10 ms·

PET scans show many Alzheimer’s patients may not actually have the disease

158 points by DrScump 9y ago

saint_fiasco 9y ago
Does that invalidate any studies on treatments for Alzheimer? If it turns out many people who show symptoms don't actually have it, it's no wonder that a treatment is so hard to find.
- carbocation 9y ago
  It reduces these studies' power to detect results. If you thought you had 100 cases and 100 controls, it turns out perhaps you really had 30 cases and 100 controls, and 70 controls misclassified as cases. Power is going to be substantially hurt.
  - gwern 9y ago
    I could see it having more implications than just measurement error reducing power. It's entirely plausible that a drug which has an effect on Alzheimers would come with side-effects that would damage those who just have senile dementia; imagine a drug which dissolves amyloid plaques while doing some moderate damage, in a trial with a mix of dementia and Alzheimers, the Alzheimers getting better is masked by the dementia ones getting worse, for a net average zero compared to the placebo group.
  - PeterisP 9y ago
    However, it may significantly increase the size of measured effect if you can go back and re-classify the patients - in your example, it may turn an earlier study where only 30 of 100 cases showed improvement to a study where 30 of 30 cases responded to treatment well.
  - std_throwaway 9y ago
    Those 70 are not controls but each may have a different disease.
- mannykannot 9y ago
  There seem to be a lot of loose ends in this article: how many of these patients will go on to develop Alzheimer's? On what basis are the current treatments for Alzheimer's considered to be effective, if we did not previously have a test to determine who has developed it? On what basis would the physicians whose patients were enrolled in this study change their care plans, and in what way? At one point, the article says "A positive test for amyloid does not mean someone has Alzheimer’s... But a negative test definitively means a person does not have it". To me, there seems to be a hint of "these patients' condition does not fit the dictionary definition of Alzheimer's, so clearly it would be wrong to treat them as if they had it", yet the article seems to leave open the door to the possibility that it is the progression of Alzheimer's that is not fully understood. I hope an expert can chime in and set me straight.
  - SAI_Peregrinus 9y ago
    Not an expert, but I read Derek Lowe's blog[1] and he tends to report on pretty much all the drug trials in the Alzheimer's space. The amyloid hypothesis (that the cause of Alzheimers is the buildup of beta amyloid plaques) seems pretty weak at this point. The drugs that remove or reduce amyloid buildup don't seem to stop the progression of the disease. The current best guess seems to be that the amyloid plaques are a symptom of whatever the underlying cause is. And the key takeaway is that we have NO IDEA what the actual cause is. We've got a bunch of guesses. One of them might even be right. Or possibly multiple, there are probably several diseases that cause the same symptoms. So if we can detect the non-presence of amyloid plaques but detect symptoms that would be good as a way to distinguish between the different diseases. Of course there might be more than two variants... [1] http://blogs.sciencemag.org/pipeline/archives/category/alzheimers-disease http://blogs.sciencemag.org/pipeline/archives/category/alzhe...
    - nonbel 9y ago
      I'll admit I wasn't aware in the 1980s when the hypothesis took hold, but it never seemed like a good one to me just because amyloids are so thermodynamically favored. There must be constant and diverse measures functioning correctly to avoid their formation.
philovivero 9y ago
This is amazing news. I love the advances we're making as a society. In that $3-5k cost of running a PET scan, I wonder how much of that is paying professional operators and physicians to interpret the results? Could ML be applied to this problem to reduce the cost of a PET scan?
- sjg007 9y ago
  Yes eventually
- maxerickson 9y ago
  Apparently they cost around $300 in India.
- jimjimjim 9y ago
  why does an IV bag cost $500? I want professional operators and physicians to look at my details. What I don't want is dozens of layers of middlemen or ticket clippers (or healthcare driven by profit).
  - duozerk 9y ago
    > why does an IV bag cost $500? It doesn't outside of the US.
    - mirimir 9y ago
      Indeed. In the US, it does because manufacturers have gamed the system. Through bundled contracting with hospitals etc, for example.
      - maxerickson 9y ago
        Hospitals pay a couple dollars for IV saline. In fact, manufacturers are required to report such prices annually to the federal government, which bases Medicare payments on the average national price plus 6 percent. The limit for one liter of normal saline (a little more than a quart) went to $1.07 this year from 46 cents in 2010, an increase manufacturers linked to the cost of raw materials, fuel and transportation. http://www.nytimes.com/2013/08/27/health/exploring-salines-secret-costs.html http://www.nytimes.com/2013/08/27/health/exploring-salines-s... (which implies that manufacturers aren't the primary beneficiaries of the price that the hospitals charge)
Spooky23 9y ago
Not surprising to me. A family member just had a stroke... the entire system is designed around maximizing billing. If someone is in a longer term situation and a Alzheimer's diagnosis makes a buck, you'll get that diagnosis. Never mind the mental condition is probably a result of the institutional environment and drugs.
- gnaritas 9y ago
  > the entire system is designed around maximizing billing Our entire world is built that way, it isn't unique to medicine.
  - mulmen 9y ago
    Except for businesses that compete on price.
    - gnaritas 9y ago
      And every business does everything it can to not have to do that, it works when there's choice and price transparency, markets fail without the right ingredients and healthcare is certainly one of the markets the free market has failed.
nerpderp83 9y ago
Fungus amungus
PeterisP 9y ago
Historically, a bunch of symptom-defined diseases (e.g. hepatitis, diabetes, etc) have turned out to actually be a set of different diseases with different causes, different treatments but similar symptoms - and understanding that split has been a big milestone in treating them. This now might be the case for Alzheimer's as well.
- std_throwaway 9y ago
  It's not much better than searching for the cure for all illness. Drink enough, sleep enough, eat well, do some sports, meditate. If that doesn't help, good luck with going to the doctors.
  - ekianjo 9y ago
    > meditate Any clinically proven benefit of meditation though? Don't throw it together with sleep and exercising...
    - nefitty 9y ago
      It's been thoroughly proven to be beneficial, in many ways. https://nccih.nih.gov/health/meditation/overview.htm https://nccih.nih.gov/health/meditation/overview.htm
      - tallanvor 9y ago
        Sorry, what? From the site: "Some research suggests that practicing meditation may reduce blood pressure, symptoms of irritable bowel syndrome, anxiety and depression, and insomnia. Evidence about its effectiveness for pain and as a smoking-cessation treatment is uncertain." I see "may" for some things, and "uncertain" for others. Nothing on that page says that it's been "thoroughly proven to be beneficial".
        danielbln 9y ago
        How about this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203918/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203918/ (mindfulness being a form of meditation)
trimble 9y ago
Pet scan: $3000 - $4000 Peanut butter: $3 - $10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823377/pdf/nihms514234.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823377/pdf/nih...
- miguelrochefort 9y ago
  > Methods: Participants with probable AD (N=18), mild cognitive impairment (MCI, N=24), other causes of dementia (OD, N=26) and matched controls (OC, N=26) were tested, with closed eyes, for their ability to detect an odor, one nostril at a time. A container of 14g of peanut butter was opened, held medially at the bottom of a 30 cm ruler, and moved up 1cm at a time during the participants’ exhale. Upon odor detection, the distance between the subject’s nostril and container was measured. > Results: The mean odor detection distance of AD patients’ left nostril (5.1 cm), and not their right (17.4 cm), was significantly less (F(3,90) = 22.28, p < 0.0001) than the other groups. The mean, standard error, and 95% Confidence Interval of the L R nostril odor detection difference (cm) for AD was −12.4 ±0.5, (−15.0, −9.8); for MCI was −1.9 ±1.2, (−4.2,0.4); for OD was 4.8 ±1.0, (2.6,6.9); and for OC was 0.0 ±1.4 (−2.2,2.1).
  - AstralStorm 9y ago
    Tiny pilot study. Where are odds ratios? Where are the multiple measurements per patient?
- zkms 9y ago
  How is this test methodology affected by phenomena like: https://en.wikipedia.org/wiki/Nasal_cycle https://en.wikipedia.org/wiki/Nasal_cycle
- NIL8 9y ago
  What..I can't... I am speechless.
- trendia 9y ago
  Peanut butter is even cheaper than that -- 10 people can smell the same peanut butter but they can't fit in the same Pet scanner.
trimble 9y ago
Pet scan: $3000 - $4000 Peanut butter: $3 - $10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823377/pdf/nihms514234.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823377/pdf/nih...
jiggunjer 9y ago
Anybody read the words sensitivity, specificity, or gold standard? Just because it doesn't show up on PET doesn't mean squat if PET has a low sensitivity.
- AstralStorm 9y ago
  So what's the gold standard of detecting Alzheimer's? (It is a rhetorical question.)
  - seesomesense 9y ago
    Brain cutting and histopathology See http://www.bu.edu/alzresearch/brain-cutting-636x433/ http://www.bu.edu/alzresearch/brain-cutting-636x433/ "one of a variety of silver impregnation staining techniques, such as the modified Bielschowski or Gallyas technique, or the fluorochrome dye thioflavin S is typically employed to visualize neurofibrillary tangles Because these techniques require either specialized equipment (the thioflavin S stain requires the use of a fluorescence microscope with specialized excitatory and barrier filters) or experienced histotechnologists (in the case of silver impregnation stains), most anatomic pathologists in general practice lack the capability to properly evaluate brain specimens submitted for the diagnosis of Alzheimer's disease. Such specimens are best referred to specialized neuropathology laboratories where the necessary experience and facilities are in place."
mirimir 9y ago
I suspect that AD diagnoses are driven largely by caregiver frustration with unhappy old people. Just as ADHD etc diagnoses are arguably driven by caregiver frustration with unhappy young people. The simplest solution is drugging unhappy people to keep them manageable.
- Beltiras 9y ago
  Spoken with the privilege of someone having never faced a diagnosis or had a close one diagnosed. One of the best things that happened to me was an adult diagnosis of ADD. Drugs really helped. Knowing what ailed me was a greater relief thou.
  - mirimir 9y ago
    Not at all. My bipolar diagnosis was great for me, because it got my depressive episodes treated properly. But an important distinction is whether medication is a choice, or is imposed by caregivers with legal authority, psychological influence, or whatever. I mean, I chose to take SSRIs for many years. And it made me crazy. Which I eventually realized. But a ten year old kid who gets put on SSRIs inappropriately? They are screwed, and perhaps permanently.
    - eigenstuff 9y ago
      I was put on ADHD meds as a 4 (almost 5) year old after my first violin lesson, this was back in the mid-90s. My mom said it was the weirdest thing she'd ever seen: I so badly wanted to sit still and listen because I wanted to learn to play the violin but I literally physically could not do it and became visibly frustrated with myself. And a bad change in meds in 1st grade (because I didn't like the bitter tablets) was enough for my 1st grade teacher to contact my mom about my change in behavior. It was only as an adult that I realized this must have been the few days where I got in trouble and had to sit out during recess, which was humiliating to me. I have anecdotes for days about this kind of stuff. I am eternally grateful my parents took me to a psychiatrist when they saw some aspect of my behavior wasn't normal and that it was affecting my quality of life, even if I was far too young to know or understand that. I think it was the humane thing to do, 100%. People talk a lot about how terrible it is that 5 year olds are put on this shit, but extreme cases like mine are out there and they are legitimate. Sometimes things show up early because they're severe enough. It'd be fucked up if 10 year olds on SSRIs was the norm, but I have no doubt that there are rare cases where it'd almost be cruel /not/ to do it. Bipolar can absolutely be diagnosed in children. If you can diagnose it that early, why wouldn't you start treating it? Isn't that what you SHOULD do as a parent?
homero 9y ago
So what did they have?
kagamine 9y ago
I may have Alzheimer's but .. uh... at least I don't have Alzheimer's. It's an old joke, but fitting for the title.
ekianjo 9y ago
> “If someone had a putative diagnosis of Alzheimer’s disease, they might be on an Alzheimer’s drug like Aricept or Namenda,” said James Hendrix, Aricept is an expensive drug and does about nothing. I dont even know why patients with AD are taking it. http://www.alzforum.org/therapeutics/donepezil http://www.alzforum.org/therapeutics/donepezil > The effect size of donepezil's benefits is small and the drug does not modify the underlying pathophysiology of the disease
dm319 9y ago
The term 'Alzheimer's' has been politicised. Making a diagnosis requires a brain biopsy, usually done as part of an autopsy. I don't believe a PET scan is capable of making the diagnosis, despite what the article says. To understand what is going on, we have to see the problem that hit clinicians and families around 10-20 years ago. It seemed like an epidemic of confused elderly patients landing on wards without a specific diagnosis, very little ability to describe what is wrong with them, and causing disruption to other patients, either directly, or because they required a nurse to attend them continually. Explaining to the family why their mother/father had gone from being someone who was independent at home to someone confused and unable to tend for themselves was difficult. Usually the blame would be attributed to infections (especially urinary tract infections, which are very difficult to diagnose in a confused patient), but doctors were reluctant to start using the term 'dementia' initially, particularly since there wasn't a good test for it. In retrospect, what was happening was that we were seeing the success of treatment for cardiovascular disease. Many patients who would normally have died in their 50s and 60s of heart disease we now making it to their 70s, 80s and 90s, albeit with arteries that were still far from ideal. Every organ in the body degrades with age. We tolerate and compensate for it up to a point. At the age of 20 our hearts can increase output from 5l/min to 20l/min, sometimes this is necessary to survive a particular bad infection. If your heart is unable to do this, we say it has decompensated. At the age of 60, even without a diagnosis of heart failure, this is not possible, but thankfully we are rarely in a position where 20L/min is necessary. The brain is no exception. An old brain with loss of volume can handle a daily routine in a familiar environment, but throw in a cold, or another infection, then make it worse by starting drugs and abruptly changing their environment, and we end up with an acute confusional state which can take weeks to resolve, if it ever does completely. My suspicion is that most cases of dementia (and mild cognitive impairment) is due to a general decrease in function as we get elderly, exacerbated by vascular insufficiencies. Alzheimer's is a specific histological diagnosis - it doesn't give us a cause, it's more of a histological finding. Since we don't really have any good treatments for dementia caused by Alzheimer's or vascular causes, and we don't have a way of telling them apart, you could argue whether this histological finding matters.. Except that Alzheimer's is a term the public are familiar with, and will donate to. NB I am not a neurologist nor a dementia expert. I've worked a lot in elderly care and have had to deal with patients and their families on many occasions. I have some amusing memories including overhearing a conversation between a confused patient on a ward who had picked up the ward phone at around 1AM - it was the bed manager calling to see if their were any beds, but the patient she was still at home so was quite confused at the question.
seesomesense 9y ago
Alzheimers is a tauprotein disorder. Alzheimers without plaques is called Primary Age-Related Tauopathy, aka PARTS.
nabla9 9y ago
Alzheimer is just the most common dementia. Valscular dementia is also common and Dementia with Lewy bodies are also possible. Is it possible that many of these were misdiagnosed other dementia's?

158 points by DrScump 9y ago

Does that invalidate any studies on treatments for Alzheimer? If it turns out many people who show symptoms don't actually have it, it's no wonder that a treatment is so hard to find.

carbocation 9y ago
It reduces these studies' power to detect results. If you thought you had 100 cases and 100 controls, it turns out perhaps you really had 30 cases and 100 controls, and 70 controls misclassified as cases. Power is going to be substantially hurt.
- gwern 9y ago
  I could see it having more implications than just measurement error reducing power. It's entirely plausible that a drug which has an effect on Alzheimers would come with side-effects that would damage those who just have senile dementia; imagine a drug which dissolves amyloid plaques while doing some moderate damage, in a trial with a mix of dementia and Alzheimers, the Alzheimers getting better is masked by the dementia ones getting worse, for a net average zero compared to the placebo group.
- PeterisP 9y ago
  However, it may significantly increase the size of measured effect if you can go back and re-classify the patients - in your example, it may turn an earlier study where only 30 of 100 cases showed improvement to a study where 30 of 30 cases responded to treatment well.
- std_throwaway 9y ago
  Those 70 are not controls but each may have a different disease.
mannykannot 9y ago
There seem to be a lot of loose ends in this article: how many of these patients will go on to develop Alzheimer's? On what basis are the current treatments for Alzheimer's considered to be effective, if we did not previously have a test to determine who has developed it? On what basis would the physicians whose patients were enrolled in this study change their care plans, and in what way? At one point, the article says "A positive test for amyloid does not mean someone has Alzheimer’s... But a negative test definitively means a person does not have it". To me, there seems to be a hint of "these patients' condition does not fit the dictionary definition of Alzheimer's, so clearly it would be wrong to treat them as if they had it", yet the article seems to leave open the door to the possibility that it is the progression of Alzheimer's that is not fully understood. I hope an expert can chime in and set me straight.
- SAI_Peregrinus 9y ago
  Not an expert, but I read Derek Lowe's blog[1] and he tends to report on pretty much all the drug trials in the Alzheimer's space. The amyloid hypothesis (that the cause of Alzheimers is the buildup of beta amyloid plaques) seems pretty weak at this point. The drugs that remove or reduce amyloid buildup don't seem to stop the progression of the disease. The current best guess seems to be that the amyloid plaques are a symptom of whatever the underlying cause is. And the key takeaway is that we have NO IDEA what the actual cause is. We've got a bunch of guesses. One of them might even be right. Or possibly multiple, there are probably several diseases that cause the same symptoms. So if we can detect the non-presence of amyloid plaques but detect symptoms that would be good as a way to distinguish between the different diseases. Of course there might be more than two variants... [1] http://blogs.sciencemag.org/pipeline/archives/category/alzheimers-disease http://blogs.sciencemag.org/pipeline/archives/category/alzhe...
  - nonbel 9y ago
    I'll admit I wasn't aware in the 1980s when the hypothesis took hold, but it never seemed like a good one to me just because amyloids are so thermodynamically favored. There must be constant and diverse measures functioning correctly to avoid their formation.

philovivero 9y ago

This is amazing news. I love the advances we're making as a society. In that $3-5k cost of running a PET scan, I wonder how much of that is paying professional operators and physicians to interpret the results? Could ML be applied to this problem to reduce the cost of a PET scan?

sjg007 9y ago
Yes eventually
maxerickson 9y ago
Apparently they cost around $300 in India.
jimjimjim 9y ago
why does an IV bag cost $500? I want professional operators and physicians to look at my details. What I don't want is dozens of layers of middlemen or ticket clippers (or healthcare driven by profit).
- duozerk 9y ago
  > why does an IV bag cost $500? It doesn't outside of the US.
  - mirimir 9y ago
    Indeed. In the US, it does because manufacturers have gamed the system. Through bundled contracting with hospitals etc, for example.
    - maxerickson 9y ago
      Hospitals pay a couple dollars for IV saline. In fact, manufacturers are required to report such prices annually to the federal government, which bases Medicare payments on the average national price plus 6 percent. The limit for one liter of normal saline (a little more than a quart) went to $1.07 this year from 46 cents in 2010, an increase manufacturers linked to the cost of raw materials, fuel and transportation. http://www.nytimes.com/2013/08/27/health/exploring-salines-secret-costs.html http://www.nytimes.com/2013/08/27/health/exploring-salines-s... (which implies that manufacturers aren't the primary beneficiaries of the price that the hospitals charge)

Spooky23 9y ago

Not surprising to me. A family member just had a stroke... the entire system is designed around maximizing billing. If someone is in a longer term situation and a Alzheimer's diagnosis makes a buck, you'll get that diagnosis. Never mind the mental condition is probably a result of the institutional environment and drugs.

gnaritas 9y ago
> the entire system is designed around maximizing billing Our entire world is built that way, it isn't unique to medicine.
- mulmen 9y ago
  Except for businesses that compete on price.
  - gnaritas 9y ago
    And every business does everything it can to not have to do that, it works when there's choice and price transparency, markets fail without the right ingredients and healthcare is certainly one of the markets the free market has failed.

nerpderp83 9y ago

Fungus amungus

PeterisP 9y ago

Historically, a bunch of symptom-defined diseases (e.g. hepatitis, diabetes, etc) have turned out to actually be a set of different diseases with different causes, different treatments but similar symptoms - and understanding that split has been a big milestone in treating them. This now might be the case for Alzheimer's as well.

std_throwaway 9y ago
It's not much better than searching for the cure for all illness. Drink enough, sleep enough, eat well, do some sports, meditate. If that doesn't help, good luck with going to the doctors.
- ekianjo 9y ago
  > meditate Any clinically proven benefit of meditation though? Don't throw it together with sleep and exercising...
  - nefitty 9y ago
    It's been thoroughly proven to be beneficial, in many ways. https://nccih.nih.gov/health/meditation/overview.htm https://nccih.nih.gov/health/meditation/overview.htm
    - tallanvor 9y ago
      Sorry, what? From the site: "Some research suggests that practicing meditation may reduce blood pressure, symptoms of irritable bowel syndrome, anxiety and depression, and insomnia. Evidence about its effectiveness for pain and as a smoking-cessation treatment is uncertain." I see "may" for some things, and "uncertain" for others. Nothing on that page says that it's been "thoroughly proven to be beneficial".
      - danielbln 9y ago
        How about this: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203918/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4203918/ (mindfulness being a form of meditation)

trimble 9y ago

Pet scan: $3000 - $4000 Peanut butter: $3 - $10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823377/pdf/nihms514234.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823377/pdf/nih...

miguelrochefort 9y ago
> Methods: Participants with probable AD (N=18), mild cognitive impairment (MCI, N=24), other causes of dementia (OD, N=26) and matched controls (OC, N=26) were tested, with closed eyes, for their ability to detect an odor, one nostril at a time. A container of 14g of peanut butter was opened, held medially at the bottom of a 30 cm ruler, and moved up 1cm at a time during the participants’ exhale. Upon odor detection, the distance between the subject’s nostril and container was measured. > Results: The mean odor detection distance of AD patients’ left nostril (5.1 cm), and not their right (17.4 cm), was significantly less (F(3,90) = 22.28, p < 0.0001) than the other groups. The mean, standard error, and 95% Confidence Interval of the L R nostril odor detection difference (cm) for AD was −12.4 ±0.5, (−15.0, −9.8); for MCI was −1.9 ±1.2, (−4.2,0.4); for OD was 4.8 ±1.0, (2.6,6.9); and for OC was 0.0 ±1.4 (−2.2,2.1).
- AstralStorm 9y ago
  Tiny pilot study. Where are odds ratios? Where are the multiple measurements per patient?
zkms 9y ago
How is this test methodology affected by phenomena like: https://en.wikipedia.org/wiki/Nasal_cycle https://en.wikipedia.org/wiki/Nasal_cycle
NIL8 9y ago
What..I can't... I am speechless.
trendia 9y ago
Peanut butter is even cheaper than that -- 10 people can smell the same peanut butter but they can't fit in the same Pet scanner.

trimble 9y ago

Pet scan: $3000 - $4000 Peanut butter: $3 - $10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823377/pdf/nihms514234.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3823377/pdf/nih...

jiggunjer 9y ago

Anybody read the words sensitivity, specificity, or gold standard? Just because it doesn't show up on PET doesn't mean squat if PET has a low sensitivity.

AstralStorm 9y ago
So what's the gold standard of detecting Alzheimer's? (It is a rhetorical question.)
- seesomesense 9y ago
  Brain cutting and histopathology See http://www.bu.edu/alzresearch/brain-cutting-636x433/ http://www.bu.edu/alzresearch/brain-cutting-636x433/ "one of a variety of silver impregnation staining techniques, such as the modified Bielschowski or Gallyas technique, or the fluorochrome dye thioflavin S is typically employed to visualize neurofibrillary tangles Because these techniques require either specialized equipment (the thioflavin S stain requires the use of a fluorescence microscope with specialized excitatory and barrier filters) or experienced histotechnologists (in the case of silver impregnation stains), most anatomic pathologists in general practice lack the capability to properly evaluate brain specimens submitted for the diagnosis of Alzheimer's disease. Such specimens are best referred to specialized neuropathology laboratories where the necessary experience and facilities are in place."

mirimir 9y ago

I suspect that AD diagnoses are driven largely by caregiver frustration with unhappy old people. Just as ADHD etc diagnoses are arguably driven by caregiver frustration with unhappy young people. The simplest solution is drugging unhappy people to keep them manageable.

Beltiras 9y ago
Spoken with the privilege of someone having never faced a diagnosis or had a close one diagnosed. One of the best things that happened to me was an adult diagnosis of ADD. Drugs really helped. Knowing what ailed me was a greater relief thou.
- mirimir 9y ago
  Not at all. My bipolar diagnosis was great for me, because it got my depressive episodes treated properly. But an important distinction is whether medication is a choice, or is imposed by caregivers with legal authority, psychological influence, or whatever. I mean, I chose to take SSRIs for many years. And it made me crazy. Which I eventually realized. But a ten year old kid who gets put on SSRIs inappropriately? They are screwed, and perhaps permanently.
  - eigenstuff 9y ago
    I was put on ADHD meds as a 4 (almost 5) year old after my first violin lesson, this was back in the mid-90s. My mom said it was the weirdest thing she'd ever seen: I so badly wanted to sit still and listen because I wanted to learn to play the violin but I literally physically could not do it and became visibly frustrated with myself. And a bad change in meds in 1st grade (because I didn't like the bitter tablets) was enough for my 1st grade teacher to contact my mom about my change in behavior. It was only as an adult that I realized this must have been the few days where I got in trouble and had to sit out during recess, which was humiliating to me. I have anecdotes for days about this kind of stuff. I am eternally grateful my parents took me to a psychiatrist when they saw some aspect of my behavior wasn't normal and that it was affecting my quality of life, even if I was far too young to know or understand that. I think it was the humane thing to do, 100%. People talk a lot about how terrible it is that 5 year olds are put on this shit, but extreme cases like mine are out there and they are legitimate. Sometimes things show up early because they're severe enough. It'd be fucked up if 10 year olds on SSRIs was the norm, but I have no doubt that there are rare cases where it'd almost be cruel /not/ to do it. Bipolar can absolutely be diagnosed in children. If you can diagnose it that early, why wouldn't you start treating it? Isn't that what you SHOULD do as a parent?

homero 9y ago

So what did they have?

kagamine 9y ago

I may have Alzheimer's but .. uh... at least I don't have Alzheimer's. It's an old joke, but fitting for the title.

ekianjo 9y ago

> “If someone had a putative diagnosis of Alzheimer’s disease, they might be on an Alzheimer’s drug like Aricept or Namenda,” said James Hendrix, Aricept is an expensive drug and does about nothing. I dont even know why patients with AD are taking it. http://www.alzforum.org/therapeutics/donepezil http://www.alzforum.org/therapeutics/donepezil > The effect size of donepezil's benefits is small and the drug does not modify the underlying pathophysiology of the disease

dm319 9y ago

The term 'Alzheimer's' has been politicised. Making a diagnosis requires a brain biopsy, usually done as part of an autopsy. I don't believe a PET scan is capable of making the diagnosis, despite what the article says. To understand what is going on, we have to see the problem that hit clinicians and families around 10-20 years ago. It seemed like an epidemic of confused elderly patients landing on wards without a specific diagnosis, very little ability to describe what is wrong with them, and causing disruption to other patients, either directly, or because they required a nurse to attend them continually. Explaining to the family why their mother/father had gone from being someone who was independent at home to someone confused and unable to tend for themselves was difficult. Usually the blame would be attributed to infections (especially urinary tract infections, which are very difficult to diagnose in a confused patient), but doctors were reluctant to start using the term 'dementia' initially, particularly since there wasn't a good test for it. In retrospect, what was happening was that we were seeing the success of treatment for cardiovascular disease. Many patients who would normally have died in their 50s and 60s of heart disease we now making it to their 70s, 80s and 90s, albeit with arteries that were still far from ideal. Every organ in the body degrades with age. We tolerate and compensate for it up to a point. At the age of 20 our hearts can increase output from 5l/min to 20l/min, sometimes this is necessary to survive a particular bad infection. If your heart is unable to do this, we say it has decompensated. At the age of 60, even without a diagnosis of heart failure, this is not possible, but thankfully we are rarely in a position where 20L/min is necessary. The brain is no exception. An old brain with loss of volume can handle a daily routine in a familiar environment, but throw in a cold, or another infection, then make it worse by starting drugs and abruptly changing their environment, and we end up with an acute confusional state which can take weeks to resolve, if it ever does completely. My suspicion is that most cases of dementia (and mild cognitive impairment) is due to a general decrease in function as we get elderly, exacerbated by vascular insufficiencies. Alzheimer's is a specific histological diagnosis - it doesn't give us a cause, it's more of a histological finding. Since we don't really have any good treatments for dementia caused by Alzheimer's or vascular causes, and we don't have a way of telling them apart, you could argue whether this histological finding matters.. Except that Alzheimer's is a term the public are familiar with, and will donate to. NB I am not a neurologist nor a dementia expert. I've worked a lot in elderly care and have had to deal with patients and their families on many occasions. I have some amusing memories including overhearing a conversation between a confused patient on a ward who had picked up the ward phone at around 1AM - it was the bed manager calling to see if their were any beds, but the patient she was still at home so was quite confused at the question.

seesomesense 9y ago

Alzheimers is a tauprotein disorder. Alzheimers without plaques is called Primary Age-Related Tauopathy, aka PARTS.

nabla9 9y ago

Alzheimer is just the most common dementia. Valscular dementia is also common and Dementia with Lewy bodies are also possible. Is it possible that many of these were misdiagnosed other dementia's?