6 ms·
FDA clears blood test to aid evaluation for Alzheimer's disease
- brandonb 1mo agoThis Alzheimer's blood test, PrecivityAD2, is based on the p-tau217 biomarker. 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.
- vintermann 1mo agoThat 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.
- simmerup 1mo agoI guess you can start spending your retirement money faster
- ButlerianJihad 1mo agoThe 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.
- reenorap 1mo agoI 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.
- 1234letshaveatw 1mo agoNo, a Medicaid funded care facility is the alternative
- simmerup 1mo agoHopefully by the time i’m there euthanasia will be legal
- brandonb 1mo agoAgreed 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.
- pokot0 1mo agoif cholesterol predicted future cognitive health we wouldn’t need dedicated tests, do we?
- xattt 1mo ago> 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?
- btilly 1mo agoThat'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.
- isolli 1mo ago
- gwbas1c 1mo agoFrom 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.
- anjel 1mo agoCreatine supplementation is showing some promising indications of being a low cost, mild to moderate intervention https://www.psychologytoday.com/us/blog/the-modern-brain/202505/new-research-on-creatine-monohydrate-for-alzheimers-disease https://www.psychologytoday.com/us/blog/the-modern-brain/202...
- AppleBananaPie 1mo agoWhether 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
- Alex3917 1mo agoIt's going to be replicated because we already know the mechanism of action. That said, many/most people would probably be better off solving the problem more upstream via whatever B-complex vitamins they need based on their bloodwork and DNA methylation variants.
- someothherguyy 1mo agoI 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=10296105574478709141&hl=en&as_sdt=0,33 https://scholar.google.com/scholar?cluster=10296105574478709...
- someothherguyy 1mo ago
- cj 1mo agoIt 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)
- kurthr 1mo agoThere 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.
- deleted 1mo ago[deleted]
- vogu66 1mo agodo you have the reference for that one? I'd be interested in reading it.
- FL33TW00D 1mo agoSeems like a no brainer for hetero/homozygous APOE4 folks.
- Pawenniag 1mo agoThat price difference seems like the key point. A $200 test can plausibly be used to decide who should get further workup; a $1500 test is already competing with the cost of the workup itself
- criddell 1mo agoFrom a medical perspective, what's the point of the initial test or the workup though? Is it just to check a box? If it comes back positive you will be told to exercise, eat well, take sleep seriously, and manage cholesterol. If it comes back negative you will be told to do the same things. I've seen up close what dying with these kinds of illnesses look like. For me, a positive test would be a sign that it may be time to say my goodbyes and plan my exit.
- nemomarx 1mo agoI do think telling you to get your affairs in order and to arrange for hospice care is probably good for the doctors. They don't want a family coming in with a sudden decline case and all the information about how to pay for it lost, at minimum
- ricksunny 1mo agoepistemics asks how many different hypotheses besides p-tau217 levels were tested before arriving at the specified spread.
- tantalor 1mo agoAre you suggesting that these research scientists don't understand basic statistics?
- ricksunny 1mo agoWhile I’ve nothing to say about these research scientists in particular, knowing precisely nothing about them, it wouldn’t be the first time that so-called ‘bonafide’ research scientists made a statistical boo-boo, even one structural to the research thesis than any sort of math error. Given the widely-reported extent of p-hacking in the biomedical literature over the decades, I’m surprised anyone would float an avid ‘but how could research scientists ever be wrong’ default reflex.
- tantalor 1mo agoI can get behind "trust but verify" approach here.
- avgDev 1mo agoWe can also test for PSEN1, which is 100% accurate in determining early onset alzheimer's disease, quite a it more expensive, so unreasonable as a screening tool unfortunately.
- brianleb 1mo agoI am skeptical of 100% anything, so did some looking: >>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/ https://pmc.ncbi.nlm.nih.gov/articles/PMC3326653/ [2]https://www.ncbi.nlm.nih.gov/books/NBK1161/table/alzheimer.T.earlyonset_familial_alzheime/ https://www.ncbi.nlm.nih.gov/books/NBK1161/table/alzheimer.T... [3]https://pmc.ncbi.nlm.nih.gov/articles/PMC4356853/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4356853/
- akarshhegde18 1mo ago[dead]
- ggm 1mo agoDo we yet have any good avoidance or mitigation regimes, be they drug or otherwise for people who show positive on a test like this? The alternative is that it lets you put things in place for when you lose agency. Good as in scientifically proven. Not speculative fantasy.
- helsinkiandrew 1mo agoThe article doesn't explicitly say but presumably you can start taking the anti-amyloid drugs to slow down the progression immediately, there's also lifestyle changes that can be made (most of those would likely benefit most people) https://www.nih.gov/news-events/news-releases/combination-healthy-lifestyle-traits-may-substantially-reduce-alzheimers https://www.nih.gov/news-events/news-releases/combination-he... > 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.
- rgmerk 1mo agoNot a doctor or medical scientist, but my understanding is a) the effectiveness of those anti-amyloid drugs as a preventative tool is unclear, and b) they have a pretty scary safety profile. Clearly the goal is to be able to prevent the disease from progressing or slow it significantly, but are we really there yet even if we have a test?
- apothegm 1mo agoAs someone with a family member taking one of the newest drugs, I can attest that it does seem to meaningfully slow progression — from rapid decline nearly to a halt in my loved one’s case. The risk of dangerous side effects seems to be much higher for those with APOE4 — before approving the treatment they required among other things a genetic test ruling that out. (There are several other genetic variants that predispose to Alzheimer’s, fwiw.) We were lucky and saw none of the concerning side effects. Are we “there” yet? Where’s there? The prognosis after this treatment is a massive improvement over what it would have been at this stage of progression if it had been reached even 5 years ago. If you can detect the disease even earlier and halt progress at a point where you retain more cognitive function, that’s a huge win — and gives you time to wait it out a bit longer in hope that we’re able to develop a treatment that doesn’t just pause but can reverse progression. Yeah, I doubt we’re ready yet to administer these drugs to people who are asymptomatic (not to mention how pricey they currently are). But for someone who likely has the genes for it, just _knowing_ would in some ways be a relief.
- maximgeorge 1mo ago[flagged]
- hn_submit 1mo agoThese tests are more or less useless because there's no treatment anyway so knowing about it a long time in advance will not lead to any substantial gain. Even slowing the disease isn't within the realm of today's technology. Today's pharmaceutical companies are close to quacks as far as Alzheimer is concerned. We know next to nothing about its origins or even how the disease progresses. The only thing you gain is giving people more time to worry and despair.
- alex43578 1mo agoEarlier diagnosis, or at least suspected diagnosis, could make a difference in studying progression, origin, etc. 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.
- hn_submit 1mo agoPatients becoming involuntary guinea-pigs for science? No thanks. 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.
- avgDev 1mo agoThis is a very poor take. My family has been affected by the disease. If I get it I would join research as it could potentially help my kid and other family members. This is how science works. There are studies all over the US which involve existing patient and many join to help themselves and those who will come after.
- toast0 1mo agoTaking an optional test is voluntary. 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.
- hnsmomdpvp 1mo ago[dead]
- ozereray1 1mo ago[dead]
- Pawenniag 1mo agoIf this gets cheap enough and the predictive values hold up in ordinary clinical populations, it could change when people actually get evaluated rather than just how they get evaluated
- deleted 1mo ago[deleted]
- willmadden 1mo agoWhy is the FDA "clearing" something that is completely innocuous like a blood test?
- komon 1mo agoI think you need FDA clearance to be able to market a test as actually being effective for treatment/prevention etc. For exactly the same reason woo-woo supplements must disclaim that they aren't intended for that purpose
- forestrywat 1mo agoBecause tests aren't completely innocuous? Because tests lead people to make significant medical decisions? 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.
- willmadden 1mo agoTheir doctor should be qualified to make that judgment without a government bureaucracy evaluating the efficacy of the test on their behalf, unless you want to completely destroy the rate of medical breakthroughs. If there's no potential harm from the procedure itself, the government shouldn't be involved at all. 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.
- forestrywat 1mo agoThere is potential harm. That's the point.
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- debo_ 1mo agoI work directly in this field (clinically validated digital cognitive tests that characterize cognition, often paired with p-tau blood tests.) Ask me anything, I guess!
- jgord 1mo agoGenerally, what progress is being made on Alzheimers ? Are advances like AlphaFold likely to speed up progress ?
- debo_ 1mo agoI see results like the OP as speeding up progress. Tests like ptau make it faster and cheaper to screen for participants in clinical trials. This allows more resources to be spent on pre-screening, to identify candidates that might be healthy at time of trial start, but who are likely to develop cognitive impairment during the trial, which can be helpful for better measuring efficacy etc. 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/PIIS0140-6736(24)01296-0/abstract https://www.thelancet.com/journals/lancet/article/PIIS0140-6...
- Utkarsh_Mood 1mo agoWhile AlphaFold is great, to my knowledge, these proteins have several non-significant IDRs (intrinsically disordered regions), which have been and continue to be hard to model with AlphaFold. I work on computational modeling, so if I had to guess, I'm very unsure if people are using it for whole protein modeling, rather than looking at more specific domains where it probably does much better.