way in which people attribute events can also vary depending upon the exact situation. For example, a person who is generally a positive thinker might use a more pessimistic explanatory style in particularly challenging situations, such as at work or at school.

In recent years, the so-called “power of positive thinking” has gained a great deal of attention thanks to self-help books such as The Secret. While these pop-psychology books often tout positive thinking as a sort of psychological panacea, empirical research has found that there are many very real health benefits linked to positive thinking and optimistic attitudes.

According to the Johns Hopkins Medicine, positive thinking is linked to a wide range of health benefits including:

  • Longer life span
  • Less stress
  • Lower rates of depression
  • Increased resistance to the common cold
  • Better stress management and coping skills
  • Lower risk of cardiovascular disease-related death
  • Increased physical well-being
  • Better psychological health

One study of 1,558 older adults found that positive thinking could also reduce frailty during old age.

Clearly, there are many benefits of positive thinking, but why exactly does positive thinking have such a strong impact on physical and mental health.

One theory is that people who think positively tend to be less affected by stress. Another possibility is that people who think positively tend to live healthier lives in general; they may exercise more, follow a more nutritious diet and avoid unhealthy behaviors.

While the terms “positive thinking” and “positive psychology” are sometimes used interchangeably, it is important to understand that they are not the same thing.

First, positive thinking is about looking at things from a positive point of view. Positive psychology certainly tends to focus on optimism, but it also notes that while there are many benefits to thinking positively, there are actually times when more realistic thinking is more advantageous.

For example, in some situations, negative thinking can actually lead to more accurate decisions and outcomes. Researchers have also found that in some cases, optimistic thinking can improve physical health.

Even if you are not a natural-born optimist, there are things you can do to learn how to think positive and become a positive thinker. One of the first steps is to focus on your own inner monologue and to pay attention to your self-talk.

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  1. How power of positive thinking works. The Harvard Gazette. Published December 7, 2016.

  2. Seligman M. Learned Optimism. New York City: Random House; 2006.

  3. Chang E, Sanna L. Virtue, Vice, And Personality: The Complexity of Behavior. Washington: American Psychological Association; 2003: 23-37.

  4. The Power of Positive Thinking. Johns Hopkins Medicine.

  5. Gale CR, Mõttus R, Deary IJ, Cooper C, Sayer AA. Personality and Risk of Frailty: the English Longitudinal Study of Ageing. Ann Behav Med. 2017;51(1):128-136. doi:10.1007/s12160-016-9833-5

  6. Alloy L, Abramson L, Chiara A. On the Mechanisms By Which Optimism Promotes Positive Mental and Physical Health. In J. Gillham (ed.) The Science of Optimism and Hope: Research Essays in Honor of Martin E.P. Seligman. Philadelphia: Templeton Foundation Press. 2002:201-212.

  7. Park N, Peterson C, Szvarca D, Vander molen RJ, Kim ES, Collon K. Positive Psychology and Physical Health: Research and Applications. Am J Lifestyle Med. 2016;10(3):200-206. doi:10.1177/1559827614550277


Research News Tip Sheet: Story Ideas From Johns Hopkins

The Power of Positive Thinking | Johns Hopkins Medicine

Newswise — During the COVID-19 pandemic, Johns Hopkins Medicine Media Relations is focused on disseminating current, accurate and useful information to the public via the media. As part of that effort, we are distributing our “COVID-19 Tip Sheet: Story Ideas from Johns Hopkins” every Tuesday throughout the duration of the outbreak.

We also want you to continue having access to the latest Johns Hopkins Medicine research achievements and clinical advances, so we are issuing a second tip sheet every Thursday, covering topics not related to COVID-19 or the SARS-CoV-2 virus.

Stories associated with journal publications provide a link to the paper. Interviews with the researchers featured may be arranged by contacting the media representatives listed.



Media Contact: Waun’Shae Blount

In recent years, a variety of treatments have enabled people with the human immunodeficiency virus (HIV) to live long, healthy lives.

However, with advanced age comes the increased risk of developing cognitive impairment, so it’s vitally important to better define the specific factors behind cognitive decline in people living with HIV to treat this group in the earliest stages.

Until recently, such understanding has been difficult to obtain, as the underlying reasons for loss of memory, thinking impairment and other cognitive deterioration among older individuals with HIV seem to overlap with those seen in seniors who do not have the virus.

In a study published in the April 8, 2020, issue of Journal of NeuroVirology, Johns Hopkins Medicine researchers used positive emission tomography, or PET, scans to determine if cognitive decline in older individuals with HIV was related only to the presence of the virus or whether it might be connected to a commonly seen factor in cases of Alzheimer’s disease and other forms of dementia: the accumulation of a protein fragment called beta-amyloid, a sticky compound that disrupts communication between nerve cells in the brain and eventually kills them.

The researchers studied 73 Maryland residents age 50 and older (48 HIV-positive and 25 HIV-negative).

Participants went through an extensive evaluation process, including a physical exam, HIV status check, neuropsychological assessment, magnetic resonance imaging (MRI) of the brain, and a spinal tap to analyze fluid surrounding the brain for beta-amyloid protein.

Finally, participants were injected with a radiotracer that binds with beta-amyloid in the brain, so that a PET scan could determine the levels of the protein accumulated there.

Among individuals with HIV, increasing cognitive decline was associated with increasing depression and decreasing intelligence (as defined by IQ scores).

These people showed greater amyloid protein buildup in the centrum semiovale, a structure within the white matter deep in the brain, compared with individuals without HIV.

Loss of function in the centrum semiovale is believed to be a factor in impairments of attention, intelligence and academic achievement.

Along with accumulations in the centrum semiovale, individuals in their 50s with HIV also exhibited greater amounts of amyloid protein in other white matter regions associated with executive function and memory, in contrast to individuals without HIV.

“These findings provide evidence for premature aging in individuals with HIV,” says James Brasic, A.M., M.A., M.D., M.P.H., M.S.

, assistant professor of radiology and radiological science at the Johns Hopkins University School of Medicine and a member of the research team.

“Our future studies will focus on investigating therapies to slow or eliminate cognitive impairment in older people with HIV, including clinical trials and extensive imaging to evaluate the impact of those interventions.”


Media Contact: Valerie Mehl

A telephone coaching and web-based weight loss plan, referred to by scientists as the “POWER-remote intervention,” helped half of overweight and obese breast cancer survivors lose 5% or more of their body weight after six months — and keep it off for 12 months, according to a recent study led by Johns Hopkins Kimmel Comprehensive Cancer Center researchers.

Published in the April 10, 2020, issue of the journal Clinical Cancer Research, the study enrolled 87 women with minimally to moderately invasive breast cancers and a body mass index of 25 or higher (a BMI of 25 to 29 is considered overweight; 30 or more is obese).

All participants had completed surgery and any prescribed radiation and chemotherapy.

A diverse group of patients ages 30 to 73, including 20% African-American women, was randomly divided into two sections, with 45 women completing the POWER-remote intervention and 42 completing a self-directed weight loss plan.

Women participating in the POWER-remote intervention received telephone-based behavioral weight loss coaching — weekly for the first three months, then monthly through the end of the yearlong study — along with access to a web-based platform to monitor their diet, exercise and weight. Women in the self-directed weight loss group received one coaching session at the start of the study, along with standard diet and exercise guidelines provided by the National Heart, Lung and Blood Institute.

After six months, 51% of women assigned to the POWER-remote intervention lost 5% or more of their body weight, compared with 12% of those who participated in a self-directed weight loss program.

Twelve months after the start of the study, 51% of those in POWER-remote group maintained their weight loss, compared with 17% of those in the self-directed group. The average weight loss in the remote coaching group after six and 12 months was 4.6 kilograms (10.1 pounds), compared with 0.

5 kilograms (1.1 pounds) at six months and 0.4 kilograms (.9 pounds) at 12 months among the self-directed group.

Women receiving the POWER-remote intervention in the trial had almost a 50% decrease in leptin, whereas the self-control group essentially had unchanged levels. Leptin, a hormone released primarily by fat cells, and a biomarker for weight gain, has been shown to increase breast cancer cell proliferation, invasion and migration.

“The results of our study showed that the POWER-remote coaching is a feasible and effective weight loss intervention for breast cancer survivors,” says Kimmel Comprehensive Cancer Center investigator and assistant professor of oncology Cesar A. Santa-Maria, M.D., M.S.C.I.


Media Contact: Michael E. Newman

Innate lymphoid cells, or ILCs, are components of the immune system that produce cytokines, protein molecules that act as signals to help direct and regulate the body’s immune response against foreign invaders.

In a recent study using mice, researchers at the Johns Hopkins University School of Medicine and the Czech Republic’s Institute for Clinical and Experimental Medicine (IKEM) demonstrated that one type of ILC can sometime switch roles, becoming an immunity villain instead of a hero by provoking the development of eosinophilic pericarditis, a rare and potentially deadly inflammation of the heart muscle.

There are three types of ILCs defined by the type of cytokines they produce. Group 2 ILCs, also known as ILC2s, are found in many organs throughout the body. They are most prevalent in the fluid filling the pericardium, the double-walled sac containing the heart and the roots of the vessels entering and exiting the heart.

“We suspected that ILC2s might be connected to the development of eosinophilic pericarditis, so we decided to try to confirm that link and, if so, then look for the mechanism behind it,” says Daniela Cihakova, M.D., Ph.D., associate professor of pathology at the Johns Hopkins University School of Medicine and the senior author of the paper discussing this research published March 3, 2020, in the journal Cell Reports.

In a 2012 study — led by former Johns Hopkins Medicine researcher DeLisa Fairweather, Ph.D.

(now with the Mayo Clinic), in collaboration with Cihakova and others — the researchers found that if they injected interleukin-33 (IL-33) — a cytokine produced by the spindle-shaped cardiac cells known as fibroblasts — into the pericardium cavity of mice, it led to a massive accumulation of eosinophils, white blood cells that in proper numbers will neutralize parasites, viruses and certain types of fungi that attack the heart. However, too many eosinophils on the job can result in a misdirected attack on healthy heart muscle cells. This causes eosinophilic pericarditis.

The researchers theorized that innate lymphoid cells might play a key role in the autoimmune heart disease process.

To test their hypothesis, the researchers conducted a set of experiments in mice.

First, they injected IL-33 into three mouse types: wild type (normal), with T and B cells — the primary immune system fighters — and ILC2s; genetically bred to only have ILC2s; and genetically bred without any of the three.

Only the mice lacking ILC2s did not get pericarditis, indicating it was the pivotal factor. To confirm the finding, ILC2s were injected into the third type of mice that did not have them naturally. They showed accumulations of eosinophils and damage to the pericardium as well.

A third mouse experiment revealed the pathway by which ILC2s lead to pericarditis.

Knowing that ILC2s release two cytokines, interleukin-5 (IL-5) and interleukin-13 (IL-13), in response to IL-33, the researchers showed that when this occurs, cardiac fibroblasts are stimulated to produce a chemical called eotaxin, which attracts eosinophils.

Concurrently, the fibroblasts produce more IL-33, which in turn, pushes the ILC2s to produce more IL-5 and IL-13 — a feedback loop that intensifies the eosinophil accumulation and its destructive autoimmune response.

Another investigation determined that the eosinophils could traffic to the heart not only through the bloodstream, but also from the mediastinal cavity — the space around the heart.

Finally, study collaborators led by Vojtech Melenovsky, M.D., Ph.D., at IKEM obtained pericardial fluid from human patients with different cardiac diseases.

The Cihakova team examined the samples and found large numbers of ILC2s exclusively in the two patients being treated for pericarditis.

This, Cihakova says, makes it highly ly that the disease in humans follows the same pathway she and her colleagues observed in mice.


Media Contact: Vanessa McMains, Ph.D.

Poverty is an independent risk factor for drug abuse that addiction treatment plans largely ignore. Experts believe that a gold-standard drug treatment intervention would be one that could promote employment, reduce drug use and help those ravaged by the opioid crisis to better integrate back into their communities, while addressing underlying poverty.

Now, Johns Hopkins Medicine researchers have tested a new wage bonus plan for treating people with opioid dependence. In a study published in the Feb. 21, 2020, issue of the Journal of Epidemiology & Community Health, the researchers report that adding $8 an hour to a paycheck may help those in recovery stay drug free longer, as well as encourage them to get and hold regular jobs.

During the yearlong intervention, 65% of people with wage supplements provided urine samples free of opioids and cocaine, compared to 45% of those without wage supplements. People with wage supplements were also 2.9 times more ly to get a job and 2.7 times more ly to rise poverty by the end of the year than those without the bonuses.

“We were hoping to have a positive result from our study, but I don’t think we expected it to work quite so well,” says August Holtyn, Ph.D.

, assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.

“The vast majority of unemployed people that participated entered into the workforce with minimum wage positions, so we think the wage supplement is helpful in providing motivation to keep jobs that at times can be stressful and difficult.”

She says participants worked in construction, grocery stores, the food service industry, house cleaning and delivery.

Although the wage supplements and drug testing stopped after the study period, the researchers plan to follow participants for another year to see if the reduced drug use and consistent employment effects persist. They also are testing their wage supplement intervention with homeless adults who have alcohol use disorder.