Comment by vintermann
15 hours ago
That sounds pretty expensive for me for a test with that low accuracy, especially when there's not much you can do different if it comes back high vs. coming back low.
15 hours ago
That sounds pretty expensive for me for a test with that low accuracy, especially when there's not much you can do different if it comes back high vs. coming back low.
From TFA:
> Early detection of Alzheimer’s disease is important since the first treatments capable of slowing the progression of the neurodegenerative disease recently became available to patients, and these drugs are more effective when started sooner rather than later. Other promising investigational drugs are in the pipeline.
A very good friend's wife had Alzheimer's caught early, and the medication she's on stopped its progression. It's much better for her than my family members who had no treatment options.
I am not personally aware of any treatment for which there is particularly compelling evidence that it meaningfully slows progression even when started early. I wish there was.
It’s also not clear that one can measure progression well enough that an n=1 data point is meaningful. And I’m also far from convinced that very early Alzheimer’s that would progress rapidly enough to be noticeable can be detected with enough specificity to rule out fairly common cases of people who test positive but effectively don’t have the disease.
Best wishes to your friend’s wife.
Agreed that that it’s an interesting question on how to detect Alzheimer’s and also how to treat. My Dad is starting to show signs of mild mental impairment (he’s 87) - more forgetful than usual, more confused than usual, not able to work his computer like he used to…
He has taken a personal interest in preventing dementia and wants to take the first generation Alzheimer’s drugs, specifically leqembi that works on amyloid plaques. And this is definitely a tough choice, because eventhough it does show some slowing of the disease, it has lot of side effects that may not be worth it.
Personally, I am against it and don’t think it’s worth it as he could do permanent damage to himself. Think he should hang on until the second generation of drugs come out, which should be in the next 1-3 years (there a lot of Alz drugs in the pipeline, but you never know of course if anything will pan out). It’s a tough choice and don’t know if there is a good option at this point.
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Creatine supplementation is showing some promising indications of being a low cost, mild to moderate intervention https://www.psychologytoday.com/us/blog/the-modern-brain/202...
I definitely wouldn't be sharing that as evidence of anything much at all
Google scholar link for the article https://scholar.google.com/scholar?cluster=10296105574478709...
Whether this ends up being replicated or not, I love the classic gym bro supplement being studied for its potential benefits to the brain.
What a time to be alive
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> the medication she's on stopped its progression
what medication is that?
what? there aren't any treatments that stop alzheimers, there are some that help manage symptoms
May not completely stop it, but lecanemab and donanemab are certainly considered to be disease-progression modifying at this point.
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Agreed that we can't do as much as we'd like. There are some general health things that are believed to prevent cognitive decline, such as managing cholesterol, HbA1c, blood pressure, sleep apnea, etc. One phrase I've heard is that cholesterol at age 50 predicts cognitive health at age 70.
But hopefully we'll start to have more options and wider approvals for things like anti-amyloid drugs.
Hi there. Actually, Leqembi is a 1st gen Alzheimer’s drugs and targets amyloid plaques. But, like other responses, amyloids doesn’t seem to be hugely responsible for Alzheimers, which is why targeting things like tau proteins is being explored.
> anti-amyloid drugs
Isn’t the viewpoint in the last decade that amyloid plaques are likely a finding rather than the underlying cause of Alzheimer’s Disease?
The "standard" theory is that amyloid leads to tau protein accumulation which leads to neurodegeneration: https://www.astralcodexten.com/p/in-defense-of-the-amyloid-h.... Which would explain why current treatments don't really work: by the time Alzheimer's has progressed to noticeable impairment there's already too much tau, so reducing amyloid will at best slow the rate of decline by reducing the formation of new tau.
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ever since the discovery of amyloid plaques, it's been an open question. Are they causative or a symptom? Would reducing or eliminating them help treat the disease? There is lots of data that supports amyloid as a disease treatment target, particularly in animal models. Of course the abject failure to actually develop a good anti-amyloid treatment that actually provable and significantly mitigates the disease weighs against the idea that amyloid is a good target. And the high profile frauds that have been discovered haven't helped. But, the biomedical community are not a bunch of morons. All these drug companies wouldn't have spent these billions of dollars on anti-amyloid and anti-tau if they were such obviously terrible ideas.
That's the viewpoint of everyone sensible outside of Alzheimer's research.
Those in it are still throwing billions per year at the idea.
Meanwhile, back in reality, no amyloid-beta drug has had any clinical effect in humans, other than reducing the plaques. But both the shingles and RSV vaccines are proven to reduce Alzheimer's risk.
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if cholesterol predicted future cognitive health we wouldn’t need dedicated tests, do we?
the better way to phrase that would be "is predictive"... there is an association, but it is not high accuracy.
The forecast predicts rain, I'm still going to look outside before I throw on a raincoat
You can do all that without an expensive blood test.
It sounds similar to Lipoprotein(a) blood test for cardiac risk.
It's (almost) purely determined by genetics. You can't do anything to improve it, other than to improve every other cardiac related risk factor.
(There are some experimental drugs in the pipeline, though)
There is an oral PCSK9 treatment (enlicitide) was recently released that provides a 30% reduction, and of course you can't get insurance coverage without the test. And there are 2 drugs with 90%+ reduction in Lp(a) in phase3 trials with expected release in 2027-8, in particular Olpasiran.
I guess you can start spending your retirement money faster
I know it’s a joke but then you’ll leave your family bearing the burden of your care. As someone whose parents had dementia, finding a place that treats your parents with dignity is extremely expensive and very rare. We were spending 12k/month and even we needed to set up camera’s and my sister slept with my mom and took care of her like a nurse. When the pandemic hit my sister couldn’t enter so every morning they took my mom, clothed her and sat her facing the bathroom all day long.
The only other alternative is some sort of mental hospital which is more like a prison than anything else.
Hopefully by the time i’m there euthanasia will be legal
No, a Medicaid funded care facility is the alternative
The sad fact is that some people really should. Many people find it far easier to be or become indigent and fall on Medicaid services. If you do not qualify for Medicaid, then there is a real possibility that your insurance carrier will help put you or your caregivers into massive debt for a long-term illness like this.
If you do go into long-term care, Medicaid will probably seize your assets to help pay for everything. For example, a house in your name. They'll use those to pay back what they paid for your care.
So if you're gonna get sick and you're gonna be a burden in your old age, best to plan for leaving this world the way you came in: naked and penniless.