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Comment by dwroberts | Hacker News Reader

The problem with this stuff is (as the article mentions) is that it’s going to take a while to figure out whether any benefit is just temporary.

I would guess that there are a lot of variables to eliminate too - eg is it possible that just having a surgery and recovering from anaesthesia can yield some of these benefits in some circumstances? Given that we don’t really understand how most inhaled anaesthetics fully work

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Yes, indeed.

I've witnessed dementia patients take a fall, and then be dramatically more confused the next couple days. I've also seen them get some kind of social exposure, sunshine, exercise, etc. and present better for several days afterwards. Measuring "how well is the mind working" isn't like reading a digital meter.

re. sunlight, pharmacological immunomodulation via UV isomerization of a substance found on skin is… interesting imo: https://www.pnas.org/doi/10.1073/pnas.0603119103

If anesthetics cured Alzheimer's temporarily then any surgery would get the same effect and we would already know about it.

Firstly it’s not curing anything, it’s yielding some improvement. But secondly: what surgeries are performed on people with Alzheimer’s disease, let alone ones where cognitive improvement is even going to be monitored or noticed afterwards? (and even if it were noticed: periods of lucidity are not rare. It would probably be ignored)

I agree. Very likely to be brushed off as "you're having a good day today" unless you are looking for it.

> Firstly it’s not curing anything, it’s yielding some improvement

It did cure some people, it yielded some improvements on average but it did yield extreme improvements in some people. That part isn't controversial.

> (and even if it were noticed: periods of lucidity are not rare. It would probably be ignored)

A year of being able to walk and talk normally when a patient could barely function at all would be noticed for sure.

> It did cure some people

Cure has a very specific definition. I don't think it applies here.

It would indicate that there is a circulatory issue in general that causes this. If so, there may be other blockages as well, at various other lymph nodes that connect to the brain, which would explain why it works better for some and not others. If you have multiple blockages this may only offer partial relief. As for what causes the blockages, my suspicion would be microplastics.

Cure means permanent. If the extreme improvements are temporary (yet to be seen) its not a cure.

It seems like you're arguing with this guy for the sake of argument. If anesthetics "yielded some improvement" in Alzheimer's temporarily then any surgery would get the same effect and we would already know about it. And what is the second point you are trying to make here - that zero surgeries are ever performed annually on Alzheimer's patients for any reason? And of the ones that are, the family wouldn't notice the dramatic cognitive improvement shown in this article, but they noticed it here?

I was not trying to say anaesthetics are actually the cure, it’s an example of the kind of elimination that has to be done to prove something is actually effective.

Look up how double blind tests are done on things that involve surgeries (eg implants)

> And of the ones that are, the family wouldn't notice the dramatic cognitive improvement shown in this article, but they noticed it here?

Because they’re primed to look for that improvement because they’re told that is the expected outcome

Does it matter if it's just temporary? If it works, it is the smoking gun of what alzheimers is and why it happens. If it is not a permanent fix, the next question is what is happening in the body that is causing these blockages. It also means that microplastics may be a leading cause.

Most likely the build up of those beta amyloid is faster than what the brain can clear by itself. The drainage likely just reduced the amyloid significant enough for the brain to recover. This is likely more of physics explanation than biological. It is similar cleaning the wound by itself has spectacular effect for recovery than you leave it cluttered with dirt and pus.

If you have the money for the surgery, an extra year of cognition is huge. Short-term quality of life improvements are totally worth it if you can afford it.

(Disclaimer: the non-paywalled part of the article did not mention side-effects or complications of the treatment so I don’t know what they are.)

Even if it is temporary, so what? Can't you just repeat it? And wouldn't clearing these drainage channels be harmless (modulo risks of any surgery) even if the theory didn't pan out? If I had early-stage Alzheimer's I'd go to the ends of the Earth and do everything I could to slow it down.

Repeat it? It's not removing a tumor. It's adding a path between lymph nodes and blood vessels. You can't just repeat that. After the surgery that path exists. It's a permanent functional change.

If some drainage good, maybe more drainage better?

Sounds like a good topic for research!

> Can't you just repeat it?

I wouldn't assume you could. I guess that's why people study these things.

All benefits are temporary, my online friend.

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