FDA clears blood test to aid evaluation for Alzheimer's disease
medicine.washu.edu
medicine.washu.edu
In one recent study, people very high p-tau217 had a 38% chance of progressing to cognitive impairment within 5 years vs 12% for those with low levels. The current tests cost about $200-300, so they're not unreasonable as a screening test. PrecivityAD2 looks to be priced around $1,400-$1,500 so at that price, this specific test likely only makes sense for people with established disease.
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.
The only other alternative is some sort of mental hospital which is more like a prison than anything else.
But hopefully we'll start to have more options and wider approvals for things like 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?
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.
I can't think of a good reason why this happened.
[0] https://www.npr.org/2021/06/11/1005567149/3-experts-have-res...
This is called working! I am struck by the double-standard applied to assessing treatment options for Alzheimer's vs cancers. Many (most?) Stage IV cancers are incurable, and the main goal of treatment is to slow progression of the disease. Adding years to patients' lives is absolutely worth it, assuming the side effects are not overwhelming and the costs are not prohibitive.
To wit: Moderna added ~30B to its market cap on the news that it observed _statistically significant_ improvement in its primary endpoint for treating metastatic melanoma. Great! I'm as excited about this development as anyone. A new treatment option for a terrible disease that meaningfully improves on the current standard of care (Keytruda). Sadly, Stage IV melanoma is still considered terminal, and no one suggested that Moderna changed that.
Why not reset expectations for Alzheimer's? If we manage to slow its development enough so that most patients (who tend to be elderly) would die of other causes while maintaining decent quality of life, that's a win in my book.
> 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.
What a time to be alive
Google scholar link for the article https://scholar.google.com/scholar?cluster=10296105574478709...
what medication is that?
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.
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.
And, would be very surprised if none of the drugs in clinical trials panned out in the next five or six year. It seems like they’re on the verge of making a major breakthrough. Here’s hoping:)
We shall see if yet another generation of amyloid-targeted treatment does any better. The amyloid-hypothesis boosters seem to think so - we had a thread about this not that long ago. But I remain skeptical.
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)
>>Mutations in PSEN1 and APP are associated with complete penetrance, meaning that all individuals who have a PSEN1 or APP mutation will develop AD if they live a normal lifespan [1]
and
>>[Age-of-onset] Usually 40s or early 50s (range 30s-early 60s) [2]
Note that this is only for early-onset Alzheimer's, representing ~5% of all Alzheimer's.
>>Our study showed that the rate of EOAD in AD is 5.5%, not 1-2% as usually demonstrated. And our results indicated that the rate in developed countries was relative higher than in developing countries [3]
[1]https://pmc.ncbi.nlm.nih.gov/articles/PMC3326653/
[2]https://www.ncbi.nlm.nih.gov/books/NBK1161/table/alzheimer.T...
Are advances like AlphaFold likely to speed up progress ?
There was a good, accessible guidelines paper in the Lancet that described helpful interventions at all stages of life to decrease the odds of developing cognitive impairment later in life.[0]
In terms of late-stage treatments to halt or reverse progression, that still seems very far away. The causes are so diverse... My father died of vascular dementia not too long ago, so I'm familiar with the caregiver side in addition to the business.
[0] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
Look at the supplements world, where grifters are shilling chemicals that cause harm and make radical claims for absurd markups. Or gas station pills. You want those companies making Alzheimer's tests? People going in to a 7-11 and buying a "all illness test card" that tells people they do or don't have degenerative diseases?
No, it's very very important to ensure tests are actually indicative and ensure they are well made. To do that, a regulating body needs to be involved.
Imagine if every new AI model had to be "cleared" by a government regulator. The role of government in healthcare evaluation needs to be simplified and streamlined. The liability needs to be shifted to doctor, and if it's a case of charlatanism, that liability should include a lengthy prison sentence.
Seems much better use of time and money to have people developing tests meet a pre-defined standard and after that point they're allowed to flood doctors with marketing for the tests.
What use is future medical advancements if it can't meet low bars like proving it works?
Definitely longer than I'd expect for "cleared" considering everybody involved should have to be licensed and pretty sure you pay a fee to the FDA so that should cover the cost of FDA hiring employees to just call each person involved to verify the submission is accurate.
Although IIUC, they were already allowed to do 50yr+ people and the recent clearance is just for 40yr+ so I'm not actually sure how uh impactful this is (a bit more confused why it takes 10 months to drop the age by 10 years).
[1]: https://precivityad.com/news/c2n-submits-us-fda-regulatory-f...
[2]: https://c2n.com/news-releases/bg2ziqcz39o3wxf5uc04u279ziw0yv
There is potential harm from the procedure itself because of https://en.wikipedia.org/wiki/Opportunity_cost and https://en.wikipedia.org/wiki/Budget_constraint and because sticking needles in people and drawing blood carries inherent medical risks.
But only another medical professional would know that; the patients were completely oblivious. I said she should blow the whistle but she “didn’t want to rock the boat”. It definitely changed how I feel about doctors. There’s a massive level of trust there, which most doctors will honor but a few will exploit.
This is like saying AI developers should be qualified to evaluate the effacy of a model without testing the model.
The only thing you gain is giving people more time to worry and despair.
Imagine the test is 100% accurate: if you gave it to a group of people, you could then try to make interventions earlier, capture more data about lifestyle before symptoms, etc.
As long as there isn't a clear root cause found and some real mitigating medicines reach the market I would propose keeping people ignorant as long as we can.
Entering a study for people who tested positively would also be voluntary.
Anecdotal responses in this topic indicate there may be some mitigatimg medicines.
Demanding a root cause before doing anything is silly. Finding root cause in biological systems is incredibly difficult; there's value in finding symptoms and managing symptoms without finding a root cause. And dangers of focusing too much on any one indicator.
That's not to say I suggest everyone be screened for everything. If there are limited mitigations, it's not appropriate for most people to be screened. But even if there are no medical mitigations, you might put your affairs in order with appropriate urgency if you knew your cognition would be much reduced in the next 5-10 years.
It would affect my financial and estate planning, and how I'd like to navigate the disease's progression.
Alzheimers can lead to all kinds of other issues like impulsivity, or aggressiveness. People gambling away their life savings, not knowing that they are even doing it. Doctors unable to intervene due to rights around patient autonomy. All of this has big consequences in the lives of those affected.
There’s a degenerative genetic disease that runs in my family that for various reasons we only found out about ten years ago. To get the test done in the UK for it, you have to go to mandatory genetic counselling where they try to convince you not to get it done. Of four siblings, the two of us who thought initially we’d definitely get it done, we’ve not, and the two who were sure they wouldn’t, have done.
They try and convince you not to get it done so you don’t end up confusing being tired one morning or tripping with “oh my God it’s starting”.
Everyone should get their affairs in order, regularly, without needing a test, if they care about their loved ones.